Maia Szalavitz on the Pioneers of Harm Reduction

Psychoactive listeners. Today's guest is somebody I've known for a very long time and maybe just about the most brilliant and persistent and innovative journalist writing about drugs and addiction over the last five to thirty years. Her name is Maya Solivits, and you may have seen her articles in all the prominent magazines and newspapers. She's written three books. I mean, the first one, back in two thousand six, was an expose on the whole troubled teen treatment industry.

It was called Helping any Cost, How the troubled teen industry cons parents and hurts kids? And then she wrote a brilliant book called Unbroken Brain, A Revolutionary New Way of Understanding Addiction about five years ago, which was part of her own story that we'll get into um. And then more recently is a book that just came out a few months ago called Undoing Drugs, The Untold Story of Harm Reduction and the Future of Addiction. But I just want to make clear that, I mean, Maya has

been doing this for a long time. So back when I was running Drug Policy Alliance, we gave her the Edward Brecker Award for Achievement in Journalism back in two thousand and five, before she even written any these three books. So she is really, uh, just a really singular figure. So Maya, thank you ever so much for being on with me today. Thank you so much for saying all those nice things about me. I really appreciate it. So you know this book, I mean, first of all, I'm

trying to think you and I first met. I think it must have been three I think I was maybe still teaching at Princeton, but it moved to New York City. You had your experience, which you've been very open about about being a uh, you know, a quote unquote junkie, A heroin addict, cocaine addict in your younger years, and you had come out of that and avoided getting caught up in the in the grips of the criminal justice system.

When a judge treated you favorably, I remember talking about methano and at that point you were almost a little anti or hesitant about methano. Although obviously you've come around with the Evans. But I'm just curious what was that about back then, because I think you your your views changed shortly thereafter. But in the book you talk about how you recognize the methan on work for a lot of people, but for you, for some reason, it had

it right that was complicated. I had gone to rehab in and in rehab by doctors, by people I thought were professionals, by everybody who was there. I was told that twelve step abstinence recovery is the only way to get better, and that if you are on methodone, you are still high. You are not in recovery, you are not so called clean. And since I was being told

this by all these professionals, I believed it. I wrote an anti methodone op ed at some point in the nineties, and I have spent the last whatever many years atoning for that because I realized that I was wrong and that I had been taught wrongly by all of these mainstream figures that I had trusted. And so this is not to say the twelve steps can't help people, but the idea that methodone is a big failure and that buprenorphine doesn't count as recovery is just killing people to

this day. So we have two medications that cut the death rate from opioid overdose and just opioid addiction in general by or more. These are method on and puperdorphin if you stay on them. And this is even more true than it used to be because of fentanyl in the supply now. So it's basically like, we have a treatment that cuts the death rate in half, and yet we prioritize a treatment that doesn't have any impact whatsoever

on mortality and may actually make it worse. So when I sort of began my journey in the addictions world, I I had learned one set of myths on the street. I had learned another set of myths in like school. I learned another set of myths from treatment and recovery programs. And it wasn't until I started reading the scientific literature across any different disciplines that I really began to understand

what I was talking about. It is embarrassing, but I think it's important to note this because a lot of people share these misconceptions to this day, and we see people with addiction as experts on addiction as soon as they have say, ninety days abstinent. We wouldn't say a cancer patient who's been in remission for ninety days is a cancer doctor, but we kind of do that equivalent in the addictions field. And while experience is really really important,

it has to be tempered with data. I remember sometimes, you know, will we be organizing conferences or panels and say, well, you need a so and so representative, a representative, a drug user, representative, youth. And I used to think, what a ridiculous IDEA Experience with drugs varies traumatically across the spectrum, So the notion of individuals sort of standing up as representatives,

you know, is a little flawed. What's important, of course, it's more general lee to have multiple voices in a way coming from lived experience of people, without assuming that one person's lived experience is this sort of basis for establishing policies, whether in a program or more broadly exactly. I mean, one of the things that I have taken to saying recently is that if I stood up and I said I speak for all white women with red hair,

people would think I was nuts. But if I get up and say I speak for all people with addiction, people will sometimes believe me. And that's not right, because

we're all unique. And one of the most harmful things in the drug policy and treatment field is this one size fits all mentality and this idea that everybody with addiction is a liar, a thief, a cheat, a manipulative person, as sociopath essentially, and those stereotypes come from the racist history of our drug laws and criminalization of certain substances.

So we have to fight against this dehumanization because there's no other group of people that we say they're all the same right now, And I think that's I think that's exactly right, you know, I mean, even going back to methodon, sorry to start off by putting you in the spot on that thing. They're little embarrassed it on

in your past. But you know, somebody, we both knew Dr Robert Newman, who was the head of a major New York City hospital but whose great passion was making method on main earn his treatment more available to people. And Bob was simultaneously the leading global advocate for making methanon available for people who had had a problem with street heroin or other illicit opioids, and at the same time the leading antagonist an opponent of the method on

treatment industry. The folks involved on the industry side of methodon, we're not always serving the interests of their patients. They might have been pursuing profit, they might have been pursuing their own ideologies, etcetera. And then when you have methon programs, you have some rights that are you know, that are very strict hyper control. They kick anybody out if they've ever tested positive for marijuana, if they don't show what periodically,

if they don't to hear every rule. And then you have what might be called harm reduction oriented method on programs, which are much more about meeting people where they're at. The problem is our regulations. Our regulations force even the most harm reduction oriented method of program to make people show up every day for the first ninety days at least to have very frequent urine testing, to have frequent counseling requirements, and all of these things that we don't

require for any other medication. And this comes from our history and our current laws which say that providing and opioid or cocaine or any other illegal drug to comfort

a quotes addict is not legitimate medicine. And so in order to get around this early Supreme Court decision and the Controlled Substances Act that kind of embodied that further, people have to dance around so that they see met the donn as assisting the treatment, so we have medication assisted treatment when in fact it is the medication that is proven to cut the death rate, not the counseling,

not any of the other stuff. We'll get into more of the issues in the present later on, but what I personally found so fascinating about your book was your going into the historical origins of harm reduction, especially in the US, going back to the really the early eighties.

