The birding began on a gringo-packed trail that snaked its way into the dense forest of the Monteverde region known for its cloud-forest tree canopies. Our guide, a veteran birder, knew all the “hot spots” where local avian celebrities hung out.

The three-hour trek (sloth-paced, barely walking on mostly flat land) was a poor match for my amped self. I was irritable and anxious and secretly looking for pumas and monkeys rather than birds. I tried my best to feign interest and dutifully scanned the treetops with my binoculars, awaiting the fateful bird moment.

But it never happened. The best we got was a half-profile view of a quetzal partially obscured by a branch (quick tip: you can also see a quetzal by googling “magical Costa Rican bird”). I celebrated the end of the bird-watching drudgery with a cold cervesa and vowed never to subject myself to the tediousness of that experience again.

After some thought over the last week, I realized I had missed the whole damn point.

No, I don’t think I like birdwatching. But come on. I didn’t even take the time to understand which birds we were looking for or how to look for them. I had done no research, and I was more interested in checking the event off my travel list than actually trying to appreciate it. My approach—a frenetic, self-centered, get-the-job-done energy—was counterproductive to the Pura Vida vibe of the birds and the culture of Costa Rica. The result was a huge missed opportunity.

Would the CDC ever tweet that birdwatching can help you get your mind off heroin craving?

My thoughts on the birds came full circle a few days after my return to the US when I read a January 5 tweet from the US Centers for Disease Control and Prevention (CDC): 

Bird watching is a great way to de-stress and keep your mind off nicotine cravings. This #NationalBirdDay, watch some birds and help your smokefree life soar. pic.twitter.com/wB4nW9WeQK

— CDC Tobacco Free (@CDCTobaccoFree) January 5, 2022

The obnoxiousness of the tweet caught me first. How can the CDC report that smoking kills 480,000 people every year (20 million people since 1964) and seriously recommend a regimen of birdwatching as its antidote?

But it was also the contrast of how tobacco use—which the tweet misleadingly conflates with nicotine dependence—was treated (as a hobby to replace) compared to other health crises, like the overdose and COVID epidemics, which the CDC covers with seriousness and reverence.

Would the CDC ever tweet that birdwatching can help you get your mind off heroin craving? Or that people with alcohol use disorder should take more birdwatching trips?

Like a city girl wandering aimlessly on a Costa Rican mountain searching for birds using all the wrong strategies, the CDC continues to miss the damn point. And the lost opportunity for our national public health agency to share messaging that would actually reduce the harms of smoking is tragic.

Even when it’s not recommending new hobbies for smokers, the CDC is emphasizing the message that vaping is harmful not only for kids but for young adults, and blatantly misrepresenting evidence to suggest that nicotine can harm brain development despite research suggesting otherwise—rather than seizing on the unprecedented opportunity for harm reduction to save smokers’ lives.

It’s not the birdwatching in the tweet that is the problem. It’s the general lack of insight or ability to understand the experience of being a smoker that screams Out of touch! 

I’ve worked with the communications folks at @CDCTobaccoFree & respect their sophistication & knowledge. I also like birds. But I’m perplexed by how tone deaf this is, as it will obviously be received as an insult by people fighting for their lives to defeat smoking addiction. https://t.co/9tYLlxs5Pl

— Cliff Douglas (@cdoug) January 5, 2022

Tobacco smokers deserve serious support from leading health authorities on ways they can successfully reduce or stop their use of one of the most deadly consumer products in the world.

I don’t know if I will ever willingly go birdwatching again. But I know my approach to the whole experience was counterproductive. And so is the CDC’s on tobacco. It’s time we both did better.

Photograph of a quetzal by Francesco Veronesi via Flickr/Creative Commons 2.0

The post Tobacco Harm Reduction Is for the Birds, According to the CDC appeared first on Filter.

But not so fast. The Biden administration has officially missed its target of vaccinating 70 percent of adults by July 4, with less than half of the population fully vaccinated at publication time. And as the highly contagious Delta variant continues to spread across the US, cases and hospitalizations are on the rise in most states, especially those with low vaccination coverage.  That leaves many people and communities at risk—disproportionately the most marginalized communities, including people who use drugs.

A study released back in September confirmed what others had noted earlier in the pandemic and did again subsequently: People who use drugs, especially opioids, are more likely than the general population to be hospitalized and die from COVID-19. Compounding these risks are conditions known to co-occur with substance use disorders, including mental health issues, HIV and chronic liver disease.

As we have learned, the effects of the virus have reached far beyond its physical symptoms. The chronic stress, isolation, and uncertainty of the pandemic have resulted in a mental health crisis, marked by increases in depression and binge drinking, and a staggering 50 percent increase in overdose deaths—with 2020 bringing the highest number of such deaths ever recorded in US history. Many of these deaths involved opioids, including fentanyl, but stimulants including cocaine and methamphetamine have also contributed. Add on a strained health care system that was already struggling to keep up with the crisis of addiction and overdose, and the result is more suffering and death for those who were already vulnerable before the virus entered our lives.

