Drugs and Society: Harm Reduction

CJ Trowbridge

2020-06-30

Drugs and Society

Section 10 Reading Response: Harm Reduction

  • Swapping Politics for Science
    • When the drug czar calls for an end to the war on drugs, it’s clearly the start of a new era.
    • Obama lifted the federal ban on needle exchanges in 2010
    • all of the top brass in the Obama administration were on record in favor of lifting the ban
    • The house went back and forth for a long time on the wording of what would essentially still be a ban.
    • research suggests that funded needle exchanges will cut down on deaths due to drug-related infectious disease
      • Inject Narcan–i.e., naloxone–into the muscle of someone who is dying of a heroin or OxyContin overdose, and within seconds he is awake and very much alive. Narcan has been used for decades in ambulances and emergency rooms to reverse opiate overdose
    • the majority of states lack legislation on the issue, so a person administering naloxone to someone else may be vulnerable to prosecution should something go wrong.
    • At least a half-dozen countries, including the Netherlands, Switzerland, and the UK, allow prescription of pharmaceutical heroin, known as diamorphine, to users who have failed to improve using all other available treatment options. Diamorphine is prescribed to “people who have been through methadone, been through jail, been through drug free [treatment facilities], been through the whole gamut of things, and for whom nothing was working,” says Ethan Nadelmann, the executive director of the Drug Policy Alliance (DPA), which worked in partnership with a group in Canada to set up that country’s first clinical trial of heroin maintenance.
      • (The trial enrolled 250 users in two cities; early results show a significant reduction in participants’ criminal involvement and an increase in their health.) As recently as this year, both the German and Danish parliaments voted to allow prescription of heroin to those who have not responded to other treatments.
      • Nadelmann is hopeful that a clinical trial similar to Canada’s can be set up in the US in the coming years. but Columbia University associate professor of clinical neuroscience Carl Hart is not so sanguine. “People have been brainwashed [into thinking], ‘These awful drugs that are causing so many problems–you’re going to give it as a medication?’ ” he says, citing deepseated public fears.
    • That precisely describes methadone. Methadone and heroin operate in identical ways on opiate receptors in the brain. They are both “full agonists,” meaning they fill up opiate receptors in such a way as to make the user high.
      • The main difference between heroin and methadone is not their chemical composition but their legality. The daily hustle for heroin often forces users into other illegal activity, like petty drug dealing, prostitution and burglary, to support their habit, and creates an expensive, unproductive revolving door between prison and the street. Methadone, covered by insurance, frees people from this cycle.
      • Because methadone is administered by physicians, it can be dispensed in amounts precisely calibrated to someone’s addiction to make that person feel “normal,” rather than high, and eliminates the craving and withdrawal symptoms that drive people to use. Heroin, sold on the black market, is “cut” with adulterants; at best, the cut (like baby powder or quinine) is itself harmless but causes wide variation in the strength of the heroin–which makes it impossible for a user to know exactly how much he is using.
    • Over the years, a cottage industry of ancillary services has grown up around methadone clinics. Everything from talk therapy to medical care to Narcotics Anonymous meetings to group picnics and bowling excursions has come to be understood as a necessary component of the treatment of such a psychosocially complicated problem as addiction.
    • Scientists have been looking for years for a gene or a pill that can treat the disease without all the messy and unpredictable psychological baggage that the meetings and talk therapy are designed to address.
      • What will happen when users can sidestep the counseling and the clinics, and just take the “anti-addiction pill” that their local primary care doc prescribes along with their blood pressure medication?
      • I find this idea laughable because it fails so completely to learn the lessons of what causes addiction.
    • yes to scs California
      • Safer drug consumption services (SCS) are designated sites where people can use drugs under the the safety and supervision of trained personnel.
      • Over 100 sites exist in 67 cities in eleven countries around the world. After 30 years of operations, SCS have demonstrated to prevent overdose, HIV and hepatitis C transmission, injection-related infection, and public disposal of syringes.
      • the California State Assembly became the first legislative body in the U.S. to pass a bill to permit safe consumption services that would allow people who use drugs to use controlled substances under the supervision of staff trained to treat and prevent drug overdose and link people to drug treatment, housing and other services.
        • passed the CA state assembly with bipartisan support
        • The bill would allow local jurisdictions to choose to permit SCS and provide legal protections for the programs and participants. It creates a pilot program, allowing a limited number of jurisdictions to operate the services, and requires a report on the efficacy of the services
        • In September of 2018, the bill was amended to only apply to San Francisco County and was brought back up for a vote. The amended bill passed both the Assembly and the Senate, but was then veteod by exiting California State Governor, Jerry Brown
      • In May 2017, Board of Supervisors President London Breed appointed a 15-member task force to assess if and how SCS could become a reality in the city
      • There is a page of links to lots of other documents
      • Most of the information on the site is years out of date. They say to follow them on twitter for more current information
    • Clean needles save lives
      • Congress voted to lift the ban on needle exchanges
      • The idea started as a way to reduce the spread of hiv by exchanging old dirty needles for new clean needles
      • In New York, about half of injection drug users in the 80s had AIDS. Over a dozen syringe exchanges were started as a way of reducing the spread of AIDS. Now, just 10% of injection drug users have HIV, so it was very effective at slowing the spread of HIV among injection drug users in New York
      • 5-10% of injection drug users nationwide are using needle exchanges.
      • A single HIV case costs over a quarter of a million dollars over a person’s lifetime.
        • Syringes cost about ten cents.
      • Syringe exchanges also offer drug users access to healthcare, mental healthcare, STI testing, and treatment for other problems associated with drug use.
        • This includes providing them the option of getting into drug treatment.
      • Syringe exchanges also teach people to use naloxone and supply it to them so they can save one another from overdoses.
    • I love my job: fighting addiction and overdose in the streets of San Francisco
      • “I would do this job for free if I won the lottery tomorrow”
      • A team stands in sf’s civic center handing out harm reduction supplies like condoms, needles, Narcan, etc.
      • Over the next couple of hours, they distribute 2,840 needles, 33 safe disposal bins, and 3 naloxone refills
      • These brief exchanges are meant to get users on the path to treatment: The idea is that after hearing Buehlman’s spiel over and over, users might actually take him up on the offer of help. “Sometimes it might be 50 to 100 times we’ll see somebody” before they make their way to Glide for supplies or treatment, he says. “Sometimes, I’ll see someone once on outreach, they come in, they do a HIV and Hep C test, we link them with our navigators, a month after that, they’re like, ‘I got into residential! I’m clean, bro!’”
      • The program is as classic example of harm reduction, a public health philosophy that encourages making illicit drug use safer so that users survive and eventually seek treatment.
      • a wealth of academic research has found that these kinds of interventions stop the spread of disease and save lives
      • Last year, users and other laypeople with no medical training used naloxone to reverse 877 overdoses—about as many as the San Francisco Fire Department, the city’s largest emergency medical provider. In 2015, San Francisco had just two documented cases of new HIV infections transmitted through dirty needles.
      • Over the past couple years, using heroin has become far more dangerous due to the arrival of fentanyl, an illicitly produced synthetic opioid that’s up to 100 times more powerful than morphine. It’s often mixed in with heroin and other drugs so that, as Todd puts it, “you don’t know what you’re doing anymore.”
    • a radical reversal
      • Early on the morning of Feb. 22, several hours before sunrise, a security guard at the Urban School on Page Street found three men sheltered in the arched doorways of the elite private academy. He couldn’t wake them, and when paramedics arrived, they pronounced the trio dead at the scene. Several hours later, the three were identified as David Clark, 31, Adam Wilson, 36, and Michael Campbell, 32 — the latter of whom was known by his friends as Pan. The friends, who all lived in the Haight, had allegedly found a baggie of drugs on the ground as they left a liquor store. Assuming it was ketamine, they smoked it, not knowing it contained fatal levels of fentanyl.
      • At the center of San Francisco’s battle against these fatal overdoses is one drug: Narcan. Packaged under the generic name naloxone, Narcan was developed to reverse opioid overdoses while they’re in process. When someone has taken too much of an opiate, their breathing slows, and may eventually cease, resulting in death. When Narcan is administered — either in a nasal spray or an intramuscular injection — the opioids are knocked out of the brain’s receptors. If applied early on in the overdose, Narcan immediately stops the effects, bringing the person to consciousness.
      • Today, more than 120 Narcan teachers have completed the training program. They have subsequently taught 10,414 others in San Francisco how to recognize an overdose and administer the overdose medication. In addition, Narcan can be found at more than 15 locations throughout the city, from pop-up needle-exchanges to food banks.
        • San Francisco’s overdose mortality rate is one of the lowest in the nation
      • “We have achieved an extremely high level of people carrying naloxone, partly because of our program structure which allows people to access it in all areas,”
      • Fentanyl test strips hit the streets in S.F. in August 2017, and the DOPE Project has closely monitored the results. Between August and January, nearly 250 surveys from people who’d used them have been turned in at syringe-access sites, presenting useful data for harm reduction researchers. Of the drugs tested, 78 percent of the speed or methamphetamine samples tested came back positive for fentanyl, as did 67 percent of the crack cocaine samples. Of those who had positive results, 92 percent of them shared the information with their community.
        • “This means 62 percent of drugs testing positive for Fentanyl,” she writes.
      • President Donald Trump has compared opioid use to his late brother’s alcoholism, saying he plans to launch an ad campaign targeted at youth that will disclose “the devastation and ruination [drugs cause] people and people’s lives.” He’s also proposed an additional $400 million for the Drug Enforcement Administration, to criminalize those dealing and using drugs.
      • There are innumerable issues with all of this: Trump launching a campaign to shame drug users, his commitment to filling prisons with dealers, and the click-bait headlines that easily skirt by the human intricacies behind the “opioid crisis.” But what is most frustrating to those who’ve worked in harm reduction for years is that this “epidemic” is only now getting attention.
        • “There is nothing new about what is happening right now,” Marshall said. “People have been dying from drug use and the War on Drugs for years. The only reason we’re calling for compassionate treatment is because the visibility right now is that white folks and affluent folks are dying from drug use.
      • worth saving
        • Back story with several anecdotes leading to the DOPE project as discussed in the previous article.
        • The threat of incarceration prevents people from acting to save the lives of others who are suffering from overdoses
        • “The idea that we engage with people where they are and help them to develop techniques to reduce harm to themselves and others is a basic tenet of practicing medicine.”
        • The central argument of the video is that while there is a pervasive fascist belief in American culture that drug users should simply be allowed to die if they overdose, educating people about saving lives during overdoses includes first showing them that people who are overdosing are worth saving. This prejudice can often be internalized by drug users. At one point in the video it is explained that when one drug user saves another drug user, they may say to themselves, “hey I’m worth saving too.”
      • Chicago Recovery Alliance: Substance Use Management
        • Disease has increased our motivation to reconsider how our help system deals with drug related problems. A more concrete focus on disease prevention as an additional goal has, for many, lead to a re-evaluation of the goals of drug help work. Such a critical examination shows how much there is to improve with the system even in the absence of blood borne disease.
        • Substance Use Management (SUM) is the practice of setting a new perspective on what constitutes help with drug problems and respectfully and collaboratively assisting the positive changes selected by the person seeking help
          • recognizes that no matter how far into drug abuse a person is their basic humanity is never completely lost
          • Our history of attempting to assist others in lessening negative consequences of drug use is relatively brief compared to other disciplines
          • More effective than abstinence models
        • SUM replaces the indoctrination of the disease model of addiction ideology so common in the treatment system today with an ideology of actual improvement and a process of respectful and collaborative engagement. Four steps to guide the counselor in the practice of SUM are described below:
          • Making a transition to SUM’s multi-goal approach requires a good degree of reframing of what it means to give or receive help for drug problems. It is so entrenched in popular belief that abstinence is the only successful outcome of the drug help system that “cleaning/drying/sobering up” are part and parcel of any common understanding of treatment. In reality, people could benefit from the treatment system by simply moderating their drug use or otherwise relieving drug related problems. These non-abstinent alternatives are real outcomes today, even though they are not assisted directly and, at some level, the individual’s continuing use is judged a failure by the program.
          • Continuing the buffet table metaphor, Step Two would involve the counselor giving the person seeking help a clean plate and silverware, introducing her to each dish if not familiar with it, and allowing her to select dishes and portion sizes . Assisting someone to make these choices freely without guiding her to the dish (approach/method/goal) you or your agency most prefer requires great skill and respect for the person. Limiting any ‘help’ in this step to explaining all options with equal balance and having the readiness to support the client’s choice(s) as they freely make them is critical. As well, accepting the client’s level of intensity and prioritizations they give each choice is a critical aspect to SUM. Such client directed selections are essential steps to initiating SUM’s work.
          • By working entirely with the choices of the person you are helping you are saying two things loud and clear that are critical to SUM’s practice: 1) The person is not only in charge but self-responsible; and 2) The counselor accepts and respects this fact at all times. I have found such an approach releases the counselor of undue responsibility for the person they are assisting and thus allows a healthier, more realistic relationship. Many counselors will rejoice in the release of this burden associated Page 9 with forcing a goal of abstinence-only. Others may struggle to accept this as truly ‘caring’ and ‘helpful’. Clearly, today’s counselor will be challenged to clarify her own desires from those of the people she is helping and to deal with the emotional turmoil that can arise from accepting and respecting the inclinations of someone not only seeking help but also who is ‘sick’. In SUM, no one is ‘too sick’ to make their own decisions regarding their drug use no matter the shame or devastation in their lives. SUM accepts the reality that people will always make their own decisions regarding their drug use. Openly addressing the issues involved in this choice allows a person to make a better decision for themselves.
          • By offering respect and working with your client’s direction and intensity you are laying the ground work for an honest evaluation of progress — beyond shame and fear of condemnation. The clarity that comes from acceptance and respect of an individual works its miracles here. Unburdened by punitive measures and failure to achieve program given goals, people can be more honest in evaluating the effectiveness of what they have chosen to work on. Such examinations should be a regular part of SUM in order to reassess any and all aspects of the chosen SUM plan. What some consider a overly permissive system in SUM is purposefully so due to the benefits from such an approach in the evaluation phase. By laying a bridge of connection through respect and collaboration the person seeking help will very likely have developed an alliance with the counselor and be likely to use this relationship to re-examine their actual experiences and plan other directions for their next effort at improvement.
        • According to Webster, enabling simply means “provision of the means or opportunity for doing”. Clearly, whether enabling is constructive or destructive depends upon what is enabled. Traditionally, talking with significant others of problematic drug users about enabling often helps them recognize their own role in the user’s drug consumption and how to ‘get tough’ in helping the drug user to get better. While self-examinations are never out of place for anyone and much can be gained from such insights to relieve drug problems, enabling must not be used to generate punishment and condemnation for lack of abstinence. Such tag-team oppression towards a person with drug problems increases her risk of harm. Still, lines sometimes need to be drawn in relations with another Page 11 person. SUM re-frames enabling as both helpful and hurtful according to both its impact and the values of the person acting it out.
          • If the enabler’s action in question is not consistent with her own values, and also directly causes harm to the other person, then this action is harmfully enabling
          • If the enabler’s action in question is consistent with her own values, and does not directly cause harm to the other person, then this action is not harmfully enabling.
        • san francisco drug user union
          • It is the tenants who set 149 Turk apart: a ragtag group of current and former drug users who make no apologies about their fondness for illegal narcotics, intravenous experiences and the undeniable rush of getting high.
          • “If you pass a drug test,” joked Gary West, a member, “you’re outta here.”
          • The union is one of several groups in the United States and Canada that advocate for the rights of drug users, following the lead of older European drug user organizations.
          • The group says they are not promoting illegal drug use, just confronting the reality that many people use.
          • “People think it’s a joke,” he said. “They think of union as a kind of trade union. They don’t understand that we’re using ‘union’ in the sense of a consumer union. And we’re consumers of drug policies, we’re consumers of rehab, we’re consumers of drugs.”
          • In San Francisco, the drug union received its first grant in 2009, Mr. Jackson said, and got more help in December 2010 from the city’s Hepatitis C Task Force, which advocated for a pilot “supervised injection facility” for intravenous drug users because they often contract hepatitis by using dirty needles. No such facility exists in the United States — a so-called safe injection site in Vancouver, British Columbia, has been considered a success there — and it has become a central goal of the San Francisco union.
          • There are lots of anecdotes about how the various members got into this work.
        • Risk Environment
          • The new public health movement of the 1980s coincided with the emergence of HIV infection and AIDS in many countries. The movement was heralded as a shift beyond bio-medical understandings towards a new understanding which encompassed the social and environmental influences on health
          • The new public health advocates the need to balance individual and collective action as a means of facilitating changes in individual and population health
          • The World Health Organization endorsed principles of the new public health movement are contained within the Ottawa Charter for Health Promotion (WHO, 1986). The five principles are:
            • developing individual personal and social skills;
            • re-orientating health services toward improving access, availability, and use;
            • facilitating and strengthening community participation and collective action;
            • creating local environments that are conducive to individual and community health;
            • and, lastly, creating public policies supportive of health.
            • Taken together, risk reduction is an inter-sectoral and multi-level activity encouraging individual, community, policy, and environmental change.
          • The principles of the new public health are one and the same as the principles of effective harm reduction. The new public health and harm reduction are parallel social movements. Not only do they coincide historically, they coincide conceptually. More than this, harm reduction has been held up as a model of the new public health movement. The international evidence for this is that the cities or countries with most success in controlling, averting or reversing HIV epidemics among injecting drug users have adopted interventions in keeping with the principles of effective public health
          • Evidence in Kathmandu shows the importance of HIV prevention coverage, with approximately 50 000 needles and syringes distributed annually to IDUs in the context of an estimated 1.6 million sets required in order to eliminate needle sharing, assuming that the estimated number of IDUs use the same needle and syringe five times
          • Neo-liberal western societies are arguably the worst for victim-blaming, despite claims to the contrary and having developed elaborate forms of citizenship rights and responsibilities. The individuation of risk reduction persists even in those settings reportedly most progressive in their pursuance of ‘new’ public health oriented drug policies. A risk environment and enabling approach seeks to work against victim-blaming.
          • A harm reduction praxis founded on a risk environment framework illuminates the parallels in how social contexts influence health and vulnerability in general as well as drug-related harms in particular. This inevitably leads to a consideration of non-drug and non-health specific factors in harm reduction, and in turn, points to the importance of what might be described as ‘non health oriented interventions’ in harm reduction. Shifts in housing policy, for example, may have harm reduction impact, as have a variety of microeconomic, employment and other community development initiatives
            • This is politically important for two reasons. First, it mainstreams drugs and harm reduction as part of wider social movements in public health. This raises the possibilities for broadening the scope for political alliances lobbying for social and environmental change. And second, it shifts the locus and politics of change from issues of drug use to wider issues of health vulnerability and human rights.
          • Micro and macro levels of influence intersect across different types of environment in inextricable ways. The distinctions between ‘macro’ and ‘micro’, and between ‘physical’, ‘economic’, ‘social’ and ‘policy’ forms of environment are to a large extent phony divides, serving an heuristic or analytical purpose and necessarily clouding the depiction of situated social realities of risk
          • In addition to types of environment and levels of environmental influence, we can consider two types of environmental factors which assist in understanding the mechanisms of how environments structure risk. The first are susceptibility factors, defined as factors which ‘determine the rate at which an epidemic is propagated’. The second are vulnerability factors, which are the ‘features of a social or economic entity that make it more or less likely that excess morbidity and mortality associated with disease will have deleterious impacts upon that unit’
            • In the context of HIV prevention, whereas susceptibility is the chance of becoming infected, vulnerability is the degree to which the epidemic has an adverse effect on the capacity to respond. Taken together, ‘a society, community or group might be described as susceptible to infection by a disease but vulnerable to its effects’.
          • A risk environment approach to harm reduction seeks to connect with wider calls for a paradigm shift in public health from behavioural to ecological approaches
            • an environmental approach highlights the parallels and connections in how context influences health and ulnerability in general as well as drug-related harm specifically
          • demand reduction and harm reduction
            • Harm reduction, that is attempting to reduce harms directly without necessarily reducing consumption, is a very valuable part of the response to all psychoactive drugs including illegal drugs.
              • Needle syringe programmes and methadone treatment are the best known examples. Both are effective, not accompanied by significant unintended negative consequences and bth are cost-effective. Harm reduction has helped to reduce the spread of HIV among people who inject drugs and from them to the general population.
            • Drug education is provided in school-based and mass education programmes. These provide only modest reduction of illicit drug use. However, prevention approaches usually chosen for implementation are relatively ineffective while prevention methods known to be more effective are rarely implemented.
            • If a substantial proportion of drug users can be attracted and retained in an effective form of drug treatment for long enough for the treatment to work, demand for drugs in that community decreases. This is why drug treatment is considered a form of demand reduction
            • The majority of people struggling with severe problems with alcohol, tobacco, prescription or illicit drugs manage to overcome their difficulties without the benefit of treatment from a clinician.
            • Evidence of the effectiveness and safety of residential rehabilitation is weak. Residential rehabilitation is considerably more expensive than methadone treatment. Often residential rehabilitation interrupts family life and employment
            • Methadone treatment attracts, retains and benefits more heroin users than any other treatment option. It has also been more extensively studied than all other treatments for heroin dependence.
            • Heroin assisted treatment involves daily, carefully supervised, high dose, self-administered, intra-venous heroin in association with intensive psychosocial assistance. The rigorous studies have been published in prestigious, peerreviewed journals. Most trials involved severely dependent heroin users who had not benefited from multiple previous episodes of a diverse range of treatments. In each of these studies, heroin assisted treatment was compared to high quality methadone treatment. Improvements of about 60% were reported in each study in physical and mental health and social functioning in the heroin assisted treatment subjects compared to those receiving methadone only. Crime fell considerably and illicit drug use also declined in the heroin assisted treatment group
            • The International Harm Reduction Association defines ‘harm Reduction’ as ‘policies, programmes and practices that aim primarily to reduce the adverse health, social and economic consequences of the use of legal and illegal psychoactive drugs without necessarily reducing drug consumption
            • Harm reduction refers to approaches to psychoactive drug use that aim to reduce the harms associated with drug use for people who are unable or unwilling to abstain.
            • The dominant global approach to illicit drugs for many decades strongly emphasized drug law enforcement rhetorically and financially. Consequently, scant emphasis and minimal funding was allocated to demand reduction.
            • A more realistic approach began to emerge after the magnitude of the threat of HIV began to be appreciated in the 1980s. Increasing emphasis was given to harm reduction though harm reduction was often (willfully) misunderstood and virtually always grossly under-funded
          • Is harm reduction a viable choice for kids enchanted with drugs
            • While the dominant approach to substance abuse treatment has been a disease model, this article describes a strengths-based alternative. Many contemporary youth are experiencing problems with alcohol or other drugs but reject the message of total abstinence and disease models of treatment.
            • Research has demonstrated that the age when adolescents first start using alcohol, tobacco, and other illicit drugs is a predictor of later alcohol and drug problems.
            • More than 40% of youth who start drinking at age 14 or younger develop alcohol dependence, compared with 10% of youth who begin drinking at age 20 or older.
            • the disease model was designed to assist substance-abusing adults, adolescent substance problems differ from those of adults with chronic alcohol dependence. Thus, very few adolescents and young adults meet the DSM-IV criteria for alcohol dependence Most young adults reduce heavy drinking as they learn their limits and begin to assume other responsibilities, such as work and parenting.
            • Over the last 20 years, the federal government has engaged in a war on drugs – the cigarette industry has been limited in its advertising targeted at adolescents, alcohol advertisements have been restricted, and states have increased the legal drinking and smoking age. Nevertheless, kids continue to smoke, drink, and use other drugs. During this same time, the disease model has shaped most research in the field. This framework has inevitably focused on the negative outcomes of illicit drugs, rather than a preventive, health-promoting perspective that could have explored patterns of adaptation and competence of kids and adults who have learned to manage their lives.
            • Strengths-based practitioners work from the premise that children and youth have strength and competence and can recover and bounce back from adversities
            • The focus becomes “finding, enhancing, and encouraging the utilizations of coping skills with which to navigate troubled waters”
            • Research shows that youthful alcohol problems are often intermittent and may remit without formal treatment, rather than becoming fatal and progressive
            • The strengths perspective offers a different lens to describe youths’ enchantment with cigarettes, alcohol, and other drugs and allows us to begin to see opportunities, hope, and solutions. Rather than channeling efforts toward correcting deficits of adolescent alcohol and substance use, we aim to achieve the desired outcome, i.e., that kids don’t become lifelong abusers or addicts. True growth only takes Place when individuals’ strengths are channeled toward goals that they themselves set.
            • A strength-based approach to kids who use drugs and alcohol focuses on reducing the risk in their lives. We promote abstinence and identify possible consequences for continued use of illicit drugs. Additionally we collaborate with youth who are unwilling to accept abstinence as a solution in order to reduce the risks of harm from their use. Success comes as each young person develops inner controls and lives a balanced and healthy life in harmony with self and others.
          • here’s how iceland radically reduced teen substance abuse
            • “People can get addicted to drink, cars, money, sex, calories, cocaine – whatever,” says Milkman. “The idea of behavioural addiction became our trademark.” This idea spawned another: “Why not orchestrate a social movement around natural highs: around people getting high on their own brain chemistry – because it seems obvious to me that people want to change their consciousness – without the deleterious effects of drugs?”
            • “We didn’t say to them, you’re coming in for treatment. We said, we’ll teach you anything you want to learn: music, dance, hip hop, art, martial arts.” The idea was that these different classes could provide a variety of alterations in the kids’ brain chemistry, and give them what they needed to cope better with life: some might crave an experience that could help reduce anxiety, others may be after a rush.
            • Young people aren’t hanging out in the park right now, Gudberg explains, because they’re in after-school classes in these facilities, or in clubs for music, dance or art. Or they might be on outings with their parents.
            • Today, Iceland tops the European table for the cleanest-living teens. The percentage of 15- and 16-year-olds who had been drunk in the previous month plummeted from 42 per cent in 1998 to 5 per cent in 2016. The percentage who have ever used cannabis is down from 17 per cent to 7 per cent. Those smoking cigarettes every day fell from 23 per cent to just 3 per cent.
            • It seems obvious that what they’ve actually accomplished is giving these kids the missing interpersonal connections from rat park.
            • State funding was increased for organised sport, music, art, dance and other clubs, to give kids alternative ways to feel part of a group, and to feel good, rather than through using alcohol and drugs, and kids from low-income families received help to take part. In Reykjavik, for instance, where more than a third of the country’s population lives, a Leisure Card gives families 35,000 krona (£250) per year per child to pay for recreational activities
            • Between 1997 and 2012, the percentage of kids aged 15 and 16 who reported often or almost always spending time with their parents on weekdays doubled – from 23 per cent to 46 per cent – and the percentage who participated in organised sports at least four times a week increased from 24 per cent to 42 per cent. Meanwhile, cigarette smoking, drinking and cannabis use in this age group plummeted.
            • Across Europe, rates of teen alcohol and drug use have generally improved over the past 20 years, though nowhere as dramatically as in Iceland, and the reasons for improvements are not necessarily linked to strategies that foster teen wellbeing. In the UK, for example, the fact that teens are now spending more time at home interacting online rather than in person could be one of the major reasons for the drop in alcohol consumption.
            • Elsewhere, cities that have joined Youth in Europe are reporting other benefits. In Bucharest, for example, the rate of teen suicides is dropping alongside use of drink and drugs. In Kaunas, the number of children committing crimes dropped by a third between 2014 and 2015.
            • Short-termism also impedes effective prevention strategies in the UK, says Michael O’Toole, CEO of Mentor, a charity that works to reduce alcohol and drug misuse in children and young people. Here, too, there is no national coordinated alcohol and drug prevention programme. It’s generally left to local authorities or to schools, which can often mean kids are simply given information about the dangers of drugs and alcohol – a strategy that, he agrees, evidence shows does not work.
          • can you get over an addiction
            • There are, speaking broadly, two schools of thought on addiction: The first was that my brain had been chemically “hijacked” by drugs, leaving me no control over a chronic, progressive disease. The second was simply that I was a selfish criminal, with little regard for others, as much of the public still seems to believe.
            • If, like me, you grew up with a hyper-reactive nervous system that constantly made you feel overwhelmed, alienated and unlovable, finding a substance that eases social stress becomes a blessed escape. For me, heroin provided a sense of comfort, safety and love that I couldn’t get from other people. Once I’d experienced the relief heroin gave me, I felt as though I couldn’t survive without it.
              • This anecdotal paragraph essentially mirrors the findings of Carl Hart’s work.
            • If addiction is like misguided love, then compassion is a far better approach than punishment. Indeed, a 2007 meta-analysis of dozens of studies over four decades found that empowering, empathetic treatments like cognitive behavioral therapy and motivational enhancement therapy, which nurture an internal willingness to change, work far better than the more traditional rehab approach of confronting denial and telling patients that they are powerless over their addiction.
            • Indeed, if the compulsive drive that sustains addiction is directed into healthier channels, this type of wiring can be a benefit, not just a disability. After all, persisting despite rejection didn’t only lead to addiction for me — it has also been indispensable to my survival as a writer. The ability to persevere is an asset: People with addiction just need to learn how to redirect it.
          • fraction of americans receive drug treatment
            • Millions of Americans suffer from alcoholism or addiction to legal and illegal drugs, but only a fraction are being treated, according to a report released on Thursday by the surgeon general.
            • One in seven people in the United States is expected to develop a substance use disorder at some point, the report said. But as of now, only one in 10 will receive treatment.
            • It calls for, among other things, a cultural change in understanding that addiction is a brain disease, not a character flaw.
              • “It’s time to change how we view addiction,” Dr. Vivek H. Murthy, the surgeon general, said in releasing the report. “Not as a moral failing but as a chronic illness that must be treated with skill, urgency and compassion. The way we address this crisis is a test for America.”
            • Trump has said that he will “try everything we can” to get Americans “unaddicted” to drugs, but his chief proposal is to build a wall on the border with Mexico. The wall, he said in New Hampshire last month, would keep out drug dealers and keep out “the heroin poisoning our youth.”
              • Even if a wall kept some heroin out of the United States, it would not necessarily solve the problem. While many Americans are dying of overdoses of heroin, many more are dying from opioid painkillers legally prescribed within the United States. And in some states, deaths from synthetic opioids like fentanyl, which are coming from China, are overtaking deaths from heroin.
            • Only about 10 percent of people with a substance use disorder receive any type of specialty treatment, the report said. And while more than 40 percent of people with such a disorder also have a mental health condition, fewer than half receive treatment for either.
            • The three final paragraphs of the article strike me as classist bullshit that hides generationality behind racist claims of inherited weakness rather than generational poverty and other social factors in the generational environment.
              • From 40 percent to 70 percent of a person’s risk for developing a substance use disorder is genetic, the report said, but many environmental factors — like how old he or she is when first drinking or trying drugs — can influence the risk.
              • People who first drink alcohol before age 15 are four times more likely to become addicted at some time in their lives than are those who have their first drink at age 20 or older, the report said.
              • Nearly 70 percent of those who try an illicit drug before the age of 13 develop a substance use disorder within seven years, the report said, compared with 27 percent of those who first try an illicit drug after the age of 17.