And interesting of course, um for me is I know and or new a lot of these folks, some of them are still active, and so I want to ask you if you could sort of, you know, use their story as a way um of maybe explaining the broader concepts. But let me start off. I think you rightly trace the origins of harm reduction to two places, one in

the Netherlands and the second to Liverpool. So let's just start with the Netherlands, right, and you talk about the history of the junkie unions the Junkie Bund I think they were called, which then spread around Europe. But explained their significance, right. So a man named Nico Adrian's, who was himself a heroin injector, founded the first Junkie Bund in Rotterdam in or and he got support from public health officials, from other people who used drugs, from drug

policy reformers. At the time, they were facing a outbreak of hepatitis B, which usually isn't deadly, but in this case it was being deadly in some instances, and I think maybe that was actually early HIV, but we don't know. Anyway, he realized that clean needles would solve this problem. As an injector himself, he knew that it was nonsense that people liked to share needles, so he started the world's

first needle exchange. He gave people clean needles, and he took the used ones off the street, and this meant that when HIV did show up for noticeably real in the next three or four years, Rotterdam had a much lower rate of infection amongst its ivy drug users compared to even Amsterdam. And so when the HIV virus was discovered, Amsterdam and the rest of the Netherlands was like, oh wow, we have something here in Rotterdam that can work for this.

So they just expanded needle exchange very broadly. And the

Dutch have always been really pragmatic about drug policy. They have the marijuana coffee shops, you know, And it was kind of the same drug policy reformers there who also began to be concerned about what they called hard drug users as well, because they recognized that making marijuana illegal was just harming their children, and they also realized that it wasn't working so great for the people who are using these other drugs either, So they developed this whole

sort of pragmatic, practical way of dealing with this as

a medical and health issue. To provide the context, in the seventy six the Dutchet passed the law that basically decriminalized but did not fully legalize cannabis marijuana, although they didn't authorize the creational coffee shops that kind of evolved out of that change in the law in the same way that some of the cannabis dispensaries began to evolve in the mid nineties in California, not actually authorized by the government, but that same law that kind of decriminalized

cannabis had actually gotten tougher on the white powdered drugs um But even in that context, there was this pragmatic tradition, and when they started giving out needles, it wasn't like we'll only give you a needle if you give us back a dirty one. It was like, throw your dirty ones in here. But even if you don't have any dirty ones to throw in, we're still going to give you a clean needle, because that's what's pivotal there. We'll be talking more after we hear this. Add Now you

then shift the story. In fact, you ground the story even more as you said in Liverpool. Yeah, So what happened was they watched as Edinburgh, which was very similar socioeconomically to Liverpool, had this horrific HIV outbreak. The first time they tested their IVY drug users. They discovered that half of them were already HIV positive. And this is at a time when AIDS was basically a death sentence.

So they had all these young people, they had a really high rate of unemployment, they had a lot of heroin, and they had a lot of injecting, and so you would see these teenagers literally who were already HIV infected.

And they realized that they had actually helped create the situation because when they started freaking out about how many kids were injecting, they cracked down on needle availability, they shut their methodon program, and they also started arresting more people, and all of this meant that there were fewer clean needles available, and there were still a ton of users, and in fact even more because they cut off the methodon't. So you end up with this absolutely horrific outbreak among

young people. And Liverpool had the same socio economic conditions. They had super high youth unemployment, their factories were shutting down, the docks were shutting down, They had real serious economic problems, and they also had a lot of heroin and a lot of injecting, but they did not have HIV yet. So public health officials and people who were injecting drugs there, came together and said, you know, if we don't want

to be Edinburgh, we got to do something. They knew that the Dutch had started needle exchange, so they knew that was part of what they wanted to do. And Dr John Marks had already been prescribing heroin to a lot of people because he'd taken over the practice of a previous doctor who did that. And at first when he came in he was like, oh, this is a terrible idea. We're supposed to be getting them off this stuff.

And yet he saw that actually prescribing to them, they were functional, They just kind of looked like everybody else, and that this was indeed a way of reducing the harm associated with their addictions, and it did not prolong addiction. In fact, he found there was less dealing because if you didn't have to support your own habit, you were not seeking income by selling to other people. So it also had a kind of anti crime effect, not only

on things like shoplifting, but also on dealing itself. And so the police were actually in favor of this, which was one of the things that allowed them to do stuff that is very hard to do. Anywhere else. Now.

I was also just say, to put this in context again, John Marks was unusual character, a very colorful personality, because in fact, the British system, which basically said that doctors are allowed to prescribe any drug in the pharm of copeda, including heroin or cocaine, went back to the nineteen twenties or before. At the same time the U s Government, that Supreme Court case you mentioned, the webcase, was banning that behavior by doctors. The British were saying, let's do that.

So for decades in fact, you had people who you know, they got their script and their doctor, they did their heroin, they did their cocaine, maybe a combo, a legal speedball, and they had full time jobs right and families, and they were oftentimes middle class people, indistinguishable. They could drive,

they could do everything. Then along come to late sixties seventies, and the UK, like other countries, starts to get flooded with heroin coming from Turkey, Southwest Asia what ever, and basically the government cracks down and so you have a contraction of doctors doing this stuff. And so by the time you get to the eighties, you're really down to only a small number of doctors who are actually doing this,

prescribing heroina cocaine sometimes to older patients. But would distinguish this John marks Um is that he's out there, he wants to let people know about this, and he's connected with the other harm reduction folks that you also describe in this book. So just talk a little more about Alan Parry and the other characters. Sure. So, Alan Parry almost everybody describes him as an incredibly charismatic and persuasive fellow. He was a former injector at the time and he

