“Stronger Than Fentanyl: A Drug You’ve Never Heard of Is Killing Hundreds Every Year” —Wall Street Journal

“This Little-Known Synthetic Opioid Is Up to 43 Times More Deadly Than Fentanyl, Resistant to Narcan and Killing Young Americans” —New York Post

These headlines are about nitazenes, the colloquial name for a category of novel synthetic opioids derived from 2-benzylbenzimidazole. They can indeed be more potent than fentanyl. And they are becoming more prevalent in the United States drug supply; we know this because more people are dying with nitazenes in their system. However, none of this means that nitazenes are killing people.

“Nitazenes” doesn’t refer to one specific substance, but to a group of substances that are chemically similar. The potency of different individual nitazenes, AKA nitazene analogs, varies quite a lot—the same way it does with fentanyl analogs. However, nitazenes tend to show up in extremely small quantities, piggybacking on fentanyl or some other drug that was ingested in larger quantities. They very rarely show up on their own.

Reports of nitazene-involved deaths overwhelmingly involve fentanyl as well, and in cases without fentanyl there was still some other psychoactive substance with potential for fatal overdose, like benzodiazepines. Invariably the information is framed in a way that invites people to assume the nitazenes caused the deaths, or at least contributed to them, but that isn’t necessarily the case. Nitazenes typically appear in trace amounts in a mixture, and—despite the fact that some are very potent—there’s no clear evidence that nitazenes are fueling any increase in overdose. 

But because as an overall group they are more potent than most other known opioids, the Drug Enforcement Administration has claimed their existence in and of itself increases overdose and problematic use. The DEA did not provide comment in response to Filter’s inquiry.

“Whenever a nitazene is found, it’s found together with fentanyl,” Dr. Miao Hua, medical director and interim deputy commissioner of behavioral health at the Chicago Department of Public Health, told Filter. “It’s not the sole ingredient. Or really the main ingredient.”

Nitazenes were first synthesized in the 1950s for medical use, but were never approved by the Food and Drug Administration. They existed in relative obscurity until early 2019, when they began gaining attention in dark web drug markets. Isotonitazene was the first analog detected in the US, and remains perhaps the most recognizable name out of the bunch. More recently, metonitazene and protonitazene have emerged as some of the more commonly detected analogs.

Media outlets frequently announce the presence of nitazenes as a harbinger of a “whole new wave” in the overdose crisis, as if they will push fentanyl out of the drug supply the way that fentanyl pushed out heroin.

“Theoretically that’s always a possibility,” Hua said. “Do I see signs of that happening anytime soon? Not really.”

As reports of “fentanyl-laced cannabis” inevitably turn out to be unfounded, nitazenes aren’t likely to show up in cannabis anytime soon either. Hua said that Chicago isn’t seeing nitazenes in its cocaine or methamphetamine supplies either—even though nitazene detection has largely been in the Midwest. But this makes sense, as the presence of fentanyl in non-opioid drug supplies is frequently overstated.

However, nitazenes do show up mixed with, or sold as, benzodiazepines; this was the case with one of the deaths in the New York Post story. 

“The stronger the strain, the more resistant the nitazene is to the overdose antidote Narcan,” the Post claimed.

Regardless of the potency of a particular analog, nitazenes are not “resistant” to Narcan. It’s a myth that naloxone doesn’t work on higher-potency synthetic opioids, or that more than two doses of Narcan are routinely required. Naloxone—like other opioid antagonists such as nalmefene and naltrexone—doesn’t act on the opioids themselves; it acts on the receptors the opioids bind to, so it does its job pretty much the same way for any opioid regardless of that opioid’s potency. Including nitazenes. 

Naloxone should always be used when someone shows signs of opioid overdose, and it won’t make the situation worse if it turns out no opioids were involved. Often when naloxone fails to reverse an opioid overdose it was administered too late, or the overdose was complicated by something naloxone does not work on—like benzodiazepines. Usually reports of “naloxone-resistant” drugs involve drugs that aren’t opioids, and for which naloxone was never applicable in the first place. 

“Naloxone is still the best tool,” Hua said. “What we find where this actually gets confounded is because there are tranquilizers.”

In addition to benzodiazepines, people who rely on street fentanyl might find their supply unexpectedly includes xylazine or medetomidine. Naloxone will still work on the fentanyl, nitazenes or other opioids causing respiratory depression in an overdose. Perhaps largely due to law enforcement misinformation, it’s a common misconception that an opioid overdose isn’t reversed until the person dramatically “wakes up.” But when non-opioid downers are in the mix, they might remain heavily sedated even after if the naloxone worked and breathing has been restored, giving onlookers the mistaken impression that they still need more naloxone.

“We very rarely see a nitazene that’s on its own.”

Erin Tracy, a research chemist with the Injury Prevention Research Center at the University of North Carolina at Chapel Hill, analyzes drug samples submitted by harm reduction programs from all over the country, and has been doing so for several years now.

The UNC program has received a handful of samples that contained a nitazene and nothing else, but this is not the norm. 

“While cocaine can be cut with other things, we see plenty of cocaine on its own. We very rarely see a nitazene that’s on its own,” Tracy told Filter. “It’s usually always in combination with fentanyl and fentanyl [analogs].” 

Anecdotally, some street-level sellers are advertising nitazenes. But as with most unregulated drug sales, knowledge of the actual contents comes from word of mouth, not necessarily from drug-checking. Nitazenes test strips do exist, but they’re not much use to drug-user communities. They’re prone to false positives and false negatives; they detect some nitazene analogs but not others; and they’re not widely distributed by syringe service programs.

In samples submitted to the UNC program, often what someone had suspected of being nitazenes turned out to contain a wide range of other drugs instead. 

“I generally give the benefit of the doubt that no one is trying to kill their customers,” Tracy said. “So I do think [nitazenes are] intentionally being added, but I don’t think that it’s intentionally being added to do harm.”

In her experience, when nitazenes are present it’s usually in trace amounts. And, despite reports of nitazene analogs sweeping the nation, it’s mainly isotonitazene and protonitazene showing up in certain regions.

“Other states that have not scheduled nitazene compounds may not be seeing them in forensic lab reports.”

As nitazenes gain prominence in the public consciousness, it may seem as if the discovery of emerging analogs is why more of them are being banned under the federal Controlled Substances Act or state-level equivalents. But often it’s the other way around: More are being detected because they’re being banned. Forensics labs don’t generally check for, or report, non-controlled substances.

Between 2020 and 2024, Ohio banned a total of 17 nitazene analogs, more than any other state. And then in addition to those 17 analogs scheduled individually, the state pharmacy board effectively enacted a class-wide ban, classifying “all compounds that meet the structural requirements of the 2-benzylbenzimidazole ‘nitazene’ opioids pharmacophores as Schedule I controlled substances” of the Ohio Administrative Code. The Ohio Narcotics Intelligence Center (ONIC) described the move as one of the “regulatory options” available to states attempting to keep up with emerging substances.”

“Other states that have not scheduled nitazene compounds may not be seeing them in forensic lab reports for this reason,” an ONIC representative told Filter. “[T]hey are sparsely reported before they are scheduled.”

ONIC said that nitazene analogs are being detected mixed with fentanyl, heroin, benzodiazepines, cocaine, methamphetamine and xylazine, and that they show up in pills and powder alike. It stated that nitazenes “are occasionally found by themselves,” but did not provide further detail. 

“The reality is a lot of these dope samples that we are collecting … contain dozens of ingredients,” Hua said. “At this point, [it’s] hard to know what is the active compound? What is the cutting agent? What is the adulterant?” 

Other recent additions to the drug supply that have begun to attract attention include medetomidine, a veterinary sedative similar to xylazine, and BTMPS, an industrial plastic preservative.

Like fentanyl analogs, nitazenes are used to stoke fear and justify harsher enforcement.

We always seem to be hearing of some powerful, frightening new drug that is unimaginably stronger than the previous one, and that has the potential to kill hundreds, thousands or tens of thousands unless certain actions are taken—actions that further the punitive policies that got us here in the first place. 

Some new arrivals do stand out. Benzodiazepines have profoundly reshaped the drug supply in some communities. So has xylazine. So have synthetic cannabinoids. Fentanyl itself began gradually taking over the East Coast opioid supply around 2013, but didn’t fully push heroin out of the West Coast until the COVID-19 pandemic.  

So far at least, nitazenes aren’t having that impact. Their trajectory is more like that of fentanyl analogs—used to stoke fear and justify harsher enforcement, but from a user-end perspective generally indistinguishable from fentanyl itself.

Like carfentanil, the highest-potency fentanyl analog identified to date, nitazenes are relatively minor players that get disproportionately featured in the media and other public messaging for the shock value of something “even worse than fentanyl.” 

Journalists, politicians, police officers and the entrepreneurs hawking products and webinars are all motivated to portray nitazenes as the new big threat, emphasizing “parallels to the fentanyl crisis.”

Asked if nitazenes were poised to become the next fentanyl, the ONIC replied succinctly: “We cannot speculate on this.” 

If heroin had never been made illegal, the market would not be veering toward highly potent, poorly understood chemicals there previously hadn’t been any demand for.

The United Nations Office on Drugs and Crime reports that each year since 2021, Europe has seen more unique new nitazenes than unique fentanyl analogs. While North America continues to see more fentanyl, the numbers of unique nitazene analogs are on par with those in Europe. 

Nevertheless, while nitazenes are the subject of an unjustified media frenzy in the US, they do pose a more serious concern in the United Kingdom, which only recently began to experience the mass deaths that result from an opioid supply moving from heroin to higher-potency fentanyl.

Europe didn’t follow the same trajectory as the US in terms of the overdose crisis. For one thing, the US is the only country with a DEA. Newly restricted opioid prescribing and a reformulation of OxyContin pushed some people from pharmaceutical analgesics to heroin, and a crackdown on heroin ushered in its more potent replacement. Elsewhere in the world, continued access to quality heroin meant there was no need for fentanyl to take its place.

But as the Taliban’s crackdown on poppy cultivation has resulted in a drastic reduction in quality and availability of heroin in the UK, for example, nitazenes have begun to find a place in the supply there, too. The new kind of dope emerging as a result is far more potent than what people are acclimated to.

The appearance of nitazenes is easily and directly linked to the crackdown on fentanyl, not just in the US but globally. As the US federal government has targeted the international fentanyl supply chain, the nitazene narrative has helped fuel the vilification of all synthetic drugs, and given drug warriors another reason to blame China. 

If heroin had never been made illegal, if pharmaceutical-grade diacetylmorphine were a regulated product like any other, the market would not be veering toward highly potent, poorly understood chemicals for which there hadn’t previously been any demand. And perhaps synthetic drugs would not be a scapegoat for any and all societal ills.

As the drug supply remains unregulated and therefore dangerously unpredictable, harm reduction for nitazenes means the same harm reduction people who use opioids have been practicing all along. Never use alone; start low go slow; check your drugs; always carry naloxone.

Top image via Franklin County Coroner’s Office. Inset image (cropped) via Department of Justice/Drug Enforcement Administration.

R Street Institute supported the production of this article through a restricted grant to The Influence Foundation, which operates Filter. Filter‘s Editorial Independence Policy applies.

The post Nitazenes, the New Synthetic Opioids, Aren’t “More Deadly Than Fentanyl” appeared first on Filter.

“It’s always been common practice that if you use a substance regularly and are poor, you’re unlikely to get an organ transplant,” a harm reduction worker in Toronto, who didn’t wish to be named, told Filter.

One thing we know is that active drug use usually disqualifies you from being on the waitlist for organ donation in the United States—although a strictly required period of abstinence could be enough to make it. The extent to which this is clinically justified is often unclear. And experts say individual transplant centers’ willingness to work with patients who use drugs is influenced by highly subjective views about their likelihood of meeting clinically-indicated requirements for a safe and successful transplant.

It is devilishly hard—perhaps impossible—to separate potential bias against people who use drugs from other obstacles to finding a place on an organ donation waiting list, including valid clinical concerns.

To be clear, people who use drugs are not automatically at higher risk of organ failure in most cases. Opioid overdose, for example, does not cause organ failure or lead to need for a transplant. Nonetheless, people who use banned drugs or have substance use disorder have been found, on average, to be admitted to hospitals more often than the general population—something not necessarily caused by that drug use, but linked to factors like social exclusion and higher rates of tobacco smoking.

Both both alcohol use disorder leading to cirrhosis and hepatitis C, which may be acquired through injection drug use, may result in liver failure. HIV, which may also be contracted through injection drug use, may result in the need for a kidney transplant. A person may need cardiac valve surgery to treat endocarditis, for which injection drug use is one risk factor.

Or people may experience organ failure for reasons unrelated to their drug use; Black and Indigenous Americans are among those to have faced disproportionately high death and hospitalization rates from COVID-19, for example, which can lead to organ damage during acute infection or later.

National data accessed in December lists 199 patients with diagnoses of drug-related nephritis on the waitlist for a kidney transplant, and 1,326 patients with diagnoses of alcoholic cirrhosis waiting for a liver. (Which doesn’t mean active substance use.)

Meg Inwood has known “almost 20” people with alcohol use disorder trying to get a transplant. “One made it. One.”

In Australia, this issue achieved national prominence a decade ago in the person of Claire Murray, who died of complications from a liver transplant in 2010, but whose search for a second liver—she disclosed having used drugs after her first transplant—provoked public condemnation and a brutal “trial by media,” with scathing articles and polls on whether she deserved a second chance at life.

In the US, a person with Murray’s history is more likely not to make it onto the waitlist for an organ, nor—if, like Murray, they are not actively using drugs while seeking a transplant—to get clarity about the reasons for being refused.

Beth Lehman, a liver cancer survivor and liver transplant recipient in Atlanta, required a transplant after her drinking resulted in cirrhosis. Already abstinent, she spent six months in alcohol use disorder (AUD) counseling to qualify for a transplant at the particular center she went to—not an option at all centers. You must first be accepted by a transplant center before you can be added to the national waitlist for an organ.

“There’s that extra step in there of the evaluation of ‘how likely is this person to relapse after transplant,’ and you get a score for that,” Lehman, now a patient advocate, told Filter. “And then … it’s on the transplant center, whether you continue on to get on the list or not.”

Recovering from AUD was crucial for Lehman. Meg Inwood, a Toronto writer with a long history of substance use, has known “almost 20” people with AUD trying to get a transplant, she told Filter. “One made it. One.”

“Then it’s the same old story, you have to wait in line,” she continued. “And cancer patients, ICU patients, accident patients—anyone who didn’t ‘do it to themselves,’ is ahead of you on the list.”

According to the Canadian Liver Foundation, “patients who continue to drink alcohol despite medical advice are not considered for transplantation in Canada.” Although since 2013, when a six-month abstinence policy applied, more programs perform liver transplants for people with less than six months’ abstinence, while policies on opioids and cannabis vary.

In the US, abstinence from alcohol for six months would, with very few exceptions, be the absolute minimum for such a patient to be considered. 

Allocation and Ethics

There, the United Network for Organ Sharing (UNOS), a nonprofit appointed by Congress, is charged with ensuring equitable and timely transplants, and with administering the Organ Procurement and Transplantation Network (OPTN)—a public-private partnership that links organ donation and transportation professionals nationwide.

Despite these networks, for a patient whose substance use precludes treatment for any condition resulting in organ failure, it might be challenging indeed to see anything equitable or timely about it.

With cardiac valve surgery, there isn’t a similar network involved, but lack of tracking of patients with opioid use disorder who receive a new heart valve makes it hard to know whether OUD patients are being unfairly denied treatment. Some people believe it’s clinically poor practice to keep offering this surgery to a person who continues to resume injecting drugs, as repeated surgery may result in scar tissue forming; again, it’s hard to separate such arguments from the idea that a person who uses drugs may not “deserve” treatment.

One rare study found an acceptable survival rate among recipients with a history of “substance abuse.”

It’s no wonder, with so little data or transparency, that people who use drugs may feel that the health care system, contrary to official claims, treats addiction as a moral failing.

A 2001 study looking back at outcomes among heart transplant patients at one center found an acceptable survival rate among recipients with a history of “substance abuse”—although resumptions of use did occur and there was greater non-compliance with transplant treatment regimens compared to other patients.

In the rationale for this rare study, the authors noted that “active substance abuse is widely accepted as a contraindication for heart transplantation because of the theory that relapse would occur after transplantation and result in compromise of graft function, lowering long-term survival.”