“The daily hustle for heroin often forces users into other illegal activity”

CJ Trowbridge

Drugs and Society

2020-06-30

Reading Response: Heroin and Social Problems

“The daily hustle for heroin often forces users into other illegal activity, like petty drug dealing, prostitution and burglary, to support their habit, and creates an expensive, unproductive revolving door between prison and the street. Methadone, covered by insurance, frees people from this cycle.”

This quote from “Swapping politics for science on drug policy” jumped out at me from this week’s readings. It connects perfectly with an argument from Sociology called Strain Theory. Strain Theory argues that social structures within society pressure citizens to commit crime. This is exactly the driver behind the social problems associated with chaotic drug use.

In general, society is unconcerned with the harm done to the self through chaotic drug use, and many on the right feel that these harms are deserved or appropriate. People on all sides of the political landscape recognize the impact of social problems like petty crime which come about as a result of users looking for money for more drugs.

As we learned in “Frontline: the meth epidemic,” there is a whole industry of fences who pay drug addicts in meth for stolen goods. This is exactly the source of most of the social problems that come from chaotic drug use. If users did not have to steal things in order to get drugs and food, then they would be able to work on themselves rather than working on getting the next hit. Rat park is the perfect illustration of the benefits that appear for users and society when people’s needs get met so they are able to have space in their life for self-reflection and personal growth.