began to do the needle exchange in Liverpool. And what he also did he was very clever about the media because typically harm reduction is met by oh my god, you're giving needles to junkies, and the media just freaks out and it's a sensational tabloid nightmare. But so what he did is say, look, we're starting this, we don't know if it's gonna work, but give us a couple of weeks and we'll give you the exclusive. So he got them on board and he told them what to

look at. Before there was a big bit of hysteria around this, and this was helped along, of course by the fact that Edinburgh had been such a disaster doing the opposite of what Liverpool was doing. And I guess, um there was a few others, right. There was Peter McDermott, who in your little full disclosure you describe as your your transatlantic romantic partner in years past, um, but who really helped provide some of the language of harm reduction

and the intellectual basis for what's going on there. Absolutely, and I mean he's one of the most brilliant people I've ever met. You know, we will not go into more details of my romantic life, but I did have to disclose that because I do say nice things about him, and I mean them, but um, the you know that relationship did occur, um. But anyway, just absolutely brilliant guy. And he was a current active out drug user, which was rare at that point. A lot of people were

covert using drugs um in that scene. But he was out about it, and he was furious about the fact that when he tried to get a job in the field, he was kicked out on his first day because he was on methodon and they told him that basically he couldn't be trusted. You know. Here was this guy who had basically dropped out of high school. But he was like studying drugs in the library when he dropped out, and he decided that, well, I get a bigger welfare

payment if I would go back to school. So he goes back to school, and he succeeds brilliantly, and then you know, goes to graduate school and gets a first class degree and he thinks, Wow, maybe I actually could get a job. Because that was not his original He just thought that he was doomed because he was a working class guy and he had this addiction, and nobody was going to ever pay attention to the fact that he actually had a lot to contribute. And he also

a ladies man. So anyway, we're not going to go there. I'm not asking Maya. But he did. Was he the one who sort of coins and popularizes the term harm reduction? Actually that's Russell Nucomb. But what Peter did was to really theorize it. I mean, he read all these people like uh Fuco and La Khan and all of this stuff. He was just very intellectual and he really thought very very deeply about addiction and what it was. And and we actually spent a lot of time arguing about the

nature of addiction. And so you know, some of us. Sometimes I convinced him, sometimes he convinced me. Um. But the you know, he really knew his stuff. And so along with Russell and along with Pat O'Hare um, they founded what was first known as the Mercy Drugs Journal and then became known as the International Journal and Harm Reduction. And they also started holding international conferences to sell people

on the idea. And so Russell Knucombe writes the article that names Harm Reduction in and it gets published in drug Link, which is kind of like a newsletter for the drug addiction treatment field. And it's such an obscure newsletter that it has like a typo in the headline it's high time for hame Reduction. Um. They fixed that later online, but um, that is the article that gives

the movement its name. And they were really thinking, like, what does you know prescribing and giving out clean needles and teaching people wound care, what is what does that

have in common? And what they came to was that like, these are measures to reduce harm, and that indeed the goal of any policy or drug policy in particular should be to reduce harm, not stop people from getting high, and so that is it seems kind of obvious, but it's actually a brilliant insight and it really really threatens the basis of the drug war, because the drug war is all about, let's get rid of these drugs, and

we don't care what the cost is. We don't care how many people we have to lock up, we don't care how many people die of overdose. We're going to crack down on these drugs and we're the good guys because these drugs are bad, and harm reduction comes along and says, wait a minute, what's bad is people getting

injured and people dying. And so what they discovered as they went along doing this was that if you're kind and nice to people and you meet them where they are, that actually helps people move towards abstinence or other forms of recovery. It doesn't enable them or encourage them to go on worse binges. When you look at the data on prescribing heroin, people don't stay addicted longer than if you just leave them on the street to get very

sick and die. Even they actually are just as likely to get into recovery as people um who are not in heroin prescribing. So the whole foundation of our ideology about drugs gets completely destroyed by harm reduction and by the data that comes from harm reduction. Because they knew they were doing something really controversial, so they insisted on

studying what they were doing at the same time. You know, so just for our listeners, you know, Maya just started these early things coming out of Liverpool and the journal she mentioned in the Mercyside Harm Reduction Journal, which then became I think with the International Journal and Drug Policy i j d P, still exists and it is still

a fantastic resource for people interest in this area. The organization that paddle Hair and others created was initially called the International Harm Reduction Association, and they had their first conference in Liverpool. They deliberately piggybacked it on a governmental conference in order to kind of get more media coverage for it. But then they decided to take it outside Liverpool and in ninety one they went to uh to Barcelona, and in ninety two they went to Melbourne and in

ninety three to rotter Damn. So really they were thinking, and I think especially paddle Hair, we're thinking, I had to take this thing into a much more global way that brought together the harm reductionists, the public health researchers, the other academics, trying to bring in some government people, and just to throw in maya one other little anecdote

I think you'll get a kick out of. I had already known John Marks and the other guys by the by the late eighties, but there was a moment in June of nine two and I remember going to a conference in Prague, right when they were officially splitting up Czechoslovakia into Czech and Slovak republics, and it was the International trans Personal Association conference. It was the first time I ever saw rahmda speak, the first time I heard

