Patt Denning on Doing Harm Reduction Therapy

medical advice or encouragement to use any type of drug. Today, we're gonna be talking about harm reduction, and specifically harm reduction in the context of drug treatment in America, where most programs are still abstinence only twelve step programs with very little flexibility to meet people where they're at when

they're struggling with drugs. My definition of harm reduction refers really to any policies or interventions that seek to reduce the risks, the harms, the negative consequences of drug use, or really any other risky or potentially dangerous activity. I mean, when it comes to drugs, we think about UH needle exchange programs to reduce the spread of HIV and AIDS and other infectious diseases, or making sure the lock zone is available for people who are using opioids and might overdose.

Or maybe it's just about getting people to use less or to use more responsibly, or to switch from injecting drugs to taking them, orally there's all sorts of ways of harm reduction. Now in my own life, I've been personally engaged in this issue. I mean not just in my own life in using drugs in a harm reduction way, but also in speaking about this and teaching about it and writing about it, and then also beginning in the early mid nineties, in helping to fund and support and

start harm reduction programs all around the United States. Now, harm reduction can apply not just to drugs or other activities. It can also involve a harm reduction approach to drug enforcement, drug policing. It can there can be a harm reduction approach to drug markets, harmorduction approach to drug policies. Today we're talking with Pat Denning about harm reduction approaches to drug treatment. Pat's run a pioneering program with her partner

Jennie Little in San Francisco for many decades. She's co authored books with Jennie she's been a teacher both in the US and around the world. So I'm delighted to welcome Pat today. I'm really happy to do it, Ethan. I I always love talking to you, and this is

just the best excuse ever. You know, the first thing I want to do is just get into the broader issue of harm reduction, and keeping in mind that there are some people who are into the nitty gritty of this subject and there are others are going harm What what's harm reduction? And so what's your elevator pitch about what's harm reduction to the people who have never heard of it? Um, my elevator pitch is that harm reduction is what we do every day in our lives, since

we're human beings. We take risks, we ride in elevators, we ride in cars, and we do things to minimize the risk. But so when people talk about harm reduction in the context of drug treatment, what they usually mean our alternatives to treatments that focus only on achieving abstinates. Well, you know, I think the other thing, Ethan, is that you know, people get confused and talking about harm reduction

because it's it's not just one thing. There are different arms to the harm reduction movement, and the original arm was very much grassroots, very much drug user driven. It resulted in things like needle exchange programs. But then another arm came in, which was the public health arm, which really was interested in reducing the spread of disease. And then there's policy and advocacy um which is really interesting it and ending the war on drug and protecting the

rights of people who use drugs. And the most recent addition, which is not actually recent anymore, is is treatment. And while I came in through multiple avenues of all the different arms of harm reduction, I think my contribution is primarily in the area of harm reduction treatment. I was looking around and I saw one of the things you

wrote in the last year or so. It's for an excellent online publication called Filter, and you wrote about your dilemma about whether or not to provide alcohol to people who were living rough on the streets. You know what we call skinro alcoholics who might suffer the d t

S if they can't get any alcohol. Yeah. It came about because for the last two and a half years we have been doing a pilot project for the Department of Public Health in San Francisco of developing mobile pop up dropping centers, and we would come into different neighbor hoods with a big the van that was outfitted as a therapy office, set up canopies, we cooked hot food for people, We had a drop in center, we did therapy, and after COVID hit, we had to start shutting down.

But in the process of shutting down our mobile sites and figuring out how to just do outreach, we started coming across people who were clearly in withdrawal from alcohol. From alcohol because the shops were closed, people couldn't like shoplift alcohol. There were no people on the streets, and so people couldn't um ask for spare change or asked for money. So people's ability to access alcohol was severely disrupted, and it was clear that people were really suffering. And

I just immediately thought, well, this is crazy. At this point, we're handing out syringes, we're handing out crack pipes, people are doing methodone take homes, and people are doing same

day prescriptions. So I'm just thinking, well, my goodness, there are all these people who are physically dependent on a legal drug that they now can't get access to, and the dangers of withdrawal from alcohol are severe, and so I thought, well, why don't we just give out alcohol just so our listeners understand and correct me if I'm wrong.

If you withdraw it from something like heroin or cocaine, it may be extremely uncomfortable, you know, terrible flu for some people, you know, all sorts of things, but it's not going to kill you. But if you've become heavily dependent on alcohol or for that matter, of benzo diazepines, valium like drugs, if you rapidly withdraw from alcohol when you are heavily dependent, that can actually be life threatening. Rapid withdrawal without some types of help can kill you.