There appears to have been no research since to either confirm or refute these findings, or determine their relevance to policy. With research driven by funder priorities and the interests of researchers, there’s no way for patients to have much confidence that current abstinence requirements are supported by evidence.

Opioid-involved overdose deaths have, meanwhile, become a substantial source of healthy organs in recent years. It’s a situation cardiothoracic surgery resident Dr. Jason Han described for the Journal of the American College of Cardiology in 2018, asking, “Should we view this as a tragedy, or dare we frame it as an opportunity?” He noted then that such donors had a median age of 31 and generally had few comorbid conditions.

People who use drugs have been “celebrated” as organ donors in articles about the unanticipated, uncomfortable “upside” of the overdose crisis. But what about those who find themselves on the other side of the donation relationship, in desperate need of an organ?

There’s almost no area of medicine that involves greater agonizing than achieving an ethical allocation of scarce organs.

“[A] concern is [with] an organ that’s a limited, scarce resource in this country that only emerges when somebody else dies from unforeseen circumstances,” Dr. Han told Filter, five years after his article was published, “Maybe that organ should not be allocated towards people who may not—I don’t want to say benefit from it—but who may not follow the clinical regimen required to take care of it.”

And yet, there’s almost no area of medicine that involves greater agonizing than achieving an ethical allocation of scarce organs by balancing principles of utility and justice.

One of the tenets of organ-donation ethics is that an idea of “social worth” should not determine who has access. In its ethical principles, the OPTN states:

“[T]he social worth or value of individuals should not be considered, including social status, occupation, and so forth. Moreover, in determining predicted medical benefits and harms, there also is consensus that it is unacceptable to use variations in transplant outcomes among social groups as a basis for predicting individual outcomes. For example, even if there is empirical evidence that survival rates of one race, gender, or socioeconomic group exceed those of another, these factors should be excluded from utility models used to justify allocation decisions.”

While utility—the likelihood of maximizing medical benefit for the most people possible—is one principle that ONUS must try to honor as it administers the OPTN, so is fairness: “Factors to be considered in the application of the principle of justice are: 1) medical urgency; 2) likelihood of finding a suitable organ in the future; 3) waiting list time; 4) first versus repeat transplants; 5) age; and 6) geographical fairness.”

This might mean “prioritizing the medically sickest patients even if it is predictable that other patients who are not as sick will have better outcomes.”

Utility, on the other hand, means that deemed likelihood of survival is a factor—among others, like distance from donor hospital or how long you’ve been waiting—in how UNOS prioritizes allocations of available kidneys and lungs (though not hearts and livers, at least not once a transplant center has put you on the list).

But as the OPTN recognizes, whether ethical principles apply in practice really depends on how people are placed or denied a place on the transplant waiting list. Here, once more, clinical considerations can be very hard to separate from other issues.

Signs of Improvement?

Societal beliefs about the efficacy of liver transplants for people with AUD—and whether they “deserve” a new liver—meant it used to be impossible for such patients to get on a waiting list. Technically or officially, this was a clinical concern.

But years of research on actual clinical concerns and safety have resulted in a change in practice over time: Now, a person with diagnosed AUD or a history of heavy drinking can get onto the waitlist so long as they demonstrate that they’re receiving AUD treatment or have been abstinent for a year, according to Arthur Caplan, a renowned bioethicist at New York University—although UNOS currently states that a six-month period of abstinence from drugs (including cannabis, as well as alcohol) is required.

Better hep C treatment has led to a change that means some people with drug-use histories can now receive a transplant that would previously have been thought unlikely.

In fact, there are a few centers in the US that—like Canada, and as has been common in Europe for some time—now perform transplants in patients who have not met this six-month requirement. Johns Hopkins, for example, transplants about 25 livers annually for patients who otherwise would not receive a desperately-needed organ—following on from research, initially in Europe, showing that the traditional abstinence period wasn’t clinically justified (although abstinence from alcohol is necessary after the transplant).

In a similar vein, better antiviral treatment for hepatitis C has led to a change in practice that means some people with drug-use histories are now able to receive a transplant that would previously have been thought unlikely to be worth performing due to poor chances of success.

Such improvements haven’t only been a question of scientific advances. They first required advocacy from community members and researchers who didn’t see people who use drugs as less “worthy.” 

As Dr. Caplan told Filter, there are three levels of decision-making on who gets an organ: overall eligibility, individual treatment center decisions, and clinical decisions as organs become available.

The second step—once ineligible groups, such as older Americans, usually 70 and up, are excluded—is when most people who use or have used drugs may find themselves excluded without recourse or explanation.

Lack of Transparency Among Transplant Centers

“To reiterate, only patients added to the waiting list can receive organ offers, which applies for all organ types,” UNOS stated recently, in response to questions about liver allocation policy from the Washington Post/the Markup. “The overall healthcare landscape in a given state, which varies widely, may impact who does and does not get added to the waitlist.” 

“Each individual transplant center gets to decide who they want to take on as a patient,” Caplan said.  “Transplant centers have no obligation to take anybody, because [in the US] there is no right to health care.” 

Is there ever documentation of whether a given patient is refused for solid clinical reasons, or whether it’s instead relating to subjective behavioral or community-support concerns?

“I’m gonna say internally,” Caplan replied. “But not in a transparent way.”

“It’s kind of humiliating that that’s what they were saying, and giving me a score on it, and I didn’t know.”

One 2021 consensus document by the International Society for Heart and Lung Transplantation provides guidance for centers around lung transplants, for example—though US centers certainly aren’t obligated to follow it. It includes a complete contraindication for patients with “active or dependent drug use,” including injection drug use and cannabis smoking, as well as tobacco smoking or vaping.

The smoking part is not about legality versus legality, or even about use disorder, but about the impact on a new lung. This may mean treatment, with transplant waitlisting then possible if the patient is deemed stable. A patient who smokes cigarettes, the document states, should demonstrate long-term (over six months) abstinence—including, perhaps bafflingly, from nicotine replacement therapy involving no inhalation. Inhaled cannabis must be stopped before transplant; orally consumed, it may be ok if medically approved. Opioids for pain or OUD treatment are to be assessed on an individual basis.

At University of Washington Medicine, to take an individual example, substance use figures in kidney transplant selection as a question of whether team specialists consider a patient’s use—prescription, legal or illegal drugs—to be harmful, and whether they accept evaluation, treatment and followup for substance use history if required. Tobacco use is an absolute contraindication.

Beth Lehman believes there should be greater transparency about what role current or past substance use might play in a given center’s evaluation.

“[S]ome transplant centers tell you you’re being evaluated and some maybe not. I was very naive going into the process,” she said. “So when the doctor came in and was talking to me—and realized that I was taking Xanax and told me that I was an addict, and I need to quit taking Xanax, and [that] I didn’t at the time realize that psychologically—that was a review of me. So I think in hindsight it’s kind of humiliating that that’s what they were saying, and giving me a score on it, and I didn’t know.”

“If you don’t have a right to health care, you’ve got a lot of discretion on the part of providers. You know what I mean?”

Dr. Caplan noted that just as a person who is homeless and needs a new liver might be quietly dismissed as a “difficult patient” (even if they could afford it), so too might anyone else. 

For instance: “If you showed up and said, ‘I’ve been referred here because I have severe pulmonary problems,’ and they did an interview with you and said, ‘Oh no, she’s kind of a pain in the neck. She has views about alternative medicine. She’s coming from far away. We’re not going to take her into our pulmonary program.’ That happens. If you don’t have a right to health care, you’ve got a lot of discretion on the part of providers. You know what I mean?”

“There’s subtle and unseen rationing” against people with substance use disorder, Caplan said, “but it’s before they make it to the national list.”

Although most clinics don’t outright refuse patients receiving prescribed methadone or buprenorphine for OUD, there is a lack of national standards to ensure they’re not discriminated against.

UNOS works to promote equitable access amid the inconsistency of individual treatment centers. “They all have their own policies and my understanding is that they evaluate patients and then bring the whole team together and discuss each case and decide whether or not to list,” UNOS media relations staffer Anne Paschke told Filter. “So we are basically the allocation piece, so once they list patients, that’s where we can adjust allocation policy based on outcomes to ensure that it is as fair to all groups of people as possible.”

Of course, a chronic shortage of organs means that a certain amount of rationing, as well as triaging to ensure those at most imminent risk of death are served with greatest urgency, is inevitable. But the likelihood that otherwise clinically acceptable transplant recipients might be denied access to a lifesaving intervention, for reasons that have more to do with subtle stigma about drug use, drug users and even addiction treatment, is chilling.

“I think in general, so many transplant centers … treat [addiction] as something that you’re to blame, and you get disqualified,” said Caplan, who has written extensively about organ donation ethics and contributed to the American Association for Thoracic Surgery’s 2023 Expert Consensus Document on adult heart transplants using donors after circulatory death. “I also think with a big shortage of organs, they’re looking for ways to exclude people because you know, they’ve got to make choices. So lifestyle, prison status.”

In a situation where rationing is necessary, though, shouldn’t there be a clear and transparent process, including at the level of the individual centers, for determining whose lifestyles are considered disqualifying factors—and shouldn’t that be based on their impact on successful or even resource-effective treatment, rather than on moral judgment?

“There are some loose criteria to suggest that this person might be high-risk versus not, but it’s nothing anybody has a definitive sense over.”

The OPTN ethical principles document mentions “ethical rules (e.g., honesty, the duty not to harm), clinical indicators (e.g., comorbidities, cause of organ failure) and psychosocial factors (e.g., financial and social support, patient adherence)” as factors relevant to being placed on a transplant waitlist that are distinct from the utility and justice principles.

Dr. Han believes that whether someone could be a candidate is mostly based on medical criteria, with perhaps 90 per cent of the discussion relating to anatomy, conditions and age. “And then in addition to that, I think the [transplant center] committee just wants to make sure in general that they would be able to take care of themselves afterwards,” he said. “And that’s a subjective discussion. And there are some loose criteria to suggest that this person might be high-risk versus not, but it’s nothing that anybody has a definitive sense over.”

“I think people take psychosocial support and these decision-making processes very seriously,” Han said. “And at least in this country, right now, it’s a heavily stigmatized subject.”

People who use banned drugs may be presumed—according to the “loose criteria” Dr. Han mentioned—to be incapable of meeting commitments or sticking to a schedule, or to be outcasts without a community to help out.

This could be a self-fulfilling prophecy, as unconventional networks of support can’t be activated if patients aren’t made aware of the possibility of doing so—cancer treatment and support for people in precarious housing situations might draw friends, harm reduction communities and social service organizations into a network of care, for example.

The OPTN observes in a notice about increasing transparency in program selection that: 

“Disparities in access to care may be exacerbated by a lack of public information about transplant programs’ listing practices. For example, patients may be unaware of differing [body-mass index] thresholds, abstinence requirements for substance use, social support requirements, and financial requirements between programs.”

But the OPTN’s goal is to improve patient awareness about obstacles to making it onto the waiting list—not necessarily to improve transparency about why a particular patient was denied. And certainly not to delve deeply into whether the criteria involving substance use or abstinence are clinically justified and to what extent.

Can You Pay?

Everyone who spoke with Filter for this article emphasized that while there may indeed be discrimination against people who use drugs or have substance use disorders, there’s an even bigger barrier facing such patients. 

Most people who use drugs and require an organ transplant will never reach the stage of facing individual transplant center attitudes, let alone consideration of their clinical suitability for a particular donor organ that becomes available, because they can’t afford to be evaluated by a center in the first place.

In fact, everything about access to a needed organ donation is subject to the issue that bedevils all US health care: ability to pay. For perhaps the majority of people who use drugs or have a use disorder, this conditions everything else.

Many people who use or have used drugs are “part of the group that’s penalized because they can’t pay.”

Ability to pay often determines access to the various steps of medical appointments and tests that would result in a diagnosis in the first place. A person who needs an organ may die without ever knowing they were on the verge of organ failure, or only learn of their condition when they present at emergency, far too late for intervention. 

Those who do get the routine health care and workup of symptoms to identify failing organs in time may still not get to the stage of identifying potential treatment centers, undergoing the treatment center’s evaluation, or making it onto the waitlist, all because of cost. 

Medicare may help with a kidney transplant, but not for most other organs. And most private insurance will cover things like a heart, but not transplants seen as more experimental, such as a limb. Immunosuppressive drugs, required long-term after a transplant to prevent the patient’s body rejecting the organ, can cost tens of thousands of dollars a year. 

As Caplan noted, many people who use or have used drugs “are also people who don’t have insurance or have very poor insurance. They’re part of the group that’s penalized because they can’t pay.”

Photograph by North Dakota National Guard via Flickr/Creative Commons 2.0

R Street Institute supported the production of this article through a restricted grant to The Influence Foundation, which operates Filter. Filter‘s Editorial Independence Policy applies.

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In the midst of a devastating overdose crisis, the need for effective, tolerable and well-evidenced treatment for opioid use disorder (OUD) has never been higher. Incredibly, there is a plant, the shrub iboga, or Tabernanthe iboga, alkaloids in the roots of which seem to have a remarkable ability to interrupt addiction and ease withdrawal.

“It was one of the most significant transformative experiences in my life,” Kevin Franciotti told Filter. He received treatment with ibogaine hydrochloride, the extract of this plant, for heroin addiction in 2011. “There are moments in your life that you think about every day, that you carry with you every day, and my ibogaine treatment certainly fits that standard.”

Ibogaine is currently illegal in the United States. That could change. But in a society where ability to pay, racial and class disparities, and deep stigma interact intensely, the exact way it rolls out and who is responsible will determine who—and whether—it helps.

Meanwhile, could the attraction of ibogaine for OUD damagingly distract from the vital need to improve access to methadone and buprenorphine, OUD medications proven to reduce mortality—or even from advocacy for safer opioid supply?

As an extract of the bark of the iboga root, ibogaine, a tryptamine, appears to have the ability to substantially reduce withdrawal symptoms while providing insight or psychological relief for the feelings that may perpetuate OUD. It also seems to reduce the desire to use other drugs, and to help people seeking abstinence to maintain it for months or, with a second dose, even years.

Tabernanthe iboga is native to West Central Africa, mostly Gabon and Cameroon, and has been used by the Mbiri and Bwiti tribes, among others, for centuries. High doses induce hallucinations in religious rites, while low doses have been used against hunger, fatigue and thirst.

Although it’s a hallucinogen, ibogaine doesn’t work on the usual brain receptor targeted by psychedelics. It’s an oneiric, or dream-inducer, causing intense waking visions that only appear when the user’s eyes are closed.

Ibogaine was isolated from the iboga root in 1901, and used in the West in the early 1900s to treat general weakness and as a neuromuscular stimulant. By 1955, researchers at the US Addiction Research Center in Lexington were trying it out on already-detoxified morphine users.

“My body feels washed in a cleansing energetic blanket that completely removes the physical discomfort I’m feeling after 36 hours without heroin.”

But ibogaine’s first prominent use in this country was by a man named Howard Lotsof, who at 19 was addicted to heroin and tried ibogaine in search of a new high. Instead, he quit drugs altogether, becoming an advocate for ibogaine treatment and the father of the “Lotsof method” still practiced by American-run ibogaine clinics.

This method of quick detoxification through ibogaine emphasizes individual attention. Administration requires, Lotsof himself wrote as recently as 2009, “art, craft, and practice,” and “each person treated and each experience has unique characteristics that must be observed and responded to uniquely.”

Ibogaine prohibition began in 1967; the FDA classed it as a Schedule I drug in 1970. Yet in 1986, Lotsof was awarded a patent for its use in opioid withdrawal. Later patents expanded its indications to dependence on cocaine and other stimulants, alcohol, nicotine and finally for “polysubstance abuse.”

Its US legal status makes ibogaine challenging to use as a treatment, and challenging to research. But ibogaine is being used legally by Americans right now. Those with mobility and money are able to access it as a treatment for OUD—plus everything from alcohol, benzodiazepine or nicotine withdrawal to depression and stress. This happens at clinics in Mexico and other countries with different rules. Americans working with local staff in Mexican clinics, particularly, hope to bring legal ibogaine treatment over the border.

Research substantiates the assertion that ibogaine has some remarkable properties for the treatment of addiction.