Terrence McKenna, the famous psychedelics writers speak. You know, my friend Sasha's Shulgin, the great psycholo innovator, was there. So there were some of the psychedelics folks were there, but also there were John Marks and I think Alan Parry. And one evening, John and Allen and I and another friend we go over to the home in the suburbs of Prague um for a dinner. And when I remember about that evening were two things that John Marx is

this guy I think he had a red beard. He was then in his forties and very you know, big rambunctious personality, kind of a classically minded brit And I remember that on our host put on this operatic music and John Marks got high on marijuana, which he had never done until he hit his forties. And he then proceeded marching back and forth in the backyard as he

was smoking this joint, singing along in German to this opera. Meanwhile, back inside, I think it was Alan who at that point may have been using heroin again and had a script from John and um, he wanted needed to go inject, and I said, well, can I watch? And the truth was, at that point, even though I'd been involved in drug policy reform in the bigger political and policy issues, I've actually never seen somebody in jack heroin. And so we just sat there while he injected, and we just kept

up a conversation and he didn't change. And I said, you know, al inside, how do you feel, And he goes, I just feel calmer now. But I mean his conversation, his thinking, nothing else changed, and the experience of just sitting with him as he calmly injected himself. Um, the way, maybe a diabeque might put in insulin and nothing happened except he seemed a little bit more relaxed. Was really

an important moment for me. And understanding that for many people, using heroin wasn't about dropping out, nodding out, or anything like that. For many people who have been using for a while, it had basically become essentially a sort of medicine that kept him from feeling sick in the same way methodon could or bupren orphan could, but also might make him feel a little better. Um, So you know, I mean, I have to say that was a huge learning experience for me. Now let me take you to

the U s now. So you bring the book to the U S and there's a couple of things. One is on you know, HIV is spreading like wildfire among injecting drug users and act up. The HIV advocacy group dominated by you know, gay men based sically is trying to figure out how it's going to relate to this issue. And there are others involved and people starting to go with you know, underground needle exchanges and trying to get

those things going. But you made an interesting point there that I've not seen somebody make before, which is that if the scientists and researchers had paid closer attention to injecting drug users earlier in the late seventies or early eighties, they might have figured out faster about what was going on about HIV AIDS, and that focusing solely on gay men, you know, while understandable in some respects, may have been a tactical strategic mistake in terms of advancing um understanding

of this disease. Well, basically, nobody cared about the IVY drug users. Everybody's just thought, oh, they're going to die anyway, so who cares if there's another disease? But there was in Rikers Island in the seventies. The local doctors who were training there um had this thing called Riker's a dentopathy which was basically AIDS. But it was before the virus was discovered and before it was known among gay people.

And so there's lots of clues that we have from these accounts from the early doctors who eventually specialized in what eventually became known as AIDS, um that they could have picked this up a lot sooner if we hadn't seen people who use drugs as people who deserve to die and be thrown away. M hm. You know you have a wonderful quote at the end of your book, and it's a fairly recent one and it's with Anthony Fauci and he's reflecting on his years going back when

he was the leader in dealing with HIV. And the quote you had is, I'm flashing in my mind how difficult it is for society to accept harm reduction, and then when you accept it, you realize, why didn't I do this before? Now, one of the pioneers. I love your story and we've talked about her and other episodes already, but know you really get into and I think you tracked your down in recent years, is Edith Springer. Right. I once introduced Edith Springer as the godmother of harm reduction,

and she quickly corrected me. She goes, Honey, I'm the goddess of harmora duction, is right, And in fact, that's how you refer to her there, And so say a little more about Edith and about why she turned out to be such an influential figure in this world of harm reduction. So Edith is an amazing person and she was working in the field of addiction treatment, and she

knew something wasn't right. She herself was abstinent because she had previously had a heroin addiction and she was told that she couldn't stay on methodone because that was not real recovery, and so she was abstinent. And she was just watching all this abstinent space treatment fail over and over and how terrible it made both the counselors and of course the people who kept failing feel about themselves.

So she was kind of in a ripe state when she met Alan Parry, who happened to be visiting from Liverpool, and Alan Parry basically demolishes her worldview, and she was so excited to hear that people were actually doing needle exchange and that they were prescribing heroin and that they were doing the things they were doing in Liverpool, because she had been losing people to AIDS and she was already trying to go out in the streets and go to the shooting galleries and teach people how to use

bleach to clean their needles. And she would have loved to give them needles, but they were illegal in New York and it was just easier in the face of a deadly contagious disease to do something to sterilize the needle than to get through the legal and political hassle that you had to do in order to get syringe exchange to be legal. But anyway, she um eventually act up,

picked up that struggle and did it well. Um But she and Yolande Serrano had this organis station called Adapt and they would just go out and you know, try to get the message about bleach out there. And when she met Alan Parry, he basically told her the theory behind what she was already doing. And she basically said to herself, my life goal is now to get this idea into as many heads as possible, and she just started.

She had she was already I believe she was already trained as a person to train people about HIV, and so she instead became a trainer on harm reduction and literally thousands of people were introduced to harm reduction by Edith herself, and among them were most of the founders of the harm reduction movement in the United States. So she was really a critical figure. And one of the reasons that she was so influential was that she did not do the I'm going to demolish your ideas sort

of tactic. She met people where they are. So she said, yep, I know that. You know, as a counselor you just keep seeing people not getting better. This is a way that we can actually help. And so she is just incredibly empathetic and incredibly able to meet people where they are in a way that so many other people who now know that we're right have a hard time doing sometimes because we just want to say no, you're wrong. Yeah, well,

you know, I remember watching her one time. She was talking to people in the audience who were coming from some sort of traditional treatment perspective therapeutic respective and she was asking them about how they did what they did. And what she then did was she picked up on a few of the things that she approved of what they were doing, and she said, but honey, you're already doing harm reduction, and she got them to open up

in that way. At some point, you say that she cites the work of the famous sociologist Irving Goffman, right, who is a remarkable sociologist who really focused on the on the sort of minute of how people interact with one another, whether it's in the workplace or in public bathrooms, you know, and I think it's a quote I just want to read here. You say, stigma is spoiled identity.

And if there's anybody whose identity is spoiled in this country, it's drug users through like the bottom of the barrel, as far as everybody is concerned, even their own families, even they treat themselves that way. They've internalized it. Yeah, Whereas so many traditional treatment programs I think felt they needed to and still feel they need to shatter people's identities and reconstruct a whole new one. Edith approached it

from a very different perspective. The whole point of the drug war and the whole point of criminalization is creating stigma. You can't if you don't create stigma and you criminalize something, nobody will not do the behavior that you're trying to criminalize because it's not bad. They don't see it as bad, and they don't think they should be locked up for it.