Drugs and Society: Meth

CJ Trowbridge

2020-06-26

Drugs and Society

Section 9 Reading Response: Meth

  • Frontline: the meth epidemic
    • Meth can be made from cold medicines
      • Cold medicines are a $3b industry
      • Cold medicine industrial complex opposes restrictions on cold medicine
    • Meth can also be made from many other things
      • Common ingredients found anywhere
    • Meth is a major factor in many social problems
      • Child abandonment
      • Criminal violence
    • Oregon conducted an in-depth study of the history of the meth epidemic
      • 85% of property crime in Oregon is committed by people who are addicted to meth
    • Fences often pay with meth
    • Even a small dose of meth is long-lasting
    • Over the years, there are huge simultaneous spikes and falloffs in drug use versus people entering treatment across all states despite the fact that these states have radically different systems in place
      • This is an effect of neurochemistry
      • Researchers examined purity of meth found on the street. It mirrored the curve of addiction versus treatment
    • The DEA started focusing on restricting essential precursors
    • Meth became a large industrial business
      • They sourced precursors from large Asian industrial chemical companies
      • In the early 90s, the Amezcua brothers purchased 170 tons of ephedrine, imported it into America, and turned it into 2 billion hits of meth.
      • The DEA accidentally interdicted a large shipment from India through the US to Mexico which led to the discovery that the Amezcua brothers even exist and later led the DEA to stop the Amezcua precursor shipments from passing through the US.
    • With reduced supply from Amezcua and the supply of ephedrine partially blocked, American meth cooks ramped up to meet demand and simply switched from ephedrine to pseudoephedrine which is basically exactly the same and available at any drug store.
      • Just like the Amezcua, these small scale meth manufacturers started importing ephedrine and pseudoephedrine from abroad.
    • Mexican drug stores started selling much larger amounts of pseudo
    • Meth continued to spread across the country with both small suppliers and large suppliers, reaching every corner of the country.
    • For decades, every attempt to interrupt the supply with new laws or restrictions has been met with new strategies that led to more supply of even higher quality meth.
  • the lost world of Benzedrine
    • from the 1930s to the 1950s, a good bit of American artistic and scientific energy was generated by this lively amphetamine
    • people discovered that it had pleasant, useful, and energizing side-effects, which led to its use by all sorts of people who needed to boost their creative energies
    • throughout the mid-century period scientists and mathematicians as well as poets and novelists relied on bennies to give them the strength to go on
    • Paul Erdős, who is said to have defined a mathematician as “a device for turning coffee into theorems,” neglected in that aphorism to mention that he relied heavily on Benzedrine as well
    • “In 1979, a friend offered Erdös $500 if he could kick his Benzedrine habit for just a month. Erdös met the challenge, but his productivity plummeted so drastically that he decided to go back on the drug.”
    • Some believed that because amphetamines did not cause hallucinations, dependence on them was morally acceptable.
    • Benzedrine wasn’t made a prescription drug until 1959, but by then the fad was already in decline, partly because people could see the damage that bennies were inflicting on their users, but perhaps even more because artistic and intellectual styles were changing. The high-speed, high-energy way was being replaced by something slower, cooler. Kerouac’s novel On the Road and Miles Davis’s record The Birth of the Cool came out in the same year, but the former was a relic of the recent past, the latter the wave of the future.
  • Why caffeine is the perfect addiction
    • a new study found that caffeine turns human beings into efficient worker bees
      • caffeine “significantly reduced the number of errors” made by workers in a series of 13 trials.
      • “One trial comparing the effects of caffeine with a nap found that there were significantly less errors made in the caffeine group,” reads the official report.
      • “The results of the trials suggest that compared to no intervention, caffeine can reduce the number of errors and improve cognitive performance in shift workers. … Based on the current evidence, the review authors judge that there is no reason for healthy shift workers who already use caffeine within recommended levels to improve their alertness to stop doing so.”
    • caffeine is America’s favorite legal high because it fuels capitalism
    • Not that capitalism totally sucks, but still: It’s good to know why you’re being sold central-nervous-system stimulants
    • Crack users aren’t good workers. Neither marijuana, methamphetamine, heroin, nor LSD increase workplace efficiency. (Neither does alcohol, yet alcohol is just as cheap and legal as caffeine. But alcohol has been ingrained in human culture for too long to yank it out, as Prohibition proved.)
      • I think most of silicon valley would disagree with the claim about LSD not increasing workplace efficiency. That’s the only way to create people like Steve Jobs.
    • Many stories were run with headlines about the results of this study
    • coffee represents a $60 billion-plus global industry, supported almost entirely by adult consumers, energy drinks comprise a $6 billion-plus global industry whose demographics tilt younger
    • According to Simmons Research, 31 percent of American teenagers — about 7.6 million — regularly consume caffeinated energy drinks. Kids with caffeine habits enrich not only companies that sell caffeine but also companies those kids will work for when they grow up
    • the National Institutes of Health classifies caffeine as a “poisonous ingredient” and recommends telephoning the National Poison Control Center in cases of suspected overdose
      • How much counts to abuse? A standard cup of brewed coffee contains between 80 and 100 mg, but caffeine’s effects depend on body weight. The new London School of Hygiene report gives a thumbs-up to workers “who already use caffeine within recommended levels.” While not recommending any caffeine at all, the Mayo Clinic classifies 200 to 300 milligrams of it a day as “moderate,” warning that more than 500 mg a day “can cause insomnia, nervousness, restlessness, irritability, nausea or other gastrointestinal problems, fast or irregular heartbeat, muscle tremors, headaches and anxiety.”
    • Methed up
      • Mexican soldiers last month made one of the biggest drug busts in history. They found 15 tonnes of the banned stimulant methamphetamine, which in America retails for more than $100 per gram, seven tonnes of chemicals used to make it, and a laboratory. The manufacturers had fled.
      • meth, once primarily a home-cooked drug, has become a mass-produced one
      • Unlike cocaine and heroin, imported from the limited regions where coca and poppy are cultivated, meth can be made anywhere
      • In 2008 the Mexican authorities identified 21 labs. In 2009 they found 191.
      • In 2010 Iran dismantled 166 meth labs, up from 33 in 2009
      • officialdom is struggling as the criminal businesses speed up, evading regulations by adapting their behaviour: more like big firms than small onesopioids and methamphetamine: the tale of two crises
    • Amid the opioid crisis, a different drug comes roaring back
      • while the opioid crisis has exploded, the lull in the methamphetamine epidemic has quietly and swiftly reversed course
      • The sheer number of opioid-related deaths has dominated the national conversation. However, that focus could distract from the larger issues of use and overdose across classes of drugs. The methamphetamine and opioid crises were previously considered distinct and affecting different populations. But in states including Wisconsin and Oregon, new patterns suggest they are beginning to overlap as increasing numbers of people use both drugs.
      • In 2005, at the peak of the methamphetamine epidemic, the economic burden was placed as high as US$48·3 billion. In comparison, a February, 2018 analysis by the health research firm Altarum estimated the opioid crisis in the USA has cost in excess of $1 trillion, with an estimated price tag of $115 billion for 2017 alone. Individual and private sector costs are enormous, but these are not trivial numbers in the scope of the federal budget. The Trump administration’s 2019 total proposed budget for Health and Human Services is only $68·4 billion, although it is reportedly seeking to expand opioid funding by $13 billion for prevention and treatment. Many experts have suggested that it is too little, too late. Although, the epidemic was declared a national emergency in October, 2017, the President’s Commission on opioids has led to little more than calls for a border wall to impede suppliers and has largely been derided for failing to meaningfully include drug policy experts.
    • adderall use rising among young adults
      • While the number of prescriptions for the stimulant Adderall has remained unchanged among young adults, misuse and emergency room visits related to the drug have risen dramatically in this group, new Johns Hopkins Bloomberg School of Public Health research suggests.
      • it is mainly 18-to-25-year-olds who are inappropriately taking Adderall without a prescription
      • a sizeable proportion of those who use them believe these medications make them smarter and more capable of studying. We need to educate this group that there could be serious adverse effects from taking these drugs and we don’t know much at all about their long-term health effects
      • Adderall, the brand name for dextroamphetamine-amphetamine, does improve focus, Mojtabai says, but it can also cause sleep disruption and serious cardiovascular side effects, such as high blood pressure and stroke. It also increases the risk for mental health problems, including depression, bipolar disorder and unusual behaviors including aggressive or hostile behavior.
    • generation Adderall
      • Adderall, the brand name for a mixture of amphetamine salts, is more strictly regulated in Britain than in the United States
      • Adderall is prescribed to treat Attention Deficit Hyperactivity Disorder, a neurobehavioral condition marked by inattention, hyperactivity and impulsivity
      • In 1990, 600,000 children were on stimulants, usually Ritalin, an older medication that often had to be taken multiple times a day. By 2013, 3.5 million children were on stimulants, and in many cases, the Ritalin had been replaced by Adderall, officially brought to market in 1996 as the new, upgraded choice for A.D.H.D. — more effective, longer lasting.
      • Adderall has now become ubiquitous on college campuses, widely taken by students both with and without a prescription. Black markets have sprung up at many, if not most, schools. In fact, according to a review published in 2012 in the journal Brain and Behavior, the offlabel use of prescription stimulants had come to represent the second-most common form of illicit drug use in college by 2004
      • In the late 1920s, an American chemist named Gordon Alles first synthesized amphetamine.
        • By the 1930s, the drug Benzedrine, a brand-name amphetamine, was being taken to elevate mood, boost energy and increase vigilance
        • The American military dispensed Benzedrine tablets, also known as “go pills,” to soldiers during World War II.
        • After the war, with slight modification, an amphetamine called Dexedrine was prescribed to treat depression.
        • Many people, especially women, loved amphetamines for their appetite-suppressing side effects and took them to stay thin, often in the form of the diet drug Obetrol.
        • By the early 1970s, with around 10 million adults using amphetamines, the Food and Drug Administration stepped in with strict regulations, and the drug fell out of such common use.
        • More than 20 years later, a pharmaceutical executive named Roger Griggs thought to revisit the now largely forgotten Obetrol. Tweaking the formula, he named it Adderall and brought it to market aimed at the millions of children and teenagers who doctors said had A.D.H.D. A time-release version of Adderall came out a few years later, which prolonged the delivery of the drug to the bloodstream and which was said to be less addictive — and therefore easier to walk away from.
      • Martha Farah, a cognitive neuroscientist at the University of Pennsylvania, has studied the effect of Adderall on subjects taking a host of standardized tests that measure restraint, memory and creativity. On balance, Farah and others have found very little to no improvement when their research subjects confront these tests on Adderall. Ultimately, she says, it is possible that “lower-performing people actually do improve on the drug, and higher-performing people show no improvement or actually get worse.”
    • stimulant-overdose-flyer
      • The goal of this booklet is to get us all to take the issue of overamping seriously and to bring attention to it as much as other kinds of “overdoses,” and also to recognize all the smart things people already do to keep themselves and their friends safe.
      • Overamping is the term we use to describe what one might consider an “overdose” on speed.
        • for too long (sleep deprivation), your body is worn down from not eating or drinking enough water, you’re in a weird or uncomfortable environment or with people that are sketching you out, you did “that one hit too many,” you mixed some other drugs with your speed that have sent you into a bad place — whatever the reason, it can be dangerous and scary to feel overamped.
      • Most of the time, when we hear the word overdose, we think of heroin, someone in a heavy nod, turning blue, not breathing. A lot of times people say “you can’t overdose on speed,” but then other people say, “I don’t know, I’ve passed out, or felt like I was gonna have a heart attack…is that an overdose?” The problem is actually with the word itself. “Overdose” isn’t really the best word to describe what happens when tweak turns bad…so we call it OVERAMPING.
      • What are the physical symptoms of overamping?
        • Nausea and/or vomiting
        • Falling asleep/passing out (but still breathing)
        • Chest pain or a tightening in the chest
        • High temperature/sweating profusely, often with chills
        • Fast heart rate, racing pulse
        • Irregular breathing or shortness of breath
        • Seizure/convulsions
        • Stroke
        • Limb jerking or rigidity
        • Feeling paralyzed but you are awake
        • Severe headache
        • Hypertension (elevated blood pressure)
        • Teeth grinding
        • Insomnia or decreased need for sleep
        • Tremors
      • According to the National Institutes of Health, “Psychosis is a loss of contact with reality that usually includes false beliefs about what is taking place or who one is (delusions) and seeing or hearing things that aren’t there (hallucinations).
      • SYMPTOMS OF STROKE are distinct because they happen quickly:
        • Sudden numbness or weakness of the face, arm or leg (especially on one side of the body)
        • Sudden confusion, trouble speaking or understanding speech
        • Sudden trouble seeing in one or both eyes
        • Sudden trouble walking, dizziness, loss of balance or coordination
        • Sudden severe headache with no known cause
      • typical signs and symptoms of a general seizure are:
        • Drooling or frothing at the mouth
        • Grunting and snorting
        • Tingling or twitching in one part of the body
        • Loss of bladder or bowel control
        • Sudden falling
        • Loss of consciousness
        • Temporary absence of breathing
        • Entire body stiffening
        • Uncontrollable muscle spasms with twitching and jerking limbs
        • Head or eye deviation (fixed in one direction)
        • Aura before the seizure which may be described as sudden fear or anxiety, a feeling of nausea, change in vision, dizziness, or an obnoxious smell (not as common with drug-related seizures).
        • Skin color may be very red or bluish.
      • more people than ever get their drugs on the dark web
        • “Despite all of the disruptions from law enforcement efforts and takedowns that have been successful, as well as the exit scams and all of this kind of thing, people are still using these sites to access drugs,” Monica Barratt, a researcher from the National Drug and Alcohol Research Centre at UNSW Australia who is part of the GDS core team, told Motherboard.
        • 8,058 GDS respondents out of 101,313 (8 percent) said they had used the dark web to source drugs
        • We can see that upward trend there. It’s there for almost all the countries
        • a large chunk of those who reported using drugs from the dark web don’t actually boot up Tor and spend bitcoin; someone else purchases the drugs for them.
        • The dark web may also be allowing users to access drugs that they typically couldn’t through other means. “Seventy-nine percent said that they did try a drug for the first time through the dark net,” Barratt said.
      • iraq faces a new adversary
        • Iraq, a country where drug problems have been rare. But growing addiction here is the most recent manifestation of how the social order has frayed in the years following the American invasion in 2003.
        • because it is a largely new problem in Iraq, neither community leaders nor government officials seem ready to deal with it other than by putting people in prison.
        • Until about seven years ago, according to the United Nations Office on Drugs and Crime, Iraq was essentially a transit country, meaning most drugs passed through on their way to somewhere else.
        • The government’s approach is to try to expunge any outward sign of the problem. Almost every night, dozens of SWAT teams fan out across Basra province, targeting users and dealers and hauling in suspects. Almost all those arrested are ultimately convicted, creating a new problem: The prisons have run out of space and the overflow — hundreds of men — is crammed in holding rooms in the province’s police stations and those of neighboring provinces.
        • Unemployment is about 20% for youth
          • at least 90 percent of those arrested for drugs are unemployed
        • Iraq is now producing its own meth which is very popular among fighters
        • There are a couple of rehabilitation centers, but they are so small they make little impact. A drug conviction in Iraq makes it difficult to ever get a salaried job because traditional Iraqi culture views drug use as a “dishonorable crime,” which makes employers shy away, said addicts and government officials.
      • stop funding s.e. asia’s brutal drug war
        • In the fall of 2015, I witnessed a late-night kidnapping. The perpetrators weren’t seeking cash, gold or any kind of ransom. They didn’t bother to wear masks. They belonged to a Baptist vigilante crew sworn to bring wrath upon drug users.
        • Sure of their righteousness, the men let me tag along and observe their crimes: home invasions, assaults and the abduction of a gaunt day laborer with a speed habit
        • drug lords continue to churn out one of the Southeast Asian underworld’s top-selling products: little candypink pills, packed with methamphetamine, that smell a lot like vanilla frosting.
        • The pills are becoming more popular in the region than heroin or even marijuana. Armed syndicates produce roughly two billion of these speed tablets a year — more than triple the number of coffees Starbucks sold worldwide in 2015.
        • Consider the rise of Pat Jasan, that vigilante collective in Myanmar’s upcountry. First assembled in 2014, it now claims to have thousands of adherents. In the local language, Kachin, the group’s name refers to “cleansing” the land of drugs. The Kachin are an ethnic minority who were Christianized in the 19th century by American missionaries — and their leaders use church networks to orchestrate this underground resistance to the meth trade.
        • Repeatedly, vigilantes told me they hope to draw America’s gaze — to provoke the consciousness of that powerful Christian nation, which once gave them the word of God and might now lend its might to their holy crusade against drugs.
        • It’s even scarier in the Philippines, where the police and death squads stalk the slums in search of meth smokers and low-level dealers. More than 12,000 have been killed in just a few years. President Rodrigo Duterte campaigned — and won — on promises to dump so many dealers’ bodies into the sea that the “fish will grow fat.”
          • the United States has funded and trained the police engaging in this bloodletting. Moreover, when these killings were in full swing in 2017, President Trump told Mr. Duterte to “keep up the good work — you’re doing an amazing job.”
        • In the United States, meth is portrayed as a tooth-rotting gutter drug. Yet in Southeast Asia, those pink pills are often taken not to party but to work harder.
        • Stitching name-brand sneakers in a Vietnamese factory, hauling shrimp from Thai waters for export to American supermarkets — all of it becomes more tolerable on meth. This drudge work in Asia fills our pantries and closets. It underwrites middle-class lives in the West, supplying our homes with cheap food, cheap clothes and cheap gadgets.
        • While one tentacle of Myanmar’s security apparatus traffics pink meth pills, another receives millions of American tax dollars to fight the spread of those very drugs.
          • The army created and oversees militias that are major players in the behemoth meth business