It's interesting in the history of alcoholics anonymous in the old days, they used to always have a bottle of booze at the meetings because they knew that the new comers who were coming in might actually go into withdrawal, and they knew it was dangerous, so they would, you know, hand somebody a bottle and have them take a swig out of the bottle of booze if they were starting to show signs of withdrawal. So we've we've known that

alcohol withdrawal is very dangerous. So I started calling up alcohol distribution places mostly and I will, I'll go ahead and use the company name bev Moo and asked them if they would make a donation of a little, uh, you know, the airplane size bottles of booze. And I told them why, and they, of course, we're just like, excuse me, but no, I don't think so. So I drove down to bev Moo and I bought a few cases of basically vodka in little bottles, and I take

it home and I'm all excited. I tell my staff, you know, oh, you know, I've got little bottles of booze. We can now hand that out for people. And all of a sudden, I'm like, oh wait a minute, pat, what hold up? You are a licensed therapist, um, and you are going to be handing a drug even though it's legal. You go be handing a drug to someone in order to help them with a medical problem that

you're not even qualified to diagnose. So here we are with this dilemma of knowing exactly what our clients need. And it's like we're not allowed to give clients an aspirin. You know, you can't dispense medicine as a therapist, and all of a sudden, I'm thinking, yeah, well I'm old and I can lose my license and it doesn't bother me. Is I'm about ready to give it up anyway. But you know that's not true of the agency, and that's

not true of most of the staff. So it was quite a dilemma that I have completely refused to answer any question about how we solve that dilemma. So, I mean, so pat you found it had been running this remarkable army reduction program San Francisco since I guess the nineties. What's the essence of that? Well, you know, it was kind of a long journey, and as as I I said in a staff meeting today, I was a you know, nice, sweet, perfect little girl who got really rebellious really fast and

started questioning everything. And the HIV epidemic came along, and that gave me a reason to really start looking at UH drug treatment and alcohol treatment because we were throwing a lot of young men into programs who were dying and treating them not very well. So that I started

thinking about alternatives. And this was in the in the early eighties, and over time just kept developing new ways of thinking and eventually met Jeanie Little, and we both had this idea of wanting to run a center that would take everyone, no matter what the status was of their drug use, no matter what if their goals were for treatment, And so it was really the two of us just being defiantly determined to do it differently. So, Pat, when you and Jennie decided to do something new, tell

me about your approach. The Harm Reduction Therapy Center UM provides individual and group therapy. At times, we also have medication available. The goal of harm reduction therapy is to help a person who is having trouble with drugs and alcohol decide how they can better their life, how they can reduce their harm in whatever ways that is going to be necessary. Are they really going to need to take psychiatric medications? Are they going to need to absolutely

quit drugs? Are they going to need to have family therapy? The clients are primarily very low income, often marginally or unhoused, often with very significant psychiatric or emotional difficulties as well, people whose drug use and emotional and family problems are so interwined that you can't separate them. So we provide the full range of services. There's no limit to the treatment. A lot of our community programs offer therapy on a drop in basis because our clients lives are often so

disorganized that they can't keep appointments. Going back to the origins of the phrasing of harm reduction, back to I guess the Netherlands in the eighties and such, and then coming in around needle exchange, both in Europe and the US and elsewhere, there was people in our world debating whether harm reduction was the right word. Then our opponents were successful in calling harm reduction and legalization were synonymous,

which in fact they weren't. It was overlapped um. And then there was a point where some of our opponents that they might try to co opt the term, and they said, well, we're doing harm reduction, we're forcing people into drug treatment, and it always saying that when other core element to the definition of harm reduction is that it needs to be non coercive. It's an absolutely fundamental distinction.

The foundation of harm reduction therapy and harm reduction treatment approaches is self determination and a true collaboration between two experts. If you will, you know, the client is the expert on their life, and often the expert on their drugs, and the therapist is an expert in helping people, you know, an expert in developing a relationship that allows a person to be honest and to find their own power in terms of changing. It's like almost anything can be harm reduction.

Twelve step can be harm reduction. Abstinence based treatment programs are harm reduction. If the client has a free choice in a menu of options, then what they choose is harm reduction, right, and the choice should not be between either take this treatment or go to jail. That's right. Has to be an element of choice that actually involves a real freedom of choice. Yes, if it evolves, especially the state involved in coercion, it can't be harm reduction.