“I know many friends that haven’t gotten the vaccine. People who use drugs are reluctant to engage with the health care system for good reason.”

“I have no doubt that there are countless untold stories of people that use drugs dying as a result of COVID-19—either from the virus itself or from reduced access to lifesaving support like methadone or syringe service programs,” Aaron Ferguson told Filter. Ferguson is on the leadership team of the National Urban Survivors Union, an organization that represents people who use drugs seeking to undo US prohibition policies.

“I know many friends that haven’t gotten the vaccine,” he added. “People who use drugs are reluctant to engage with the health care system for good reason. Most of my fellow drug users have experienced discrimination in health care settings ,and may have experienced severe consequences for seeking medical care due to mandated reporting that can result in losing our families, communities and livelihood.”

Unfortunately, despite the work of advocates like Ferguson, efforts to support drug users have fallen short during the pandemic. The CDC only recently acknowledged substance use as an underlying health condition that should be prioritized for vaccination.

Dr. Nora Volkow, the director of the National Institute on Drug Abuse, agrees with the prioritization and is frank about the risks at hand. “Getting the COVID-19 vaccine is crucial for substance use populations because they have a much greater likelihood of having severe outcomes from the virus, including death,” she told Filter.

“The risk might be due to an increased likelihood of underlying medical conditions, reduced access to health care, or increased chances of living or using drugs in group settings,” she continued. “The acute effects of drug use might also complicate the signs and symptoms of the virus. For instance, breathing difficulties can be exacerbated by opioid use.”

No study to date has examined whether vaccination rates differ depending on a person’s drug use history. But we do know with great confidence that no matter who you are, the vaccine can save your life. On July 4, Dr. Anthony Fauci announced that over 99 percent of recent COVID-19 deaths in America have involved unvaccinated people.

So, what is being done to support people using drugs as we navigate the next stages of COVID and the vaccine rollout?

“The messengers matter as much as the message.”

One promising effort is a collaboration between the Addiction Policy Forum (APF) and Foundation for Opioid Response Efforts, called the “Vaccine Navigator Initiative.” The program increases outreach to people who use drugs (and caregivers) by answering questions and providing information about COVID, the vaccine, vaccination sites and other support services. The “navigators,” which include social workers, certified drug and alcohol counselors, and peer engagement specialists, can be reached through an online form or by phone/text at 833-301-HELP.

Jessica Hulsey, APF’s CEO, emphasizes the importance of trust in the Vaccine Navigator Initiative. “The messengers matter as much as the message,” she told Filter. “Utilizing peers, trained individuals in recovery from substance use disorder, to discuss vaccinations, answer questions and help clients with any other challenges is key.”

Trust is a concept central to the larger conversation about vaccinations and relates to the severe barriers that people who use drugs face in navigating health care systems, as noted by Ferguson. In a recent study, there was evidence that treatment was withheld from patients diagnosed with COVID-19 when those patients also had chronic liver disease and a history of alcohol use disorders. The consequences of this biased care were devastating, with 80 percent of these patients ultimately succumbing to the virus.

This type of stigmatization can understandably erode trust in health care providers. And when it comes to COVID vaccination, one survey study found that at least a quarter of people with current or past substance use disorders were unwilling to get the vaccine due to distrust.

Phillip Rutherford, chief operating officer at Faces & Voices of Recovery, sees vaccine access and distribution as the more pressing issues, echoing nationwide concerns about inequities in vaccine distribution.  “You have to meet people where they are out in the community,” he told Filter of vaccination efforts. President Biden made just this point on July 6 when he highlighted the importance of mobile vaccination clinics.

For the most part (with some exceptions), COVID-related outreach in the substance use community has focused on providing information rather than the vaccine. However, it could be that mobile vaccination—similar to programs in Boston for people experiencing homelessness and in Baltimore for aging adults—could be tailored to reach people who use drugs and want to get the vaccine. Likewise, there could be unmet opportunities to embed vaccine education and administration efforts into existing infrastructures that support people who use drugs, including methadone clinics or community treatment centers. I was unable to locate any widespread COVID vaccination programs utilizing these strategies.

For Dr. Josh Barocas, assistant professor of medicine at Boston University School of Medicine/Boston Medical Center and the author of an editorial on this issue in the New England Journal of Medicine, the lack of tailored vaccine efforts is less about motivation and more about competing priorities.

“I suspect that while organizations may want to provide additional services such as vaccines, the issue is about capacity and resources.” he told Filter. “We are dealing with upticks in HIV and hepatitis C among people who inject drugs as well as a surge in overdoses. Because of resource limitations, service programs have to prioritize, and without additional resources, they are likely unable to add vaccines to the long list of services they are providing.”