So you just won't be able to enforce the law unless you get people to realize that this is bad and these people are bad, and they're going to go to jail and they're going to suffer terribly because we think this thing is bad. So, you know, one of the things that struck me when I first got into this field was, as a person who injected drugs, nobody

cared enough to teach me about bleach. I heard about it randomly from a woman I ended up tracking down when I was writing the book, and that saved my life because I was about to inject with somebody who was probably already HIV positive. So I was just infuriated by the idea that, like, not only would they not teach me about bleach, they would try to tell other people not to teach me because I was supposed to die to send the right message about drugs. Two kids.

Now they probably never see me dying, but that was going to send the message anyway somehow. So I was just that whole idea just seemed awful to me because it was just treating people's objects. You know. At that time, being an active drug user, I was kind of filled with self hatred, but I didn't think anybody should be treated that way, like just no, that's wrong, you know. And I'm a child of a Holocaust survivor. So that also the dehumanization that was there just really struck me

and really struck me as being evil and wrong. So the whole sending the right message thing is the essence of criminalization and of the drug war. And once you're not trying to do that anymore. If it's not sending a message, what is it doing. It's increasing overdose death, it is not helping HIV, it is not helping poor people. It is in fact destroying communities. What are we incarcerating people for. Let's take a break here and go to an ad tell us about Dan Williams and his story

and his struggles. Sure, so, Dan Williams was a gay black man from South Carolina and he joined Act Up because, I believe, because he had lost a lover two AIDS, and he heard about Needle Exchange, which they were then doing illegally, and it just hit him that we're providing healthcare and people actually don't want us to do that. It's illegal for us to provide healthcare to these people, Like,

what's wrong. So he was really struck by it, even though he was not a drug user himself, and he became involved with the Needle Exchange and he became one of the Needle eight defendants who deliberately got arrested in order to challenge the law that made needle exchange criminal in New York State, and that trial was amazing. I was there for that trial, and it was you could just tell that it was historic because people were making all the best arguments in favor of needle exchange as

public health. And so for me as a writer, it was a great way to tell the story and get some of those arguments in in a nice little courtroom drama. Um. But Dan Williams was um one of the defendants, and as a black man, he was really really alone, and he talked about how, you know, he felt isolated in the black community because he was gay, and in the

gay community because he was black. And when he was speaking in favor of needle exchange, almost the entire black leadership of New York was seriously opposed to needle exchange. They thought it was genocide. They said it was an experiment being done on people, and that like if they were white people, they would give them treatment. They didn't want to listen to the fact that even if we poured all the money we could into treatment, people relapse. So you still need to keep people who were using

safe um. You know, as we used to say in the day dead addicts don't recover, So he was incredibly brave to stand up and do this. And he would go and try to talk to the Black AIDS organizations and say, you really can't oppose this because this is essential to stopping the epidemic, and he got told, oh,

you've been sent by the white boys. So you know, he was an incredible figure in terms of that, and there were, you know, in the black community, there was this whole debate about respectability because white people for so long had used drugs to stigmatize in stereotype and incarceory black people, so they didn't want to be seen as pro drug quite rightly, but they didn't see anything else

to do. And part of the story that I tell in the book is how Michelle Alexander's book The New Gym Crow helped undo that kind of ideology by showing that actually the drug war just locks up a lot

of Black people and does not successfully fight addiction or drugs. Yeah, you know, I think it's almost almost a double edged consequences of the Tuskege Syphlis experiment, right, which is such an extraordinary historical sort of point that's constantly referenced Tuskegee was an experiment about, you know, black people with syphilis not being treated, just to see what happened to them, about black people being treated in research study, the ways

that white people would never be treated. On the one hand, it speaks to the kind of underlying systemic, conscious and unconscious racism which colors American health policy to this day. All the ways in which you know, people black people are treated differently in hospitals, different than different, access to pain medication, different and a whole range of other areas.

Yet on the other hand, the ways in which but what about Tuskegee has been used to block public health interventions that are the exact opposite of the Tuskegee situation has also been an extraordinary tragedy. When you talked about method on you know, where people black people would say

that Tuskegee, talk about needle exchange, Tuskege. You're even bringing up to today with with you know, the vaccine Tuskegee, Tuskegee, and these are all cases of innovations, health innovations that in fact are first done on white people, right, white

people in Europe, white people in America. Standard But still that Tuskegee reference point lands up being used incorrectly in a historically inaccurate way to block the sorts of interventions that actually would be saving tens of thousands, if not

hundreds of thousands of black lives over time. So it's a it's a particularly painful piece of all of this, and you know, it's at the same time reassuring to see that oftentimes it was black leaders who are able to flip fairly quickly, whether it was Calvin Butts, the famous minister at Abyssinian Church in Harlem, whether it was young legislators in the Congressional Black Caucus which initially opposes needle exchange and then comes out more quickly than white

legislators to support it. So it is I mean, we've been we've already gott into this before in some episodes, and we'll get into it much more in future episodes. But okay, wait, I just want to say one more thing on race here, because Velmonette Montgomery, who is still in the New York State Legislature, stood up for needle exchange when no other politician would. So I think she

deserves her props here. That's true, as does say something like her smoke the brave mayor of Baltimore who called out the drug war back in and pushed very hard to try to get needle exchanged going into city against the resistance of most of the black and a good

part of the white political establishment. So there were some brave voices, but the power in the community and the black establishment and the Black church were so vociferously opposed to this that it really hobbled some of the efforts that could have saved huge numbers of lives in the

early years. But wait, let me add one more thing. Um, That's also why Michelle Alexander's work is so important, because she her book became a bestseller, because she caught on in black churches, and because of her speaking in black churches, and because of the way the Black church picked up her work and said, whoa, we have been doing something wrong here. We need to fix this. We have been stigmatizing the incarcetory people amongst us instead of realizing that

they are victims of a racist system. Often. So it's a complicated issue, but I just think it's it's very important to give credit to the people who did stand up there. Yeah, it's true, But I remember Michelle's book, which is a historically important and path breaking book and changing the nature of the whole discussion around the drug war, and and and putting it and driving home the notion

of the new gym. Crow. Even when she first puts that book out right, she gets resistant from other black leaders. How can you dare associate the drug war with Jim Crow history? Right? Um? But that book comes out around two thousand six or seven, I think, and we're here, we're still talking about the nineties, and so there's a whole decade where this resistance continues in a very powerful way, and where people trying to make that case still are having a hard time finding traction when it talks to

the issue about needle exchange. Moving out of just a few cities, a couple of names stand out. Once John Parker coming out of New Haven. Sure so um. John Parker was a bit of how shall I say this, Uh, He was a maverick and he just did his own thing.