Now when you get to elements of compulsion by family or employers, I guess it gets a little cloudier. Then, huh, well, it gets cloudier. But the difference is who is the therapist loyal to and in a lot of the drug treatment programs, especially because the carceral system is so involved. Now the funding and drug treatment is coming in enormous measure from the criminal justice system, and so now drug treatment is very much in bed with this coercive system,

with all of its racial and oppressive undertones. And so now if you're coercing, even if it's family that's coercing, the therapist cannot be part of the coercion. The therapist has to be free. So you know, I've worked with people who have been mandated to treatment before um, mostly professional athletes, and the first therapeutic duty is for me to say, um, you have to be here, and you

don't have to talk to me. You know, what goes on between you and me in here is confidential, and your main decision is are you going to show up? And if not, are you prepared to take the consequences. And if you show up, are you going to try and use this to your advantage or you're gonna sit here quietly for two years. Any time the therapist or counselor has the power to harm a client, it is

not harm reduction. If you need to have drug testing, that's fine, but you have to go somewhere else to get your drug testing, and we won't allow the results of that drug testing in your chart. We'll be talking more after we hear this ad. You and I were presenting it some drug treatment conference years ago, and this was a real aha moment for me. Somebody was asking you, well, I get harm reduction when it comes to opiates. I get it when it comes to needle exchange and all

this sort of stuff. You know, I'm gonna have a lot of patients dealing with mitth anthetamine. Well, um, I think we're getting into the area of one of my favorite topics, which is the adaptive or the self medication uses of drugs. And there are people whose functioning is

actually improved by the use of certain drugs. And this one particular guy was very depressed, very disorganized, had all sorts of other issues going on, and it was clear that when he had had little speed before he came into a session, he was much more focused and much more able to actually talk. Because usually even within some harm reduction treatment programs, they will say just don't show up high to treatment. You know, you don't have to be absinent, but don't don't use on the day that

you have a session. And it's like, no, no, no, actually, maybe you should use before you come. And and I had another woman who was a polly substance user, very serious mixed drug use, and she was finally able to say to me, I can't come here if I don't have a drink. And my office at the time was on the third floor of the building and there was

a bar on the first floor. Sort of handy for a harm reduction program, because what happened is that she would come to therapy, she would get so overwhelmed talking about things that she would go home and be incredibly suicidal and would cut on herself or would do all sorts of drugs. And she was finally able to say, I can't do this, I can't talk about these things. And I just said, well, if you had a couple

of drinks, would it make it better? And she's like, well, of horse, it would, but I'm not allowed to do that. And I said, well, I'm just trying to help you not kill yourself while you're in therapy. And what you're dealing with is so painful that if you need some alcohol in order to be able to talk about it, I just think you ought to go right ahead and take care of yourself. I mean, hell, it makes sense.

And I also remember you're saying that even with that person you know who're taking the speed before, and the alternative was if he hadn't done that, he'd be sitting in that session with you, and all that would be on his mind would be getting out of that room with you so he could score again and use again. So I mean, in a way, it's basically harm reduction as this sort of fundamentally pragmatic approach to dealing with problematic behavior substance abuse. Who would have you? People use

drugs for reasons. The reasons are pretty simple. Do you use drugs either increased pleasure, decreased pain, or alter your consciousness. That's kind of what people use drugs for. And we have somehow decided that it's not okay to alter one's consciousness for any of those reasons. In America and prohibitionist America, we've decided it's basically not okay to get high alcohol, well except maybe but not too often. Actually, as a therapist, we were trained to be suspicious of anybody who drinks

every day. So anybody who has a couple of glasses of wine with dinner, we're really trained to go, oh, you mean you drink every day? And it's like in Europe they think we're nuts. But the prohibition mentality in America permeates everything, and it's really, of course extreme when it comes to illegal drugs because somehow we as a society believe that if drugs are illegal, they were made

illegal because they're bad and they're dangerous. And what we don't understand is that certain drugs were made illegal based on racial prejudices and attempts at racial control. So I picked up the paper the other day and there's this report about some of the national health agencies wanting to discourage people from drinking every day because they now believe, although it may have slight cardiovascular benefits, that it also