“If someone comes in looking for harm reduction supplies and information, and you are coercing them into getting vaccinated, that is not harm reduction.”

That raises questions about support for harm reduction itself. Because if resources and time are going to be invested into the programs focused on the COVID vaccine among people who use drugs, then shouldn’t we be investing the same time and resources into other life-saving, evidence-based interventions, including syringe service programs, safe consumption sites, naloxone distribution and medications for opioid use disorder?

“I believe every opportunity to talk to people who use drugs is a good time to discuss the impacts of fentanyl, overdose prevention, syringe service programs and yes, the COVID-19 vaccines as well,”  Mike Selick, associate director of capacity building at the National Harm Reduction Coalition, told Filter. “The issue here is how programs treat people rather than the services being combined. If someone comes into your organization looking for harm reduction supplies and information about how to use drugs more safely, and you are pushing them and coercing them into getting vaccinated, that is not harm reduction.”

Selick offers an important reminder that starting from a place of respect, listening and consent is essential if trust is to be built—supporting people who use drugs in making informed decisions about their own health, whether that’s a COVID vaccine or harm reduction and treatment resources.

Ferguson’s lived experience as a drug user reinforces this point. “COVID vaccines could be an opportunity to engage people who use drugs in the health care system in a non-stigmatizing way and as an entry point to other types of care,” he said. “Otherwise such efforts will continue to be disproportionately offered and serve as yet another reason for us to distrust health care.”

With the vaccine rollout continuing, the risks of COVID ought to subside further as the year moves on. But the risks of using drugs from an adulterated, unregulated supply will not. It’s vital that we learn the lessons of these times—about the need for equitable access to health resources and the need to empower people who use drugs through many options and resources, not just those related to COVID.

Photograph by US Secretary of Defense via Wikimedia Commons/Creative Commons 2.0

The post How Can We Improve COVID Vaccine Access for People Who Use Drugs? appeared first on Filter.

Panicked neighbors rushed to him and frantically hoisted his bloodied body onto a motorized tricycle for a desperate 15-minute ride to the closest hospital. But there was too much damage; he needed a neurosurgeon and the closest was hours away.

With ambulance sirens blaring, they rushed south through the Philippine countryside while he coughed and choked on his blood.

For the next days and weeks, Brandon Lee’s body hovered on the thin line between life and death, as his heart sputtered and lurched in and out of its rhythm through eight cardiac arrests.

“The neighbors told my family that there were two men waiting at my house before I got there, acting suspiciously,” he relates.

“The CCTV had been disabled for 10-15 minutes during the time I was shot.”

Months later, through the unwavering support of family and friends, enough funds were scraped together for a 20-hour medical transport flight that lifted him away from his home for the past 10 years and back to the United States.

At the time, Brandon wasn’t convinced he should take the flight. “I didn’t want to leave. But in hindsight I realize it made sense because my injuries were much worse than I thought and I needed specialized care that just isn’t an option there.”

I turn my head as he tells me these things, a year and a half after his shooting, hoping that he can’t see my tears through our shared Zoom portal.

Brandon, on the other hand, is steady and unshaken by the truths he shares. He clarifies that the reason our interview needed to be midday rather than morning wasn’t because of his exhaustion, as I had assumed, but simply because of the practical and very time-consuming steps he must take each day to stay alive as a person with quadriplegia, paralyzed from the chest down.

“When my family tried to investigate,” he continues, “they looked nearby where there is normally [CCTV] that records things, but it had been disabled for 10-15 minutes during the time I was shot.”

And with his youthful face close to the computer screen, he also explains that on that August evening in 2019, at the home he shared with his wife and their infant daughter, it was the Philippine government that had tried to assassinate him.

Stories like Brandon’s remain shocking even as they have, tragically, become familiar under the current Philippine administration. What’s far less familiar to most is that US dollars, including those from anti-vaping interests led by Michael Bloomberg, are helping to support this murderous regime.

Red-Tagging

The Philippines is a Pacific Ocean archipelago of over 7,000 islands, some so delicate that they come and go with the tides. The country is rich in resources like gold, petroleum and timber, with long shorelines offering both sandy beaches and opportunities for international trade (especially with the United States).

But the Filipino people have long suffered at the hands of brutal colonizers seeking to exploit these assets, beginning with the arrival of the Spanish in the 1500s (the islands are named after King Phillip II), and followed by the Americans and the Japanese in the 1900s.

My US education taught me nothing about the Philippines, its people or their history, and I was conscious of the glaring gaps in my knowledge as I logged in to an online meeting of the Baltimore chapter of the Malaya Movement for the first time a few months ago.