Drugs and Society: Cocaine

CJ Trowbridge

2020-06-23

Drugs and Society

Section 8 – Reading Response: Cocaine

  • coke: the history and truth of cocaine
    • Cocaine is snorted, smoked, or injected
    • Coocaine is addictive
    • Cocaine is often cut with many other things
    • Biopharmacology
      • Reuptake inhibitor for serotonin, dopamine, norepinephrine
    • Second most popular drug in the world after marijuana
    • Natural substance found in the coca plant
    • South American cultures have used cocaine since ancient times
    • Conquistadors used taxes on cocaine to fund their conquests
    • Cocaine was isolated and synthesized in the nineteenth century in Germany
    • Vin Mariani was a wine sold with cocaine mixed in
    • Coca cola started as a cocaine syrup
    • Companies sold needles full of cocaine in drug stores, ready to inject into your veins
    • Sherlock holmes did a lot of cocaine in the stories
    • Initially white people thought cocaine could improve black neighborhoods and marketed it there for that purpose.
    • Later white people decided it would make black people “worse” and banned it, mass incarcerating the people they had just pushed it on.
  • uber cocaine
    • Freud describes his experience of using cocaine
    • He recommends what we would today call a point (0.1g) as an effective dose.
    • He concludes that it is not harmful to the body if used in moderation.
    • He says alcohol is far more harmful than cocaine
    • He goes on to recommend cocaine as a possible cure to several medical problems, and as an aphrodisiac.
  • what the crack baby epidemic tells us about the opioid epidemic
    • The racist claim that black people are more likely to be addicted to crack was used to justify eugenics arguments and the sterilization of black women.
    • Babies can be born with chemical addiction if their mothers use drugs while pregnant.
      • With treatment, they can go on to live happy and healthy lives
    • “Crack Baby” is a racist term used to dehumanize black children by implying they are somehow more likely to be born with chemical addiction and then go untreated, and live hopeless lives of addiction.
    • It builds on the false idea that once someone uses a drug, they will always be addicted and incapable of personal growth. Therefore, the argument goes, babies born with chemical addiction can not become functional members of society.
    • These claims have been thoroughly debunked, but they are still commonly used and assumed as true in racist arguments.
  • Crack Babies: Twenty years later
    • Children exposed to crack during the epidemic were demeaned and dehumanized
    • Many racist people used this idea to argue that black children could never become healthy and functioning members of society.
    • The reality is that these children are growing up to lead normal lives.
    • The same things are never said of nicotine which kills far more people.
      • Alcohol, etc.
    • Many false claims were made about inevitable future problems with children born to parents who had addiction.
      • These false claims were based on facts about fetal alcohol syndrome.
      • The evidence shows that while cocaine use by pregnant mothers does not cause brain damage in children; alcohol and nicotine by contrast cause extreme brain damage in children.
    • Alcoholic parents have more responsible rearing practices than crack addicts, but children born to alcoholics have extreme brain damage while children born to crack addicts have normal brains.
      • This leads to better outcomes for children born to crack addicts versus alcoholics.
    • The Rational Choices of Crack Users
      • Like other scientists, [Carl Hart] hoped to find a neurological cure to addiction, some mechanism for blocking that dopamine activity in the brain so that people wouldn’t succumb to the otherwise irresistible craving for cocaine, heroin and other powerfully addictive drugs.
      • “Eighty to 90 percent of people who use crack and methamphetamine don’t get addicted,” said Dr. Hart. “And the small number who do become addicted are nothing like the popular caricatures.”
      • At the start of each day, as researchers watched behind a one-way mirror, a nurse would place a certain amount of crack in a pipe — the dose varied daily — and light it. While smoking, the participant was blindfolded so he couldn’t see the size of that day’s dose.
        • Then, after that sample of crack to start the day, each participant would be offered more opportunities during the day to smoke the same dose of crack. But each time the offer was made, the participants could also opt for a different reward that they could collect when they eventually left the hospital. Sometimes the reward was $5 in cash, and sometimes it was a $5 voucher for merchandise at a store.
        • When the dose of crack was fairly high, the subject would typically choose to keep smoking crack during the day. But when the dose was smaller, he was more likely to pass it up for the $5 in cash or voucher.
      • “They didn’t fit the caricature of the drug addict who can’t stop once he gets a taste,” Dr. Hart said. “When they were given an alternative to crack, they made rational economic decisions.”
      • When methamphetamine replaced crack as the great drug scourge in the United States, Dr. Hart brought meth addicts into his laboratory for similar experiments — and the results showed similarly rational decisions. He also found that when he raised the alternative reward to $20, every single addict, of meth and crack alike, chose the cash. They knew they wouldn’t receive it until the experiment ended weeks later, but they were still willing to pass up an immediate high.
      • “The key factor is the environment, whether you’re talking about humans or rats,” Dr. Hart said. “The rats that keep pressing the lever for cocaine are the ones who are stressed out because they’ve been raised in solitary conditions and have no other options. But when you enrich their environment, and give them access to sweets and let them play with other rats, they stop pressing the lever.”
      • So why do we keep focusing so much on specific drugs? One reason is convenience: It’s much simpler for politicians and journalists to focus on the evils of a drug than to grapple with the underlying social problems.
      • Hart also puts some of the blame on scientists. “Eighty to 90 percent of people are not negatively affected by drugs, but in the scientific literature nearly 100 percent of the reports are negative,” Dr. Hart said. “There’s a skewed focus on pathology. We scientists know that we get more money if we keep telling Congress that we’re solving this terrible problem. We’ve played a less than honorable role in the war on drugs.”
    • prison and the poverty trap
      • Why are so many American families trapped in poverty?
      • For most of their daughters’ childhood, Mr. Harris didn’t come close to making the minimum wage. His most lucrative job, as a crack dealer, ended at the age of 24, when he left Washington to serve two decades in prison, leaving his wife to raise their two young girls while trying to hold their long distance marriage together.
      • “Basically, I was locked up with him,” she said. “My mind was locked up. My life was locked up. Our daughters grew up without their father.”
      • Among African-Americans who have grown up during the era of mass incarceration, one in four has had a parent locked up at some point during childhood. For black men in their 20s and early 30s without a high school diploma, the incarceration rate is so high — nearly 40 percent nationwide — that they’re more likely to be behind bars than to have a job.
      • No one denies that some people belong in prison. Mr. Harris, now 47, and his wife, 45, agree that in his early 20s he deserved to be there. But they don’t see what good was accomplished by keeping him there for two decades, and neither do most of the researchers who have been analyzing the prison boom.
      • The number of Americans in state and federal prisons has quintupled since 1980, and a major reason is that prisoners serve longer terms than before. They remain inmates into middle age and old age, well beyond the peak age for crime, which is in the late teenage years — just when Mr. Harris first got into trouble.
      • After dropping out of high school, Mr. Harris ended up working at a carwash and envying the imports driven by drug dealers. One day in 1983, at the age of 18, while walking with his girlfriend on a sidewalk in Washington where drugs were being sold, he watched a high-level dealer pull up in a Mercedes-Benz and demand money from an underling.
        • “I’m watching the way he carries himself, and I’m standing there looking like Raggedy Ann. My girl’s looking like Raggedy Ann. I said to myself, ‘That’s what I want to do.’ ”
      • Within two years, he was convicted
        • He says he went into the apartment, in the Shaw neighborhood, to retrieve $4,000 worth of crack stolen by one of his customers, and discovered it was already being smoked by a dozen people in the room. “I just lost my cool,” he said. “I grabbed a lamp and chair lying around there and started smacking people. Nobody was hospitalized, but I broke someone’s arm and cut another one in the leg.”
      • An assault like that would have landed Mr. Harris behind bars in many countries, but not for nearly so long. Prisoners serve significantly more time in the United States than in most industrialized countries. Sentences for drug-related offenses and other crimes have gotten stiffer in recent decades, and prosecutors have become more aggressive in seeking longer terms — as Mr. Harris discovered when he saw the multiple charges against him.
      • Eleven years after her husband went to prison, Ms. Hamilton followed his advice to divorce, but she didn’t remarry. Like other women in communities with high rates of incarceration, she faced a shortage of potential mates. Because more than 90 percent of prisoners are men, their absence skews the gender ratio. In some neighborhoods in Washington, there are 6 men for every 10 women.
        • “With so many men locked up, the ones left think they can do whatever they want,” Ms. Hamilton said. “A man will have three mistresses, and they’ll each put up with it because there are no other men around.”
        • Epidemiologists have found that when the incarceration rate rises in a county, there tends to be a subsequent increase in the rates of sexually transmitted diseases and teenage pregnancy, possibly because women have less power to require their partners to practice protected sex or remain monogamous. When researchers try to explain why AIDS is much more prevalent among blacks than whites, they point to the consequences of incarceration, which disrupts steady relationships and can lead to high-risk sexual behavior. When sociologists look for causes of child poverty and juvenile delinquency, they link these problems to the incarceration of parents and the resulting economic and emotional strains on families.
        • Some families, of course, benefit after an abusive parent or spouse is locked up. But Christopher Wildeman, a Yale sociologist, has found that children are generally more likely to suffer academically and socially after the incarceration of a parent. Boys left fatherless become more physically aggressive. Spouses of prisoners become more prone to depression and other mental and physical problems.
        • “Education, income, housing, health — incarceration affects everyone and everything in the nation’s low-income neighborhoods,” said Megan Comfort, a sociologist at the nonprofit research organization RTI International who has analyzed what she calls the “secondary prisonization” of women with partners serving time in San Quentin State Prison.
      • This social disorder may ultimately have the perverse effect of raising the crime rate in some communities, Dr. Clear and some other scholars say. Robert DeFina and Lance Hannon, both at Villanova University, have found that while crime may initially decline in places that lock up more people, within a few years the rate rebounds and is even higher than before.
      • The benefits of incarceration are especially questionable for men serving long sentences into middle age. The likelihood of committing a crime drops steeply once a man enters his 30s.
      • “A lot of the men have been away so long that they’re been crippled by incarceration,” she said. “They don’t how to survive in the community anymore, and they figure it’s too late for someone in their 40s to start life over.”
      • “People who go to prison would have very low wages even without incarceration,” said Dr. Western, the Harvard sociologist and author of “Punishment and Inequality in America.” “They have very little education, on average, and they live in communities with poor job opportunities, and so on. For all this, the balance of the social science evidence shows that prison makes things worse.”
      • Western and Becky Pettit, a sociologist at the University of Washington, estimate, after controlling for various socioeconomic factors, that incarceration typically reduces annual earnings by 40 percent for the typical male former prisoner.
      • DeFina and Hannon, the Villanova sociologists, calculate that if the mass incarceration trend had not occurred in recent decades, the poverty rate would be 20 percent lower today, and that five million fewer people would have fallen below the poverty line.
    • the new drug highway
      • there has been an explosion in the number of boats, sometimes carrying more than a tonne of cocaine, making the journey across the Pacific Ocean to feed Australia’s growing and very lucrative drug habit.
      • Hundreds of kilograms of cocaine have washed up on remote Pacific beaches, ships laden with drugs have run aground on far-flung coral reefs, and locals have discovered huge caches of drugs stored in underwater nets attached to GPS beacons.
      • “Draw a direct line between Bogotá and Canberra and it goes straight through the islands,” says Dr Andreas Schloenhardt, professor of criminal law at the University of Queensland.
        • Caught in the middle are countries such as Fiji, which the Guardian visited as part of a series investigating the Pacific drug highway. Other countries affected include Vanuatu, Papua New Guinea, Tonga and New Caledonia, whose waters and beaches are being used as storage grounds for billions of dollars worth of illicit drugs.
      • In 2004, police seized 120kg of cocaine on a beach in Vanuatu, a bust the AFP heralded as “the biggest such haul in the Pacific nation’s history”. Nine years later, police made a bust involving more than six times this amount.
      • Australia and New Zealand have the highest rates of per capita cocaine use of any in the world
        • Australians and New Zealanders also pay more for the drug (about AU$300 or £180 per gram) than those anywhere else in the world, making it a lucrative market.
      • There is no data collected in Fiji about drug use or addiction. There is no rehab centre in Fiji, no methadone clinic, no addiction health specialists, not even a Narcotics Anonymous meeting to be found. Collingwood says there is also no understanding of addiction as an illness.
        • “No one has recovered here, there’s no such thing,” Collingwood says. “I know heaps of people here who want to do it, they just don’t know what to do.”
      • “We cover one-third of the world’s mass,” says Tevita Tupou from the Oceanic Customs Organisation, waving toward the map. Tupou checks off challenges on his fingers. “Porous borders, maritime borders, geographical spread, limited resources. That’s our operating environment.” He laughs. “Where do you start?”
      • “You cannot eradicate the issue of drugs, because there will always be a demand, there’s always money to be made out of it, but we can make it hard for them,” he says. “That’s our endgame … the only thing we can do is just make crime random.”
    • Mexico’s Drug War
      • Mexican authorities have been waging a bloody war against drug trafficking organizations for more than a decade with limited success.
      • Over the last decade, the U.S. government has committed more than $2 billion in funding and intelligence resources to supplement Mexico’s counternarcotics efforts, but Washington’s primary focus has been stanching the flow of drugs into the United States and bolstering domestic law enforcement.
        • Meanwhile, gradual moves have been made at the U.S. state level toward legalization and decriminalization of marijuana, one of the primary substances involved in the drug war.
      • Mexican drug trafficking organizations (DTOs) are the largest foreign suppliers of heroin, methamphetamines, and cocaine to the United States, according to the U.S. Drug Enforcement Administration.
        • Mexican suppliers are responsible for most heroin and methamphetamine production, while cocaine is largely produced in Bolivia, Colombia, and Peru, and then transported through Mexico.
        • Mexican cartels are also leading manufacturers and suppliers of Fentanyl, a synthetic opioid many times more potent than heroin. U.S. seizures of the drug have soared in the last five years.
      • The cartels also produce and smuggle vast quantities of marijuana into the United States, but legalization of the drug in some U.S. jurisdictions has diminished cartel profits. As a result, experts note that DTOs are shifting their focus to harder drugs like heroin.
      • Calderon declared war on the cartels shortly after taking office in 2006. Over the course of his six-year term, he deployed tens of thousands of military personnel to supplement and, in many cases, replace local police forces. Under his leadership, the Mexican military, with U.S. assistance, captured or killed twenty-five of the top thirty-seven most wanted drug kingpins in Mexico.
        • This strategy splintered the small number of large organizations into a huge number of small organizations. Now instead of twenty or thirty kingpins, there are a hundred or more, and the smaller groups are resorting to more aggressive and violent tactics like assassinations and kidnappings to grow their revenue and influence.
        • Since this strategy began, homicides in Mexico have doubled.
      • The next president continued the policy, and tens of thousands of civilians have disappeared or been murdered since he took office.
      • Mass protests erupted across the country in 2014 after forty-three students disappeared in the town of Iguala, in the state of Guerrero, following deadly clashes with local police. Mexican investigators found that the police handed the students over to a local drug gang at the behest of the mayor, who had ties to the gang.
      • Through the Merida Initiative, the United States has committed to providing approximately $2.5 billion in funding, technical assistance, and intelligence over more than a decade to increase Mexico’s institutional capacity to address drug trafficking. The United States has provided information and equipment that has helped Mexican authorities capture several high-profile traffickers, including Guzman.
      • Trump has shifted focus to tactics we already know don’t work like building walls.
      • The future is uncertain, but there is no indication that things will get better.
    • why is coca production on the rise in Columbia
      • Early March, 2017: The United States government and the United Nations announce large increases in the amount of coca being cultivated in Colombia.
      • the Colombian Minister of Foreign Affairs blames the growth on the machinations of drug trafficking gangs and greedy peasants
      • According to the text of the peace agreement the government should be weaning campesinos (peasant farmers) off growing coca by first offering incentives to grow alternative crops. Nevertheless, forced manual eradication takes place across the country, and the Colombian government has announced the largest cultivation target in its history: 100,000 hectares.
      • In the first few months of the year more than 40 “blockades” are recorded: eradication teams are prevented from working by communities who demand the assistance they have been promised. The government responds with the specialised police force, the ESMAD, who disperse the protesters with tear gas and rubber bullets. In one case the police arrest protesting farmers and the community responds by detaining 15 officers for 24 hours.
      • The government’s own comptroller general recognises that “after almost 200 years of reforms and counter-reforms, and many billions of pesos invested, the same crisis reigns in agriculture”(pdf). The “agricultural policy crisis”, noted the comptroller general’s report, is the result of “the lack of political will on the part of the state to make viable the campesino economy”.
      • President Juan Manuel Santos and his administration have adopted reforms that officials say will lead to a more equitable distribution of land. But these policies “in reality display the contrary”, notes the report. Like his predecessors, Santos is committed to the promotion of “exclusive trading strategies, based in ‘mega-projects’ which don’t solve the underlying problem”. Instead, they could “consolidate and deepen even further both displacement and concentration of land”.
      • The result of such policies? Rural poverty and backwardness are by every measure a national scandal. Today in the countryside one in ten people cannot read or write. One in five children between five and 16 years of age do not attend school. Three quarters of people aged between 17 and 24 are without access to an educational institution. In some regions four out of every five people live below the poverty line
      • The Free Trade Agreement with the United States correlates closely with the beginning of the rise in cultivation. This directly caused around 1.8 million farmers to suffer a significant drop in their income, leaving them with few options except migration, joining the FARC, or growing coca. “As was entirely predictable,” reported the Colombian press one year after the treaty came into effect, “the initial damage is occurring in agriculture, where the country’s tariffs have been relinquished and US subsidised goods accepted.”
      • The government publicly attributes coca cultivation to the machinations of peasants, the guerrilla and criminal groups, and Santos has even felt comfortable enough to claim that the demobilisation of the FARC will mean Colombia can finally become drug-free.
      • Inside Colombia, political activists, community leaders and human rights defenders recognise the source of the problem and call for fundamental changes in the nature of the society. They are currently being murdered at a rate of around eleven a month. A political party that includes a new economic model in its charter has had more than 120 of its members murdered in the past five years.
      • What is called “counter-narcotics funding” has in fact been funding for the Colombian military and police, which are now both modernised and enormous. Around 70 percent of Plan Colombia’s “counter-narcotics” funding actually never leaves the United States because it used to purchase arms and equipment.
    • Africa’s Drug Problem
      • In recent years, Guinea-Bissau has emerged as a nodal point in three-way cocaine-trafficking operations linking producers in South America with users in Europe; the value of the cocaine that transits this small and heartbreakingly impoverished country dwarfs its gross national product. The Gulfstream arrived unexpectedly from Venezuela on July 12, 2008, and taxied to a hangar at the adjacent military airbase — where soldiers formed a line and unloaded its contents. The contents, reportedly more than a half-ton of cocaine, vanished. The crew was arrested and released. The army permitted the government to impound the plane only after several days. Since then, the plane has sat in the harsh sun, a reminder of Guinea-Bissau’s helplessness before forces far more powerful than itself.
        • The high-ranking military officials who coordinated the arrival and unloading of the Gulfstream in 2008 were never charged, and the case was closed for lack of evidence.
      • Just as the efficient marketplaces of the world’s financial capitals serve as the nexus for global trade, so ungoverned or remote places offer an indispensable service for global criminals. And West Africa includes 10 of the 20 lowest scorers on the United Nations’ index of development; governments are correspondingly brittle and corrupt.
      • According to U.N. reports, as well as American law-enforcement and intelligence officials, cocaine crosses the Atlantic from South America either in small planes, including Cessna turboprops outfitted with an extra bladder of fuel, or in commercial fishing vessels or cargo ships.
        • The drugs are then transported in bulk along one of several routes. Some are taken to the international airports in Dakar, Senegal and Accra, Ghana or elsewhere, where they are generally swallowed in relatively small amounts by couriers and flown to European cities. Other shipments are transported northward by truck or carried overland across ancient smuggling routes before crossing the Mediterranean into southern Europe. The African couriers and crime syndicates are often paid in “product,” which has the additional effect of creating a local market for cocaine.
      • In November, an old Boeing 727, which had taken off in Colombia, crossed West African airspace and touched down on an airstrip controlled by terrorist groups in the desert of Mali. The plane was almost certainly carrying cocaine and perhaps guns as well; no one knows, since the cargo was unloaded before the plane was burned.
      • Guinea-Bissau offered proximity to Europe, a purchasable state structure, a desperate citizenry and a hopelessly overmatched police force.
        • Guinea-Bissau sold narcotraffickers access to several islands in the Bijagós; the country’s minister of justice at that time suggested to him that the international community secure islands of its own as a counterstrategy.
        • The Judiciary Police numbered a few dozen and had no vehicles and few weapons, handcuffs, flashlights — a serious problem in a capital with no streetlights — or even shoes.
        • Their prison consisted of a few locked rooms with barred windows in their headquarters on the road leading out of the capital.
        • Corruption was rife. And yet they made some spectacular arrests. Jorge Djata, the deputy chief of the drug squad, told me that in September 2006, he received word of a shipment of drugs coming into Bissau from a town to the northwest. He and several colleagues jumped into one of the rattletrap Mercedes taxis that ply the city’s streets, followed the car to a house rented by Colombians and took them by surprise. The haul was 674 kilograms, or nearly 1,500 pounds, of cocaine with a street value of about $50 million.
        • What happened next, however, defines the problems of law enforcement in countries like Guinea-Bissau even more than does the lack of shoes and guns and cars. Djata and his colleagues took the three Colombians and the drugs to their headquarters. Then, Djata says: “We got a call from the prime minister’s office saying that we must yield up the drugs to the civil authorities. They said the drugs would not be secure in police headquarters, and they must be taken to the public treasury.” A squad of heavily armed Interior Ministry police surrounded the building. Djata said his boss replied, “We will bring the drugs ourselves, and then we will burn them.” Government officials refused. Djata and his men relented, and the drugs were taken to the public treasury. And soon, of course, they disappeared — as did the Colombians.
      • Everybody wants to help West Africa with its drug problem: the U.N. Office on Drugs and Crime and other U.N. bodies, Interpol, the European Union, the West African regional organization known as Ecowas, individual European states and the United States. The United Nations, Interpol and Ecowas are spending $50 million in four countries partly to build “transnational crime units,” interagency bodies that will gather information, conduct investigations and turn over their findings to prosecutorial authorities. An agency of Ecowas monitors money laundering throughout the region. A group of European countries deploys ships and narcotics officers to interdict boats carrying drugs from West Africa to Europe. A multitude of U.S. government agencies, coordinated by the new African Command, provide equipment to law-enforcement groups, as well as training for those groups and naval and coastal officers. But those who know the problems best tend to be the least confident.
      • what to do with the Gulfstream jet: Sell it and invest the proceeds in social programs. Converting drug contraband into clinics would send just the right message. Unfortunately, other officials told me that the plane has been sitting in the tropical sun so long that it might have to be sold off in pieces.
    • the new drug highway
      • (This was on the list twice)