He was not a person who is very much organized with the movement, but he did really important work because what he did was he went around two cities up and down the East coast and even um some in the Midwest, getting himself arrested to bring these legal cases to change the law in order to allow needle exchange to be legalized. And so the New York Times called

him the Johnny apple Seed of needles. And he was one of the defendants in the Needle eight trial in New York because he joined with Act UP in this instance to um uh, you know, get this arrest happening and and get the law changed. So although there are definitely some activists who are not fans of his, um he did do important work in terms of helping challenge

these laws. Let me get you old story about John because you know, in the early years, I think when the Drug Policy Foundation first started giving out awards, they give a big word to John Parker and I think Dave Purchase in order to support needle exchange. So John was a real hero going up and down, especially the Northeast coast, you know, doing this sort of thing. But um so I knew him from back in those days. But in ninety four I start the Lindis Smith Center,

you know, the Drug Policy Institute within Sorrows Foundation. And about a year later, I'm sitting in my office and it's at eight seventh Avenue across the Street from Carnegie Hall right here. At that point my office was in this still in the same building, the foundation of the same building where Sorrows' office was, with his uh financial management side, and I get a phone call. Uh, Ethan,

we got a problem here. What was the problem? Well, John Parker had shown up at George Soros's office and dumped a half dozen vials of heroin on the receptionist desk, asking to be arrested. So John, by that point I think was spinning out a bit. And uh, you know, that was one of those things where Sorrows at that point I think I had just persuaded and to become the biggest funder in the world of needle exchange programs, both in the US and and and the former Civiet

Union Eastern Europe. And it was a moment we had to workaways through. Now. On the other hand, Dave Purchase

out of Tacoma was quite a different character. Yes, well, he was all about working with people and spreading the word in ways that would be sustainable, and so he founded the North American Syringe Exchange Network, which was kind of the seed bed for the rest of harm reduction activism in the US and so he started the first needle exchange in Tacoma by simply setting up a table in a neighborhood where there was a lot of ivy

drug use and putting out syringes. And he was sort of such an affable character that he got the Health Department to buy in right away. So they became the first legally funded syringe exchange in the United States because of sort of his ability to get along with everybody from like the Hell's Angels to the Health Commission. Now, Dan big at a Chicago is one of the historical figures as well. He plays a pivotal role in getting

needle exchanged going. He is essentially the godfather of the locks own you know, the antidote for overdose, and uh, you know, I mean really is an historical figure in that way. And we've talked about him, I think already on on other episodes. But he does something else interesting

and there's a sort of overlap with Edith here. He names his organization in Chicago as harm Reduction Organization the Chicago Recovery Alliance, using the word recovery, which is typically a word that's been used in the twelve step movement to refer to achieving abstinence. Say something about Dan and he's thinking about all that. So harm reduction not only had to redefine addiction, but it also had to redefine recovery because of the way it challenged all the conventional

ideas around it. And Dan Big was essential to this, as well as his friend John Zisler, who actually came up with the idea that recovery should be defined not as abstinence but as any positive change. They named themselves the Chicago Recovery Alliance because they wanted to show that recovery can be many different pathways. That you can start recovering by using clean needles. You can start recovering by injecting less, you can start recovering by smoking pot instead

of injecting. Just as there's a zillion different ways of becoming addicted, there's a zillion different ways of recovering. And so Dan Big emphasized that, and it was really helpful because you can't describe a phenomenon that affects so many different people in so many different ways and say there's only one way to recover. And you know, I bought into that early on because I was taught it by

the place that helped me get off of heroin and cocaine. Um, but that is not the only pathway, And by saying it's the only pathway, we doom a lot of people because a lot of times people are told in rehab and in twelve step programs that the only alternative is jails, institutions, or death, and that's not true. There are different pastor recovery, and all of them are valuable. The other critical thing in terms of recovery is that it really should be

defined by are you getting healthier? Are you getting happier? Are you getting more productive? It really shouldn't have to do with what substances are in your bloodstream. And this is how methodone can be recovery, and bubnorphine can be recovery, and marijuana can be recovery. For some people, it is about are you doing well? Not are you getting high?

So it's basically about sitting with people who are struggling with drugs and with life, and rather than focusing on getting abstin and cutting back drugs, whatever it might be, asking the fundamental questions, um, what do you want to be accomplishing your life? What are you trying to do?

And let's figure out from there, in what ways are the drugs either helping or getting in the way, And in what ways maybe can your drug use and other elements of your life be managed to help you better attain what it is and acknowledging that even the tiniest

little steps can make a difference. It's not at all or nothing, saying absolutely and looking back at it now, My recovery probably started the day someone told me to use bleach, you know, because that was when I started to become kind of politically awakened around the issue, and it was part of my pathway to getting to absentance recovery and to not being HIV positive when I did. Yeah, you have a great little story about Les PAPIs in

San Francisco who becomes bleach man. Right, And and just so our listen to understand this is a point where oftentimes needle exchange or access to sterile syringes was banned in most states in one way or another, and the safest option, the fallback strategy was just to make sure you were cleaning your syringes with bleach before you use them. And so you know, it was a campaign to make most make little bleach kits available and to show people how to use it and to get them to do it.