“My body feels washed in a cleansing energetic blanket that completely removes the physical discomfort I’m feeling after 36 hours without heroin,” wrote Franciotti in 2015 testimony for the Multidisciplinary Association for Psychedelic Studies (MAPS) about his treatment, which was part of a 2011 MAPS clinical trial. Franciotti is now a psychotherapist and harm reduction advocate who has also written for Filter.

The easing of opioid withdrawal symptoms is just one of ibogaine’s relevant properties.

It was sold in France for many years as Lambarène, an antidepressant and stimulant post-infection or in cases of fatigue, before being removed from the market due to adverse effects (of which, more later). It has a profound impact on structural neuroplasticity in the brain’s cortex.

It’s a Luxury Treatment

Ibogaine Clinic and Research Center is a private facility of the type Franciotti first attended in northern Mexico, but located further south, at a spa-like beach resort in gorgeous, sunny Playa del Carmen, in the state of Quintana Roo.

American founder David Dardashti’s colorful history, according to his LinkedIn profile, includes being cantor at the United Synagogue in Palm Beach, developing shopping malls in Florida, studying ethnomusicology, and “healing 7,000 individuals” (his clinic website states that 3,000 patients have undergone its “life-changing ibogaine retreat, rehab and detox experience”).

The center offers ibogaine hydrochloride-assisted treatment for a remarkably wide range of indications: Suboxone dependence, sexual trauma and eating disorders are listed, as well as “executive burnout” and “chakra alignment” (according to the website, Dardasthi treats himself once a year for “anti-aging purposes”).

Although this is just one of dozens of ibogaine clinics, its rhetoric and claims—even the offbeat life history of its founder—might be viewed as fairly typical. Its website freely mixes references to peer-reviewed scientific papers, New Age language and the promise of a detox experience that is easy but potent, safe but life-changing, specialized yet responsive to practically any condition, offered by staff trained at “prestigious institutions.”

You can see a similar presentation—with a bit less New Age language but not without far-reaching claims, massage, and nutraceuticals pre- and post-treatment—at Clear Sky Recovery, in Cancun, Mexico. The facility boasts founders including Dr. Deborah Mash, a scientist who held the first FDA approval for clinical testing of ibogaine on humans with substance use disorder, and who remains perhaps the most prominent advocate for its medical use.

Dr. Mash did not respond to interview requests, but Filter spoke by video call with Ibogaine Clinic and Research Center’s operations director, Cole Barressi.

Barressi described ibogaine as a substance that touches the subconscious, making events, including traumas and shame going back to childhood, run like a picture reel through patients’ minds.

“The brain is firing again on all cylinders after arriving in treatment, and in the long term it’s not something that wears off.”

“We do use it for every substance,” he said. “There’s a proper protocol for everything … our protocols are much different now depending on what they’re on. Even alcohol looks much different from opioids, stimulants—Adderall, methamphetamines. Cocaine is much different than the others. We’re treating people for neurological disorders, bipolar, schizophrenia, early stages of Alzheimer’s, Parkinson’s, neuropathy.”

Barressi claimed that nerve pain is cured 100 percent of the time, while for dementia, the clinic can guarantee a 65 percent better lifestyle. “It’s a drastic improvement where … most people actually are declining at a rapid pace.”

He also claimed that the therapeutic effects can be permanent: “What we do know is that the brain is firing again on all cylinders after arriving in treatment, and that in the long term it’s not something that wears off.”

Unlikely though it sounds—and indeed, there is no solid evidence to date that ibogaine is an effective treatment for aging, nor indications like Alzheimer’s, despite initial findings that it acts on a particular brain receptor implicated in this and other diseases—ibogaine does indeed offer the possibility of finally having an effective medication-based treatment for addictions to substances other than opioids, such as cocaine or nicotine.

“We do have options particularly for [opioid] use disorder and then to a lesser extent a few for alcohol use disorder, but we have nothing for stimulants. Benzodiazepines are brutal [to withdraw from] and the illicit drug market is constantly changing,” Franciotti noted.

However, while anecdotal reports exist, there is currently little evidence, particularly human clinical trial evidence, supporting ibogaine for treatment of benzodiazepine or methamphetamine use disorders.

At Ibogaine Clinic and Research Center, different substances, conditions and protocols come with different costs. For “stress management optimization” for “high-functioning executives,” professional athletes, singers and others, a four-day treatment costs approximately $6,500, roughly in line with similar clinics.

All of this is financially out of reach for most people.

An eight-day program for someone “in psychosis, completely disconnected from reality” due to excessive cannabis smoking along with antidepressants or other psychiatric medication—Barressi’s example—might involve two ibogaine treatments at $9,500.

The center also offers to help people to quit effective, relatively cheap OUD treatments that are demonstrated to prevent death.

A program involving withdrawal from buprenorphine, methadone, fentanyl or other opioids might involve three treatments, 10-to-12 days in the clinic, and a cool $11,500-$13,000.

Some treatments, such as for dementia, might require a month-long stay.

All of this is financially out of reach for most people. The clinic does offer discounted rates for repeat guests, and Barressi, whose commitment to his patients is palpable—he postponed the interview twice to attend to new arrivals—said he’d be delighted if they could work with insurers to reduce costs to patients (or to the parents who often foot the bill for younger clients). 

It’s Often Tied to Abstinence

One of the advantages of ibogaine is that it’s not an ongoing treatment. However, it’s not clear just how long its effects may be relied upon, which poses important questions about the safety of the technique.

People who use opioids will have lowered tolerance if they become abstinent; in a dangerous, unregulated opioid market, they run a high risk of overdose if they return to use.

A mentee of Howard Lotsof and an early underground provider of ibogaine in the early 2000s, New York City harm reductionist Dimitri Mugianis has since become highly critical of forms of ibogaine advocacy that he sees as putting people at risk through a focus on abstinence.

“The vast majority of people go back to using, making them susceptible to overdose, but also to a lot of shaming.”

“These folks who would call themselves harm reductionists are actually operating from an abstinence-based place,” he told Filter in a video interview. “That’s the only measure of success, particularly with ibogaine and opiates. So you go through an arduous process, which sort of interrupts the addiction … a lot of cases you go through hell and then … the vast majority of people go back to using, making them susceptible to overdose, but also susceptible to a lot of shaming.”

Mugianis himself received successful ibogaine treatment in the Netherlands in 2002, for addiction to substances including heroin and cocaine. “Then you look at a lot of people’s lives and the least of their problems is the actual drug use,” he said. “There’s structural issues.”

Franciotti, whose first ibogaine treatment took place in 2011, began using heroin again in 2017, following his father’s sudden death. He avoided overdose and ultimately self-tapered back to abstinence.

Faced with another family tragedy in 2022, Franciotti felt that it was only a matter of time before he risked resuming heroin use. To preempt this, he took part in a traditional iboga grief ceremony in Costa Rica, and is once again doing well.

Franciotti, who advocates for US ibogaine access, is acutely conscious of how expense, as well as laws, impede this, although he does see value in intensive programs or rituals accompanying ibogaine use.

“It’s complicated, particularly in the United States,” he said, “because when I imagine what it would actually take to bring a medicine like ibogaine into a regulated environment, we’re no longer talking about, you know, a $30,000 stay at a 30-day inpatient facility. We’re talking about $30,000 a week.”

It’s a “Dirty Drug”

Ibogaine is “a dirty drug because it activates or inhibits a bunch of different receptors especially in the central nervous system,” Brian Shoichet told Filter. A professor in the Faculty of Pharmaceutical Chemistry at the University of California-San Francisco, Shoichet seeks out new methods of drug discovery by synthesizing molecules and modeling the way biological molecules work together.

Dirty, when applied to drugs in this context, isn’t a pejorative term; for toxicologists and others, it just describes how ibogaine works on our kappa-opioid receptors, on our nicotine receptors and on one of our serotonin receptors, among other targets.

This property, technically called polypharmacology—promiscuous is another term applied non-pejoratively—may be helpful to treat conditions that involve behaviors, like depression, schizophrenia or, yes, addiction. But these drugs are hard to dose correctly because of great variability in how different people metabolize them.

Ibogaine has additional major drawbacks. It may be neurotoxic, is definitely cardiotoxic, and has been associated with deaths—although very few, relatively speaking, and with “advanced preexisting medical comorbidities” often present in those cases.

Of greatest concern is its risk to the heart, particularly by causing arrhythmias. At the Dardashti clinic, according to the website, they screen for cardiac risk and spend a lot of time checking people’s cardiac response.

“Ibogaine is a really exciting molecule that teaches us a lot, and you can develop molecules that are more selective.”

It’s a measure that Shoichet doesn’t think would be adequate, partly because the cardiac risk comes from ibogaine’s effect on a particular potassium ion channel in the heart, not something you can test for. This ion channel poses a particular problem that often leads the FDA to tell drug developers a given drug is not safe, according to UC Davis chemist David Olson, who also spoke with Filter about his ibogaine research.

“I think that ibogaine is a really exciting molecule that teaches us a lot, and you can develop molecules that are more selective,” Shoichet said.

In fact, that’s exactly what he and his team have done by discovering two SERT inhibitors, which block the brain’s serotonin transporter similarly to ibogaine and SSRI drugs like Prozac. These molecules, they report, are potent, less promiscuous than ibogaine, and not problematic for the heart.

In 2020, meanwhile, Olson and his colleagues engineered tabernanthalog, or TBG, a synthetic molecule that’s again like ibogaine, but without the hallucinogenic aspect.

“Essentially what we did is we took the structure [of ibogaine] and we sliced off different parts of it,” Olson said. To use a car analogy, “we chopped off the door, we removed the windshield, and we found that we still had something that produced everything like therapeutic effects, but was a lot easier to manufacture.”

The new drug is licensed to Delix Therapeutics Inc., a company Olson started, and is still at a preclinical stage, having been tested on zebrafish so far and confirmed to not bind to the ion channel of concern in the heart. Promisingly, the researchers also found that it encouraged formation of new dendrites, or branches, on rat neurons—and new spines on the dendrites. This suggests effects like the neuroplastic and brain cell regenerating property of psychedelics such as ketamine, LSD and DMT.

Such neuroplasticity may be an important aspect of ibogaine’s effect on addiction, re-establishing synaptic connections in the prefrontal cortex that appear to be damaged in people with substance use disorder.

Core to these explorations is the notion that one day, drugs with ibogaine-like properties could—in the absence of substantial risks—be take-home medications for far more people than will ever access ibogaine itself.

And It’s illegal

Ibogaine is illegal in the US and several other countries. But its sale is decriminalized in Portugal, and it’s unregulated in Germany and Mexico. It’s controlled in other places and can be prescribed, for example, in Australia and New Zealand. In the Netherlands, where it’s not regulated but also not criminalized, there are many ibogaine treatment centers, the same situation as in Costa Rica.

Hopes of bringing ibogaine to the US rest largely on the growing interest in psychedelics and on initiatives to decriminalize or medically regulate drugs in this class.

States like Colorado and Oregon seem like the most immediate prospects for progress.

There’s certainly no shortage of people ready to launch businesses selling ibogaine or ibogaine treatment the minute it’s legal to do so. Barressi said his clinic works with veterans’ organizations and others in the US, including MAPS, who want to see an expansion of access to the addiction treatment.

States like Colorado and Oregon seem like the most immediate prospects for progress. Ibogaine made it onto Colorado’s Proposition 122, which squeaked into law last year; so licensed “psychedelic healing” facilities, and perhaps addiction treatment centers, should be able to offer ibogaine, among three plant-based psychedelics, in the state as of 2026.

At the federal level, Rick Doblin, founder of MAPS—whose drug development subsidiary has just submitted an application to the FDA for medical approval of MDMA—expects ibogaine to eventually receive a similar nod.

In 2022, the Substance Abuse and Mental Health Services Administration said it would explore creating an interagency psychedelics task force to investigate possible use and deployment of psychedelic medicine and therapy. It’s possible, but not guaranteed, that ibogaine could be included by such a task force, which has yet to be announced.

Perhaps more surprisingly, in July, the Kentucky Opioid Abatement Advisory Commission discussed possible use of opioid settlement money to fund development of a safer, ibogaine-based OUD treatment, possibly to the tune of $7 million over six years.

What About the Masses?

Like other researchers focused on the active molecules in the iboga plant, Shoichet argues that the goal of addiction medicine is to scale up to treat millions of people in need.

His and Olson’s approaches—and similar molecule-based ventures, like the isolation of ibogaine analog 18-methoxycoronaridine, or 18-MC, which works on nicotinic receptors and appears to offer ibogaine’s anti-craving properties without the downsides—all aim to satisfy that requirement. What they’re looking to produce must be easy to administer, not require heavy clinical oversight, be relatively safe, be cost-effective to produce, and be standardized.

The contrast to the current, Lotsof-inspired ibogaine model of unique, individualized experiences couldn’t be greater.

How are we to assess the relative merits of a small, attentive clinic setting, where part of the therapy is kind attention, psychotherapy, massage and individual tweaking of the program—or a traditional, time-honored ritual, where it’s impossible to separate out the different components—versus the merits of a relatively safer, cheaper, easy-to-administer take-home treatment that can be implemented at scale?

Each comes with the potentially corrupting profit motive. Each has a natural philosophical appeal: A synthetic can be made accessible to most people, and avoids the environmentally and culturally destructive aspects of illicit sales of iboga from Gabon (fair trade is so far not a major component of iboga sales, and it’s usually smuggled out of its country of origin). A small treatment center provides holistic supervision in a pleasant environment with a break from regular life.

But again, these options share a critical caveat in the real-life context of mass opioid-involved overdoses and deaths: the risk of a person returning to use with increased vulnerability.

“It won’t move the needle on the so-called opioid crisis or the overdose crisis. It won’t move the needle.”

Unlike with the gold-standard OUD medications, methadone and buprenorphine, this risk is not mitigated by the person having maintained a level of opioid tolerance. Where abstinence is held out as the overriding goal, OUD patients will be required to put great faith, with limited evidential backing, in the long-term ability of ibogaine or similar drugs to protect them from the statistically extremely high risk of returning to use in a deadly unregulated market.

When I asked some of the people quoted in this article about the risk of letting a person detox without providing a safety cushion in case of resumed use, various responses acknowledged but downplayed it. They pointed to ibogaine patients’ lack of desire to use again, thanks to newly gained insight into the causes of their substance use; or denied it’s like other forms of opioid detox and abstinence treatment, which raise the risk, compared to methadone and buprenorphine, of overdose death and emergency room admission.

“It won’t move the needle on the so-called opioid crisis or the overdose crisis. It won’t move the needle,” Mugianis said of ibogaine.

Kentucky’s overdose crisis, he argues in a recent op-ed, demands urgent action on proven large-scale responses targeted directly at the most marginalized people, instead of “diverting [opioid settlement] funds to an exotic research project.” As well as funding opioid agonist treatment, this could include housing, job training, childcare or covering transportation costs so that people can access evidence-based OUD treatment.

“There’s an idea,” Mugianis told Filter, “that psychedelics will somehow magically transform society and will somehow lead to the … destruction of structural issues around class and race and gender … It’s just absolute fetishism, and harmful fetishism. We need to do the hard work of change.”

It doesn’t have to be a zero-sum game.

The promise of ibogaine is indeed enticing. It has been genuinely transformative for people like Franciotti. And it is emphatically worthy of further investigation—particularly in the form of a cheap, accessible pill, and particularly for addictions that don’t already have a medication-based treatment.

But with improvements to dosing, convenience, side-effect management and dignified, equitable access, our existing OUD medications might turn from “liquid handcuffs” to something just as amenable to either spa resort treatment or a simple-to-take pill.

It doesn’t have to be a zero-sum game. After all, a diversity of treatment options is good, and abstinence from opioids is a valid goal for people who choose it. But an opioid strategy that diverted either public awareness or resources away from methadone and buprenorphine in favor of ibogaine would be a costly mistake.  

Photograph of Tabernanthe iboga by Scamperdale via Flickr/Creative Commons 2.0

R Street Institute supported the production of this article through a restricted grant to The Influence Foundation, which operates Filter. Filter‘s Editorial Independence Policy applies.

The post Neither Snake Oil Nor Silver Bullet: Ibogaine for Opioid Use Disorder appeared first on Filter.

The harm reduction gains are real, even if programs don’t reach nearly enough people and far more remains to be done. Each has only been won through painstaking activism, often civil disobedience or legal challenges, by people who use drugs and their allies.