increases the risk of cancer. And we know that when it comes to cigarettes, we know smoking cigarettes is not good for you, but you see the government getting really behind a campaign to ban the consumption of nicotine in any form. Conversely, Americans are now saying marijuana should be legal. We're increasingly accepting of people using marijuana up not just medically, but to get high in a way. One thing we've been fighting for for a long time is to get

people to change their minds. The problem is that they may be changing their minds to the right way when it comes to illegal drugs, but maybe heading the wrong way when it comes to the legal ones. And there's that undercurrent of prohibition that is going it's going to raise its ugly head and it's it just depends on the times and the culture and who's in charge of

which drugs are going to get demonized. You know, when we had prohibition in this country, you know, for thirteen years, the law of the land said alcohol is so dangerous, it's so poisonous, that no one should ever be allowed to consume it. Thirteen years later, we made it legal again. And so what we had to do as a society to make that make any sense at all, is that we had to adopt this idea that there's this disease called alcoholism, and some people have it and some people don't.

And if you don't have the disease of alcoholism, you can drink whenever you want to, because alcohol doesn't cause alcoholism, it's only activated by drinking. That's an insane way of reintroducing a drug into society is by saying, oh, well, ten percent of you can't drink at all, and the rest of you can drink as much as you want to. I think the important thing is recognizing that it's a

political ideology, it's not settled science. Behaviors as complex as serious drug problems are always a combination of biology, psychology, and socio cultural factors, and for each person, the relative weight of those factors can be different, and it can be different for different drugs. You may have a sort of biological propensity to overuse alcohol, but you might have a psychosocial propensity to overuse marijuana. You know, drugs are psychoactive.

They act in the brain. They cause brain changes. Every activity that we engage in repetitively causes brain changes. So it doesn't necessarily mean it's a disease or it's even damage. It's you know, it's a difference. And is it more important than a person's psychology. Sometimes often not, But it is very much the case that people have the drugs they can handle on the ones they can't um you know.

And I have a friend and colleague. I won't mention his name for the purpose of the show, but this is somebody who's real problem was um opiates in heroin. But when he put that behind him, he found that he could be a regular consumer of red wine and marijuana, even a daily consumer, and lead a remarkably successful in productive life. And and we all have our drugs of choice, you know, And whether that be because it's the most fun drug, or because it's the one that helps take

care of us the most. You know, if you could only have one drug for the rest of your life, what would it be? You know, I'm I'm absolutely clear that my Crown Royal is coming with me to the desert islands. You know, that's a tricky one from me. I wonder let's take a break here and go to an ad. You know this issue now right with overdose fatalities hitting sixty seventy eighty thousand a year nationwide, getting

worse in this past year with COVID. I used to always explain to people that overdoses was actually the wrong word, and the vast majority of cases it wasn't people taking too much of one drug. That's the real accurate definition, and overdose whose fatal drug combinations, you know, taking opioids combining with booze, or with benzodiazepines, valium type drugs. But now along comes FENTONYL right, which has got a special

kick to it, more opponent than heroin. You know, it hits my city in New York first, but I can see San Francisco is getting hammered by it now, so I mean, what are your thoughts about what's going on when I see these? I think your rate of overdose in San Francisco is much higher now than ours in New York, and ours is already incredibly high. What's your take on the overdose thing and whether information needs to

change in light of fentonyl playing a bigger role. Yeah, you know, it's it's really complicated, and and I'm not really the expert on you know, sort of street level drug and drug distribution. Um. You know, what I do know, um, is that part of the problem with COVID has been that when we have been able to place people who have been formerly houseless in the shelter and place hotels all of a sudden there alone, and so we started seeing a lot more overdoses, partly because people weren't on

the streets anymore. And the streets of San Francisco, there's a lot of narcan out there. There's a lot of people who can save your life. Yeah, we should just explain to everybody that narcan is the kind of common name of a drug called in the lock zone, which is essentially a miracle antidote for heroin or other opioid overdose that if you administer quickly through the nose or a skin prick or whatever it is, that can really save people's lives. And so there's been a big effort

to get that out much more broadly to people. But if you're using alone, right, if you're using alone, you can't do it. So that's one problem. I think that that is contributing to the overdose increases. The other thing, of course, is fentyl And you know, I listened to a webinar recently on fentyl by Dan Chickarni, who's a noted researcher in the area of drugs, and what he was saying was fascinating to me that fentanyl is really the only drug on the streets that was not created