Malaya, Filipino for “free,” was formed—along with organizations such as the International Coalition for Human Rights in the Philippines (ICHRP)—to educate people like me to help change US-led policies that support political killings and human rights abuses in the Philippines.

It was during one of these meetings that I met Brandon Lee and learned about his red-tagging.

Red-tagging is a threatened death sentence to anyone critical of the actions of the Philippine government. Red-tagging lists, featuring the names and faces of people being targeted, are posted on the doors of neighborhood buildings and on social media by Philippine police, military or connected vigilantes. Their message is clear: Quit speaking out or die.

Traditional burial blankets were left outside their homes, along with a message: “Gray May, June Gloom, No-Sky July.”

Brandon Lee’s red-tagging came in response to his work as a journalist and environmental activist, campaigning against the harms that hydropower projects could have on local farmers in his community in the Northern Philippines Cordillera region, Ifugao. His activism included his role as human rights officer for the Ifugao Peasant Movement (IPM)—a position he took on when his predecessor, William Bugatti, was gunned down in 2014 by Philippine forces after being red-tagged.

Soon after Bugatti’s shooting, Lee and several fellow activists received an ominous warning. Traditional burial blankets were left outside their homes, along with the following message: “Gray May, June Gloom, No-Sky July.”

One recipient, Ricardo Mayumi, was assassinated a year before Lee was shot.

In December 2020, Lee spoke to the Philippine Senate about his years of red-tagging and his attempted assassination. He ended his comments by pleading for an answer to some basic questions. 

“Who is the monster here? Who is the real terrorist?”

Everyone in attendance knew the answer: President Rodrigo Duterte.

Duterte’s Murderous Evolution

Duterte’s evolution into a murderous dictator began decades ago with an ostensibly virtuous focus on public health, prompted by escalating rates of “shabu” use (a form of methamphetamine) among the poorest and most underserved citizens—initially in the southern city of Davao, where he served three spells as mayor. It was here, where he allegedly deployed death squads against suspected criminals, that he earned his nickname, “The Punisher.”

Supposed addiction is no longer the sole focus of Duterte’s hate, but it was his first. Since he won the presidency in 2016, this hate has evolved into an unimaginable, national “quit or die” drug war and human rights tragedy, as noted by the United Nations, the US Department of State and a recent, independent investigation by ICHRP.

His tactics include “Tokhang” (knock and kill) operations, which involve police going door to door to locate supposed offenders. Not only has he admitted to killing people with his own hands, but he has also empowered the police and military, and masked vigilantes closely linked with those entities, to do the same.

The confidence with which Duterte has defended these mass murders and other abuses committed in the name of public health is terrifying. His rhetoric brutally dehumanizes anyone remotely associated with drugs—calling them the “walking dead” that no longer have “cognitive value.” In one speech he bragged, “I used to do it personally just to show to the guys that if I can do it, so can you.”

Duterte has grotesquely exclaimed: “Hitler massacred three million Jews … there’s three million drug addicts. There are. I’d be happy to slaughter them.”

And like Hitler, Duterte’s control and power over his people has morphed and expanded over time—allowing him to undermine democracy and to attack activists and journalists like Brandon and the indomitable Maria Ressa, as well as lawyers, lawmakers, universities and even children (whom Duterte has called “collateral damage”).

Just last month, on a day now labeled Bloody Sunday, nine activists were shot and killed near Manila during a Tokhang red-tagging operation that took place two days after Duterte told police: “Kill them, make sure you really kill them, and finish them off if they are alive.”

His hate extends beyond activists and opponents, beyond people who use or sell illicit drugs. To smokers, for example.

Duterte’s policies have caused the mass murder of nearly 30,000 Filipino people (that can be counted) since he took office, with numbers growing daily.

His hate extends beyond activists and opponents, beyond people who use or sell illicit drugs. To smokers, for example. Arguing for increases in tobacco and alcohol taxes for public health reasons in 2019, Duterte—a former smoker himself—declared that smokers “should be exterminated from the face of the earth.”

His drug policies, by forcing people to hide their drug use (which can mean foregoing treatment)—or simply eliminating drug users by killing them—offer the rapid, visible appearance of change. And disturbingly, by marketing this image of change in the name of public health—rather than addressing the complicated and systemic issues around drug use and harms (poverty, mental health, education, to name a few)—Duterte has built a formidable public following.

Polls have shown Duterte’s approval ratings in the 80s and 90s. This despite the evidence that his brutal policies have been a “massive failure” in reducing the illicit drug supply, as the murders continue. 

US and Bloomberg Funding

The power of a Duterte is not grown in isolation, however. It relies on powerful supporters and collaborators. And a difficult truth for Americans is that we are part of the problem—because the US Congress regularly appropriates assistance, our tax dollars, to the Philippine government to support arms sales, law enforcement and military training in the name of national security (efforts are currently under way to halt this funding until Duterte’s human rights crimes cease).