Drugs and Society: Opiates

CJ Trowbridge

2020-06-16

Drugs and Society

Reaction Paper – Section 7

  • inside the story of america’s 19th century opiate addiction
    • Morphine was seen as a wonder drug which could immediately ameliorate many common symptoms in the short-term
    • Morphine quickly created an addiction epidemic. By 1895, morphine addiction was commonplace in America.
      • Benjamin Franklin took opium regularly
    • During the civil war, the union issued over twelve million doses of opium to its soldiers, leading to widespread addiction
      • Doctors used opium to treat chronic pain from war wounds, so even those who came home from the war not addicted would likely become addicted later as a result
    • Opium quickly became one of the most prescribed drugs.
      • 60% of opium addicts were women. Doctors prescribed opium for many common conditions. By 1861, opium addiction became more common than all over diseases combined.
    • By 1900, germs had been discovered, and doctors began to take addiction concerns seriously, but addiction was already widespread.
    • Chinese immigrants brought traditions of smoking opium unproblematically; they had an ancient cultural knowledge of safe practices and limited opium behaviors, unlike white people who used opium to excess in an information vacuum.
    • As a result of widespread opium addiction and rising awareness of the dangers of overprescribing, doctors began cutting back on the opium prescriptions. People then began smoking it at home, and opium dens sprang up across the country.
    • Roosevelt saw an international political opportunity in opposing the opium trade in order to take power and wealth from pacific islanders and consolidate American power in The Philippines.
    • At a time when Heroin was still sold by Bayer in every drug store, authorities “responded” to the nascent crisis of white opium addiction in America by leveraging racism and ignorance to blame these white problems on Chinese immigrants and ban the smoking of opium; an unproblematic Chinese custom which was completely unrelated to issue of white addiction.
      • This led to widespread mass incarceration and laid the foundation for many future “drug bans” which were actually bans on the customs of ethnic minorities in order to facilitate mass incarceration by the white ethnostate.
    • Overnight, opium prices shot up by more than a factor of ten.
    • Because so many Americans were already addicted to opium, they responded to rising prices by seeking out stronger and more concentrated alternatives like morphine and heroin.
    • When the US first banned opium, it established nationwide narcotics clinics to treat addiction. These lasted about two years before they were closed in 1921, ending any serious attempt to address the problem of opium addiction as a public health issue.
    • Since then, pharmaceutical companies have been allowed to develop and market ever more concentrated forms of opiates, via doctors who have never learned their lesson, to an ever more opiate addicted population.
  • Why are more Americans than ever dying from drug over doses
    • Overdose deaths are rising exponentially, more than doubling for both of the last two decades
    • The drugs epidemic… has spread across the whole country
    • illegal narcotics are more readily available than ever, as drug distribution networks have expanded to rural and suburban areas
    • In the 1990s, pharmaceutical companies aggressively lobbied doctors to prescribe new formulations such as OxyContin, which they falsely claimed could provide effective pain relief with no real addiction risk even to long-term patients
      • As a result, medical opioid consumption more than tripled, soaring far beyond levels seen in other countries. Today, the US medical sector ranks second in the world for opioid use behind only Canada, which is struggling with its own overdose crisis.
    • The article proposes no solution and offers no hopeful message about the situation improving in the future.
  • Prescribed painkillers didn’t cause the opiate crisis
    • “A 5-sentence letter helped trigger America’s deadliest drug overdose crisis ever.” (Vox)
    • “The One-Paragraph Letter From 1980 That Fueled the Opioid Crisis” (The Atlantic)
    • “1980 NEJM Letter the Genesis of the Opioid Crisis?” (Medscape)
    • The letter in question was entitled “Addiction Rare in Patients Treated with Narcotics.” It noted that the researchers had examined records of more than 10,000 hospitalized patients treated with opioids for pain and found only four new cases of addiction.
    • The paper had no details about methodology whatsoever
    • The paper was cited over 600 times
    • citations increased dramatically at the time when the makers of Oxycontin were marketing the drug as being unlikely to cause addiction, which was no coincidence.
    • evil drug companies pushed greedy doctors to prescribe unnecessary drugs, which turned innocent pain patients into people with heroin addiction.
    • the drug companies irresponsibly and reprehensibly misused the legitimate concern that pain was being undertreated to sell massive amounts of product
    • Purdue Pharma inaccurately claimed that Oxycontin was a less addictive opioid
    • salespeople pressured many doctors into prescribing far more than made sense
    • people who developed new addictions in recent years were overwhelmingly not pain patients
      • they were mainly friends, relatives, and others to whom those pills were diverted, typically young people
    • Among the older patients, many who appeared to be newly addicted had actually relapsed or never recovered from prior addictions
    • less than a quarter of people who start misusing these drugs obtained them directly from one or multiple doctors
      • Half of new users, in fact, say they got them from a friend or relative for free
      • an early study of people being treated for Oxycontin addiction found that 77 percent of them had also taken cocaine
    • only 3.6 percent of people who misuse prescription opioids ever even try heroin.
    • This speaks to the unlikelihood that many prescription pain patients became addicted to heroin without having had a prior history of drug problems
    • The vast majority of people who use opioids do not become addicted
    • one study of more than 640,000 surgical patients who had never previously taken opioids found that few used the drugs for more than three months after recovery from surgery: rates varied from less than 0.12 percent for people who had C-sections up to 1.4 percent for those who had knee surgery
    • the idea that patients who take medications as prescribed are the cause of this problem is inaccurate
    • While the media loves to highlight “innocent victims” who became addicted through medicine, the fact is that this group is a minority. Medical use surely increased access to the drugs—but the people who got hooked tended to do so while using medication that was either prescribed for someone else or otherwise distributed illegally.
    • stop thinking that simply cutting the medical supply will work
      • People who start opioid use illegally are not going to have problems finding substitutes for prescription medications on the illicit market—indeed, shunting them away from medical sources will increase their risk of dying.
    • research finds that 67 percent of surgical patients do not take all of the opioids they are prescribed. Limiting initial prescriptions to several days with refills only as needed will help dry up this supply, with little harm to patients
    • ensuring that chronic pain patients have been given appropriate access to alternatives before starting long-term opioid use makes sense—as does making sure patients are benefiting
    • pain patients report that their doctors have either cut them of entirely or involuntarily tapered them to doses that aren’t sufficient—due to increasing scrutiny from medical boards, insurers, and police.
      • This is inhumane and does nothing to prevent addiction. In fact, more than 90 percent of all addictions start when people are in their teens or early 20s: the people we need to be most careful with when prescribing opioids are not typically older folks in chronic pain, but youth.
    • American drug policy tends to make irrational swings from being too relaxed about opioid prescribing to being too harsh.
      • Perhaps if we actually tried to understand how and why people really become addicted we could find a happy medium
    • opioid epidemic white-washed
      • Opioid-related deaths doubled between 2000 and 2015, and rose more than 20% between 2015 and 2016.
      • African American men and women, and Latino men, experienced an increase in opioid death rates from 2015 to 2016, according to the Centers for Disease Control and Prevention. At the same time, deaths among other demographic groups fell or remained the same.
        • Across Illinois, nearly one out of four opioid overdose deaths was of an African American in 2016.
        • In Chicago, nearly half of all opioid overdose deaths were of African Americans. Since African Americans account for only about 15% of the state’s population and about 32% of Chicago’s population, those statistics show that black people are dying at a disproportionately high rate.
      • this crisis has been “whitewashed,” leaving out the communities of color who have been powerfully impacted by the epidemic for decades
      • If a drug crisis is perceived to affect white Americans, it’s a public health crisis. If a drug crisis is perceived to impact African Americans, it’s a criminal justice problem.
      • The structural racism in our health and criminal justice systems has led to public policy that, again and again, pointedly targets African Americans. The false narrative continues: Blacks need – no, require – prison. There is no drug treatment that will work.
        • Examples of historically racist commentary and legislation are given
      • The failure to make this clear is not just an affront to the devastation wreaked in our communities. It also ignores this truth: In all issues, including this one, Black Lives Matter.
    • the chronic pain quandary
      • Dr Kertesz is a leading advocate against policies that call for aggressive reductions in longterm opioid prescriptions or have resulted in forced cutbacks. He argues that well-intentioned initiatives to avoid the mistakes of the past have introduced new problems. He’s warned that clinicians’ decisions are destabilizing patients’ lives and leaving them in pain — and in some cases could drive patients to obtain opioids illicitly or even take their lives.
      • Around 2015, Dr Kertesz started hearing that patients who had been taking opioid painkillers for years were being taken off their medications. Sometimes it was an aggressive reduction they weren’t on board with, sometimes it was all at once. Clinicians told patients they no longer felt comfortable treating them.
      • “I think I’m particularly provoked by situations where harm is done in the name of helping.”
      • “What really gets me is when responsible parties say we will protect you, and then they call upon us to harm people.”
      • It’s a case that Kertesz, 52, has tried to make with nuance and precision, bounded by an emphasis on the history of overprescribing and the benefits of tapering for patients for whom it works. But against a backdrop of tens of thousands of opioid overdose deaths each year and an ongoing reckoning about the roots of the opioid addiction crisis, it’s the dialectical equivalent of pinning the tail on a bucking bronco. Kertesz’s critics have questioned his motives. He’s heard he’s been called “the candyman.”
      • as doctors try to move beyond their days of overprescribing while responsibly treating chronic pain, the debate is playing out
      • as of October 20182020, 33 states had codified some prescription limits into law. Pharmacies and insurers capped prescriptions at 90 MME. Law enforcement agencies warned high prescribers.
      • Some initiatives have focused on avoiding “new starts,” not on tapering legacy patients.
      • “It is imperative that healthcare professionals and administrators realize that the Guideline does not endorse mandated involuntary dose reduction or discontinuation,” read a March letter2323 coauthored by Kertesz calling on the CDC to reiterate its recommendations were not binding. The letter continued: “Patients have endured not only unnecessary suffering, but some have turned to suicide or illicit substance use.”
        • More than 300 patient advocates and experts, including three former White House drug czars, signed it.
      • Pills that Kill
        • fentanyl is 100 times more potent than morphine
        • fentanyl is 50 times more potent than heroin
        • a single pill can kill
        • A very small amount ingested, or absorbed through the skin, can kill you
        • most people who use fentanyl don’t even know they’re taking it
          • After Prince died, investigators found pills labelled as prescription hydrocodone, but made of fentanyl, in his home, suggesting he bought them on the black market. The police concluded he died from a fatal mix of the opioid and benzodiazepine pills, a particularly dangerous combination. It is likely Prince did not even know he was taking fentanyl.
          • Jerome Butler, a former driver for Budweiser beer who was training to be a security guard, thought he was taking a prescription pill called Norco. His mother’s voice breaks as she recounts what she knows of her son’s last hours. Natasha said she was aware he used cannabis, but had no idea he was hooked on opioid painkillers. She said her son at one time had a legitimate prescription and may have become addicted that way. She has since discovered he was paying a doctor, well known for freely prescribing opioids, to provide pills.
        • The ingredients for fentanyl, on the other hand, are openly available in China and easily imported ready for manufacture. It is so much more powerful than heroin that only small quantities are needed to reach the same high. That has meant easy profits for the cartels. The Drug Enforcement Administration (DEA) has said that 1kg of heroin earns a return of around $50,000. A kilo of fentanyl brings in $1m.
        • making pills with a drug like fentanyl is a fairly exact science. A few grammes too much can kill. “It’s very lethal in very small doses,” said Morris. “Even as little as 0.25mg can be fatal. One of our labs had a dime next to 0.25mg and you could barely see it. It’s about the size of the head of a pin. Potentially that could kill you.”
        • When investigators sent counterfeit pills seized after the Sacramento poisonings for testing at the University of California, they found a wide disparity in the amount of fentanyl each contained. Some pills had as little as 0.6mg. Others were stuffed with 6.9mg of the drug, which would almost certainly be fatal
          • The DEA thinks the difference was probably the result of failing to mix the ingredients properly with other powders, which resulted in the fentanyl being distributed unevenly within a single batch of counterfeit pills
        • authorities don’t know for sure how many people fentanyl kills because of the frequency with which it is mixed with heroin, which is then registered as the cause of death
        • The DEA reported 700 fatalities from fentanyl in 2014 but said it is an underestimate, and rising. In 2012, the agency’s laboratory carried out 644 tests confirming the presence of fentanyl in drug seizures. By 2015, the number of positive tests escalated to 13,002.
        • some Mexican cartels have long relationships with legitimate Chinese firms which for years supplied precursor chemicals to make meth amphetamine.
          • Mexican cartels use ingredients from labs in China where production of fentanyl’s ingredients is legal.
        • The Wrong Way to Treat Opioid Addiction
          • Case study
            • Before Joe Thompson switched treatments for his opioid addiction, he was a devoted stay-at-home father, caring for his infant son after his wife returned to work. His recovery was aided by the anticraving medication buprenorphine. But after over two years free of heroin, Mr. Thompson, a former United Parcel Service worker from Iowa, relapsed and decided to try another kind of treatment program. Unfortunately, his new counselors insisted that continuing his buprenorphine, though it was approved by the Food and Drug Administration, was just as bad as using heroin, according to his wife, Deborah. He wasn’t even allowed to start therapy until he’d been abstinent for several weeks. Stressed by withdrawal, he went to a third center. It, too, banned medication. Within a week of entering the program, he was dead from a heroin overdose. He was 35.
          • Buprenorphine is one of only two treatments proven to cut the death rate from opioid addiction by half or more.
            • The programs Mr. Thompson tried viewed abstinence as the only true recovery — even though abstinence treatment has not been shown to reduce mortality and is less effective than medication at preventing relapse.
          • Only about one-third of American addiction programs offer what many experts worldwide see as the standard of care — long-term use of either methadone or buprenorphine.
          • This widespread rejection of proven addiction medications is the single biggest obstacle to ending the overdose epidemic.
            • Funding isn’t the barrier: Outpatient medication treatment is both more effective and significantly cheaper than adding inpatient beds at rehabilitation centers.
            • The problem is an outdated ideology that views needing a medication to function as a form of addiction.
          • Rather than defining addiction as destructive, compulsive behavior, this ideology focuses on physical dependence. If you need a drug to avoid being physically ill, you are considered addicted. So Prozac would be considered addictive, but not cocaine, because quitting Prozac abruptly can cause flulike symptoms while stopping cocaine doesn’t, even though it elicits extreme craving.
          • both the National Institute on Drug Abuse and the Diagnostic and Statistical Manual of Mental Disorders reject the idea that addiction is synonymous with dependence. Unfortunately, many clinicians, including doctors, haven’t caught up.
          • What is addiction, then? The root problem is craving, which drives a compulsion to use drugs despite the harm they cause. That’s what makes crack addictive, while Prozac can be therapeutic.
          • Because methadone and buprenorphine are opioids themselves, it’s easy to assume that using them is “substituting one addiction for another.” However, the pattern of taking the same dose every day at the same time means that there is no high or intoxication. Patients on maintenance doses are able to nurture a baby, drive, work and be a loving spouse.
          • we need to publicly recognize that recovery on medication is every bit as valid as any other treatment. What matters is whether, as Freud put it, you can love and work, not the chemical content of your brain or urine.
        • east bay doctors treat heroin users on the street
          • A veteran and his wife who are both homeless and addicted to heroin are being treated by the Oakland Street Team with suboxone or buprenorphine.
            • They haven’t used in a month
            • This drug blocks cravings and withdrawals
            • The street team arrives at the homeless encampments and doctors prescribe and treat patients on the spot
          • Studies conducted since the national opioid epidemic started claiming record numbers of lives show people who take buprenorphine and other similar medications are less likely to die from overdoses and more likely to stay in treatment
          • Doctors require at least eight hours of special training to prescribe buprenorphine, and in Contra Costa County, where Morris was fortunate enough to land a prescription, only about 3 percent of providers are licensed to write them, a figure roughly 2 percentage points below the national average.
          • A county civil grand jury last May concluded that there were not enough treatment options of any kind available for opioid addiction.
            • “There is a need for on-demand treatment, but delays in access to medical care result in missed opportunities to reduce harm, aid recovery, and prevent overdose deaths,” the report read.
          • Dr Mega leads the Oakland Street Team which attempts to meet some of the unmet needs for the homeless population
            • “If you create multiple barriers to accessing something, they’re just going to say, ‘Forget it, I can’t do this,’”
          • Once users receive prescriptions, they can pick up their medicine at any local pharmacy. Mega’s street medicine team has prescribed Suboxone to 58 people on the streets in the past year. The program has a nearly 45 percent retention rate — defined as the percentage of patients who went on to receive at least three prescriptions.
          • “We’ve been trained in medical school for a long time that opioid withdrawal is not dangerous in the sense that it won’t kill people,” Mega said. “But what happens after the withdrawal can be dangerous.”
            • The physiological effects of withdrawal are agonizing and compel some patients to leave the emergency room to find more heroin before they’re discharged, he said. So many people have died from opioid overdoses that by 2017, there was a decline in overall life expectancy.
            • only about 30 jails or prisons across the country widely offer Suboxone or methadone, according to U.S. Justice Department data. Yet research shows the consequences of not providing such treatment can be especially deadly. One 2018 study showed that people in custody are 40 times more likely than the general population to overdose after they’re released.
            • “People come into jail, quit cold turkey, and their cravings are increasing because they are addicted and their brain chemistry has changed,” said Jessica Hamilton, lead physician for Contra Costa County’s Detention Health Services. “When they are released, people often go back to the similar amount they were using and die.”
          • “What am I supposed to tell my patients? Die more slowly, be a little more sick?” Stalcup said. “We’re at a point in medical history where we have a clearly life-saving medication that people can’t get.”
        • Afghan Taliban Awash in Heroin Cash
          • Afghan police and American Special Forces keep running into heroin refining operations all over Afghanistan
          • the labs’ proliferation is one of the most troubling turns yet in the long struggle to end the Taliban insurgency.
          • the country has consistently produced about 85 percent of the world’s opium, despite more than $8 billion spent by the United States alone to fight it over the years
          • Various police forces bear the brunt of the drug war in Afghanistan, but are often complicit in the opium trade themselves, feeding corrupt networks within the Afghan government, both locally and nationally
          • A senior counternarcotics official in Kabul, who spoke on condition of anonymity to avoid reprisals, recounted how the elite unit was painstakingly following a network of money launderers in one opium-rich province who were helping to import the chemicals needed for refining heroin. The officers finally had enough evidence to make a high-level arrest, nabbing one of the network’s leaders — only to lose him when a powerful police commander personally stepped in to set the suspect free.
          • the small National Interdiction Unit, sequestered in a secure mountainside base in Kabul, has been one of the surest bets in striking against the opium and heroin networks.
            • Its top commander was replaced recently for failing a polygraph test and “was probably leaking information to hostile forces,” according to a report by the U.S. Special Inspector General for Afghanistan Reconstruction.
          • “The Taliban derives its funding from the narcotics taxing, sales and trafficking,”
          • elite forces and their American advisers, often flying up to six helicopters from Kabul, operate at night. They land miles away from the target to avoid fire, and then make their way by foot. The raids rarely, if ever, result in arrests; the suspects often flee as soon as they hear the motors
        • An Opioid Popularized by a Nazi Doctor is Ravaging Africa
          • Many Africans have become dependent on a pain pill called tramadol, which is milder than Oxycontin, though it can still get users quite high.
          • The opioids of abuse in America are highly regulated, but in Africa nearly anyone can get tramadol—and not just from street hawkers, but from legitimate pharmacists.
            • In Africa, the affected population are largely children.
          • The former director of the drug enforcement agency in Nigeria estimated in 2016 that seven in ten boys in northern states were abusing drugs like tramadol.
          • Nigeria is by far Africa’s most populous country, and the problem is particularly acute there. “About three years ago I started noticing that a lot of people would ADVERTISEMENT come and ask for it without prescription, especially young people, young boys and girls,” Oluwatosin Fatungase, a Nigerian pharmacist and youth counselor, told VICE. “I was wondering, ‘Why is everybody coming to look for tramadol?’”
            • pills of tramadol—which are made by the boatload in Indian factories and distributed in Africa through both legal and illegal channels—are incredibly cheap, roughly 30 cents for a pack of ten
          • Kids like them because they’re discreet (no smoking required), and can be taken between classes. “When you ask young people why they take it, they say ‘to get high,’ or ‘it makes me work longer,’ or ‘I can have sex for many hours,’” Fatungase told VICE. “But they are not looking at the side effects. They go into a coma and they die. It’s really alarming and heartbreaking.”
          • “Scheduling of tramadol in Africa would probably have a very limited impact on use, but create a huge and uncontrollable black market for the substance, and would most probably have a significant impact on the availability of tramadol for medical purposes.”