to satisfy a demand. It was created to develop a supply, So it's a supply driven problem. Dan Chi is probably one of the best research in the country writing about this stuff. You know, for our listeners who may not be aware, federal is something that hundreds of thousands of people get legally in the hospital post surgery. It's an incredibly effective pain killer, you know, like morphine and things like that. Uh, it works really well. It's very potent,

but in a very tiny dose. And the thing that's scary is that they see when you have drug dealers and people selling drugs who are mixing fan and other drugs are selling it, getting the amount right is really tricky, you know, and this stuff is being imported from China, China vie in Mexico, are now being made in Mexico

or whatever. So it's one of these things where law enforcement really is sort of helpless because you can send through the mails, you know, a small box which is enough for tens of thousands of doses, and really there's no chance for law enforcement to interceptive stuff, not that they could with even the more with marijuana, which was

much bulking. You know. What happens also because the supply is so robust, the dealers often have no idea what's in the drugs that they're now selling, which did not used to be the case routinely. You know, if you had a regular dealer, you could pretty much trust that the person would say, hey, this stuff is really good, or you know, this stuff isn't as strong as you're used to, or you know, this stuff is really potent.

You might want to, you know, be careful. They can't honestly educate their customers now because they often have not a clue if there's Fentinel in it, or even how much there is, So you don't have that kind of community education and support going on, and so people learn by their mistakes, and unfortunately, with Fentinel, the mistakes are

often fatal. So when you have somebody in your program and you know they've been playing with vent at all or addicted to opioids and using federale, what what's your guidance for them? I mean, obviously you're dealing with them from a psycho therapeutic dimension, but you're also trying to

keep them alive so they keep coming back. Just as an example, if you don't know any people you have in mind or generally that you can think of, the first thing that we do is make sure that people know that what they say to us will not only not go anywhere, but that will take them seriously. So communicating that is really important, and being able to say to people you don't necessarily even have to tell me what you're doing, but can I tell you some things

that might help? So we don't even necessarily have to ask for self disclosure. You know, I can start off by saying, I don't know if you're using drugs, but here's a few things that I know that are out on the streets. Here's some safety precautions. UM, here's a list of syringe exchange programs. Oh, by the way, they also have safer crack pipes. You know, so I can start harm reduction education and support without knowing anything about what the person is actually doing. Well, let me ask

you this. I mean, I'm reading now about you know, San Francisco has got this, you know, once again growing problem, not just with overdoses, but with homelessness and people building tens and what would you be advising the mayor on this sort of stuff? Yeah, you know, thank thank god, I am not at at that level. I do think, however, that there is a fundamental conflict between the haves and the have nots. That the economic disparities in San Francisco

have dramatically changed over the last ten fifteen years. UM, that the conflicts between um, you know, neighborhoods that have less economic opportunity, the racial disparities, the economic disparities is enormous. It's like the San Francisco earthquake. And and that's a fundamental problem that I don't know how it is going to get addressed. I mean, the the hate Ashbury is a good example. Um, you know, Hate Ashbury has been

a haven for runaway youth since the sixties. It still is, but now there are people who are paying millions of dollars for houses in that neighborhood and they don't want any homeless kids there anymore. They don't want their trash, they don't want whatever. It's the standard issues around gentrification and clashes in community. Yeah, you don't pay you all the supersomn issue because you're talking about class in this context,

you alas struck me. Though then in a way, when it comes to dealing with clients patients in a harmonuction perspective, there's the same kind of class issue because if you have enough money or insurance to a for private psychotherapy, the odds are very good that you and your therapist, if you're struggling with some type of addictionary dependence, you know it's gonna be in a somewhat non judgmental setting

unless the psychiatry, what ever, is very judgmental. You're sitting in that office and the state's not part of the picture, whereas if you don't have money right and you're looking for some type of treatment or at help, in much of the country, the only way you're ever going to be able to get that help, you know, or meet with counselors is going to be in something that's offered through the criminal justice system. That in fact, there is

a very strong class dimensioned to this as well. I absolutely agree that there are major differences in class and what kind of treatment you get. However, for the most part, the expensive rehabs in this country use exactly the same treatment models as the public rehabs and the criminal justice based rehabs, because there's only one model that's allowed in this country, and that's the Minnesota model, which is twelve

step and disease model and total abstinence. That's changing in some but probably still of drug treatment programs use that model, And what you're saying about therapists is also changing, but it's not as rosy as you think. I was trained that if somebody comes to me and I discover that they have a drinking or a drug problem, I'm supposed to immediately refer them to a drug treatment program and refuse to see them if they don't agree to be

abstinent and go to treatment. That's how we're all trained as therapists. Yeah, no, no, I get your point. I really think the major distinction is that if you're poor, a lot of this treatment of any sort is going to come with the role of the criminal justice system involved.