Like wider drug prohibition in the Philippines, Duterte-backed nicotine regulations have very mean teeth.

Former President Trump embodied this support in 2017, when he called to “congratulate” Duterte “on the unbelievable job” he had done with his drug war, and offer a warm invitation to visit the Oval Office. (Duterte did not visit, but instead Trump made the trek to the Philippines later that year, where Duterte sang him a love song over a shared dinner).

Partnerships with the private sector—especially among the mining, agribusiness, logging and coal industries—have also fueled Duterte’s political power. These conflicts of interest have made the Philippines one of the deadliest countries for environmental activists such as Brandon Lee.

But the powerful influence of US power and money in the Philippines doesn’t stop with tax dollars and private funding. It also extends to donations made by the US-based billionaire philanthropist, Michael Bloomberg.

Bloomberg began sending funding to the Philippines in support of “comprehensive national tobacco control management” nearly 15 years ago through the “Bloomberg Initiative to Reduce Tobacco Use.” Between 2007 and 2020, 60 Bloomberg grants were awarded to various Philippine organizations. 

Taken at face value, the mission of Bloomberg funding—“ensuring better, longer lives for the greatest number of people”—would seem the antithesis of Duterte’s views on human life.

If banning nicotine is the primary focus of Bloomberg’s funding, then he is certainly getting a return on investment.

Yet Bloomberg and Duterte share a common belief in nicotine prohibition policies—as reflected by their simultaneous signing of public smoking bans in their respective mayoral cities of Davao City and New York City in 2002.

And if banning nicotine is the primary focus of Bloomberg’s funding, then he is certainly getting a return on investment. Duterte has signed into law both a 2017 nationwide ban on smoking in public (which includes a penalty of four months in jail and a fine if caught) and a 2020 ban on harm reduction options such as vapes, heated tobacco products and other novel nicotine delivery systems. 

And like wider drug prohibition in the Philippines, these Duterte-backed nicotine regulations have very mean teeth. Duterte has not only told smokers and vapers that they will be arrested and jailed should they smoke or use nicotine in public places, he has arrested them—including 14,000 smokers (in one city in one year) and 200 e-cigarette users.

It’s hard to believe that Bloomberg Philanthropies and its affiliated tobacco control organizations, The Union and the Campaign for Tobacco Free Kids, didn’t realize that the grants being awarded to enforce tobacco bans in the Philippines (some with unsettlingly aggressive titles such as “Greater Teeth and Tools: Enforcing and Implementing the Tobacco Regulation Act”) could be used to add a further crackdown to the extrajudicial arrests, incarcerations and killings already taking place.

After all, Bloomberg’s own news organization has profiled Duterte’s murderous drug war from its start through the present.

But the truth is, Bloomberg and affiliates were quite aware of what they were doing. This was revealed in October 2020, during public talks hosted by the Philippine FDA (P-FDA) on the topic of e-cigarettes and heated tobacco products. Filipino citizens and stakeholders in attendance voiced concern that the P-FDA authorities charged with making decisions about nicotine policies had been awarded grants by the Bloomberg Initiative and The Union.

P-FDA representatives first denied and then subsequently confirmed the claim. In response, a House resolution was submitted by two Philippine Congresspeople on December 2, 2020 detailing the contributions of Bloomberg and the conflict of interest inherent in such funding. It would arguably appear to be a violation of both the Philippine Constitution and US law, given that Bloomberg funding can be seen as a foreign agent intended to influence Philippine policy. The ensuing congressional investigation revealed that the P-FDA has taken at least $150,000 from Bloomberg Philanthropies in support of tobacco control efforts.

“Whether the grant was meant to influence the FDA’s decision leaves little to the imagination.”

Clarisse Yvette Virgino is the Philippine representative for CAPHRA (Coalition of Asia Pacific Tobacco Harm Reduction Advocates) and a law student. Living in the Philippines, she is also a former smoker who has been a vaper for the past 10 years.

“The conflict of interest arises from the fact that the recipient of the fund is a regulatory agency that was specifically tasked to draft the guidelines for the regulation of these novel products,” she explained, “while the donor is an anti-vaping foreign organization which promotes its own advocacy on tobacco control.”

“Whether the grant was meant to influence the FDA’s decision leaves little to the imagination,” she added. “The P-FDA, by the way, is an attached agency of the Department of Health.”

Her summary of these deeply troubling implications raises the question of how the tobacco control movement, which should be designed to support human life, has gotten so perverted that one of its largest funders is willing to bankroll law enforcement for a murderous regime in the name of nicotine prohibition.

Unfortunately, my repeated efforts to get comments and clarification from both the Bloomberg organizations and the P-FDA met with silence.