Drugs and Society: Marijuana

CJ Trowbridge

2020-06-16

Drugs and Society

Reaction Paper – Section 6

  • Illegal drugs and how they got that way: marijuana
    • Most drugs were previously legal and later banned
    • 20 million Americans have been incarcerated for marijuana since it was banned
      • At the time, Marijuana was growing all over the country as a weed and had been enjoyed for centuries by all kinds of people dating back to ancient India, Greece, and China.
    • Marijuana grows everywhere in the world since ancient times.
      • Napoleon brought it to Europe
      • It came to the new world with the conquistadors
    • All drugs are banned not because they are harmful but because they are associated with a particular group seen as deviant
    • Marijuana took off in America at the same time as the religious right was trying to ban alcohol
      • This led to lots of new interest in marijuana
        • This is closely related to the rise in jazz music at the same time
      • This also led to the religious right seeing marijuana as bad
    • Entrepreneurial journalists wrote false and sensationalist stories connecting marijuana use by black people to violence and crime
    • Banning marijuana in the south was seen as banning black violence
    • Throughout the south, marijuana bans were used to mass incarcerate people of color for decades or even life sentences
    • Federal politics adopted these policies nationwide, leading to the war on drugs and widespread mass incarceration of minorities under the false pretense of fighting crime and deviance
    • Marijuana became connected with immigration politics. The idea was that finding a way to ban Mexican immigrants so they would leave white communities and states.
    • The federal ban on machine guns was used as a framework to ban marijuana nationwide
      • Federal marijuana stamps were required for possession though none were printed
    • Dissenting opinions were presented by many experts at the time including a four-year study commissioned by the city of New York which found;
      • Marijuana is not addictive
      • Marijuana use is not widespread among children
      • Marijuana is not a determining factor in major crimes
      • Public statements about the purported social problems caused by marijuana are unfounded
    • Ansligner, the Caesar of the early drug war, bans further research on marijuana
      • He also starts targeting celebrities for arrest and incarceration to make headlines about his crusade against marijuana
    • Hitler’s Blitzkrieg was a quick tank invasion across all of Europe
      • Running tank crews 24/7 was powered by methamphetamine
    • Hitler injected meth at least five times a day
    • Japanese military had similar use of meth
    • Meth was widely adopted as a way to improve many of the virtues that were seen as core values of America
      • Truck drivers could drive all night
      • Writers could write all night
      • Artists could make art all night
      • Soldiers work longer and harder
      • Etc
    • Meth became the most prescribed drug in history
    • Elvis Pressley was famously introduced to meth by the army
    • Physicians developed 39 common reasons to prescribe amphetamines
      • Everything from hiccups to depression
    • Timothy Leary got the federal marijuana ban overturned in the supreme court
    • The Controlled substances act was then passed which banned many drugs
  • Can Drug Policy Prevent Reefer Madness
    • Do strict alcohol and marijuana laws actually prevent their use?
      • although strict alcohol laws may prevent kids from drinking, strict marijuana laws don’t do much at all to curb use.
    • The [US] treats alcoholic beverage purchase, possession and, in some states, consumption as criminal offenses. It also has the strictest marijuana laws: Purchase and possession (in some states) of marijuana are criminal misdemeanors, and 23 of the 50 states require mandatory sentencing for possession of relatively small amounts.
    • Canada has a more moderate stance on alcohol and drug use. The legal drinking age is 19 in most of Canada, but only 18 in three of its provinces. Marijuana possession and use in Canada is treated as a statutory offense (in most cases), resulting in a fine but not a criminal record or incarceration.
    • The Dutch have no minimum drinking age, but 16 is the minimum age to purchase alcohol. Regulated sales of small amounts of cannabis in “coffee shops” are legal for anyone over the age of 18. Although it is technically illegal to grow and sell the plant, police don’t make drug enforcement a priority.
    • The data provide no evidence that strict cannabis laws in the United States provide protective effects compared to the similarly restrictive but less vigorously enforced laws in Canada, and the regulated access approach in the Netherlands
  • new age of marijuana regulation
    • Although international drug treaties prohibit the production, distribution, and possession of cannabis for non-medical and non-scientific purposes, several jurisdictions have implemented new laws and policies, including some that remove criminal penalties for possession of small doses of cannabis
    • In Spain, Cannabis Social Clubs (CSCs) have been operating since the early 1990s. These clubs produce and share cannabis among their members, both for medical and non-medical purposes.
    • the first Belgian CSC was established in 2006.
      • cultivation of cannabis is currently still illegal under Belgian drug law.
    • the first cannabis retail stores in Colorado opened following the legalisation of cannabis in this state in 2012.
    • Stores in Washington are expected to open in mid 2014.
    • Uruguay has recently become the first country to legalise and regulate production and sale of cannabis for nonmedical and non-scientific purposes, following intense debate and attended by critique from the INCB
    • The review of these four countries’ cannabis production and distribution regimes for non-medical and nonscientific purposes allowed us to identify a number of distinguishing features.
      • in Belgium and Spain there is covert distribution within CSCs
      • in Colorado, Washington, and Uruguay this will take the form of an overt marketplace, with Uruguay allowing cannabis clubs as well.
    • It’s time for a new discussion of marijuana’s risks
      • The benefits and harms of medical marijuana can be debated, but more states are legalizing pot, even for recreational use. A new evaluation of marijuana’s risks is overdue.
      • The greatest concern with tobacco smoking is cancer, so it’s reasonable to start there with pot smoking.
        • A 2005 systematic review in the International Journal of Cancer pooled the results of six case-control studies. No association was found between smoking marijuana and lung cancer
        • There’s no evidence, or not enough to say, of a link between pot use and esophageal cancer, prostate cancer, cervical cancer, non-Hodgkin’s lymphoma, penile cancer or bladder cancer.
        • There’s also no evidence, or not enough to say, that pot has any effect on sperm or eggs that could increase the risk of cancer in any children of pot smokers.
      • Driving while impaired is a major cause of injury and death in the United States. Six systematic reviews were considered of fair or good quality by the national academies, and the most recent one pooled three of the others. It contained evidence from 21 studies in 13 countries representing almost 240,000 participants.
        • For people who reported marijuana use, or had THC detected through testing, their odds of being involved in a motor vehicle accident increased by 20 to 30 percent, the study found. This is, of course, a relative increase, and shouldn’t be confused with the overall percentage chance of getting in an accident, which is much smaller.
      • There’s moderate evidence, from many studies, that learning, memory and attention can be impaired in the 24 hours after marijuana use. There’s limited evidence, however, that this translates into worse outcomes in academic achievement, employment, income or social functioning, or that these effects linger after the pot has “worn off.”
      • Are people who smoke pot more likely to develop mental health problems? Or are people with mental health problems more likely to smoke pot? It’s complicated.
      • risk of a “contact high,” the amount of THC detectable in secondhand smoke is negligible.
      • Almost all the harms the medical literature focuses on involve smoked cannabis. We know little to nothing about edibles and other means of administration. Nor do we have any consistent manner of measuring the level of exposure.
      • it’s important to note that the harms we know about now are practically nil compared with that of many other drugs, and that marijuana’s effects are clearly less harmful than those associated with tobacco or alcohol abuse.
    • cannabis capitalism
      • Two hours north of San Francisco, in Mendocino county, orderly roadside vineyards give way to the rugged forests and misty coast of the Emerald Triangle, America’s most celebrated marijuana growing region.
      • In California alone, tens of thousands of farms grow the plant, which is increasingly processed into gorgeously packaged vape pens and edibles marketed to customers outside the core stoner demographic of young men.
      • since Colorado opened the world’s first regulated recreational marijuana market, the business climate for weed companies has proven immensely difficult for a range of reasons, including high taxes, rapidly changing regulations and a still robust illicit market.
      • While white Americans use marijuana and other drugs at roughly equal rates to African Americans and Latinos, in virtually every respect, racial minorities have been disproportionately incarcerated and otherwise punished for involvement with drugs, including selling marijuana.
      • One company, Acreage Holdings, which closed on $119m in investment capital this summer, has enlisted the former Republican speaker of the House John Boehner to help it navigate the market. Boehner has never smoked pot – “he hasn’t felt the need or inclination”, according to a spokesperson – and he declared himself “unalterably opposed” to legalization when he was in office. With legal marijuana now one of the country’s fastest-growing industries, who profits is as much of a civil rights question as who gets punished.
      • The industry’s moral challenge is to ensure the groups who have suffered the most under the drug war can participate in the green rush and enjoy the spoils of legalization.
      • Oakland’s equity program had been laboriously developed over years to maximize not just jobs for Oaklanders but local ownership of marijuana companies.
      • Marijuana farming in California has never been easy. Those who succeed are skilled, cunning and well-versed in the law.
    • A billion dollar industry, a racist legacy
      • Three years ago, Jesce Horton, a former engineer in his early 30s, quit his corporate job to set up his own small, family-owned cannabis cultivation business in Portland, Oregon.
      • the young entrepreneur sees the partial legalization of cannabis as an opportunity not just for business, but to acknowledge past wrongdoing and seek economic justice.
      • There is an obvious chasm between the number of people of color who have been jailed for simple possession during the “war on drugs” and the number of white men who are starting to make millions in profit from the industry.
      • Last year, an investigation by Buzzfeed estimated that less than 1% of cannabis dispensary owners across the country were black.
      • Solutions are now being explored through reparations – mainly in the form of measures addressing this imbalance. For the first time, policy and local pieces of concrete legislation in cities including Oakland, California, and Portland, Oregon, encourage participation in the regulated marijuana industry by communities of color, or reinvestment into these communities.
      • Cannabis culture may be open in ethos, but so far, with few exceptions, the industry has proven itself glacier white. Horton and fellow advocates offer three reasons for this.
        • most states have barred anyone with a criminal record from entering the industry. The US is home to an 70 million Americans with criminal records, and a  number of those are men of color (according to a Pew Research Center  in 2013, black men were six times more likely to be incarcerated than white men).
        • depending on the state, the economic barriers to entering the industry (application fees, license fees and startup fees) are extortionately high.
        • even where there are funds to be sourced, communities of color are often loath to take a chance on openly doing business with a drug they have seen too many of their kin targeted, criminalized and locked up over.
      • “Unless measures are taken to recognize and reconcile the harm done by the war on drugs, unless we reach out to communities of color to include them, communities will see legal cannabis as a slap in the face and won’t use it,” Horton says.
      • the American Civil Liberties Union (ACLU) found that over the course of the first decade of the 21st century, even as cannabis legalization was beginning to take hold, cannabis arrests increased, rather than the opposite. The study recorded 8m marijuana arrests across the country, 88% of which were for possession alone.
      • Oakland, California, has offered perhaps the most groundbreaking laws to date addressing the issue.
        • Under new rules, at least half of new cannabis business permit holders, issued by the city at a maximum rate of eight a year, will have to go to “equity applicants”. Applicants must earn less than 80% of the city’s median income; and they must either have been residents of police beats disproportionately targeted by law enforcement in recent decades, or they must have been sent to prison on cannabis charges within the last 20 years.
      • The Dirty Secret of California’s Cannabis, It’s Dirty
        • Someone’s gotta grow it, and in Northern California, that often means rogue farmers squatting on public lands, tainting the ecosystem with pesticides and other chemicals, then harvesting their goods and leaving behind what is essentially a mini superfund site. Plenty of growers run legit, organic operations—but cannabis can be a dirty, dirty game.
        • As cannabis use goes recreational in California, producers are facing a reckoning: They’ll either have to clean up their act, or get out of the legal market. Until the federal prohibition on marijuana ends, growers here can skip the legit marketplace and ship to black markets in the many states where the drug is still illegal. That’s bad news for public health, and even worse news for the wildlife of California.
        • Labs are checking marijuana products for contaminants as well as toxic agricultural chemicals
      • there was less crime in border states after medical weed was legalized
        • Medical marijuana has proven indispensable for many people, from autistic children to veterans with PTSD. There’s even a case to be made that, used as a painkiller, marijuana could help solve the country’s opioid problem.
        • A new study suggests that medical marijuana laws (now on the books in 29 states and Washington, DC) have led to a decrease in violent crime in states that border Mexico. Areas closest to the border saw the most pronounced drop overall, as well as in crimes related to drug trafficking, which suggests that legalizing the production and distribution of marijuana in the United States is hurting Mexican drug trafficking organizations.
        • To see how changes in state laws affected traffickers, researchers used data from Uniform Crime Reporting Program, an FBI-maintained database. They found that MMLs were linked to a 12.5 percent decrease in violent crime—homicides, aggravated assaults, and robberies—in states bordering Mexico. Using data from the FBI’s Supplementary Homicide Reports, they attributed the decrease in homicides largely to a drop in drug-related killings.
        • drug markets are, after all, markets. They’re violent, but defined by rules of supply and demand; illegal, but not beyond the law of competition. High-tech fences haven’t kept out drugs or deterred the violence associated with their distribution, but legal, non-violent competitors just might.
      • getting worse, not better
        • In the forests of Northern California, raids by law enforcement officials continue to uncover illicit marijuana farms.
        • In Southern California, hundreds of illegal delivery services and pot dispensaries, some of them registered as churches, serve a steady stream of customers.
        • In Mendocino County, north of San Francisco, the sheriff’s office recently raided an illegal cannabis production facility that was processing 500 pounds of marijuana a day.
        • the unlicensed, illegal market is still thriving and in some areas has even expanded
        • “We are the taxpayers — no one else should be operating,” said Robert Taft Jr., whose licensed cannabis business in Orange County, south of Los Angeles, has seen sales drop in recent months.
        • Only 620 cannabis shops have been licensed in California so far. Colorado, with a population one-sixth the size of California, has 562 licensed recreational marijuana stores.
        • many cannabis businesses are reluctant to go through the cumbersome and costly process to obtain the licenses that became mandatory last year
        • roughly 14 million pounds of marijuana is grown in California annually
          • less than 20 percent is consumed in California
        • criminal enforcement in the past had disproportionately targeted people of color.
        • “We can’t do Drug War 2.0,” she said.
        • Licensed dispensaries pay a cumulative state and local tax rate of 32.25 percent. Unlicensed shops pay no tax.

Drugs and Society: Hallucinogens

CJ Trowbridge

2020-06-11

Drugs and Society

Reading Response – Section 4

  • Illegal drugs and how they got that way – hallucinogens
    • All currently illegal drugs were recently legal
    • All cultures have parties, usually including the use of drugs
    • Ecstasy fills an unmet need for connection, empathy, connectedness, and openness between people in a hostile culture, especially for young people
    • Young people throughout history have always used drugs to escape their hostile cultures
    • Drugs unite generations
    • Ecstasy is not chemically addictive
    • The pentagon tried and failed to find a way to ecstasy it as a weapon
    • Shulgin showed psychotherapists how to use ecstasy for therapy
    • Despite current medical use, the DEA overruled the judge who was ruling on the drug’s status and banned any further research into its safety and lack of addiction potential.
    • “One man’s schizophrenia is another man’s enlightenment.”
    • Early on in prohibition, possession of a single dose of LSD could be punished with a twenty-year prison sentence.
    • Leary: Turn on, tune in, drop out.
      • Psychedelics quickly became a threat to the authoritarian establishment
      • Ban leads to a whole series of bans on any drugs that are directly a threat to the authoritarian establishment, or associated with any ethnic or racial group outside of white nationalism and systemic racism in America.
    • The government came to see psychedelics as a causal factor behind the civil rights movement and other activist movements, and therefore took stands against psychedelics in order to prevent future social progress.
    • “Since the use of marijuana and other narcotics is widespread among members of the New Left, you should be alert to opportunities to have them arrested by local authorities on drug charges.” -J Edgar Hoover
    • Nixon runs on widespread prohibition of drugs
    • The Controlled Substances Act gave the president unlimited power to declare drugs illegal for specific people under specific circumstances and mass incarcerate them.
      • Nixon used it to mass incarcerate social dissidents during the Vietnam War.
      • No longer does congress have a role in drug police
    • Michael Pollan on What It’s Like to Trip on Mushrooms
      • Stamets says that like many psilocybin species, “azzies are organisms of the ecological edge. Look at where we are: at the edge of the continent, the edge of an ecosystem, the edge of civilization, and of course these mushrooms bring us to the edge of consciousness.”
      • Why in the world would a fungus go to the trouble of producing a chemical compound that has such a radical effect on the minds of the animals that eat it? What, if anything, did this peculiar chemical do for the mushroom?
        • One could construct a quasi-mystical explanation for this phenomenon, as Stamets and Terence McKenna have done: Both suggest that neurochemistry is the language in which nature communicates with us, and it’s trying to tell us something important by way of psilocybin. But this strikes me as more of a poetic conceit than a scientific theory.
      • many plant toxins don’t directly kill pests, but often act as psychostimulants as well as poisons, which is why we use many of them as drugs to alter consciousness
        • Think of an inebriated insect behaving in a way that attracts the attention of a hungry bird
      • Instead of seeing nature as a collection of discrete objects, the Romantic scientists—and I include Stamets in their number—saw a densely tangled web of subjects, each acting on the other in the great dance that would come to be called coevolution.
        • “Everything,” Humboldt said, “is interaction and reciprocal.” They could see this dance of subjectivities because they cultivated the plant’s-eye view, the animal’s-eye view, the microbe’s-eye view, and the fungus’s-eye view—perspectives that depend as much on imagination as observation.
      • You are probably wondering what ever happened to the azzies Stamets and I found that weekend. Many months later, in the middle of a summer week spent in the house in New England where we used to live, a place freighted with memories, I ate them, with my wife Judith.
        • However, after only about 20 minutes or so, Judith reported she was “feeling things,” none of them pleasant. She didn’t want to be walking anymore, she said, but now we were at least a mile from home. She told me her mind and her body seemed to be drifting apart and then that her mind had flown out of her head and up into the trees, like a bird or insect.
      • I went out and sat on the screened porch for a while, listening to the sounds in the garden, which suddenly grew very loud, as if the volume had been turned way up.
      • Whenever I closed my eyes, random images erupted as if the insides of my lids were a screen.
      • I discovered that all I needed to do to restore a sense of semi-normality was to open my eyes. To open or close my eyes was like changing the channel. I thought, “I am learning how to manage this experience.”
      • I felt as though I were communing directly with a plant for the first time and that certain ideas I had long thought about and written about—having to do with the subjectivity of other species and the way they act upon us in ways we’re too self-regarding to appreciate—had taken on the flesh of feeling and reality.
      • “Everything is interaction and reciprocal,” wrote Humboldt, and that felt very much the case, and so, for the first time I can remember, did this: “I myself am identical with nature.”
    • researchers turn to popular club drug to treat ptsd
      • Mdma releases dopamine, oxytocin, and serotonin in the brain
      • In therapy, it helps patients open up about trauma
      • It was first used this way in therapy before finding adoption in clubs
      • Examples from therapy case studies
        • Use in treating PTSD
      • Studies have shown that mdma was efficacious for 82% of participants in ptsd trials
    • dancesafe
      • This website was broken when I tried to open it, but I am very familiar with dancesafe. They test drugs for people at parties, and in harm reduction more broadly. I work at a nonprofit in SF which throws big parties. This year we built an internal department which mirrors dancesafe and provides many of their services at our events, in partnership with Zendo and several other similar organizations
    • mind altering drug could offer life free of heroin
      • Several clinical trials have shown that low doses of ibogaine taken over the course of a few weeks can greatly reduce cravings for heroin and other drugs.
      • Ibogaine’s mind-altering effects mean that today, the US Drug Enforcement Agency defines it as having a high potential for abuse with no recognised medical use. It is classed as a schedule I drug, the most restrictive legal designation.
      • the Multidisciplinary Association for Psychedelic Studies (MAPS), a US non-profit research organisation, decided to investigate whether there was any scientific validity to the reports.
        • Legal restrictions in the US severely limit funding for clinical trials of this kind, so the volunteers recruited – this is where I come in – were those who had sought treatment independently in Mexico, where there are fewer restrictions on ibogaine use.
      • With my withdrawal symptoms completely gone, I am perplexed by the state of clarity I am in while seeing the most profound stream of visual phenomena. I am also filled with a sense of awe at the potential for a life free of heroin. Emotional memories force me to deal with some of the deep subconscious guilt I have repressed for years
      • the results appear to show compelling preliminary evidence of ibogaine’s efficacy at a single dose
      • Of the 29 others who took part in the trial, none are now reported as having problematic drug use. Two years after that one dose of ibogaine, I abstain from all drugs.
    • the heady, thorny journey to decriminalize magic mushrooms
      • In recent years researchers have shown that psychedelics like mushrooms and LSD appear to treat a range of disorders, including depression and PTSD.
      • the FDA has granted MDMA breakthrough status in phase 3 trials, thus fast-tracking the approval process. Psilocybin itself is undergoing two separate clinical trials.
      • Oakland, California, city council voted unanimously to decriminalize a range of psychedelic plants, including mushrooms and cacti
      • Oregon is considering a measure in 2020 to allow access to “guided psilocybin services,” while lowering penalties for possession.
    • ayahuasca, a strong cup of tea
      • After arranging yoga mats and blankets on the floor, they each paid $150, listened to a Colombian shaman and his assistant welcome them in Spanish and English, signed a disclaimer, and accepted large plastic takeout-style containers for vomiting.
      • each got up to receive a cup of thick brownish liquid with a muddy herbal taste. It was ayahuasca (eye-uh-WAH-skuh) tea, a hallucinogenic brew from the Amazon that they hoped would open them to personal insights through optic and auditory hallucinations.
      • In a world increasingly dominated by screen time, not dream time, it is not surprising that many people, having binged on yoga and meditation for years, are turning to a more dramatic catalyst for inner growth. But those who swear by ayahuasca’s usefulness (many say it’s like having 10 years of therapy in a night) also caution that it has to be treated seriously, calling their experiences while under its influence “work” because, in addition to causing them to vomit and sometimes have diarrhea, it can be frightening and challenging to the psyche.
      • although two religious organizations in the United States are sanctioned to use it legally, the N, N-Dimethyltryptamine (or D.M.T.) in ayahuasca is a Schedule I controlled substance — considered to have no medical use and a high potential for abuse. It is in the same category as ecstasy and heroin.
      • a visit for ayahuasca tourists can become a nightmare, “and some don’t go home at all.” Inexpertly mixed brews or the use of another more dangerous plant, Toe, have contributed to bad reactions, as well as poor screening for medical issues. There have been cases of sexual molestation, too.