But Canada’s gains also face—increasingly, perhaps—an organized, ideologically right-wing backlash. Opponents of harm reduction vigorously seek to link progressive drug policy with social strife, stoking moral panics that translate to votes and then to deaths, as life-saving interventions are weakened or eliminated altogether.

Benjamin Perrin should know. A conservative from his early teens, he rose through party ranks to become advisor on public safety issues for Conservative Prime Minister Stephen Harper in 2012, just as the toxic drug supply saw a dramatic surge in overdose deaths.

He’s not the first person to become more progressive upon leaving their position of leadership or influence (the pro-decriminalization Global Commission on Drug Policy is full of former presidents who upheld prohibitionist or punitive policies while in office). But Perrin’s change of heart was a bit more like a transplant. After close personal encounters with the lived realities of intergenerational trauma, addiction, disability and mental health challenges, he “found freedom and peace in Jesus Christ,” according to his website. And he began to take an interest in the impact of poverty and other forms of marginalization on people he once saw as the problem.

“Substance use has become enmeshed in right-wing narratives such as homelessness.”

Perrin now speaks across the country about the need for compassionate, evidence-based policies, and wrote a progressive-minded, if not radical, book on the subject. But he doesn’t believe more evidence is likely to change people’s opinions.

“Ideology is firmly in the driver’s seat,” he told Filter. In fact, it’s not an old-fashioned conservative ideology that he describes—although he draws links to the traditionally conservative idea that people should “pull themselves up by the bootstraps”—but moralism, what he calls “moral panic.”

Most worrying, drug policy has joined other hot-button issues as the subject of massive misinformation campaigns, which Perrin describes as mob-like and fear-based.

“Substance use has become enmeshed in right-wing narratives such as homelessness,” he said.

This has played out most recently in relation to safe supply, in stories that illustrate complicated connections between anti-harm reduction rhetoric, people making money from unregulated addiction treatment, and the right wing in Canada and beyond.

The Anti-Harm Reduction Wave

In January, Last Door Recovery Society, a private, abstinence-only addiction treatment center in Vancouver, provoked a national-level debate with an inflammatory press release alleging “diversion” of safe-supply hydromorphone in the city. Although these allegations have been debunked, Conservative Party leader Pierre Poilievre seized on the issue. In doing so, he aped US global warming apologist Michael Shellenberger’s argument in his 2021 book, San Fransicko: Why Progressives Ruin Cities: that unhoused people and permissive drug policies are to blame for urban problems.

This draws liberally from the playbook of right-wing activist and journalist Aaron Gunn, whose incendiary documentary, Vancouver is Dying, came out in October. The fim takes direct aim at the federal government and politicians who have promoted harm reduction policies. It interviews cops, people with histories of addiction, and victims of crime to advance the debatable view that crime in that city is out of control, and the baseless assertions that it results from harm reduction policies, and is perpetuated by unhoused people who use drugs (but not from policies like deregulated rent that result in homelessness). A frequent, nonsensical analogy made in the film—which has garnered millions of views—is that providing opioid safe supply is like encouraging people with alcohol use disorder to drink and drive.

On the back of the Last Door tempest, a swarm of poorly-informed articles flooded Canada’s mainstream right-wing media. In May, the National Post dedicated an unheard-of 10,000 words to an opinionated investigation of safe supply “diversion” that was deeply careless with the facts. On the further reaches of far-right media that have spread in recent years, the trifecta of violent crime/homeless encampments/harm reduction has become an almost constant bugaboo.

April was Alberta’s worst month on record for overdose. Yet in May, instead of rethinking her attacks on harm reduction, Premier Danielle Smith promised to legislate forced addiction treatment.

In Alberta, meanwhile, the United Conservative Party (UCP), which forms Canada’s most right-wing provincial government, has been vociferously opposed to safe consumption sites (SCS); defies the evidence by promoting abstinence-based treatment for opioid use disorder; and has thrown lives into chaos with its recent reduction of access to an existing safe supply program.

April was Alberta’s worst month on record for overdose deaths. Yet in May, instead of rethinking her attacks on harm reduction, Premier Danielle Smith—selective in her libertarian opposition to government overreach—promised to legislate forced addiction treatment. She stated, without evidence, that this “will allow us to save the lives of addicts who are at risk of dying from an overdose and protect those who are at risk of being randomly attacked in our communities.”

It’s not clear, however, that anti-harm reduction positioning reflects the views of the average Canadian.

“I think that generally speaking, the Canadian public tends to be fairly supportive of harm reduction,” Elaine Hyshka, an associate professor at the University of Alberta’s School of Public Health, told Filter. “I think for most people it is becoming increasingly, like, common sense that in order to reduce the harms of substances in society, we need to take multiple different approaches. And one of those approaches is harm reduction.”

In support of this, Hyshka cited her recent work on public opinion about safe supply. Even in Alberta and Saskatchewan, the relatively conservative provinces she polled, Canadian public opinion didn’t follow anti-harm reduction rhetoric: in Alberta in 2021, for example, a full 63.5 percent of respondents were in favor of programs that replace illegal drugs with pharmaceutical alternatives for people who haven’t been able to stop using.

“We found that the majority of people were supporting the idea of prescribing pharmaceutical alternatives or providing pharmaceutical-grade alternatives to illegal drugs for people who are dependent on the illegal drug supply,” Hyshka said.

Nonetheless, Canada’s right-wing backlash to harm reduction is loud, determined and politically powerful. Perrin now looks at the movement a bit like someone who has escaped a cult—even as it goes further in a direction set by the government he served.

Cycles of Blame

To understand the appeal of that cult to at least a significant proportion of Canadians, consider the “right-wing authoritarian personality,” as defined by Canadian-American social psychologist Robert Altmeyer. He describes a personality type submissive to authority, highly adherent to social conventions endorsed by authorities, and quick to condemn, and aggressively punish, supposed enemies identified by assertive leaders. Typically these “enemies” are outsiders, or people perceived as morally degenerate.

“One kind of theory is that Canadian drug policy is very dictated by these oscillating moments, of panic and then indifference,” Alex Betsos told Filter. A PhD student studying Canadian drug history at Rensselaer Polytechnic Institute, he’s also an international working group member for the harm reduction organization Youth RISE.

Betsos pointed to the wave of limited but progressive initiatives that governments got behind for a couple of years, as a result of panic about surging overdose deaths around 2016. Over this period, increasing public understanding of the evidence supporting SCS and other harm reduction interventions was evident, as borne out in polls like Hyshka’s.

Since then, though, many Canadians have returned to the indifference part of Betsos’ cycle, the COVID-19 pandemic having seized everyone’s attention (and severely worsened the overdose crisis).

“People’s feelings about the city and crime go up and down … drug users or people without housing get the blame for it. And we’re seeing one of those cycles happening.”

Perhaps this sense of comparative indifference created a vacuum into which right-wing advocates of prohibitionist, punitive drug policy could step, gathering up a mob of vocal followers to unleash a pattern of online, often transnational mobilizing, with right-wing media outlets stoking local and in-person outrage—seen around everything from SCS and immigration to the use of gas stoves.

“Regardless of what crime statistics say, people’s feelings about the city and crime go up and down,” Garth Mullins told Filter. A longtime drug-user activist and member of the Vancouver Area Network of Drug Users (VANDU) and the BC Association of People on Methadone, he also hosts and produces the award-winning drug-war podcast Crackdown.

And then, when those feelings take a downward turn, he continued, “drug users or people without housing get the blame for it. And we’re seeing one of those cycles happening.”

“You know, if people are feeling unsafe, then it starts with a genuine feeling,” Mullins said. “And then it pivots to blame new enemies. And that’s how right-wing and far-right propaganda often works … When there’s a complicated situation, to find enemies you can point to—like Pierre Poilievre, you can just point to Look, look here, these people on the street who are completely visible, that’s what’s causing the problem, instead of something like the price of food or the inequality in the system or the Controlled Drugs and Substances Act.”

Betsos noted that attribution of “urban blight” and visible homelessness to failed progressive drug policy isn’t a new thing. But, he said, it wasn’t until recently that it gained new traction. “It’s taken a while to get off the ground, I think, and that’s maybe why we’ve been really caught off guard.”

What seem like spontaneous reactions and inadequate education—and what harm reductionists have typically countered, in good faith, as such—are increasingly arising from the larger anti-progressive movement that specializes in disinformation and is eager to find a way to be partisan about everything.

“People can have views about things, but if they’re not organized, they haven’t found each other and coordinated their messaging and actions, [it’s] not very effective,” Mullins said. “But now, right-wing politicians and commentators in the media have all found each other, and they’re coordinating their action. And so they’re being very effective about it.”

“This is all [rooted in] a sort of nationwide or continent-wide law-and-order backlash,” he added. “When it first came to my attention that this is a continent-wide thing that was gonna affect us was when that Shellenberger guy was getting ready to write his book.”

When he saw how San Fransicko fuelled pundit and public outrage—by attributing public homelessness, similar to Vancouver’s, to compassionate drug policy—Mullins knew that this argument would have a lot of currency in Canada.

Follow the Money

Another line of thinking: At the bottom of this, it isn’t really a debate about the pros and cons of harm reduction at all. Some Canadian harm reductionists have begun looking into the links between would-be privatizers of Canada’s public health care systems, right-wing influencers and movements across North America, and government or political party workers on the Canadian right who benefit financially from private addiction clinics and services.

Bringing such connections to light clarifies narratives that benefit those for whom deaths and suffering among certain groups of people who use drugs are the cost of doing business. In this case, it’s not really views on harm reduction that are driving policy, but right-wing ideology acting as a justification of profiteering.

Last Door—the residential addiction treatment facility that set off a storm in Canadian politics—is, as various harm reductionists have carefully traced, deeply enmeshed in a network of anti-harm reduction advocates who are also entrenched in US right-wing movements. And, in contrast to publicly-accountable harm reduction programs, unregulated treatment centers like Last Door take public funding but make private profits.

Euan Thomson, executive director of Each and Every: Businesses for Harm Reduction, a coalition of small businesses promoting evidence-based responses to the overdose crisis, points out in his newsletter that Last Door’s director of community development is the chair of Recovery Capital Conference of Canada, which runs the influential and prohibitionist Alberta Recovery Conference (ARC).

This annual conference, open only to those who can pay CA $500 to attend, draws speakers from among the most outspoken North American opponents of harm reduction. These have included US doctors Keith Humphreys and Anna Lembke; Julian Somers, a British Columbia psychiatrist known for his conflation of homelessness, addiction, drug use and crime; and Marshall Smith, chief of staff to Danielle Smith and an advisor to the United Conservative Party on addiction and recovery.

Thomson additionally flags a network of public and governmental organizations in Alberta that provide massive funding to Last Door.

Smith, who comes from BC, experienced homelessness and addiction to methamphetamine and alcohol in the early 2000s. Shortly after receiving residential treatment himself, he became the director of a private treatment center. Later, he was a senior staffer in an abstinence-based “therapeutic community.”

This heavily government funded but private residential rehab allegedly farmed out patients as free labor for businesses run by donors to the right-wing BC Liberal Party—for which Smith had been a ministerial aide—as well as providing contracts for work at the rehab to donors, and funneling donations from the party to another treatment center. Smith is alleged (and none of these allegations have been proven in court) to have had his addiction patients cold-calling Liberal party members to solicit support for his favored candidate to lead the party.

Since leaving BC, he’s parlayed his combination of political influence and experience into a career as driving force for the so-called Alberta Model. US-based pundit Sean Speer, a fan of Margaret Thatcher and Ronald Reagan’s “coherent and intellectually-rooted policy agenda,” is another former Stephen Harper advisor who has praised the Alberta Model.

Thomson additionally flags a network of public and governmental organizations in Alberta that provide massive funding to Last Door—for example, a 2021 contract worth over CA $1.2 million to create a phone app. Another sponsor of the ARC, Edgewood Health Network, was awarded tens of millions of public money by Alberta’s UCP government to open residential “therapeutic communities,” providing unregulated, abstinence-based addiction treatment.

The inaugural ARC sponsor, meanwhile, was Our Collective Journey—a UCP-funded, Medicine Hat-based recovery coaching organization. Our Collective Journey is a member of North America Recovers, a transnational organization that has run ads in Washington, DC calling on President Joe Biden to shut down SCS.

First established in Seattle just this year with the aim of also shutting down encampments of unhoused people, North America Recovers promotes abstinence-based treatment, with a distinctly right-wing philosophy that draws on ideas similar to San Fransicko.

Like the UCP, North America Recovers advocates mandatory medication for mental health issues and forced treatment for addiction—including treatment known to increase the risk of death, relative to other options, for people with opioid use disorder.

In this vision of the world, encampments should be razed and unhoused people forced into emergency shelters even at risk of disease, overdose or other harm. Human rights like safe shelter should be conditional on abstinence or compliance with mental health and addiction treatment. And drugs should remain illegal, even as the lucrative treatment industry lines its proponents’ pockets.

Fighting Back

During an earlier overdose crisis in the 1990s, drug-user activists who had argued for a range of solutions, including decriminalization—which might have prevented the later rise of illicit fentanyl—were forced to compromise on their demands. They wound up with a single SCS in Vancouver.

A single SCS was deeply inadequate given that prohibition was already worsening overdose risk in an illicit drug market centered in the Downtown East Side, an impoverished area where gentrification increasingly pushed residents to homelessness. The site also bought into a medical model many drug-user activists would prefer to avoid. Yet it was better than nothing, and viewed as a first step. And so, despite these concessions, they later had to defend it, and other imperfect responses, from attacks by Stephen Harper’s Conservative government.

“When Harper came to shut it down, we had to defend it,” Mullins recalled. “And there was a whole bunch of myths fabricated around the safe injection site as well. And we had to clarify those myths.”

While Harper’s former advisor Perrin tries to convert Christians to the harm reduction cause, those in the harm reduction trenches and others see it as less about cajoling compassion and more about claiming rights.

“We’re always … trying not to step on toes, and so we’re making all these compromises.”

Betsos, for example, argues that while harm reduction initiatives are falsely characterized as not working because they are too radical, in fact, the reason they don’t work as well as they could is that they don’t go far enough.

“We’re always … trying not to step on toes,” he said, “and so we’re making all these compromises.”

Dr. Hyshka believes the same. In her research, she’s found that while generic harm reduction rhetoric is often used by governments, there are still relatively few substantial harm reduction policies in any of the provinces or territories.

“I actually think that in some cases, the fact that these programs have been implemented incrementally [is] providing critics an opportunity to say, well, we’ve tried that and it doesn’t work,” she said. “They have not been scaled to the size that they need to be.”

Like Hyshka, Betsos points to the backlash against very restricted hydromorphone programs, which were developed in response to some evidence that some people can’t distinguish hydromorphone from heroin under certain conditions. Critics of such programs say sarcastically that you might as well give everyone heroin, or fentanyl. In fact, Betsos agrees.

While hydromorphone, like methadone, works very well for those for whom it works, it was yet another compromise for drug-user activists and harm reductionists. It was simply easier to seek approval for hydromorphone than the less politically-palatable diacetylmorphine, the pharmaceutical version of heroin.

“We’ve been kind of stymied by the potential for conservative backlash,” Betsos said.

Harm reductionists know that many people who use opioids now seek not heroin, but more potent, shorter-acting fentanyl. As a direct substitution, prescription fentanyl programs—some isolated examples are emerging—would be more likely to retain people and help them stabilize their lives.

Perhaps, Betsos suggests, harm reduction advocates need to go not smaller in their demands, but bigger—lining up more squarely behind evidence and a holistic grasp of the dynamics in which people are suffering.

“One point is [the potential of] meeting the political moment as a moment to open up possibilities,” he said.

“The problem is, we have to explain the system, and they have to just point to a scapegoat … so our job is a little harder.”

Mullins is focusing on building coalitions to make common cause with labor movements, civil rights groups and others against the right-wing momentum across North America. These efforts seek to bring drug-user voices into the conversation, and to educate the public—including his fellow VANDU members, whose lives are directly affected by the rhetoric—to see through right-wing talking points.

At a recent VANDU meeting, Mullins played video clips from the House of Commons debate on Poilievre’s (eventually-defeated) motion seeking to defund nationally-funded harm reduction programs like safe supply.

“Everyone is like, booing [Poilievre], but also kind of shocked to see our issues being lied about in the most powerful room in the country,” he said.