A Tightening Noose

When I speak to Brandon about the Bloomberg conflicts of interest, he points out how, similar to smoking and nicotine restrictions, the COVID-19 pandemic has helped Duterte tighten the noose on the Filipino people under the guise of public protection.

Duterte’s efforts have included telling police to “shoot them dead” when it comes to people who don’t adhere to mask and quarantine restrictions (others have been locked in cages as punishment for perceived quarantine violations).

This increase in Duterte’s power, even if under the virtuous guise of fighting COVID-19—”public health” again—has been disastrous. It has seen extrajudicial killings increase by more than 50 percent with the murders of 7,000 people in 2020, according to Human Rights Watch and Amnesty International.

These deaths have been further fueled by Duterte’s 2020 Anti-Terrorism Act, which includes a broad and ambiguous definition of “terrorist,” to include anyone deemed to pose a serious risk to public safety. The legislation has caused outrage, including among US Congress members who have called for the US to finally cease funding the violence and destruction.

Brandon has a sense of urgency in his voice as he recounts the growing number of atrocities taking place in the Philippines—a marked shift from the equanimity with which he described his own shooting earlier in the conversation.

“The COVID restrictions are very militaristic,” he says. “You have to wear a mask and face shield when you leave your home and you need a travel pass that usually only lasts for 24 hours just to go to the marketplace for food. Otherwise you might be detained or abused by police.”

“Last July, in the region neighboring where I lived, a 15-year-old and her 18-year-old cousin were detained for quarantine curfew violations and sexually assaulted and raped by the policemen that detained them. The 15-year-old was murdered by gunmen the next day right after she reported the rape at the police station.”

As he describes these unbearable realities, I see a glimpse of the spirit of activism that drives him. He is a true humanitarian—full of integrity and fierceness, and inspired by protecting others, not himself. Traits that are in short supply among the powerful US leaders and donors who continue to support Duterte in the service of their own interests, with callous disregard for the profound suffering and loss of life that they are causing.  

The author’s fee for this article is being donated to ICHRP-US (the International Coalition for Human Rights in the Philippines).

Top photograph of a mural in the Philippines by Helen Redmond. Photograph of Brandon Lee courtesy of Lee.

The post Bloomberg Anti-Nicotine Lobby Among US Backers of Duterte’s Drug War appeared first on Filter.

I don’t enjoy smoking all that much, with the exception of a cigarette or two a year. Ideally on a summer patio. My dislike of cigarettes, or nicotine for that matter, isn’t because I listened during DARE class or have a will of steel. It’s just that my anxiety and amped-as-all-hell tendencies drag me towards vices with much more sedating properties (think Cheetos, beer and a specific herb that is legal in some states). But this week, maybe more than ever, I very much understand the need for a brief moment of forgetting delivered by a substance that can give me a pause on life and quickly, but not permanently, take the edge off. For some people that is a cigarette.

And as I continued my sluggish walk around the neighborhood, it occurred to me that our current circumstances—a global pandemic driven by a highly contagious respiratory illness that is steamrolling society—make it particularly difficult time to be a smoker.

On the one hand, it seems more urgent than ever to protect ourselves and our lungs from what is turning out to be a very dangerous virus that is pushing our healthcare system to capacity. This thinking has prompted some researchers to write a piece for the British Medical Journal asking current smokers to consider stopping smoking in response to COVID-19 concerns—what is often referred to as a “teachable moment” by tobacco cessation specialists.

Missing from these headlines is the reality of what many people are also balancing.

In response to media coverage on the topic, the UK-based organization Action on Smoking and Health has clarified that while smoking cigarettes is a risky decision and could “make the impact of coronavirus worse”, it is also the case that “Smokers who have switched to vaping should be reassured that this is better for them than smoking.”

If you have managed to look at any COVID headlines recently (I am on a 15-minute cycle these days), many of them tell you what you should and should not think about smoking. Some scientists suggest smoking is associated with COVID-19 (even if the data they are examining are low in quality). While others, using the same data/studies, suggest that current smoking might even be protective if you are exposed to COVID-19.

More confusing is that these warnings have begun to expand to include nicotine vaping. At least one article has suggested that doing either in the time of COVID-19 could be a death sentence. Other clinicians and scientists remind us that vaping is less harmful than smoking and vape clouds will not transmit COVID. (There is, to be clear, no evidence that vaping makes people more vulnerable.) Feeling confused yet?

But the context that is missing from all of these headlines is the reality that many people who might be struggling with whether to keep smoking cigarettes are also balancing isolation from friends and family, getting laid off from work (or overhauling their whole routine in order to work remotely), caretaking children due to school cancellations, the obligation to lock down within a troubled relationship, and much more. Low moods, lack of sleep and stress are not the best emotional and physiological cocktail to produce a motivation to quit right now.

You do have other options if you don’t want to completely stop.