Drugs and Society: Legal Drugs

CJ Trowbridge

Drugs and Society

2020-06-09

Section 3 Reading Response

  • treat drug users as you would want to be treated
    • We are all drug users. Coffee, alcohol, cigarettes, weed, Viagra, ecstasy, antidepressants, anti-anxiety pills and more: people are using these drugs on a weekly or even daily basis.
      • Coffee helps me start my day and gives me a little boost in the afternoon. While I know how harmful my cigarette habit is, it also gives me pleasure.
    • It’s clear to me that some of my drug use is because of stress and an attempt to push down some anxiety and difficult feelings. Life can be hard.
    • While most people use drugs, not everyone has the same relationship with these different drugs and some of us have different experiences with drugs depending on the night or what is going on in our life at that time.
    • While it is counterintuitive, it is worth pointing out that the overwhelming majority of people who use drugs don’t become addicted.
      • Carl Hart, a neuroscientist and professor at Columbia University has done groundbreaking work around drug use and addiction and notes that, “80 to 90 percent of people who use illegal drugs are not addicts. They don’t have a drug problem. Most are responsible members of our society. They are employed. They pay their taxes. They take care of their families. And in some cases they even become president of the United States.”
    • While drug use and abuse don’t discriminate, our drug policies do. The war on drugs is a vicious war on people and African Americans and people of color feel the brunt of this war. Despite similar rates of use and sales, African Americans go to prison at 13 times the rates of whites for drugs.
    • So if we can agree that the majority of people in society are using drugs, and if most people who use drugs don’t have a problem, what should be done about it?
      • 1) Offer treatment and compassion to people who want help for their drug problems;
      • 2) leave people alone who don’t want or need treatment;
        • the vast majority of people who use drugs don’t have problems from their use.
      • 3) continue to hold people responsible for crimes that harm others;
      • 4) fight like hell to end the war on drugs and stop locking up our brothers and sisters.
    • Deadly Persuasion
      • Alcohol and nicotine are by far the most widely used drugs, and they do by far the most damage.
      • These are also some of our most heavily advertised products
      • Nicotine kills more people than all other drugs plus car deaths, homicides, suicides, and aids combined.
      • Over $9b/year spent on cigarette advertising in the us
      • $3b/year spent on alcohol advertising in the us
      • Advertising for smoking and drinking are a public health issue.
    • Tobacco Education and Media
      • The video argues that kids take queues from celebrities on how to behave
        • These celebrities are often used as advertising tools for cigarettes and alcohol.
      • Kids say they are not affected by media
      • The fact that kids can recognize logos and brands is seen as evidence that they will start smoking and drinking if actors smoke and drink.
      • Literacy education should include critical thinking and skepticism of advertising
    • Ban on former legal highs has driven trade underground
      • The government’s blanket ban on novel psychoactive substances, formerly legal highs, has succeeded in shutting down high street trade in the substances but has led to products such as Spice being added to the regular menu of illicit street dealers, according to an authoritative report.
      • Gangs from inner-city drug hubs in London, Liverpool and Birmingham are moving into more rural areas and using higher-quality drugs to take over local dealing networks.
      • One police officer told researchers that 14 out of the 24 shops in his area had closed in the week before the law came into force, before the police had a chance to deliver a warning letter. The north-east area ambulance service reported a significant reduction in NPS-related callouts after May. However, the report says that as a result of the ban, Spice and other NPSs have become just another street drug being sold by illicit dealers.
    • how big tobacco got a new generation hooked
      • While teenage cigarette smoking rates have recently fallen below 5 percent, America is now contending with an epidemic of young people using e-cigs, vapes and other nicotine delivery devices,” as the tobacco industry christened them years ago in secret memos, searching for an official alternative to describing their products as cigarettes.
      • If Juul were serious about marketing to adults, it could use pinpointed digital marketing to make sure that those seeing its ads are over 21. Stanford researchers found the company’s launch marketing “was patently youth-oriented.”
      • Traditional tobacco products have strict regulations. But since Juul is a nicotine delivery device with no tobacco leaf, it is largely free to market as aggressively as possible. You won’t hear cigarette ads on the radio. You could hear from Juul. You can’t see cigarette ads on your televison. But you might see one for Juul, or any of the others.
    • The World Pushes Back Against E Cigs and Juul
      • “in five years, 50 percent of Juul’s revenue will be international “ -CEO
      • The company has been met with ferocious anti-vaping sentiment and a barrage of newly enacted e-cigarette restrictions, or outright bans, in country after country. As a result, its ambitious overseas plans have collapsed.
        • The company has been met with ferocious anti-vaping sentiment and a barrage of newly enacted e-cigarette restrictions, or outright bans, in country after country. As a result, its ambitious overseas plans have collapsed.
        • Juul was kicked off the market in China last fall after just four days. The company has had to abandon plans for India after the government there banned all electronic cigarettes. Thailand, Singapore, Cambodia and Laos have also closed the door to ecigarettes. In the Philippines, President Rodrigo Duterte ordered the arrest of anyone caught vaping outside designated smoking areas.
        • Juul has postponed its launch in the Netherlands and has pulled out of Israel. In South Korea, the number of Juul customers has plummeted after the government issued dire health warnings about e-cigarettes, and the company has scaled back its distribution there.
        • “It has been an extraordinarily quick backlash,” said Kathleen Hoke, director of the Network for Public Health Law at the University of Maryland. “Countries that you wouldn’t necessarily describe as progressive public health nations are attacking this new product so that it doesn’t become embedded in their culture as cigarettes have.”
      • Public health officials abroad fear the same youth vaping epidemic that has been declared in the United States. Although Juul stopped selling its fruit- and dessert-flavored nicotine pods in the United States ahead of the national ban, it has not done so overseas, where it is offering glacier mint, mango nectar, royal crème, alpine berry, and until recently, apple orchard.
      • South Korean health officials, prompted by the outbreak of lung ailments in the U.S., issued a stark warning about e-liquids, saying they posed the risk of “serious lung damage and even death.” A month later, the South Korean Army banned e-liquids on all military installations. In December, South Korean health authorities announced the results of testing on a number of vaping products, including the apple orchard flavor formerly made by Juul, and said that in some products they had detected trace amounts of vitamin E acetate, the adulterant U.S. health authorities have linked to most of the lung injury cases.
      • “Juul has been very aggressive in India, and they hired well-known lobbyists,” said Ms. Shah. The end came swiftly. In November, around the time Juul had planned to launch, Prime Minister Narendra Modi signed a law banning the manufacture and sale of any e-cigarettes.
      • Philippine president Duterte banned most e-cigarette products including potential arrest for using them.
      • While Juul often labels itself as a harm reduction product, the fact that they deliberately market dessert flavors to children disproves any claim that they are good people trying to improve conditions for smokers.
    • The opioid crisis changed how doctors think about pain
      • WILLIAMSON, West Virginia — This town on the eastern border of Kentucky has 3,150 residents, one hotel, one gas station, one fire station — and about 50 opiate overdoses each month.
      • On the first weekend of each month, when public benefits like disability get paid out, the local fire chief estimates the city sees about half a million dollars in drug sales.
      • “Elderly folks who depend on blood pressure medications, who can’t afford them, they’re selling their [painkillers] to get money to buy their blood pressure drug
      • The underlying drugs are often being prescribed for real reasons.
      • where drug companies pushed too-good-to-be-true statistics that promised opioids to be safe and effective, when they were in fact addictive and deadly.
      • Pharmaceutical companies sent 780 million opioid pills to West Virginia — a state with fewer than 2 million residents — over six years
      • In the 1990s, a new movement swept through professional medicine that urged providers to not just reduce pain but cure it entirely.
        • pain scales with smiley faces and scowls suddenly appeared in doctors’ offices
        • big hospital systems, including the Veterans Health Administration, dubbed pain the “fifth vital sign,” just as important as blood pressure and temperature
        • opioid painkillers, meanwhile, had just begun to roll onto the market. They promised the pain relief that doctors now believed they needed to deliver
        • “There was a push that we had to get pain to zero,”
      • The ensuing opioid addiction crisis has now forced doctors to rethink some very fundamental pillars of how they practice medicine: How much can they do to treat pain? Were they right to consider it a vital sign? How much should they do? Is it more ethical to ask patients to live with pain when they know relieving pain can have horrific side effects?
      • Doctor groups have recently begun pushing for a new practice of medicine that deemphasizes the role of pain. Accordingly, the federal government announced in 2016 that it would not pay out financial rewards to the hospitals that have the biggest reductions in patients’ pain.
      • “Most of us went into medicine to alleviate suffering,” says Andrew Gurman, president of the American Medical Association. “One of the expectations our patients have is that pain can be completely eliminated. We as a medical community are coming to an understanding that this is not realistic.”
      • In November 1998, the Veterans Health Administration sent a memo to its 1,200 clinics requiring clinicians to ask patients’ about their pain level at each visit. The initiative was called “Pain as the 5th Vital Sign.” A pain score above 4 was meant to trigger “a comprehensive pain assessment and prompt intervention.”
      • “I could hear my nurses taking the history of patients, taking the vital signs, and then asking, ‘Do you have any pain today?’” Young says. “It’s not what the patient is there for, but then it’s like, well, now that you mention it, my left toe has been hurting me. It felt like patients got more demanding that they get medication.”
        • “People thought their pain should be a zero,” he says of his patients. “If you injure yourself or have a chronic injury, your pain is never going to be zero. But there was this expectation of getting there, and the goal of acquiring the smile face instead of the scowl.”
      • over time, patients develop a tolerance to opioids and require higher and higher doses to achieve pain relief
      • articles have found that long-term opioid users do no better at regaining quality of life than those who don’t use the prescriptions
      • “The intensity level of pain is not a good outcome to measure,” Ballantyne says. “If you focus just on pain intensity, the tendency is just to use opioids, because opioids are the only thing that will reduce pain so immediately.”
      • “We have felt trapped now, for years, between patients wanting their pain adequately treated and the safety of the products we have available for treating their pain,”
      • “The goal of pain relief should be 30% to 55% improvement, and therefore the patient should be expecting tolerable pain levels, not 0 pain levels,” Harvard surgeon Haytham Kaafarani and his co-authors argued.
      • “Assessing and understanding the impact of pain doesn’t mean we write a prescription for an opioid,”
      • “The problem of persistent pain is widespread,” said Kevin Vowles, a health psychologist at the University of New Mexico. “The evidence base for interventions like surgery or medications has never been super strong for getting people back to participating more fully in life.”
    • alcohol and harm reduction
      • In the late nineteenth and early twentieth centuries, a commitment to alcohol prohibition became the leading force in alcohol temperance movements in the USA, Britain and its English-speaking colonies and dominions, and in most of the Nordic countries. In the context of the First World War, these movements succeeded in their goals in the USA, Canada, Finland and Russia, and came close to success in Norway, Sweden, Iceland and New Zealand. In all of these countries, alcohol prohibition proved to be controversial, however, and was sooner or later abandoned.
      • In the language of the time, this alternative was known as ‘liquor control’. In current language, we might think of it as a harm-reduction movement. That is, it started from an acceptance of the use of alcohol, but sought to structure and influence the use so as to limit the social and health harm from drinking
      • Most alcohol prohibitionists, therefore, had an abiding dislike for the liquor control alternative, and were willing to see things get worse, from their perspective, rather than accept its solutions.
      • reducing ‘public nuisance’ has often been a source of political support for harm-reduction programmes, factored into such specifics as the location of programmes.
      • The alternative framing is to define harm reduction in terms of the goal—a goal of reduction of harm from alcohol or drug use, as opposed to a goal of elimination or prevention of the use. In this framing, a wide variety of strategies can be counted as harm reduction, including even the prevention of use.
      • The aims of liquor control
        • Focus on the harms
        • Pragmatism in policy
        • Liquor control and the inveterate drinker
      • One striking commonality between the modern drug harm-reduction movement and the liquor control approach of the early twentieth century is the positioning of both as the alternative to and antagonist of prohibitory approaches. In both cases, the political weight tended to lie with the prohibitory approach (at least through the early 1920s in the case of liquor control), while both drug harm reduction and liquor control commanded strong intellectual resources as well as practitioners with much practical experience.
    • toxic and untaxed
      • half of all alcoholic drinks consumed in countries across Africa and Latin America are illicit
        • Methanol, mortuary formaldehyde and battery acid were among a cocktail of toxic ingredients found in unregulated drinks
      • In Kenya, one of the most common varieties of home-produced alcohol is called “chang’aa”, or “kill me quick” . The spirit is widely available in poor townships and is often made with contaminated water and potentially lethal methanol. One variant, “jet-five”, is spiked with jet fuel, while another contains embalming fluid.
      • The production of illegal alcohol, which is cheaper and often more readily available than regulated alcohol, is largely driven by poverty, the report found
      • In five of the seven African countries examined – Uganda, Tanzania, Cameroon, Malawi and Mozambique – at least 61% of the alcohol consumed is illicit. Unrecorded alcohol is also widespread across Asia and in parts of Europe, the report said, but comparable data was not available. In Russia, bootleg accounts for 38% of all alcohol consumed.
    • Reducing Harm from Youth Drinking
      • Alcohol is the psychoactive substance used the most often by adolescents and college students and is associated with more youthful dysfunction and morbidity than any other drug.
      • The thrust in the public health field has been towards labeling alcohol an addictive drug and towards reducing and even eliminating youthful drinking.
      • Differences in drinking have frequently been noted among religious groups in the U.S. and elsewhere, including among youth and college students. Drinking by Jews has been one special object of attention due to their apparently low level of drinking problems. Weiss indicated that, although drinking problems in Israel have increased in recent decades, absolute rates of problem drinking and alcoholism in Israel remain low compared with Western and Eastern European countries, North America, and Australia.
      • The nonproscriptive approach to alcohol characterizes not only Jewish drinking. Some American Protestant sects are highly proscriptive towards alcohol (e.g., Baptists); others (e.g., Unitarians) not at all. Kutter and McDermott studied drinking by adolescents of various Protestant affiliations. More proscriptive denominations were more likely to produce abstinent youth, but at the same time to produce youth who binged, and who binged frequently. That is, while 90 percent of youth in nonproscriptive sects had consumed alcohol, only 7 percent overall (or 8% of drinkers) had binged 5 or more times in their lives, compared with 66 percent of those in proscriptive sects who had ever consumed alcohol, while 22 percent overall in these sects (33% of drinkers) had binged 5 or more times.
      • These European data show regular drinking is inversely related to binge drinking. Countries in which people are unlikely to drink daily (Ireland, UK, Sweden, and Finland) have high binge drinking rates, while countries with higher rates of daily drinking (e.g., France, Italy) have lower levels of binge drinking.
      • At this point, it is obviously easier to point to failures in alcohol education and prevention programs for youths than to identify successes.