And my Les Pappas, who's still a harm reduction advocates, still doing good work in the field. Um, you know, I set up a whole PR firm to do work around harm reduction, I think. But back then it was dressing up in a costume like a Superman costume and and handing out bleach kits, right, and some of the hardest neighborhoods in San Francisco. Not only did he like have this giant jug head of a bleach bottle and

a cape. Um, he would go around with a giant syringe like you know, three ft long or something and demonstrate how you do it. And there's actually a commercial that aired on late night TV with bleach Man's origin story. He cannot cure AIDS, but he can bleach. So, I mean, it was kind of incredible to me as someone in New York, where you weren't even allowed to talk about it, that in San Francisco they were having these commercials on late night TV and really trying to help people, right.

I think it was those stories. There's probably nobody who has had his picture taken by so many people living on the streets, homeless, doing drugs, but who just felt honored that here was this superhero who actually cared about their well being and their well wellies. Well, the last person I want to bring up you only bring up

interesting In the book. Of all the people your profile, I think there's only one academic, one professor in the entire book, and that's Alan Marlatt, who was a Canadian born and raised but you know, taught the University of Washington, somebody who actually you know, wanted to have on the board of Drug Policy Alliance. And then he unfortunately died at a young age. Um, but just say something about Alan's special contribution in this field. So Alan was an

amazing person. And what he did was recognized that alcohol is part of the conversation and that to bring harm reduction to America and to bring harm reduction into the world of addiction treatment, that he had to work with it in alcohol, not just other drugs. And so he began teaching people things like how to reduce your drinking

rather than you must be totally abstinate. And he also did experiments that showed that, for example, this idea that the first drink gets you drunk, and that once you start,

you completely lose control. If you've ever had an addiction, like what he did was they did this experiment in what he called the bar lab, and it was basically a bar, and sometimes they got served tonic and sometimes they got vodka tonic, I believe, but sometimes they were told the opposite of what the drink actually was, and their drinking escalated in relation to what they were told was in the drink, not in relation to the actual

alcohol content of the drinks. In other words, it was the belief that the first drink gets you drunk, not the alcohol, that caused this escalation of loss of control. And so if we didn't inculcate that belief in people, obviously we prefer if you're being abstinent to not re leaf.

But if you do, you don't want to get into what he labeled the abstinence violation effect, and what that is you could also call it the Funcket effect, because you count your sobriety by the number of days you have been away from alcohol or other drugs, and if you have anything, you go back to square one. So this leads to people who just have one sip and then they like, well, I've already blown it, so I may as well have a binge, and this can be

deadly in some cases. So he sort of elaborated the psychology of how addiction works, and he brought that into the addictions field and into psychology in a way that hadn't been done previously. And so I admit in this book I tried to focus on the activists and on the people who were themselves people h use drugs, and I feel bad for not being able to have featured people like Ethan Moore. And I hope that somebody will do the story of drug policy reform in the United States,

which has lots of interesting people in features. Oh, in time,

Maya in time. But you know, I should tell our listeners that yesterday UM reading Maya's chapter where she talks about Alan and the experiment where you know, people are getting multiple drinks of alcohol, but if they think there's no alcohol, they don't seem to be getting drunk, and and and those drinks that don't have alcohol in it, but they think do they are getting drunk in the whole placebo effect on And I remember I first read about that back in six I was reading a wonderful

book by Stanton Peel called The Meaning of Addiction, which had a big impact on me, and he talked about Alan study and other ones like it back in the day. Anyway, this is yesterday, and I'm reading Maya's account of this thing and remembering reading it in Stanton's book many years ago. And then an hour it are, I'm making myself some dinner.

I pull out the latest copy of New Yorker magazine and there's a piece by a journalist John Seabrook, who describes himself as currently being in recovery, and he's talking about this explosion now in craft beers that have no alcohol, alcohol free craft beers which are actually being to taste good. And he's talking about his own journey about is it okay for him with somebody who has now been abstinent for five years, and is it okay for him to do this? And pops right back up the story of

Alan Marlatt and those bar experiments. So it's one of the most powerful experiments in terms of getting people to understand the nature of addiction. I think that's ever been performed. Going to add something about that John Seabrook article, because he doesn't use it to make the point that we have been making. I mean, it's it's just very odd. It's still maintains the abstinence and the first drink gets you drunk view, which is completely undercut by the experiment.

So he didn't really explain it well as I guess what I'm trying to say. And I found it a little sad the way he mentioned it, because it was much more powerful than the way he described it. Yeah, my is funny because I actually saw this guy going

through this incredibly ambivalent experience. Like here, he's for the first time trying something that all the cues of drinking, the bar and all these sorts of things in doing it, and then he takes it and he doesn't go and start binging on alcohol, but meanwhile he's worried he might, I mean, while his wife's worried he might and all that sort of thing. I just felt this tremendous sense of ambivalence coming out of a very intelligent man who's

wanting to retain his abstinence and recovery. But meanwhile, you know, because I mean, you know, life's complicated in that way, I guess, And so I guess I gave Seabrook a little bit of benefit of doubt, and he had a little tongue in cheek about his own experience through this whole thing, you know, And I have to say that, like you know, I'm I'm looking for people to be sending the message of more complexity in this area, and