In defense of those media sources, scientists and healthcare providers telling you to stop smoking: Smoking cigarettes is one of the most harmful things you can do to your respiratory system. But in defense of a larger argument, there are lots of other things we do to our bodies that are very unhealthy. Drinking alcohol in large quantities is horribly unhealthy. I thought I would cut back on drinking while on quarantine, but here I am, with no shortage of wine bottles in my recycling bin. We all have to get through this however we can.

You aren’t alone. And you do have other options if you don’t want to completely stop drinking, or smoking, or vaping, or whatever else you do.

If you are currently smoking and just can’t find it in you to stop smoking, that’s okay! You can reduce how much you smoke, you can substitute smoking with gum, nicotine replacement therapy, or nicotine vaping products. Or you can simply be aware of your smoking—try to log how many cigarettes you get through and make goals for adjusting. Maybe you will get to a point when you just decide you don’t want to smoke anymore. Or maybe, you will try out a new vape product and find out you feel much better and haven’t picked up a cigarette in a week. Or maybe the best you can do is just try each day, go to sleep, wake up and try again.

You can also check out this tweet clinic hosted by British expert Louise Ross (@grannylouisa) on Twitter with the hashtag, #QuitforCovid. It starts on April 1, and you can tweet her questions about smoking, stopping, switching, vaping or staying stopped.

Try a variety of options and keep in mind, there is no one-size-fits-all for any behavior change. There is a reason there hasn’t been a medication approved to stop smoking since 2006. It’s hard, so go easy on yourself and I will try to do the same. 

Photo by Helen Redmond

The post Being a Smoker or Vaper in the Time of COVID-19  appeared first on Filter.

What caused this and other vaping-related cases of lung damage became clearer in the past week, when the FDA announced that the majority of such cases were due to adulterants in illicit “products containing THC.” The conflation of these illicit THC vape products with nicotine-containing products has likely left many people confused.

Is it still true that vaping nicotine is substantially less harmful to health than smoking (but not risk-free), as reported, for example, by the National Institute for Health and Care Excellence in the United Kingdom? Or, do we follow the new warnings from the California Department of Public Health to stop vaping completely?

Perhaps the answer can come from an unlikely hero: that 70-year old lifetime heavy smoker we were talking about.

What kind of facts do we have about that person? And what do they tell us about the potential for nicotine vaping to reduce the harms of smoking?

The first fact is the harshest. Most smokers don’t make it to 70 because they die an average of 10 years earlier than non-smokers.

They include my dad, who died a daily smoker at age 63. I wrote his obituary five years ago today. In that same year (and each year before and after), well over 400,000 other obituaries could have been written describing lives that ended early due to smoking-related disease. The number of smokers who die prematurely could fill seven pro-football stadiums every year.

Over time, Bob’s side-stream smoke and chattiness grew on me. We were a fit from the start.

But with advances in science and healthcare, a good number of smokers are living well into their 70s despite the damage done by cigarettes. One of those older smokers happened to be my neighbor. I’ll call him “Bob.”

Bob had a gray, wispy mustache and liked to smoke cigarettes on his front stoop looking out over the narrow, cracked alley we shared on the east side of Baltimore. It was 2008 and I had just moved to town, with student loan debt and a recession rolling in. Over time, Bob’s side-stream smoke and chattiness grew on me. We were a fit from the start—I was in need of friends and conversation, and he had an affinity for both.

I learned he had grown up in a blue-collar suburb not far away, and had recently let go of his cross-country trucking route for a local gig. He wanted to slow down and buy a motorcycle he could ride through the tree-lined backroads of Maryland. He was in his 70s and lived with his older brother in a tiny rowhouse his family had owned for decades. His brother had severe emphysema (I’m guessing from his own years of smoking) and mostly stayed inside with his oxygen tank while Bob held court on his front steps.

After a few weeks of small talk, Bob asked what I did for a living. I told him I was a scientist up the road at Hopkins, starting a fellowship in addiction. In fact, I said, gesturing towards the cigarette burning between his fingers, I spent nearly six years in graduate school studying smoking.

That caught his attention. He wanted to know what I knew—were cigarettes really that bad for people? He had started smoking in high school, and once he joined the military the habit stuck. He had tried to quit, but nothing helped. The patch and gum were useless.

I can’t remember exactly how I responded, but I know I paused. Who am I to tell a 70-year-old what to do with his body or health? For all I knew, cigarettes were one of the most enjoyable parts of his day. And how was I going to tell him something new about cigarettes when he had smoked over 300,000 in the last 50 years? He was more of the cigarette expert than me.

I’ve since discovered that older smokers, like all of us, have a lot to learn about smoking. Older people are more likely than younger smokers to think that the evidence about the harms of smoking has been exaggerated, and that smoking is something they can do little to change. They are also more likely to inaccurately believe that nicotine is the primary disease-causing ingredient in cigarettes, and that cigarettes without nicotine are safer than those with nicotine.