Drugs and Society: Public Health and Harm Reduction

CJ Trowbridge

HED 315

2020-06-04

Reaction Paper: Unit 2

  • Reducing Drug Related Harm (Powerpoint)
    • Course goal: To give participants the opportunity to examine drug-related harm, and help participants gain a basic understanding of how harm reduction principles, policy and practice work together to address that harm.
    • Harm reduction is an approach that aims to reduce drug-related harm experienced by individuals and communities, without necessarily reducing the consumption of drugs.
    • Racial disparities in enforcement
      • 1992: 92.6% of federal crack arrests were black.
      • 1991: 52% of those reporting crack use were white.
      • 1993: 88% of federal crack distribution convictions were black; 4.1% were white.
    • Racial disparities in sentencing
      • 5 grams of crack cocaine = 5 years in prison
      • 500 grams of powder cocaine = 5 years in prison
    • Drug, set, and setting
      • Drug: pharmacology
      • Set: individual drug user
      • Setting: contexts of drug us
    • Continuum of drug use: Low risk -> ? -> high risk
      • Abstinence
      • Experimental
      • Occasional
      • Regular
      • Heavy
      • Chaotic
    • Structural factors impact harm
      • Race
      • Class
      • Sex
      • Gender
      • Sexuality
    • Types of harm
      • Physical
      • Psychological
      • Social
      • Economic
      • Legal
      • Political
    • European context of harm reduction
      • Universal healthcare
      • Political pragmatism
      • Activism and inclusion
    • Merseyside Model of Harm Reduction
      • HIV is a greater thread than drug use
      • Abstinence should not be the only goal
      • Reach out to users
      • Innovate with services
      • Multi-disciplinary approach
    • US context for harm reduction
      • No universal healthcare
      • Cutbacks in welfare
      • Politics not science
      • Punishment instead of treatment
      • Institutional racism
    • Effects of the US war on drugs
      • Lack of information
      • High opportunity costs
      • Increase in drug related harm
      • Growth of prison industrial complex
        • 5 million people incarcerated
        • 25% are for drug charges
        • 95% of the 1985-1995 prison population increase was drug related
      • Principles of Harm Reduction in the US context
        • Decision to use drugs is accepted
        • Drug users treated with dignity
        • User expected to take responsibility for their own behavior
        • Reducing harm, not consumption
        • No pre-defined outcomes
      • Growing support for harm reduction
        • Scientific evidence
        • New political leadership
        • Waning support for war on drugs
        • Frustration with the abstinence model
      • Harm reduction program elements
        • User involvement
        • Any positive change is good
        • Supportive agency policy
        • Collaborations with other providers on the continuum
      • Harm reduction in practice
        • Making contact
        • Meeting survival needs
        • Engaging
        • Holistic needs assessment
        • Focus on consumer’s own needs and goals
        • Meeting needs to reduce harm
        • Maximizing health and potential
      • Collaborative model
      • Harm Reduction Theory (pdf)
        • Abstract: This paper discusses the user side of harm reduction, focusing to some extent on the early responses to the HIV/AIDS epidemic in each of four sets of localities—New York City, Rotterdam, Buenos Aires, and sites in Central Asia. Using available qualitative and quantitative information, we present a series of vignettes about user activities in four different localities in behalf of reducing drug-related harm. Some of these activities have been micro-social (small group) activities; others have been conducted by formal organizations of users that the users organized at their own initiative. In spite of the limitations of the methodology, the data suggest that users’ activities have helped limit HIV spread. These activities are shaped by broader social contexts, such as the extent to which drug scenes are integrated with broader social networks and the way the political and economic systems impinge on drug users’ lives. Drug users are active agents in their own individual and collective behalf, and in helping to protect wider communities. Harm reduction activities and research should take note of and draw upon both the micro-social and formal organizations of users. Finally, both researchers and policy makers should help develop ways to enable and support both micro-social and formally organized action by users.
          • Drug users are active agents in their own individual and collective behalf, and in helping to protect wider communities.
          • both researchers and policy makers should help develop ways to enable and support both micro-social and formally organized action by users.
        • IHRA recommends that the term harm reduction should be understood to mean, ‘policies and programmes which attempt primarily to reduce the adverse health, social and economic consequences of mood altering substances to individuals drug users, their families and their communities.
        • We have seen users themselves as the ones with primary agency in harm reduction. It is their actions that do or do not transmit infections, do or do not result in overdoses, do or do not create problems for their neighbours.
          • Agencies like syringe exchanges can provide risk-reduction supplies, information and counselling, but users themselves – individually and in groups – take the decisive actions.
        • The authors focus on case studies of four areas and the way the presence or lack of the afore-mentioned principles of harm reduction impacted the spread of HIV and the public health response to HIV.
        • New York
          • In 1975 New York, “IDUs were living in a particularly hostile legal and sociopolitical environment… New York City government’s fiscal crisis led to the closing of many social services. Partly because of this, massive waves of arson-induced and other fires ravaged impoverished and minority areas of the city, leaving behind considerable community demoralization, overcrowding and many half-destroyed structures that became the sites of shooting galleries in which HIV spread rapidly among IDUs… During the 1980s, New York IDUs also faced increased stigmatization, incarceration rates, community hostility, and police pressure due to an enhanced Federal government “War on Drugs” and then to an emerging large-scale “crack epidemic” among poor minority youth.”
          • The public health response to the epidemic among IDUs was long-delayed and limited because: (1) New York was the “first city” to confront epidemic HIV among IDUs; (2) the massive demonization of drug users made both officials and communities slow to react, and led to opposition from higher authorities that slowed the beginning of syringe exchange for years. Opposition to syringe exchange included sections of the African-American community. Even outreach and treatment-based educational efforts for IDUs began to emerge only in 1986, and they were slow to develop.
          • A massive city-wide, semi-public illegal street market in sterile syringes began in the late 1970s and rapidly expanded in the early 1980s.
          • Had HIV incidence rates continued at the 10+ percent rates of the last years of the 1970s, HIV prevalence among IDUs would have reached levels of 70 percent or more by the time large-scale outreach began in 1987 and even higher rates by the time syringe exchange began. Luckily, this tragedy was mitigated to a degree by the grass-roots, micro-social actions of many IDUs themselves, so HIV prevalence never reached above 50 percent or, in some local areas of New York, perhaps 60 percent.
          • Starting in 1990, a group of activists that contained both current and former IDUs, members of ACT UP, and NDRI researchers on their “free time,” organized themselves and set up a number of underground syringe exchanges in several locations in the City. This created circumstances that facilitated New York State’s making them legal and then funding them later on.
        • Rotterdam
          • In 1986, the first HIV study among Rotterdam IDUs found 12 percent HIV-positive. This rate never got any higher. In Amsterdam, one hour’s drive from Rotterdam, HIV-prevalence among IDUs was already 30 percent in 1986, a figure which gradually declined to 26 percent in the second half of the nineties.
          • In the early 1980s, before HIV was known to be prevalent in the Netherlands, the Dutch government had changed its drug policy from a psycho-therapeutic and detoxification-oriented approach towards harm reduction, including large-scale methadone maintenance programmes. Absolute priority was given to keeping IDUs from penury, malnutrition, homelessness and bad health. This context was relatively supportive for self-organization of drug users. Most drug users had homes.
          • Grassroots groups rose up to meet the need for sterile needles and dissemination of information, without having to face a hostile domestic political and sociocultural landscape like that of the US.
          • By the end of the 1980s needle exchange programmes were operational in 60 Dutch cities.
        • Buenos Aires
          • The first AIDS case from injecting drug use in Argentina was diagnosed in 1985.
          • Injecting use has become a more hidden and individual practice. In many cases the IDUs do not talk about their injecting practice even with their partners. Their silence is related to the stigma that associates drug injecting with AIDS and death.
            • In contrast to the New York “shooting galleries” where large groups used together, sharing needles.
          • Friendship groups of drug injectors in Buenos Aires reacted to HIV infections and AIDS deaths in their social networks by reducing their risk behaviours beginning in the late 1980s when they began to develop an understanding of the disease. This was well before harm reduction programmes began there in the late 1990s.
          • Harm reduction programmes began in the late 1990s in the Buenos Aires Metropolitan Area conducted by NGOs. It took several years more to involve governmental agencies in the acceptance and development of harm reduction strategies.
        • Central Asia
          • The injection-driven HIV epidemics in countries of the former Soviet Union constitute the fastest growing HIV epidemics in the world.
          • Use of homemade opiates in medicinal teas, a practice indigenous to Uzbekistan’s villages, has, since the collapse of the Soviet Union, been largely overtaken by injection of opiate preparations including heroin trafficked from Afghanistan and bound for markets in Russia and the west.
          • Unlike some other countries, Uzbekistan appeared to embrace the implementation of syringe exchange… Unfortunately government support has neither meant access to syringes nor widespread use of these trust points by injection drug users, since the creation of needle exchange was accompanied by government decree that state “narcological” (drug treatment) centers were the only ones authorized to implement the HIV prevention strategy.
          • A legacy of Soviet era psychiatry, the psychiatrist/ narcologists and the narcological dispensaries in which they work are more linked to government drug control than to health services… Paid staff are largely untrained in harm reduction, much less counselling
          • Non-governmental contributions to harm reduction are blocked by the Uzbek government’s aggressive campaign to block NGO access to bank funds, subject them to tax audits, and require foreign NGOs to prove in court that they have not exceeded the mandates of their missions. This crackdown is part of a broader government effort to prevent engagement of civil society in the public sphere with particular restrictions applied to those activities that try to fill the vacuum left by government.
          • The American notion of addiction and the moral character of abstinence, assumed to be universal and stable, do not migrate well across Central Asian borders. There is no recovery culture, nor even a stable notion of drug users, and often, no stable drug supply.
        • Perhaps most evident in this review is the fact that grassroots drug users have often acted for themselves to find ways to protect themselves and each other from HIV and other harms.
      • marlatt: come as you are (pdf)
        • The purpose of this paper is to describe what harm reduction is, how it developed, how it works, and why it is becoming a major revolutionary force in the way we respond to human problems ranging from addiction to AIDS.
        • Although, as we shall see, harm reduction has its origins in Europe, it is quickly taking hold as a middle-road alternative to the two established traditional approaches favored in this country: the moral model (War on Drugs) and the disease model of addiction.
        • The principal goal for drug policy should instead be to reduce the harms to society arising from the production, consumption, and control of drugs. Total harm (to users and the rest of society) can be expressed as the product of total use and the average harm per unit of use and thus can be lowered by reducing either component. Attention has been focused on the first; greater attention to the second would be beneficial
        • harm reduction is much more attractive. Each policy or programmatic decision is assessed for its expected impact on society. If a policy or program is expected to reduce aggregate harm it should be accepted; it is expected to increase aggregate harm, it should be rejected.
        • shifting a drug injector to a less dangerous form of drug use may be more important than persuading an occasional user of marijuana to cease consumption.
        • the purpose of the Santa Cruz program is not to “help” young people — rather, young people want to learn how to do it for them
        • much of U.S. drug policy is racist in its consequences, particularly in terms of the number of African-Americans in prison for drug offenses.
          • The minimum sentence for possession of five grams of crack cocaine (favored by African-Americans) is 5 years imprisonment-yet possession of cocaine in powder form (favored by whites) does not carry the same 5-year sentence unless possession is 500 grams (100 times as much of the same drug, cocaine).
        • Foreign visitors to Amsterdam and other major cities in the Netherlands are often struck with what appears to be a liberal and permissive approach to drugs and sex. Special “coffee shops” sell marijuana and hashish, which can be consumed in the shop or taken home. In the red light district, prostitutes can be viewed sitting in their parlor rooms along many streets, beckoning to prospective “window-shopping” clients. Prices for sexual services are fixed and condom use is mandatory. Pornography shops and “live sex” shows are predominant throughout the district, where police on bicycles patrol the streets, providing protection for both prostitutes and their customers. In another part of the city, one of several mobile vans known as the Methadone Bus is parked on a side street, servicing addicts who fine up for oral methadone, condoms, and clean hypodermic syringes (given in exchange for their “dirty” needles).
          • The Dutch being sober and pragmatic people, they opt rather for a realistic and practical approach to the drug problem than for a moralistic or over-dramatized one. The drug abuse problem should not be primarily seen as a problem of police and justice. It is essentially a matter of health and social well-being.
        • The United Kingdom pioneered the “medicalization” approach in which drug abusers can be prescribed drugs such as heroin and cocaine on a maintenance basis.
          • Although prescribing drugs for addicts fell into disfavor over the ensuing years, this policy continues to be practiced in Merseyside, England, serving the population around the city of Liverpool
        • Australia has planned a trial of providing heroin and other opiates to injecting drug users
        • American views of drug use and addiction have been based on two competing and sometimes conflicting models: the moral model and disease model. In terms of the moral model, American drug-control policy has determined that illegal drug use and/ or distribution of such drugs is a crime deserving of punishment.
          • the criminal justice system has collaborated with national drug policy makers in pursuing the “War on Drugs,” the ultimate aim of which is to foster the development of a drug-free society. The majority of federal funding for drug controls has been based on a “supply reduction” approach. Federal enforcement agencies are funded primarily to promote interdiction programs designed to reduce the supply of drugs coming into this. National, state, and city police are funded to arrest drug dealers and users alike in an attempt to further reduce the supply of drugs. As we have already noted, American courts and prisons are overcrowded with inmates convicted of drug offenses.
          • The second approach is to define addiction (e.g., alcoholism or heroin addiction) as a biological/genetic disease that requires treatment and rehabilitation. Here the emphasis is on prevention and treatment programs that focus on remediation of the individual’s desire or demand for drugs, a “demand reduction” approach. Despite the apparent contradiction between viewing the drug user as either a criminal deserving of punishment or as a sick person in need of treatment, both the supply reduction and the demand reduction models are in agreement that the ultimate aim of both approaches is to reduce and eventually eliminate the prevalence of drug use by focusing primarily on the drug user (“use reduction”).
        • Harm reduction, with its philosophical roots in pragmatism and its compatibility with a public health approach, offers a practical alternative to either the moral or disease models. Unlike proponents of the moral model, who view drug use as bad or illegal and who advocate supply reduction (via prohibition and punishment), harm reduction shifts the focus away from drug use itself to the consequences or effects of addictive behavior. Such effects are evaluated primarily in terms of whether they are harmful or helpful to the drug user and to the larger society, and not on the basis of whether the behavior itself is considered morally right or wrong. Unlike supporters of the disease model, who view addiction as a biological/genetic pathology and promote demand reduction as the primary goal of prevention and abstinence as the only acceptable goal of treatment, harm reduction offers a wide range of policies and procedures designed to reduce the harmful consequences of addictive behavior. Harm reduction accepts the practical fact that many people use drugs and engage in other high-risk behaviors and that idealistic visions of a drug-free society are unlikely to become reality.
          • Harm reduction recognizes abstinence as an ideal outcome but accepts alternatives that reduce harm
          • Harm reduction is not anti-abstinence. Harmful effects of unsafe drug use or sexual activity can be placed along a continuum
        • Harm reduction has emerged primarily as a “bottom-up” approach based on addict advocacy, rather than a “top-down “policy
          • Addiction and AIDS are problems that are so plagued with stigma and tainted with moral condemnation that individuals who suffer from these problems are often marginalized by society. Unlike other disorders such as cancer or heart disease, in which those who are afflicted or affected have formed powerful lobbying groups and “patient advocacy” societies, it is rare to find parallel advocacy groups in the addictions field.
        • Harm reduction promotes low-threshold access to services as an alternative to traditional high-threshold approaches
          • Street-outreach programs provide an example of the low-threshold approach to harm reduction.
      • We waged a war on drugs for a century: who won?
        • While Rodrigo Duterte was campaigning to be elected president of the Philippines last year, he said on many occasions that he would arrange, if elected, for people who sold or used drugs to be killed.
          • Extrajudicial killings began even before his inauguration, with victims usually shot and then drugs and guns planted to make it look like the assailants had acted in self-defence.
          • at least 9,400 people have already been killed by police and vigilantes
          • So far, with the exception of praise from the US president, Donald Trump, there has been strong international condemnation of the extrajudicial killings in the Philippines, including from Amnesty International and Human Rights Watch. The United Nations human rights council voted 45-1 to urge the Philippines to desist.
        • The unpalatable fact for policymakers everywhere is that extrajudicial killings of people who use drugs would never occur without the sanction of a global drug prohibition
        • Global drug prohibition was expected to reduce the international drug market and make it less dangerous. But this is the opposite of what happened.
          • their price fell by 80% over a quarter of a century
          • More than 100 new psychoactive drugs are identified within the EU every year
          • drug-related deaths, disease, violence and corruption have in many places increased rather than decreased
          • property crime – taking money or property without threat – has skyrocketed from the 1960s to the present day
        • In the past few years, former world leaders – and even some in office – have started calling for drug law reform
          • In the past few years, former world leaders – and even some in office – have started calling for drug law reform
          • improve treatment
          • start reducing and, where possible, eliminating sanctions for drug use and drug possession
          • regulate as much of the drug market as possible, starting with recreational cannabis
          • shrink extreme poverty, which exacerbates drug problems
        • Countries implementing at least some of these measures have seen a decrease in deaths, disease, crime and violence
        • It should not take extrajudicial killings in the Philippines in 2017 to make the world realise that global drug prohibition has turned out to be an expensive way of making a bad problem much worse.
      • Edith Springer
        • Work with street-based crack-using sex workers in New York City in aids prevention
        • Religious organizations had trouble doing outreach to these people
        • They invited Edith to develop a project to conduct this kind of outreach and harm prevention
        • Recruited six kids to be aids educators
          • Mostly volunteer, plus a small weekly stipend and a metro card
        • Discovered patterns of crack use
        • Explored positive changes that could happen
        • Expanded education
          • HIV
          • Safer drug use
          • Money management
          • Anger management
        • 30% of them quit crack, even though no one told them to
        • Instead of saying, we’re not going to provide you a meal until you stop smoking crack, they just said we’re going to provide you a meal, and the people decided to quit on their own.
        • Work is extremely important
        • 7/10 active drug users employed full-time
        • Most people who can’t handle drugs are alcohol users
        • We teach people not to use drugs but we don’t teach people how not to use drugs
        • Cultures where people don’t learn how to drink are cultures that have alcohol problems
      • staying alive
        • Insite is a place where people can go to inject safely
        • Reactionary politicians don’t like it
          • They feel that it enables addiction
        • Building relationships with drug users is key to getting them into services that can help them recover
        • Almost everyone with chaotic drug use was sexually abused as a child
        • This was a really complicated piece with a lot of examples and anecdotes that reinforced the major points.
        • There are major political forces in opposition to harm reduction
        • Success comes in small steps
      • Carl Hart: Drug Use is not the Problem
        • Goal is a nationwide shift towards liberalizing drug laws
        • Drugs aren’t the problem
          • Poverty, drug policy, lack of jobs are the problem
        • 80-90% of people who use drugs do not get addicted
        • If you provide alternatives to people, then they don’t overindulge in drugs
        • The majority of drug users maintain normal lives and don’t have a problem
        • The same 10-15% of people who use alcohol have a problem
        • People get addicted because of trauma
        • All schedule 1 drugs are defined as “no current medical use” and yet all schedule 1 drugs are currently sold by doctors for medical purposes.
        • Discussions of rat park and human replications
        • There is no absolute, abject addict, and there is no drug that reliably does that to people at large. Addiction is always a small percent of the users of any drug.
      • illegal drug classifications are based on politics, not science (pdf)
        • Illegal drugs including cocaine, heroin and cannabis should be reclassified to reflect a scientific assessment of harm, according to a report by the Global Commission on Drug Policy.
        • “The international system to classify drugs is at the core of the drug control regime – and unfortunately the core is rotten,” said Ruth Dreifuss, former president of Switzerland and chair of the commission.
        • Restrictions on milder, less harmful drugs should also be loosened, the commission said, to include “other legitimate uses”, including traditional, religious or social use. Some illegal drugs, including cocaine, heroin, cannabis and cannabis resin, were evaluated up to 30 years ago or have never been evaluated, Dreifuss said, which seriously undermines their international control.
        • “It was a political decision. According to the studies we’ve seen over past years, substances like cannabis are less harmful than alcohol,”
        • After 50 years, the war on drugs has not been won, Santos said. It had caused “more damage, more harm” to the world than a practical approach that would regulate the sale and consumption of drugs in a “good way”.

“The drug war is the international projection of a domestic American psychosis.”

The drug war is the international projection of a domestic American psychosis.

Focusing just on drug use and not on the causes for addiction, I was struck by this line from Ethan Nadelmann’s Ted Talk. It reminded me of arguments made by founding Queer Theorist Michel Foucault in his landmark book Discipline and Punish. Foucault talks about the way that the early pandemic response in urban European environments was built around building a line separating the clean from the unclean and punishing the unclean. He went on to give us the idea of cultural expectations as a panopticon or a prison of identity where we as prisoners enforce the rules on one another. He also talked about the modern punishment being indefinite examination rather than drawing and quartering as was the case in ancient times. In particular, Foucault explores the idea of pathologized categorizations of certain kinds of people who are bad or sick or unhealthy based on seemingly irrelevant behaviors. This is essentially identical to the discourses around addiction in America, as well as many other modern cultural issues.

Do you choose to use adderall and ritalin, or rather the less legal forms of amphetamines?

Do you choose to use vicodin and norco, or rather the less legal forms of heroin?

What factors contribute to the decision on which of these a given person may choose to use, and why is it the decision between which forms of each drug that means a person should be treated as “sick” and punished?

Many of the texts and videos we went through in this unit make the same argument; that underprivileged people are given pathologized identities based on which drugs they choose to use, and then marginalized on that basis. There are many queer arguments to make about drug use, but I think this is the core one; pathologizing a given behavior — only when certain kinds of people have that behavior, and not for other groups — is merely an extension of the systemic oppression of racism, classism, and other forms of bigotry and prejudice.