It’s not easy countering the lies, though. “The problem is, we have to explain the system, and they have to just point to a scapegoat … so our job is a little harder,” Mullins explained. “That’s the great thing about the invisible hand of the market. It’s invisible … so those market forces that are making everybody’s lives so much more difficult are hard to just point to directly.”

Photograph by Tony Webster via Flickr/Creative Commons 2.0

The post The Right-Wing Backlash to Harm Reduction in Canada appeared first on Filter.

Indigenous land defenders’ struggle to wrest back control of land—from both illicit actors (like drug trafficking organizations or wildcat, “artisanal” miners) and, increasingly and usually more significantly, legal or nominally legal ones—is a difficult, dangerous and terribly lopsided battle.

Perhaps, as Guatemalan ecological activist Julio González suggested to Filter, it is inevitable that people living in relative harmony with environmentally and culturally significant land will be pushed too far by those seeking to extract profit at any cost, and armed conflict will (continue to) erupt around the world.

But land defenders continue to pursue new avenues to end impunity for the destruction of irreplaceable ecological heritage and ways of life.

Going International

Pedro Landa, a Honduran human rights defender, spoke with Filter on the seventh anniversary of the murder of his former colleague, Berta Cáceres.

Cáceres was a beloved Lenca Indigenous leader and environmental activist who co-founded and led the Council of Popular and Indigenous Organizations of Honduras (COPINH). She had been fighting the Agua Zarca hydroelectric dam project on the Gualcarque river in the country’s northwest. Her assassination in her own home in 2016, a couple of days before her 45th birthday, drew international outrage.

Berta Cáceres in 2015. Photograph by coolloud via Flickr/Creative Commons 2.0

Murders of people defending their ancestral, environmentally sensitive territories remain rampant and mostly garner little attention, with the 2022 killings of journalist Dom Phillips and Indigenous activist Bruno Pereira a rare exception.

As Landa described, the situation for land defenders on the ground is truly grim. By September 2022, close to 90 environmentalists had filed complaints relating to threats to their person in that year alone, according to the United Nations High Commission for Human Rights.

The convictions have triggered no changes to protect land defenders on the ground, Landa said.

Landa has worked over the years in Africa, as well as Central and South America, on organizing committees and with many different local advocates. So he’s in close contact with many Indigenous groups defending their waterways and ancestral lands, and has observed again and again how their opponents operate.

“I’ve identified common patterns of imposition that occur,” he said, of a neoliberal, extractive model that allows private companies to pillage Indigenous lands. These “permit impunity, the non-application of the law to companies but also to public functionaries who, in collusion with companies, sack territories and are responsible for crime such as assassinations.”

In 2022, Roberto David Castillo, the former CEO of Desarrollos Energéticos (DESA)—and once an intelligence officer in the Honduran army, trained by the United States military—was sentenced for his role as “intellectual author” of Berta Cáceres’ murder, having monitored her for years before planning, arranging and getting the money to pay for the fatal hit. Castillo was the eighth person to be sentenced in relation to her death.

DESA, a Honduran state company, was one financier of the Agua Zarca project along with Chinese and European investors (this is a good overview of the case, and how international companies tacitly or actively assent to repressive practices against local opposition). Other powerful shareholders in the dam, believed to be implicated, remain untouched.

Yet the convictions have triggered no changes to protect land defenders on the ground, Landa said.

Honduras and El Salvador are the only Latin American or Caribbean nations which have not signed on to the Escazú Accord, an initiative of the United Nations agency CEPAL (Economic Commission for Latin America). This 2018 agreement contains legally binding requirements for signatories to protect environmental defenders. Globally, about 200 land defenders are murdered every year, according to a 2022 Global Witness report.

Since 2010, 120 Honduran environmentalists have been murdered. Two Honduran activists were assassinated in the first week of 2023.

Cáceres’ 25-year-old daughter, Bertha Zúñiga Cáceres, now heads her mother’s organization. Colleagues of Landa and Cáceres continue to face regular threats.

“Worst of all,” Landa said, “in addition to the corruption [of companies and officials], we have the issue of drug trafficking: narcominería, or the investment of cartels in extractive projects in order to launder their money.”

Organizations that would not exist, of course, without global drug prohibition.

Sometimes, Landa said, minerals aren’t even mined, but illicit earnings are reported as resulting from mining (a claim supported by research). Vast profits are laundered in this way. Indigenous and other land defenders therefore face conflict with mining companies and trafficking groups alike.

It is hard to overstate the degree to which narcominería and other forms of corruption related to the global drug trade shape Honduras. Porfirio Lobo, the son of the country’s 2010-2014 president, trafficked cocaine for the long-dominant Cachiros organization—which laundered profits through companies that won contracts from the Lobo administration.

After Lobo came Juan Orlando Hernández, whose brother was convicted in the US for drug (and weapons) trafficking. The president himself is accused (in testimony from the US trial of Joaquín “El Chapo” Gúzman) of accepting millions in campaign donations from traffickers—giving him their “license” to lead the country (as explained by Nina Lahkani in her book on the Cáceres murder, and her longtime reporting from Honduras).

It is on the international front that Landa sees the possibility, however slight, of change.

Tight, complex connections between elected officials, private security forces, resource extraction companies and traffickers with tremendous resources make it impossible to trust the “system” to protect Hondurans who want a project off their land.

“When there is conflict,” Landa said, following destruction of water reserves or assassinations, for example, “the powers responsible for administration of justice are also co-opted.”

So it is on the international front that Landa sees the possibility, however slight, of change.

He attributes the current situation to the wave of multilateral and free trade agreements countries like Honduras and Guatemala signed in the 1980s, which privileged private profit over national autonomy, forcing lower environmental and social expectations. Vast profits made from drug prohibition—profits best hidden, at least nominally—create a perfect storm of corruption and violence.

“And this is why you see that we have to go to the international bodies,” Landa said, “like the Inter-American Court of Human Rights or like the International Court of Justice in the Hague, or look for judicial process in the countries of origin of corporations […] or the banks that finance them.”

To these ends, Landa works as project coordinator and country representative for Honduras with a coalition called the International Platform Against Impunity. He’s also involved in the development of guiding principles relating to corporations and human rights with the United Nations and the European Union, and has participated in networks of different Amazon countries facing similar issues. Seeking enforcement of internationally recognized rights within Honduras, Landa has addressed the United States Department of State, the UN Forum on Business and Human Rights and COP23. In 2011, he testified to Canada’s House of Commons about the situation in Honduras and the complicity of Canadian mining companies.

But such multinational efforts, often seeking consensus between numerous parties, can be as slow-moving as they are necessary. And it may simultaneously be possible, sometimes, to use national legal systems to preserve land title and ensure enforcement of environmental protections. For this, there is perhaps no more compelling example than that of the Atrato River, in Colombia.

If a Corporation Can Be a Person, Why Not a River?

Like the Ganges in India, or the Whanganui in New Zealand, the Atrato River is not merely a long waterway (Colombia’s third-largest). It’s the site of a complex relationship between the people who live along its banks, and ecologies connecting the forest and other lands through which it runs with that of the river itself.

The Atrato River. Photograph by Almajoir via Wikimedia Commons/Creative Commons 4.0

Cutting through different regions and communities, the Atrato nourishes plant, animal and human life, sustaining livelihoods through fishing and agriculture. And it is used to transport all manner of goods. The Atrato is a major route for cocaine shipments bound for Panama and the Caribbean.

“You’ll have noticed I’m a backpack lawyer, because I live so much in the field,” Andrea Torres told Filter on a video call. A lawyer for the Colombian non-profit Tierra Digna, she was speaking from a hotel, minutes before she was due to fly by small plane into the rainforest.

There, in the western state of Chocó, she spends much of her time among the communities she represents: Afrodescendent peoples who live in intimate relationship with the Atrato river. They taught her of their need to make Colombia’s Constitutional Court understand it’s not possible to separate ancestral human activity from the ecology of the river.

Torres explained that Chocó, through which the Atrato flows, is remote and difficult to enter. Some communities can only be reached by boat. Infrastructure is scarce in this mountainous rainforest region, and poverty widespread.

“We don’t have other ways to live. But we don’t want to cultivate drugs, we don’t want to mine gold. We need our ancestral ways of life…”

Besides cocaine being shipped along the Atrato, illegal gold mining takes place there, with monstrous floating dredges dubbed “dragons” that suck up silt. There is an ongoing history of armed conflict and forced displacement, and sometimes the cocaine traffickers and gold miners are paramilitary groups for whom these are sources of financing, along with illicit logging.

The Atrato is also an important legal trade route between Chocó’s river communities and the port cities of Barranquilla and Cartagena. And the ecology of the river biome and the lives of its people are imperiled by mercury contamination and environmental degradation. Despite Chocó holding the world’s rainiest lowlands, with close to 400 inches of annual precipitation, there is a lack of potable water in its capital, Quibdó.

Tierra Digna has worked in the region since 2010: providing training for leaders in the large Afrodescendent community, identifying megaprojects that threaten their way of life and those of Indigenous communities also living on the Atrato, and listening to what community members want.

“We don’t have other ways to live,” Torres recalled them telling her. “But we don’t want to cultivate drugs, we don’t want to mine gold. We need our ancestral ways of life…”

Protection for the river that includes protection for these ways of living, they have emphasized over and over, must be guaranteed rights.

Through long stays in the Amazon, Torres and her Tierra Digna colleagues began to understand that the communities held a view of these rights that differed from the dominant economic or environmental models. “They taught us that we have to show the Constitutional Court this different vision of the relationship between humans and nature,” Torres said.

Tierra Digna agreed to represent several Afrodescendent, Indigenous and subsistence farming communities—and on their behalf, Torres spearheaded the acción tutela for the protection of constitutional rights. She argued that the government’s failure to prevent illegal mining in Chocó violated communities’ constitutionally-protected fundamental rights to life, health, water, food security, a clean environment, and to their ethnic cultures and territory.

The communities in question share with communities living alongside the Ganges in India a similar “spiritual and philosophical vision of the relationship between humans and nature,” Torres said. This underlies the rights lawyers sought on their behalf for both the Ganges and the Atrato.

The different Indigenous groups who have lived on the Atrato, and the Afrodescendent people whose ancestors were brought there as slaves, have distinct “cosmovisions,” as Torres put it—her Afrodescendent clients’ concepts are informed by Yoruba spiritual beliefs—but fundamental commonalities. “Both peoples and both visions coincide in that nature is essential for their existence.”

Torres paused and smiled. “I’ll be honest. We did not expect what resulted.”

Her clients proposed that rather than creating a defensive policy to respond to the incursions of armed conflict, drug traffickers and illegal miners, the lawyers help them develop a positive response, focusing on the concept of interdependence.

The lawyers thought this would be a sort of symbolic case, where they could at least get a different vision to the extractive economic model heard and recorded. “We wanted the court to hear the people and understand that there are different ways to see things … That there must be a model where nature is treated like a human being, with care, with respect.”

Torres paused and smiled. “I’ll be honest. We did not expect what resulted.”

To their surprise, the court was deeply affected by community members’ testimonies. Its judgment, delivered on November 10, 2016, formally recognized the river itself, with its tributaries, as a subject of rights—a legal entity—distinct from the rights of the communities that live on it.

This means that the Atrato has the right to be protected, maintained and restored by the government and the communities. With a series of orders, the judgment required the Colombian government to move to a vision of the region in which the relationship between people and nature is considered indivisible. The government must consider climate change when developing energy and mining policies; must create an economic development plan that respects interdependence; and must appoint two guardians, one from the government itself and one from the claimant communities, to represent the rights of the river.

Even if policy details had yet to be determined, a fundamental principle was established. 

Rivers With Rights

As it happens, just a month before the Atrato decision, a constitutional court in New Zealand made a similar judgment on the Whanganui, where similar interdependence exists between river, humans and non-human life. And at the very same time, a tribunal in India granted biocultural rights to the great Ganges.

The Colombian Constitutional Court cited the freshly-delivered Whanganui decision and a related law in its judgment, with the two-guardian model derived from New Zealand’s—showing that step by step, communities separated by thousands of miles may be able to indirectly support each other’s efforts to change the framework.

“Implementation has been terribly difficult.”

But it’s one thing to get an amazingly good judgment in the court, and another to see its effect in daily life on the remote river. “Implementation has been terribly difficult,” Torres admitted.

There has been a notable lack of success in putting together the policy required by the Constitutional Court. The government, Torres feels, still doesn’t understand the conceptual shift grounding the notion of the river having biocultural rights.

“It’s been five years, and it seems that the government of Colombia doesn’t really understand the philosophy,” she said. “So they haven’t been able to develop a public environmental policy that respects the contribution of [the people living alongside the river].”

In April 2018, the Supreme Court of Colombia built on the Constitutional Court’s Atrato decision by further granting legal rights to the Amazon river ecosystem. It did so in its judgment on a lawsuit brought against the then-president, national ministries and agencies, and local governments by 25 young people, alleging that their rights were violated through continued deforestation of the Amazon.

But the challenges Tierra Digna observes with implementation of the Atrato decision don’t seem to bode well for the various required action plans. The economic policy aspects have been a particular challenge, with policymakers struggling to grasp the ways in which these should vary from standard national economic policy.

“They’ve never developed a policy of environmental conservation starting from the guardians of nature, that is, from the philosophy and way of life of these communities,” Torres said of the Atrato case. “Why haven’t we been able in Colombia to develop a public economic and environmental policy from this philosophy?”

With no answers, Torres will be meeting in April with other lawyers, experts, forest guardians and stakeholders—as required by the Constitutional Court—to discuss the ongoing challenges of ensuring rights granted to the Atrato and its peoples don’t exist merely on paper. Torres and her colleagues are right now working with Chocó communities to prepare for this meeting.

She believes that coca must be legalized and regulated “just like alcohol.”

Other projects may ultimately help. A partnership between Chocó locals and a university in Scotland, for example, aims to equip land defenders to generate evidence—such as on heavy metals resulting from mining—that can be used to demand specific protection or rehabilitation interventions under the Colombian government’s new legal obligations.

But there are obvious challenges that can’t be easily fixed by granting a sort of personhood to the river. Torres argues that to make the victory meaningful, alternative policies are needed to give people options for economic survival beyond mining and coca cultivation.

She believes, at the same time, that coca must be legalized and regulated “just like alcohol … that is how to get rid of the mafias.” Illegal mining, she said, should also be addressed via locally controlled economies and international regulation. And finally, after nearly 60 years of conflict, there must—somehow—be disarmament of armed groups, and total peace.

There have been criticisms—mostly academic—of the biocultural rights approach. These range from its uneven and limited application to the critique that it perpetuates anthropocentric framing (individualizing rights and responsibilities under law and internalizing neoliberalism, rather than emphasizing interconnectedness).

And then there is the challenge of enforcement.

If “persons” don’t have practical guarantees of their rights—when governments and their legal and enforcement systems are too often corrupt, or see their role as defending private interests—can we really expect that personhood language will do better for a river?

The Belly of the Beast

Another approach is to attack the very profit motive that tramples ecosystems and human rights. As Torres said, one part of that is legalizing coca and other drugs. But beyond that, an entire network of interests benefits from illicit trade and corruption.

In fact, when Landa argues that change will need to come by using international law to force compliance with environmental and human rights obligations, he suggests that the targets may not be in countries like Honduras or Colombia. Rather, they may be thousands of miles away: in the centers of finance where international resource extraction companies have their head offices, and where their shareholders live.

My home city, Toronto, is what the Mining Injustice Solidarity Network describes as “the belly of the beast.”

This would require far greater vigilance over financial transactions and money laundering, together with the dismantling of prohibitionist policies—and implementation of policies that incentivize and mandate sustainable, harmonious land management. Taxes and elimination of loopholes are basic ways to discourage companies from entering environmentally sensitive land at all. But the bigger-picture need is a more fundamental shift—essentially, reversing the last 30 or so years of neo-colonialist economic policy by removing commitments that overrule the integrity of irreplaceable natural environments and their peoples, and creating economic policies that support this change.

My home city, Toronto, is what the Mining Injustice Solidarity Network describes as “the belly of the beast.” Projects that garner outrage in Africa and Latin America for their blatant human rights violations and environmental destruction originate here, high in the gleaming towers of Bay Street—the financial district where many of Canada’s mining and energy companies make their homes and their deals.

Bay Street. Photograph by Ken Lund via Wikimedia Commons/Creative Commons 2.0

Back in 2011 when Pedro Landa testified in Canada’s House of Commons, he noted how “Unfortunately, Canada is seen abroad as a country that makes off with other countries’ natural resources without any concern for society.”