But you have the same kind of ideology and pickheadedness really at all levels of this thing you know going on, you know, right, and and then you've got you know, because the criminal justice system is, you know, disproportionately made up of people of color, and you know, the other thing that happens is that we forget that everybody who uses drugs doesn't need drug treatment. And a lot of the people who end up being arrested they don't need

drug treatment. They've been dealing drugs and not particularly using them, or they're using them and they don't have a big problem with them. But they are sometimes given the choice to go to treatment or jail. Most people who eventually put a drug addiction behind them did so while they

were not in drug treatment. People may go through drug treatment programs five six, seven times, and basically what happens is they hit a point in life when they're maturing out or they're ready or change in life when they're able to put it behind them, and that typically happens not when they're in treatment, but some other time for

some unrelated reason. Right, the treatment industry has this belief that our treatment is perfect, our clients are not, and so if the treatment doesn't work, it's the client's fault, which is exactly the opposite of the approach we take in most medical care, which is, if my intervention is not working, I better try something else, because we can't blame the patient for this sickness. We have to figure out what the right intervention is. You're right, so it's

a perfect area or ideology just getting ready. People need to understand also, it's not as if it's abstinence versus harm reduction, because attaining abstinence or sobriety is a perfectly legitimate objective of any type of harm reduction and ambition or training in intervention. But it's the reaction against abstinence as the only way, the my way, or the highway. The eye can't help you unless you're willing to be sober and and drug free before you even come to

see me. But for the people who can't cut it according to your abstinence only program. What's your fallback? Are you at least gonna have you know, Pat Denning and g Little's phone number available so that you can send them to their program. What has been your relationship with the people running the the abstinence only programs? Do they see you, do they call you? Do they say you may be able to help this person? For the most part, No, I've done a lot of training, especially locally in drug

treatment programs, and um, they're very slow to change. Even though San Francisco had a harm reduction policy, is its public health policy. We've had it for twenty some years now. Um, most of the drug treatment programs are still very much old school in terms of their approach. So I'm feeling, you know, a little discouraged at the end of my career that, um, there's so much that is still the same. Um. And every time I say that, people around me go, oh, no, Pat,

all sorts of things have changed. It's like, okay, yeah, I know all sorts of things have changed, but you're right, it is. It is frustrating. So Pat, I gotta ask you one last question. I don't have to, but you know, and I hope I'm not crossing online, but I'm curious. You know, a few years ago I heard that you were dealing with leukemia, and you know, I hope you've

come through that cleanly down and it's all good. But I just wonder, in reflecting on your work and reflecting on harm reduction, where there any interesting insight specific to the work and thinking you've been doing all these decades where anything came out of that. It was really nice to be treated in a medical system that wasn't crazy

about drugs. I was hospitalized for five weeks at a time, four different times for the intensive chemo, and every time a nurse came in the first thing they would say is are you having any pain? Which I thought, thank you, that's really nice. And and I remember one time I said, um, you know, I'm a headache and I'm not a person who tends to get headaches, and she immediately said would you like some morphine for that? And I was like, uh no, I think a thailand all will do, but

thanks for asking. But you know, it was really nice to be in a setting where, um that when I was in pain at different points, it was freely given. As we're benzos for sleep that there was no hysteria about oh you know, we can't get you addicted to all of this stuff, so it was incredibly passionate. So I really loved that. Well, listen on that note, I want to thank you so much for joining me on this.

I really look forward to seeing you before long. I wish you all the best, not just for your program, but for uh, you know, your forthcoming retirement, and and notwithstanding our mutual frustrations that harm reduction has not become common wisdom and the dominant ideology, the fact remains that you've done some extraordinary work and helped a huge number of people throughout your life. So thank you so very

very much. This was really fun. This really was Say hi to GENI okay, and look forward to seeing you. Psychoactive is a production of I Heart Radio and Protozoa Pictures. It's hosted by me Ethan Edelman. It's produced by Kacha Kumkova and Ben Cabrick. The executive producers are Dylan Golden, Ari Handel, Elizabeth Geesus and Darren Aronovski for Protozoa Pictures, Alex Williams and That Frederick for iHeart Radio and me

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