I am probably overly harsh. Well, people will need to read It's John Seabrooks article in New Yorker magazine in late September if you want to read it, so my, you know, one of the things, as you talk about in the book is how effectively brilliant the phrase harm reduction is. Who can be against it? And of course everybody wants to reduce harm in it, and it equates with a whole notion in medicine at first, do no

harm um. Yet, on the other hand, I have to tell you that as an advocate for harm reduction and trying to get that into the broader public discourse and politically, I found it both incredibly advantageous for the reasons that you described, but also very frustrating. And it was frustrating in this sense that it wasn't really catchy, it wasn't something to get excited about. And the contrast right was

with the phrase in marijuana legalize it legalize. It was a highly motivating and you know, exciting and it sounded right, but it also had the downside that it kind of scared people a bit, right, And so it's that trade off. But I mean, you think about harm reduction, and I don't think the New York Times starts to really use the phrase outside of quotation marks for twenty or thirty rs after it emerges, and people there's a kind of

hum hole. And I would mention how harm reduction to journalists like a thousand times, but the numbers of times which they actually put in the article was a tiny fraction as opposed to a more catchy phrase. Well, part of it is that people don't realize how powerful it is. Who does realize how powerful it is. Our prohibitionists and they, the serious drug warriors in this country, made a real

effort to stamp out the phrase harm reduction. They didn't allow it to be used when people were seeking grants. If they wanted to actually get a grant from N I H or C D c UM, they went to the U N. And when other countries were trying to suggest this as drug policy, they just took it out of all the documents, so they knew it was powerful, and so it's it's a little bit complicated. Um. But I think, you know, some people have said, like, oh, we should focus more on pleasure from drugs, or on

the upside or things like this. But the reason I believe harm reduction is important phrase and should be the center of the movement is that policy should be concerned with reducing harm. Policy should not be focused on pleasure. I don't want the government trying to like either take away my pleasure or give me pleasure. That would be kind of weird. M Yeah, No, I mean, I I mean, I remember this history vividly because I was so much engaged in those battles. I remember the opposition trying to

demonize it. I also remember a brief pier where they tried to co opt it, and they claimed that even coercive approaches were reducing harm and that therefore that was harm reduction. I remember discussions within the harm reduction movement about whether to jettison the term because it had developed so much negative baggage from our opponents. Uh. In my discussion with Nora Vocal on one of the episodes of psychoactive.

Not long ago, I asked her why was it that all sorts of researchers were told to not use the phrase harm reduction and their grant applications, And she was fairly frank about, sort of suggesting it was the politics, and if you could fund harm reduction research without calling it,

maybe that was the thing you need to do. Um And I sometimes felt that I may have played something of a personal role in all this, because you know, in the late nineties, George Sorrows and his foundation was funding of both harm reduction and drug policy reform around the world, not just in the US, and I was the principal advisor and gate keeper of all of that, And so we were simultaneously funding harm reduction programs all

around while at the same time challenging the whole prohibitionist approach. Um And I think our opponents saw that if you could smear everything with the label of legalization and even suggest it was all about a free market, libertarian legalization that didn't care about kids, I think they saw that as a useful tactic. So my last question to you is you repeatedly point out in the book on how much harm reduction is now spreading the very notion, the

idea of the language. I mean, in fact, I think if you google on it now you almost see it referring more to tobacco harm reduction, which is now become its own controversial field and which I become quite personally involved. But you point out the ways in which harm reduction is now being embraced, both the language and the thinking in a host of other areas, and including around COVID. So why don't we finish up by just talking about how you see it's it's broader acceptance in American society.

So the beauty of harm reduction is that it allows you to look at risk and context, and if you want to make good choices, you have to do that. It also shows you that there are behaviors that people are just not going to abstain from. People are going to take risks, and for the example of COVID, people are going to socialize because it is fundamental to human biology. So you're not going to really be able to expect

abstinence to last very long. So how do you manage that? Obviously, masks are one thing, and now we have vaccines, But the real thing is when you want people to change behavior in a consistent fashion. You need to have them focus where it matters the most. And so, for example, wearing a mask outside is a little bit silly. Wearing a mask inside where you're in a crowd definitely important. So if you're going to so called mess up and not use the mask, outside is way better than inside.

And so that's harm reduction in practice. And one of the reasons I like to look at all the different places that harm reduction is now showing up, whether it be in terms of environmentalism, or eating disorders or many many other things, is that this is a gift from people who use drugs. People who use drugs invented this whole idea, along with academics, along with public health folks, along with drug policy reformers. But this comes from people

who everybody tends to hate and see as useless. And yet now it is being used for the biggest two of the biggest problems we have, including global climate change and um the pandemic. Because in terms of climate change, for example, if you eat meat one less day a week, that would make a huge difference to the environment, and that's harm reduction right there. Well, on those words, maya

let's wrap this up. So as I said it to be getting, I truly think that you are one of the most brilliant people writing and thinking about drug use and drug users and addiction. You know, not just in the country, but around the world. I know my opinion is broadly shared. Thank you ever so much. I'm counting you to continue writing and all sorts of creative ways in this field for many decades to come. So thanks so much for being my guest on Psychoactive. Thank You.

Psychoactive is a production of I Heart Radio and Protozoa Pictures. It's hosted by me Ethan Nadelman. It's produced by Kacha Kumkova and Ben Kibrick. The executive producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren Aronovski for Protozoa Pictures, Alice Williams and Matt Frederick for I Heart Radio and me Ethan Nadelman. Our music is by Ari Belusian and especial thanks to a Vivit Brio, Seph Bianca Grimshaw and

Robert Beatty. If you'd like to share your own stories, comments, or ideas, please leave us a message at eight three three seven seven nine four sixty. That's one eight three three psycho zero. You can also email us as psychoactive at protozoa dot com or find me on Twitter at Ethan natal Main. And if you couldn't keep track of all this, find the information in the show notes. Next week we'll be talking about iby gaine, the powerful psychedelic

that comes from the Aboga Route in West Africa. Our guest will be Dmitri Mucgainis, who has helped hundreds, indeed thousands of people to deal with their addictions through the use of iber gaine and other powerful psychedelic substances. It might take three to four to five days for someone to come out of the experience completely. Holding that space is the most intense experience that I've ever experienced, and

I did it hundreds and hundreds of time. You have to be in there, why people are suffering, why people are processing, why people are vomiting, why people might want to start to use again or questioning why they use again, and it's an incredibly sacred space. Subscribe to Cycleactive now, see it, don't miss it.