Canada is not alone here. The United States, of course, has countless environmentally voracious companies of its own—plus a long record of exporting its War on Drugs and providing military support to repressive governments in the name of anti-Communism.

Following the 2008 coup in Honduras, and right up to Berta Cáseres’ murder by a US-trained military intelligence officer, the US supplied the country with some $200 million in military and police aid—providing material support for the despoiling of traditional lands and their re-titling to private companies. Private security companies employed by trafficking groups and mining concerns alike may rely on US-provided counterinsurgency training to violently suppress Indigenous land defenders.

Yet Canada’s anti-corruption laws and enforcement are weaker than those in the US, and a 2010 bill that would have forced mining, oil and gas companies operating abroad to meet social responsibility standards was defeated. Although the current government pledged to institute an independent ombudsperson with the power to subpoena enterprises, it did not come through.

So Canada remains a concentrated example of the internationally exploitative model. Its resource-oriented economy includes a strong, subsidized mining sector active both within and beyond its borders—typically in regions where Indigenous people live in close relationship with natural resources. Canadian mining and hydro-electric companies are disproportionately implicated in many of the land-grabs described in this series.

“Canadians are everywhere,” Jamie Kneen, Canada program lead and outreach coordinator for MiningWatch Canada, told Filter. His organization is one of a handful of nonprofits focused on the harms of mining projects both abroad and in Canada—and the immense power imbalances that characterize these projects’ relationships with local and Indigenous communities.

“Take this investment and shove it isn’t something you can tell a shareholder meeting.”

The Indigenous-led legal rights approach had been attempted unsuccessfully in Canada before. But in 2021, the Mutuhekau Shipu, or Magpie River, in northern Quebec, which runs through ancestral lands of the Ekuanitshit Innu community, was granted similar legal rights to the Atrato. As a legal person, it now has the right to flow, to maintain biodiversity, even to sue. Whether enforcement in the face of hydroelectric development will succeed remains to be seen.

In Toronto or Ottawa, where Kneen works, prospects for change seem muted. Most Canadians are blithely unaware of the damage their companies do abroad, and the government is strongly supportive of exporting traditional strengths in resource extraction.

MiningWatch is busy defending Canada’s environmental laws as an intervenor in court, doing research and speaking out on industry trends in Canada and abroad, and providing input on policies—such as a proposed free trade agreement with Ecuador that local land defenders believe will increase both human rights violations and Canadian mining companies’ destructive impact.

Among MiningWatch’s projects to combat environmentally and socially harmful mining abroad is its campaign, with other organizations, for Canada to adopt a corporate due diligence law, similar to one in France (Switzerland also has a weaker version).

It does seem that no single approach or target is yielding substantial success.

But rejection of a mining or hydroelectric or monocropping project on traditional lands isn’t one of the goals built into any proposed laws on corruption or corporate due diligence.

“Clearly stopping a project is not on that list,” Kneen acknowledged. “Take this investment and shove it isn’t something you can tell a shareholder meeting.”

That, however, is precisely what Julio González, the Guatemalan environmental activist who spoke with Filter in Part 2 of this series, described as land defenders’ demand.

While activists like Landa see potential in taking on destructive companies in their countries of origin, Kneen recognizes severe limitations to this approach, even though his work is devoted to supporting, from Canada, the work of land defenders abroad.

“All we can meaningfully do here,” he said, “is to try and ensure that there’s enough attention and focus on what they’re doing to provide some protection and some political space for them to do what they do.”

While the Canadian response may appear lackluster given the life-or-death stakes, it does seem that no single approach or target is yielding substantial success. So long as companies are able to purchase a license to destroy a river, a valley or a community by pledging to open a school or community center—or simply paying a bribe—the land-grabs and the violence against environmental defenders and communities are likely to continue almost unchecked.

We must work to deepen solidarity with those fighting the worst consequences on the ground.

As this series has explored, the drug war substantially set the stage for—and continues to supply a profit motive for—corruption with devastating, irreversible consequences for human lives, biodiversity, natural resources and ancestral ways of life.

On World Drug Day last June, Ann Fordham of the International Drug Policy Consortium noted that the United Nations Office of Drugs and Crime fails to recognize the impact of prohibitionist drug policy on the environment—even as it discusses this nexus for the first time.

“UNODC again falls short of outlining how drug policies themselves can fuel environmental damage and making clear what policy changes are needed,” she wrote.

As we demand an end to prohibition and the drug war from North America, drug policy reform advocates must be insistent in linking their impact on global environmental, Indigenous and human rights. And we must work to deepen solidarity with those fighting the worst consequences on the ground.

This article is the third in a three-part series examining intersections of environmental injustice and the drug war. Part 1, published on January 23, is How the Drug War Fosters Devastating Land-Grabs. Part 2, published on Feburary 9, is How the Global Drug War Threatens Environmental Defenders.  

Top photograph of land defenders in Guatemala by Julio González

The post Environmental Ruin, Aided by Drug War: How Can Defenders Fight Back? appeared first on Filter.

In many places around the world, local people—whose livelihoods and cultures are inseparable from the lands on which they have lived for generations—are organizing against harms like poisoning of soil and water, birth defects, and razing of rare and endangered species. Those who do frequently face violence that is often perpetrated by the illicit organizations that drug prohibition fosters—which may be paid to provide “security” to controversial projects, and which may benefit from corrupt relations with officials and law enforcement.

The violence surged after the mining began.

Community members of the ejido (communal land) of Carrizalillo, in Guerrero, Mexico, have for years opposed Los Filos and other open-pit mines owned by Canadian mining company Equinox Gold, as described in Part 1 of this series. In 2022, they formally rescinded the agreement that had permitted mining on their land. Throughout their campaign, they have been subjected to violence, extortion, kidnapping, forced displacement and dozens of murders attributed to drug-trafficking organizations fighting for control of the area. The violence surged after the mining began—much like it has in nearby Nuevo Balsas, another Guerrero town, where Canadian company Torex found gold in 2012.

Further north along the Pacific Coast, in the biodiverse desert region of Sonora, Fresnillo PLC—the world’s largest silver mining company, owned by Mexico’s fourth wealthiest man, Alberto Baillères—was likewise forced to vacate communally owned lands. A 2014 decision by an agrarian magistrate found in favor of claims initiated by five members of the El Bajío ejido, a community that includes subsistence farmers and the Tohono people who are the land’s original inhabitants.

But the impact of Penmont, the gold mine Fresnillo operated in the Sonora desert, is still being felt, ejido member Jesús Javier Thomas told Filter. Locals experience high rates of miscarriages, birth defects and spina bifida—not just in the ejido, but in the entire area around the mine.

Landscape of the Seri ejido in Sonora, Mexico. Photograph by Stephen A. Marlett via Wikimedia Commons/Creative Commons 3.0. 

The terrain has been physically transformed by Penmont, the open mining pits leaving great bare craters. Protected species, too, like the pronghorn (American antelope), have been gravely affected by the physical destruction and contamination of land, water and air with chemicals including arsenic and cyanide.

As a result, and with the constant threat of re-initiation of activities at the mine, the 74 families of El Bajío have maintained a camp—ever since 2013, when with the help of federal police the community forced the Penmont subsidiary of Fresnillo to cease illegal mining—to keep the company off their land.

Exceptionally, the agrarian tribunal decision required Fresnillo to remediate 300 of the total 1,825 hectares of land vacated by Penmont—and to return gold extracted illegally by the company.

“I don’t know of other decisions that require a company to return the gold that they took from their territory and to restore the territory to its original state,” Jen Moore, a researcher and associate global economy fellow with the Washington, DC-based Institute for Policy Studies, and former Latin America program coordinator at MiningWatch, told Filter.

Ejido members say no such restoration work has occurred, and that illegal gold mining continues, with armed groups providing “security” at the site of the mine (the company says it is only occupying areas subject to a different legal case, where a judgment has yet to be made).

Contaminated tailing pools overflow and soak into the groundwater when it rains. So the ejido members continue to rely on bottled water, at immense cost. In recent years, Fresnillo’s annual reports don’t even mention the project’s enduring impact  upon the lives—and deaths—of ejido families. Fresnillo did not respond to Filter’s request for comment by publication time.

“I have seen … how the presence of organized crime has been used to hide violence directed against El Bajío for its resistance to the mine.”

Meanwhile, ejido members say that 2021 documents show the company intends to re-open Soledad-Dipolos, a mine on their territory that was forced to suspend operations as a result of a 2011 agrarian tribunal decision.

Most worryingly, since 2013 there have been a number of furtive or violent incursions into the ejidatarios’ territory by people with alleged links to Penmont. Since the ejido has been organizing to demand compliance with the court order, such violence has increased, said Moore. “I have seen … how the presence of organized crime has been used to hide violence directed specifically against El Bajío for its resistance to the operation of Fresnillo’s mine.”

Ejido members have been threatened, arrested and detained, kidnapped, tortured, “disappeared” and assassinated, according to members working with the London Mining Network, an NGO that supports land defenders resisting mining projects around the world. Journalists covering a kidnapping of one community member and the assassination of another have also reported receiving threats from security staff associated with the mine.

Local authorities vaguely blame internecine wars among local drug-trafficking groups for what the ejido maintains—though this has not been proven in court—are the actions of armed groups working on behalf of Fresnillo. It’s the same with the media, Moore said. “They have tried to pass this type of violence off as narco violence disconnected from any mining interest, while [in] reality there is, or it’s believed that there is, a strong connection.”

A federal police force with military training provides services to private companies, including mining concerns.

Murky links between private security forces defending private interests and illicit organizations are nothing new in Mexico. Neither is drug war-related military and police activity that’s rife with corruption, and often acting in defense of private companies.

“The response of the government [to the US-led drug war] here since 2006 has been militarization, to militarize more,” Moore said.

But unbelievably, it is getting worse. Most recently, this militarized response is spearheaded by the new National Guard, which is no longer subject to civilian oversight as a result of recent reforms—and by the new Mining Police, part of a federal police force with military training that provides services to private companies, including mining concerns. This so-called pandemic economic response measure was put in place by Mexico’s secretary of state, who is now governor of the state of Sonora, in which El Bajío sits.

Members of Mexico’s National Guard. Photograph by Notimex via Wikimedia Commons/Creative Commons 3.0

According to the ejido members, Fresnillo PLC has been illegally occupying their land since 1996, when it was given permission to mine on part of the territory, but expanded its reach and constructed mines to which the communal ownership never agreed.

The drug war makes Sonora a dangerous setting for those who seek justice and a restored environment. The same goes for Guererro, a state with a long history of political repression and illicit organizations. Drug enforcement in general has been shown to foster violence—creating power vacuums when it removes certain groups or individuals, which are inevitably and rapidly filled by new players, incentivized to seek dominance through conflict. In Guererro, this has resulted in organizations splitting into smaller and more numerous groups, with some 40 estimated to operate in the state.

“Violence linked to mining operations descends directly from organized crime,” said one person with intimate knowledge of the Carrizalillo ejido’s decade-long struggle with the series of companies involved in the Los Filos mine in Guerrero. They spoke with Filter on condition of anonymity, for their own protection. “But it also connects to local actors. Like the state attorney, the state government, the unions … in the context of how violence takes place … these are the operators in the area.”

“It becomes extremely dangerous for people to articulate those connections.”

This person described the way extortion and bribery, pervasive in much of Mexico, have hit everyone—down to the local tortilla vendors. Drug-trafficking organizations put up signs in nearby Iguala, Guerrero, they said, setting a cap on the price of tortillas and threatening reprisals for any who increase prices on the staple item. It’s just one of the signs that democratic governance has essentially been replaced.

While ejido members document attacks on their own, they say, they don’t often publicize specific incidents because any complaint is easily traced back to the person making it, putting them at further risk.

“It becomes extremely dangerous for people to articulate those connections between how the crime groups are working, but it’s basically the crime groups, the cops and the army,” Mexican-resident journalist Dawn Paley, author of Drug War Capitalism (2015), told Filter—speaking generally about situations where the drug war creates conditions for resource extraction despite community opposition.

Apparent complicity between official actors at various levels, the illicit organizations they are tasked with opposing, and resource extraction companies has implications far beyond the drug trade. Even setting aside drug trafficking—which is not directly part of the El Bajío issue despite occurring at the nearby border, nor of the Carrizalillo case, despite the pervasive presence of trafficking organizations there—the use of illegal means to ensure vast profits is how things get done now, experts and locals say.

Ultimately, of course, the production and transportation of drugs is not in itself the problem. Rather, the profit motive that emerges from prohibition drives illicit-market operators, while incentivizing police to play-act enforcement while allowing and even facilitating their activities. These have diversified far beyond drugs, to include support for mining concerns, as well as wildlife trafficking, gasoline theft, logging, fisheries, avocados and limes, among an ever-expanding list of ways to profit from relations of convenience established through prohibition.

While relationships with legal businesses allow illicit actors to move from drugs into new areas of profit, ostensibly legal businesses have learned from those relationships as well.

“In Mexico in particular, the mining companies act like organized crime,” said Jesús Thomas, of El Bajío. “The mining companies disappear people, assassinate people, jail people … the mining companies, just like organized crime, pay local authorities, all the government functionaries, so all the [prosecuting authorities and local police] do what the mining companies ask them to. If they ask them to assassinate someone, to incarcerate them, to accuse them of robbing X or Y equipment, the police will do it … so it’s sometimes not always that organized crime is taking care of the mines but that the very mining companies are doing it, because that’s where their [financial] interest lies.”

“We believe that dignity has no price.”

Mining police operating not far from El Bajío have effectively suppressed opposition to another mining project in a neighboring community. But Thomas said that for his ejido, nothing will prevent them defending their land. “We believe that dignity has no price.”

Thomas, and his fellow land defenders, have paid a heavy price to maintain this stance. He has received death threats and been arrested. And an apparent assassination attempt against a colleague was halted only when the assailants realized they’d mistaken another man for Thomas, their intended target.

“Fresnillo Plc categorically denies that it was involved in any of the activities that you mentioned at these events. It saddens us to hear their story and it saddens us to see violence in the area where we have mining activities,” said company representative Octavio Avidrez when confronted by ejido members, including Thomas, who bought shares in Fresnillo in order to attend and ask questions of directors at the company’s 2022 annual general meeting in London.

But, in the case of Fresnillo and others, members of affected communities and the odd journalist have demonstrated links that make it implausible that they could have no idea what security and paramilitary forces are doing, allegedly on their behalf.

Similar situations exist in many states across Mexico. In fact, the infamous 2014 disappearance (mass kidnapping, followed by murder) of 34 students in Iguala, Guerrero, has been linked by some journalists to Canadian mines defended by private security forces armed with German weapons. 

Paley noted that the case, which has received popular and media attention since 2014, has helped clarify some of the usually covert relationships between the army, the police and paramilitaries (what are more commonly called drug cartels or criminal groups)—just like those the ejido members in El Bajío blame for the murders of their fellow land defenders.

Mexico has been described as the world’s deadliest country for land defenders, with 200 killings documented in 2021.

“These are huge institutions, at least in the case of the cops and the army. And there’s so many of them. And it’s so bureaucratized as well,” Paley said of her own work tracing similar relationships. “So there’s a lot that’s happening formally that can be traced, to an extent; there’s a lot that’s just going to be oral commands and that kind of stuff, where there’ll be no record of it. And then there’s a whole other kind of sphere, which is their communication with criminal groups.”

In the latter case, there’s no obvious—or safe—way to prove complicity. Instead, it’s inferred. After all, illegal activity is heavily policed, and the police are heavily compromised, and it’s scarcely credible that illegal activities could routinely take place on such a scale without material “permission.” In many cases, there is movement of actors from organized crime to military; from military to the government or judicial system; and from military or paramilitary to groups like, for example, the so-called Gulf and Zeta cartels, formed from Mexican special forces defectors and other elite ex-members of the Mexican army.

“There’s a lot of cases where we’re probably never going to get that smoking gun,” Paley said.

But sometimes we are. A recent massive data leak provided evidence of top law enforcement personnel in different states accepting bribes, and members of the military selling fragmentation grenades, tactical gear and information on military movements to trafficking organizations. Further revelations include links between such groups and mayors, other elected officials and governors.

“It’s a constant that there’s cooperation between armed groups: state armed groups, illegal armed groups,” Paley said.