Quitting can add years to your life regardless of your age—including people 80 years and older.

Perhaps all this misinformation has kept some of these older smokers, well, smokers. A recent US-based survey found that nearly a quarter (24.2 percent) of smokers aged 65 and over reported never planning to quit smoking—compared to only 9.8 percent of 18-to-34-year-old smokers. And a separate report from the CDC found that smoking cessation rates are significantly lower for older compared to younger smokers.

But all hope is not lost if a person finds themself aging into smoking. Quitting smoking can add years to your life regardless of your age—including people 80 years and older. And if complete cessation isn’t possible (as was the case for Bob), then evidence suggests that reducing the number of cigarettes smoked per day can also benefit older smokers.

Yet I decided to not say much to Bob about cigarettes. I didn’t want to be preachy, I just wanted to be someone he could count on. Like some sort of weird friendship sitcom about a 30-something lady with a cat and her 70-something gruff neighbor with a smoker’s cough.

But Bob was definitely the better friend. In the winter he cleared the snow and ice on my steps (hours before I woke up), and was always sure to add a coat of salt so I didn’t slip as I walked to my car. And in the summer, he would bring me fresh fish that he caught during his weekend trips to the Chesapeake Bay, wrapped delicately in parchment paper.

He yelled at the construction crew working on the townhouse next to me when he caught them stealing electricity from my outdoor plug. And when he finally got that motorcycle, he waited next to it until I stepped outside, so he could show off its extra seat he got installed in case I ever wanted to take a ride.

And one time, he brought me roses.

It was early December 2012, and I was going through a couple of back-to-back break-ups. Unexpectedly, on a crisp, gray afternoon, I heard a knock on the door and opened it to see Bob handing me a vase overflowing with flowers.

He waited on my steps as I read the small card sandwiched between the petals and stems: “I hope these flowers will mend the broken heart that those two guys gave you. I always be here for you.” 

Cards from “Bob,” with identifying details redacted.

Soon after I found Bob on my front stoop with those roses, he was diagnosed with lung cancer.

The treatment would include surgery and chemotherapy, and he was scared. His treatment moved fast, and I watched as his body and energy withered with each update he gave me on his weekly outpatient appointments. He had to sell his motorcycle to pay for the costs of his healthcare. He lost one of his lungs in surgery.

When I saw him outside smoking one afternoon, I couldn’t resist asking: Had he thought about switching to e-cigarettes instead?

I explained that they were new to the market but didn’t burn, so wouldn’t deliver the carbon monoxide he inhaled when smoking. This was around 2014 so we had yet to learn what leading scientists now say—that we could save at least 1.6 million early deaths, if all smokers in the US switched to vaping over the next 10 years. This is because completely switching significantly reduces exposure to known toxicants found in combustible cigarettes.

His doc said that e-cigarettes hadn’t been studied long enough, weren’t recommended by the FDA, and weren’t worth the risk. So Bob kept smoking.

It turns out Bob did know about e-cigarettes, even if he didn’t know these facts, and had asked his surgeon about them. But his doc said that e-cigarettes hadn’t been studied long enough, weren’t recommended by the FDA, and weren’t worth the risk. So Bob kept smoking.

When Bob moved away, he told me I could visit him at his new assisted living home. His brother had passed away and he didn’t have the money to keep paying rent to his family. When he let them know, they decided to sell it. And although his cancer was in remission, he needed help getting around because his breathing was getting worse. He coughed all the time.

I moved soon after, and just like the motorcycle ride I had passed up a couple years before, I never took him up on that offer for a visit. Maybe I’m sharing his story to make amends.

Bob’s story, and the millions of others like it, should be a call to action to shift the debate around the risks and benefits of vaping to include all ages of nonsmokers and smokers. The debate is false and incomplete if we continue to focus on youth and young adults to the exclusion of older smokers—the population that carries the greatest burden of smoking’s harms.

Aging smokers deserve more than a brief mention in a catchy article offering sensationalized news on youth vaping. They deserve to be the headline about the potential for cigarettes to be made obsolete by technological innovation, such as vaping products that can serve as safer, effective and appealing substitutes for smoking.

Every day, 1,300 Americans lose their lives to smoking-related illness and most of them are older adults. Each of these lives has a story—a story cut short because we have yet to use our scientific and regulatory resources to make harm reduction products and information fully available to the smokers who have not been able to successfully quit.

The lives of our oldest smokers are worth just as much as those of our youngest.

This article is dedicated to the author’s father, Dr. Ray Kleykamp (1951-2014).

Top photo by Patrick Hendry on Unsplash

The post Older Smokers Are the Forgotten Victims of Our Vaping Wars appeared first on Filter.