Mexico has been described as the world’s deadliest country for land defenders, with 200 killings documented in 2021 by human rights group Global Witness. But it is far from the only country plagued by this dangerous form of cooperation.

There’s a War on Everything

The Philippines have the misfortune of serving as an exemplary model of the ways in which drug-war policies and violations of environmental defenders’ rights interact and reinforce each other.

“The war on drugs is part of the bigger war mentality,” Jaybee Garganera, the national coordinator of Alyansa Tigil Mina (Alliance to Stop Mining, or ATM), based near Manila, told Filter.

“There’s a war on drugs. There’s a war on poverty. There’s a war on terrorism, there’s a war on COVID,” he continued. “So that kind of mentality [makes it seem] that only violence is the solution to the problem. We have criminality and drug users and drug pushers; the only way to eliminate them is to kill them all. We have insurgents and we have communist groups; the only way to resolve the insurgency is to kill them all. There’s a virus, and our [former] president, Duterte, publicly said we will kill this virus with all impunity, without even understanding what he was saying.”

Those who oppose resource extraction-based development are thus characterized as enemies of the state.

Rodrigo Duterte, president from 2016-2022, was globally notorious for such thinking—and above all for his murderous drug war. But it has continued under his successor, Ferdinand Marcos Jr., who is the son of Marcos Sr., the country’s dictator from 1965-1986. An autocrat with Duterte-like attitudes to drugs, Marcos Jr. is also notably pro-mining.

Jaybee Gargarena at the “People’s Mobilization” during then-President Duterte’s State of the Nation address, 2019. Photograph courtesy of Alyansa Tigil Mina.

Environmentally, with a gorgeous, biodiverse and threatened natural landscape and large and diverse Indigenous population, this is a country where there is much to lose—and much to gain by those who exploit prohibitionist rhetoric and policy for their own ends.

Gargarena explained how Duterte instrumentalized this mentality to institute military control. “He put a general in charge of the environment ministry. He put several generals in charge of the interagency task force on the pandemic. Of course, he put generals on the anti-terrorism council. So it was like the whole government was put under military supervision without declaring martial law.”

This produces a chilling effect for conservation activism, including that of Indigenous communities seeking to defend their lands against mines, plantations and dam projects. Being “anti-development” is equated with being anti-government, and environmentalists and others who oppose resource extraction-based development are thus characterized as enemies of the state.

As a result, Gargarena explained, “human rights defenders and environmental defenders found our space to be shrinking… so you have the war on drugs since 2016. And [in 2018, when an anti-terrorism law passed in Congress expanded the definition of “terrorist” and allowed warrantless arrest] the president said the Indigenous people and the Indigenous community are the hotbed of communist recruitment. And that pronouncement was followed by a series of bombings and violent attacks against Indigenous peoples.”

Gargarena noted that while the government has admitted 6,800-7,000 people were killed in the name of the drug war, others estimate up to 30,000 killed over a six-year period. While many of the killings were carried out by police and security forces, vigilante groups with various degrees of affiliation with the state are responsible for many others.

ATM is part of an umbrella organization called iDefend, which seeks to address the impunity of those who commit such atrocities, together with other social justice and human rights issues that have only worsened since the COVID-19 pandemic. It does this, in part, by challenging the accepted narrative that “war” is either necessary or effective.

In Ecuador, “the government is now trying to call the protestors narcos.”

But it’s such a tempting narrative. And in too many places, it remains all too convenient to suggest that it’s the opponents of environmentally harmful projects, rather than the perpetrators of shady activity in support of them, who are involved in drug trafficking. This discredits local land defenders’ cause in the eyes of the public, while also putting them at risk of official or unofficial retribution.

In Ecuador, to take one last example, where anti-resource extraction protest has been criminalized, “the government is now trying to call the protestors narcos, and suggesting that they’re involved in narco activity,” Paley said.

Last year, President Guilllermo Lasso alleged that protests by the Indigenous guard against illegal mining were funded by drug traffickers—in cahoots with Ecuador’s ex-president—to destabilize the country.

“It’s a way to scare people off,” Paley said. “The thing is, the discourse is so flexible.”

Flexible indeed. Criminalization of protest, using drug-war rhetoric backed up by drug war-facilitated militarization, may find an expedient target in land defenders. But the method quickly generalizes to anyone who threatens officials or governments using their office for private gain. Even if that means a war on everyone.

This article is the second in a three-part series examining intersections of environmental injustice and the drug war. Part 1, published on January 23, is How the Drug War Fosters Devastating Land-Grabs. Part 3 published on March 23, is Environmental Ruin, Aided by Drug War: How Can Defenders Fight Back? 

Top photograph of environmental defenders in Guatemala by Julio González

The post How the Global Drug War Threatens Environmental Defenders appeared first on Filter.

As a recent United Nations publication about drugs and the environment, part of last year’s UNODC World Drug Report, frankly admits, there has been relatively little research to date on the environmental impacts of illicit drug production, use, trade and prohibition and their interaction with legal (or mostly legal) industry.

The global drug war, a set of policies and practices pursued in the framework of environmentally-voracious capitalism, plays an increasing role in the destruction.

Yet damage to forests, watersheds and other natural environments related to illicit drugs occurs in a variety of ways. For one thing, crackdowns on drug trafficking or production in one area may move illicit plantations into more remote and environmentally sensitive areas (in the same or a neighboring country). This has happened, for example, with cannabis and poppy cultivation in 1970s Mexico; with opium growing and heroin production in 1990s and 2000s Burma (now Myanmar); and with coca crops in 2000s Colombia. That’s one of the few phenomena in this area that has been relatively well-studied.

The global drug war, a set of policies and practices pursued in the framework of environmentally-voracious capitalism, plays a role—an increasing role—in the destruction of long-evolved biodiversity, carbon sequestering and homes for many of the Earth’s people. Academics, journalists and activists have often carefully traced direct and overtly violent land-grabbing that occurs as a result of the drug war—such as when armed counter-insurgency groups have taken over guerilla-controlled land during wartime.

Flying largely under the radar is another sort of land-grab, in which the drug war serves as a convenient excuse to steal land. The process is very much like that described by Canadian journalist Naomi Klein’s argument in The Shock Doctrine: The Rise of Disaster Capitalism (2007). Drawing on research in many disciplines, Klein most famously defined the process by which rapacious companies step into a vacuum systematically created by war and natural disaster. Here’s how a very similar process takes place in the context of the drug war.

A Land-Grabs Pattern

Diego André Lugo-Vivas was born and raised in Cauca, a state in the south-west of Colombia. A powerful region in past centuries, Cauca’s influence began to wane from the time Bogotá became the capital in 1830. Since then the remote area, largely forested, has been neglected by federal governments, allowing for weak local governance and little development. And yet there is great natural wealth here, both in the form of gold, and through cultivation of Cauca’s fertile soil for legal crops, to grow cannabis, or to sustain livestock. Cauca also represents the country’s fourth-largest area of illegal coca cultivation.

“I actually come from a town that is full of coke,” Lugo-Vivas told Filter. Cauca serves as a corridor for drugs being transported from the south to the Pacific coast. Illegal or wildcat mining is common. This context has shaped Lugo-Vivas’s interests as an academic—he’s an adjunct professor at Universidad del Valle in Cali and a researcher at Universidad San Tomás in Bogotá—and as an activist.

“The more War on Drugs we have, the less feasible the outcome is,” he said. “Because 60 years later, we have more coca in Colombia, Peru and Bolivia, and we have way more consumption in Asia Pacific, North America and Europe.”

“I found the same pattern, which is a strong implementation of a military policy, of a military campaign to re-control the frontier in strategic environmental and conservation areas.”

This paradoxical and failing war looks, however, far more successful if you set a different metric for “success.” Lugo-Vivas has used econometric models to analyze patterns in what he terms “land-grabbing” and land-ownership concentration, and how they relate to the various forms of conflict, punctuated by peace negotiations, that have plagued Colombia for decades. He studied what exactly happened during and after peace negotiations between the government and paramilitary and rebel groups—such as the far-right, paramilitary AUC (Autodefensas Unidas de Colombia) and the Marxist-Leninist guerilla group FARC (the Revolutionary Armed Forces of Colombia, which demobilized in 2017)—across different periods from 1998 up to 2019, and its relationship to forced coca eradication and substitution in three different regions.

Colombian police air service in 2010. Photograph by National Police of Colombia via Wikimedia Commons/Creative Commons 2.0

“I found the same pattern,” he said, “which is a strong implementation of a military policy, of a military campaign to re-control the frontier in strategic environmental and conservation areas.” And after this military campaign, the land has new owners, and new purposes.

“They opened the land to investments from Brazilian investors, German investors, Colombian investors, and the largest North American company, Cargill,” Lugo-Vivas said. Cargill, described by one environmental advocacy organization as “the worst company in the world,” first deforested land, then used it to raise cattle for beef, or for monocropping of corn or palm oil. Other investors may also restrict themselves to grazing or agricultural crops, while an increasing number use their land acquisitions for mining gold or coal. Sometimes the land is initially cleared for large-scale agriculture and later becomes a mining concession.

Cauca has become, according to Lugo-Vivas, perhaps Colombia’s most active state in terms of fighting for Indigenous and campesino rights. 

“In the last decade, we have an entire repertory of actions to acquire land that go beyond direct intervention [by men with guns from either side of the conflict simply taking the land],” Lugo-Vivas said.

Partly as a result of these other actions that result in the new owners and new purposes Lugo-Vivas mentions, by 2010, about 70 per cent of the formerly forested Cauca Valley had been converted to human use. Very little of the remaining dry semi-tropical forest lowlands, with many endemic species, holds regional or national environmentally protected status, despite being one of six Colombian biomes identified by researchers as hotspots in urgent need of conservation. In the face of the onslaught Cauca has become, according to Lugo-Vivas, perhaps Colombia’s most active state in terms of fighting for Indigenous and campesino (tenant or subsistence farmer) rights. 

Managing the Economy

In her book Drug War Capitalism (2015), Mexican-resident Canadian writer Dawn Paley argues that the so-called War on Drugs in Latin America has always been a cover for neoliberal expansion, with legislation, policies and practices ensuring the northwards movement of capital—privatizing, extracting and opening up natural resources, and using militarization and paramilitary activity to do so.

Describing the violence that clears the way for this expansion, Paley prefers the term “paramilitary group” to “drug cartel.” She sees such organizations as tools for the enforcement of social control, including via “permissions” that allow them to operate. She points to the Mexican armed forces as an example of such quiet permission-givers.

“Prohibition is not a hands-off system. Prohibition is an active system of management of the illicit economy.”

“Prohibition is not a hands-off system, where the government’s looking the other way,” she told Filter. “Prohibition is an active system of management of the illicit economy—creation of the illicit economy and its management.”

That’s certainly what we see in Guatemala, where ecological activist Julio González belongs to a collective called Madreselva (“Mother Forest”), devoted to defending the country’s rich natural and cultural resources from destruction, and promoting alternative models in which local people sustainably manage the land. Both rule of law and human rights, and Madre Selva herself, are at stake as powerful resource extraction and energy companies divvy up the land.

“There are rivers that have been completely sacrificed,” González told Filter, describing the impact of one hydroelectric project that drew international attention after a Q’eqchi’ Maya schoolteacher and activist, who had won a later-reversed Constitutional Court decision against it, was sentenced to over seven years on flimsy evidence (he was released in 2022 after serving four).

Environmental justice protest in Guatemala. Photograph by Julio González.

Since 1996, Madreselva has monitored government ministries in charge of biodiversity for compliance, pushed for Indigenous communities’ right to consultation on resource extraction projects, and supported such communities in the courts against powerful companies, as well as in carrying out local and sustainable infrastructure projects to build energy autonomy.

González argues that the long history of the drug war in the region is essential background for understanding the recent increased militarization of Guatemala and the brutal reversal of short-lived attempts to address endemic corruption at the highest levels. It’s this history, he said, that explains just how it is that land and water—stolen from under the peoples who’ve lived on it since before colonization—is now being contaminated by mining tailings or turned over to sugar cane or palm oil monocrops, destroying millions of years of evolution of biological diversity. 

The Spoils of War

As González explained, a US-led crackdown on cocaine trafficking from Colombia via the Caribbean in the early 1960s turned the countries of Central America into important conduits for land transit of drugs previously trafficked by air or sea. This process continued through decades of civil war, military-backed government repression including genocide of Mayan people, left-wing insurgencies, a right-wing coup, and the deaths of some 200,000 Guatemalans including 40,000 “disappearances.”

A 1996 peace agreement, signed after three years of UN-brokered negotiations between the Guatemalan government and Unidad Revolucionaria Nacional Guatemalteca (Guatemalan National Revolutionary Unity), threatened the state control and wealth enjoyed by military and paramilitary officers and their networks up to that time. But the drug war provided them with a natural opportunity to make new friends.

“In effect, these people  … are practically coworkers in the trafficking.”

These connections “gestated from the moment of signing the peace agreement, because by ending the war, [military and paramilitary officers would] lose control of the state to some extent and [therefore] sought allies to continue with the business,” González said. “In effect, from there these people made links with Colombian drug traffickers and from there to here they are practically coworkers in the trafficking.”

“What they want is to control the market, not to impede it. It’s definitely a business that is run at high levels.”

The people at these “high levels” include current and former military officials, police officials, members of the wealthy families who form the oligarchy that rules the country directly and through corruption and influence, and others whose mysteriously acquired wealth and connections fuel entry into political life as representatives or mayors. A variety of reports and evidence support the contention that corruption, fed simultaneously by drug prohibition and drug trafficking, is essentially holding the country hostage.

Given the vast illicit sums made, it became necessary to find ways to launder the profits: finance, real estate and resource extraction. “There needs to be an outlet for all this money,” González said. He described the forced consolidation of some 37 banks that occurred in 2006, resulting in just a handful of surviving banking organizations, run by wealthy Guatemalan families. These banks take a cut from remittances sent to struggling family members by Guatemalans working abroad, while pushing poor Guatemalans to rely on the credit the banks offer. And they finance projects in energy (petroleum and electric) and agrocombustibles (sugar cane and palm oil), entrenching the resource-extraction model.

It’s a model that has destroyed, according to one 2021 study, over 713,244 hectares of forest in Guatemala between 2000 and 2019—in association with a shift towards large landowners, often fuelled, as González suggested, by drug profits and co-optation of those who ought to protect it.

Today, he said, we see a “new world order” of poor countries around the globe subject to similar wholesale sacking of their natural resources, with companies from wealthy industrial nations—China and the United States, for example—competing to block each others’ access to the spoils, their governments quite happy to support corrupt and human rights-trampling regimes like Guatemala’s to do so.

“For the benefit of their own interests, they are playing with gunpowder.”

It’s a process that has occurred on a massive scale all over the world since roughly the 1990s, as private investors rush to gobble up what’s left of unspoiled land on Earth. But while it is accelerating now, González believes that there are limits to what local people will tolerate.

“Where every state is increasingly subject to sacking [of its natural resources] and environmental destruction […proponents of the extractive model] create the conditions for confrontation, not just at the national level but regionally,” he said. “It’s inevitable. They have always underestimated the historical capacity of peoples to rebel in conditions of difficulty. They don’t read history. For the benefit of their own interests, they are playing with gunpowder.”

Madreselva protest. Photograph by Julio González

License to Operate

In the state of Guerrero, Mexico, Los Filos, one of the world’s largest open-pit gold mines, has devastated the area’s biodiversity and transformed its topography. Toxic tailings, including cyanide and arsenic that have contaminated local water, force residents of the nearby town of Carrizalillo to rely on bottled water to drink and bathe. The area is barren. A volcano-like mountain of tailings sending heavy-metal-laden dust through the breeze across the closest communities of the ejido early every morning.

Back in 2007, an 83-day blockade by Carrizalillo ejido community members (an ejido is communally owned land), upon whose land Los Filos sits, halted production at the mine after its owners were found to have illegally purchased collectively owned lands, and until a new land-use agreement was negotiated. At the time, Los Filos was owned by Goldcorp, a Canadian company and the world’s second largest gold-mining company (now largest, following a merger).

All along, the ejido has owned the land,yet the succession of mining companies have, ejido members allege, repeatedly breached their legal agreements.

Following repeated allegations of breaches of the agreements, the ejido shut down production again in 2014. In 2020, members of the ejido set up an encampment to prevent the mine’s then-owner, Equinox Gold, from occupying the territory. Finally in 2022, they formally rescinded the social-cooperation agreement (which Equinox took over from an intermediate owner, Leagold Mining) that had permitted mining on their land.

The small community is plagued with cases of illness, delayed development, birth defects and stillbirths. All along, the ejido has owned the land, yet the succession of mining companies have, ejido members allege, repeatedly breached their legal agreements, disputing title at every turn, going ahead and exploiting areas without permission, and overseeing the wholesale transformation of a formerly species-rich biome into a poisoned ruin dangerous to flora and fauna, including the humans who have lived there for generations.

Trafficking organizations, which reap vast profits from the prohibition of drugs like heroin, methamphetamine and cocaine, have also moved in. Forced displacement and dozens of murders of community members have been shrugged off by Equinox as the unfortunate but unavoidable result of illicit organizations fighting for control of the area.

In such ways, the legal and illicit industries interact and depend on each other.

But this kind of violence has surged since the mining began—much like it has in nearby Nuevo Balsas, another Guerrero town, where Canadian company Torex found gold in 2012; and elsewhere in Mexico. Violence is often perpetrated by illicit organizations providing services—such as security—to mining companies eager to keep local activists away from their worksites, whether the companies are actually allowed to operate there or not. 

Cerrejón open-pit coal mine in Northern Colombia. Photograph by Tanenhaus via Wikimedia Commons/Creative Commons 2.0

A Symbiotic Relationship

In such ways, the legal and illicit industries interact and depend on each other.

In Colombia, Diego Lugo-Vivas sees parallels with post-conflict Myanmar at the end of the 1990s.

There, there were “massive land concessions to Chinese and Southeast Asian companies that were acquiring former opium growing areas to make the transition to legal forest and palm and monocrop legal sectors,” he said.

“In Colombia what we start seeing is massive land titling …  and although land is supposedly being cleared of drugs and given over to new industry, in fact following this process, Myanmar hit a peak in opium growing and heroin production, and Colombia reached its highest historical level of coca growing,”  Lugo-Vivas said.

“[It’s] just a type of strategy to legalize areas that were full of cocaine before you open it and then capital investment, foreign investment, financial capital comes to Colombia, and we have this massive acquisition of land.”

At the same time, “outside all the areas that were grabbed by industries, outside these areas we see a lot of illegal activities, a lot of illicit income related to opium in Myanmar, and related to coca in Colombia,” Lugo-Vivas said.

As he has demonstrated in his work, military and paramilitary actors around the world have taken advantage of the stabilization of political landscapes following peace negotiations to turn land—acquired with the ostensible goal of clearing areas of drug trafficking—over to private hands instead of back to the people who lived sustainably there for generations. Drug production and trafficking either co-exists and collaborates with the new owners or simply moves elsewhere.

The implementation of these policies relies on the organized illicit activity that drug prohibition fosters, but which has spread to new areas.

Rather than focusing on drugs, it would make more sense to look at which policies result in reduced local and non-extractive control over environmentally significant areas. These would include forced eradication, promotion of environmentally harmful alternative crops, and, especially, re-titling or awarding of concessions to lands.

The implementation of these policies relies on the organized illicit activity that drug prohibition fosters, but which has spread to new areas. It relies on private security with historical ties to both drug trafficking and authoritarian regimes, and on legal if unethical activities that conceal relationships of convenience between corrupt official actors and (other) illicit operators.

In the face of land-grabbing and expansion of corporate and private ownership to new and environmentally precious lands around the world, Indigenous people and small farmers have emerged as the frontline of defense. Yet the drug war further puts these people—and the right to protest in general—at risk.

This article is the first in a three-part series examining intersections of environmental injustice and the drug war. Part 2, published on February 9, is How the Global Drug War Threatens Environmental Defenders. Part 3 published on March 23, is Environmental Ruin, Aided by Drug War: How Can Defenders Fight Back? 

Top photograph of deforestation in Brazil by Kate Evans/CIFOR via Flickr/Creative Commons 2.0

The post How the Drug War Fosters Devastating Land-Grabs appeared first on Filter.

This is reflected by increasing research focus on benefits rather than harms. Meanwhile, 108,000 Americans died from overdoses involving other drugs, primarily illicit opioids, last year. Given the prominent (though far from exclusive) role of opioids in the current drug poisoning crisis, there is naturally great interest from policymakers, researchers and investors in the possibilities of cannabis in addressing both perceived and real harms around opioid use.

I’ll say right away that I have a personal stake in this. I’ve tried both a prescribed synthetic cannabinoid and a variety of regular cannabis preparations through Canada’s medical cannabis program, in hopes of finding a readily accessible alternative to effective but stigmatized opioid medication for the management of my pain from ankylosing spondylitis, a degenerative spine disease.

Ultimately, however, a low dose of an atypical opioid has proven to be the most tolerable treatment to restore my function and quality of life over more than a decade. I have not experienced opioid use disorder (OUD).

But what does the research say? It was long near-impossible to study cannabis in the United States (and challenging elsewhere). Yet over the past couple of decades, research on the drug has grown. As a result, data pointing to the potential of cannabis or its constituents to reduce opioid-related harms have increased, and—given the way in which such harms increasingly frame research questions—continue to accumulate.

Prior to 2010, access to legal cannabis did seem to prevent overdose, but as opioid use shifted from prescription drugs to heroin and then fentanyl, this became less relevant.

In sorting through this literature, it’s important to tease out conflicts of interest and wishful or ideological thinking that color the framing of studies and the conclusions that may be drawn. Nevertheless, there are many good things to say about the increasing availability of cannabis in a society where both pain and anxiety are rife.

Indeed, there has been hope that cannabis legalization and decriminalization may already be having an organic effect. A 2014 review of death certificates and medical cannabis laws in all 50 states between 1999 and 2010 found significantly lower rates of opioid-involved deaths in states with medical cannabis laws.

When this study came out, its exciting findings—at a time when, as now, overdose deaths were skyrocketing—received significant media attention, and it has been cited by hundreds of other research papers since.

Later studies, however, have seriously muddied the rosy picture in which cannabis straightforwardly replaces opioids and all harms are reduced. One review, for example, showed that by extending the study period of the 2014 paper, the negative association between medical cannabis laws and opioid-involved overdose mortality lost statistical significance.

That is, prior to 2010, access to legal cannabis did seem to prevent overdose (and admissions for opioid painkiller addiction treatment), but as opioid use patterns shifted away from prescription drugs to heroin and then illicit fentanyl, this became a less relevant protective factor.

Most recently, a 2022 case control study and individual-level data review simply found no such protective association between fatal opioid-involved overdoses and state medical cannabis laws. There is a profusion of more local data, though, and it’s rarely studying exactly the same thing in the same way over the same time period—and often seems contradictory.

A 2017 study, for example, concluded that adult-use cannabis legalization resulted in a small monthly reduction in opioid-involved overdose deaths in Colorado, but a 2020 study of this relationship over a longer time period found inadequate evidence to say that adult access to cannabis reduces opioid-involved deaths.

There’s potential in the increasing availability of cannabis for reducing opioid-related harms—if we can figure out the right policies.

When it comes to medical cannabis use, the ways in which it may influence opioid use and overdose clearly depend on many ever-shifting factors. And yet, more experimental and mechanistic research, as well as anecdotal reports, suggests continuing potential in the increasing availability of cannabis for reducing opioid-related harms—if we can figure out the right policies and practices to take advantage of it.

“People almost exclusively talk about the quality of life being better on cannabis than opiates,” Peter Grinspoon told Filter. He’s an addiction medicine doctor well-known for both his medical cannabis advocacy and his openness about his own past experience of prescription opioid addiction (he’s written a book about the latter; a second book, looking at data on cannabis in historical perspective to address common misconceptions, will be published next spring).

Dr. Grinspoon outlines four ways in which he says cannabis can help: to start new chronic pain patients on cannabis rather than either opioids or non-steroidal anti-inflammatory drugs, which can have severe side effects especially with long-term use; to (voluntarily, he specifies) transition chronic pain patients from opioids to cannabis; to use cannabis in conjunction with opioids to treat pain disorders; and to treat opioid withdrawal.

Each of these is indeed a possibility—although the first two, in particular, are controversial among harm reduction advocates and pain patients—and it’s worth examining the data supporting each of these uses of the much-redeemed drug. 

Before Trying Other Drugs for Pain

While few people die of overdose from opioids prescribed to them for pain, there is a theoretical risk of accidental overdose as well as a real risk of suicide by overdose in this population, to which I belong. Then, although illicitly obtained prescription opioids could be seen as protective if they replace a dose of heroin or illicit fentanyl of unknown potency, many people who use non-prescribed opioids actually do so to treat physical pain, and are at higher risk of harms, including overdose, than “official” patients.

The risk is that in the enthusiasm for cannabis or the rush to avoid opioids, a patient is denied fair treatment.

Long-term effects of opioids—such as reduced androgens like testosterone and consequent risk of bone thinning, as well as tolerance and physical dependence (which can also arise with chronic, heavy cannabis use but is less problematic)—might also be avoided by never starting them in the first place.

It’s because of this that opioids are very rarely considered a first-line treatment for chronic pain; typically, a patient will first have been asked to try non-pharmaceutical and at least one and probably more non-opioid pain medications. Such pain treatments, often taken for long periods, include non-steroidal anti-inflammatory drugs (NSAIDs), which may come with serious long- and short-term side effects.

Cannabis works on a different body system from opioids, but with many overlapping effects; most notably, analgesia (killing pain) and anxiolysis (killing anxiety). While opioids bind to the mu-opioid and other opioid receptors, triggering a cascade of biochemical effects on the brain, gut, and other parts of the body, cannabis triggers the endocannabinoid system, which, just like the endogenous opioid system, produces self-made chemicals similar to the active molecules of cannabis.

Cannabis has a notable benefit over opioids: there is no risk of respiratory depression, and overdose death is essentially impossible. If it were possible to get equivalent analgesic and anxiolytic effects from cannabis, it would therefore be generally far safer for people using opioids, especially illicit opioids, to treat mild-to-moderate (not severe) pain, unless they have potential contra-indications, such as (for example) high risk of heart attack or schizophrenia. If a well-tolerated dose of cannabis isn’t effective, the patient might then and only then consider NSAIDs or opioids.

The risk of advocating this, of course, is that in the enthusiasm for cannabis or the rush to avoid opioids at all costs, a patient is denied a fair trial of opioid pain treatment even when it best balances the risks, benefits and individual values of that person. Caution is warranted.

Transitioning Pain Patients From Opioids to Cannabis

Tyler Prock, a 37-year old Texan, told Filter that he moved to Colorado in 2012 to gain access to medical cannabis after he was prescribed two opioids (tramadol and hydrocodone) and another painkiller to deal with pain from scoliosis. Although he was only on opioids for two weeks, his personal psychological experience with them was negative, yet his doctors expected he would continue with them indefinitely.

After what Prock described as terrible opioid withdrawal (“It was worse than any hangover I’d ever experienced with alcohol”), and six months of experimentation with cannabis products to find the best type, dose and route of administration for them, he has not looked back. He mentioned that his wife’s autoimmune disorders, for which she had tried a variety of medications, also seem to be under control thanks to five daily dabs of cannabis.

“I was just lucky that I had a friend introduce me to cannabis before [opioid use disorder] would be an option,” Prock said.

(A 2018 meta review found incidence of opioid use disorder among long-term pain patients of just 4.7 per cent including all studies; about 3.1 per cent if only “good” quality studies are included; and approximately 0.2 per cent among patients with no prior history of substance use disorder.)

Besides obvious variations in individual preferences and tolerances, different types and intensities of pain respond better to cannabis than others. Esther Choo and colleagues (2018) note that evidence on the use of cannabis to treat pain is limited by the number and quality of studies, and by the difficulty of drawing useful conclusions for patients given the wide range of cannabis strengths, compositions and preparations available.

While evidence validates its use for certain types and intensities of pain, it has been promoted far more widely and it is prescribed for any number of indications. Of course, it’s not unusual for a drug to be prescribed for “off-label” uses; but if it is pushed without adequate evidence on patients who were stable on a given type and dose of opioid, they may be risking hard-won stability on the basis of wishful thinking.

Even if not coerced, patients fearing opioids might avoid seeking the best-evidenced treatments.

In New York State and Illinois, laws were amended in 2018 to allow patients with an opioid prescription to access cannabis instead. Although it offers welcome flexibility for patients who want to try cannabis, some commentators warn that in the process of encouraging what is increasingly seen as an innocuous, “natural” panacea as an alternative to opioids, more effective but more stigmatized alternatives are being underprescribed, including methadone and buprenorphine (well-evidenced treatments for people with OUD and for some people with chronic pain). It could also, perhaps, increase stigma for patients who choose to stick with opioids.

In cases of opioid cravings in patients who believe, rightly or not, that they cannot access opioid treatments, an unsuccessful experiment with cannabis could be fatal if they then resort to the illicit opioid market. In developed cannabis markets like Canada and legalized US states, marketing often emphasizes myriad supposed medical benefits.

Even if not coerced, patients with fears around opioids, whipped up by overdose headlines and politicized crackdowns on prescribing, might avoid seeking the best-evidenced treatments and instead self-medicate with cannabis for conditions for which it doesn’t work, risking reduced function as well as overdose.

Dr. Ziva Cooper, a researcher who studies cannabinoids at UCLA, also warns of the limitations of survey studies that self-select for people who have had positive experiences with cannabis use for pain being generalized to others, and of the need for research to better determine who might benefit, and how.

Given evidence that the opioid crisis doesn’t substantially involve opioids prescribed for pain, it seems unlikely that replacing pain treatment with cannabis will prevent overdose deaths.

As a Co-Treatment With Opioids

The notion of offering cannabis as an adjunct treatment to patients who are already prescribed opioids is well founded, however. When pain patients have access to cannabis, they often voluntarily reduce their regular opioid dose. Given that patients often require higher doses of opioids over time due to the development of tolerance, even maintaining a constant dose with the help of cannabis can be considered a victory that could reduce the likelihood of opioid side effects.

Dr. Cooper has been working with colleagues on the experimental use of sub-therapeutic doses (too low to be expected to help with pain, and too low to trigger side effects) of the opioid oxycodone in combination with smoked cannabis THC, to see if the synergistic effect can provide adequate pain treatment with fewer negative effects. This was an attempt to build with placebo-controlled human studies on still poorly-understood interactions that have been found between opioid (mu-opioid) and cannabinoid (CB1) receptors.

“There’s overlapping behavioral and physiological effects of drugs that act at these two receptors,” Cooper told Filter. “If you have an animal that is opioid dependent, so they’re receiving opioids daily, and then you take the opioid away, just like with a human being, you’ll see opioid withdrawal symptoms. If you then give that animal a drug that acts as a CB1 receptor, like THC, you will see a reduction in that withdrawal, and vice versa.”

Cooper’s team found the same in their volunteer human population—although Cooper warns that this was experimentally-induced acute pain in a non-pain patient population of existing cannabis users, a highly selected group for the highly controlled study. More human research is needed to say whether the same results might be found with other forms of cannabis, a complex pain patient population, or a population with experience of opioids and no experience of cannabis.

Is the association because it reduces pain? Because it eases opioid withdrawal? Or because it helps with stress, or insomnia?

An important 2019 study of people who use illicit drugs in Vancouver, where opioid-involved overdose rates have been extraordinarily high, compared drug users with chronic pain who used cannabis with a similar population of drug users, also with chronic pain, who did not. It found that daily cannabis users had about a 50 per cent lower likelihood of using illicit opioids on any given day than those who didn’t use cannabis, suggesting that daily (but not occasional) cannabis use has an opioid-sparing effect for chronic pain.

Other research has shown the same. Dr. Stephanie Lake, lead author of this study, notes it did not prove that cannabis can work as a direct substitute for opioids, however. “Now we need to figure out what is driving the association,” she told Filter. Is it because it reduces pain, for example, because it eases opioid withdrawal, or because it helps with other symptoms associated with pain, such as stress or insomnia?

A law similar to Illinois’ that makes it possible for people to access cannabis in addition to their methadone, buprenorphine or chronic pain opioid treatment—and that makes it illegal to kick someone out of treatment for using cannabis—could be a sensible idea that’s well supported by evidence.

To Treat Opioid Withdrawal

The most contentious assertion about cannabis in relation to opioids is that it can function as a direct replacement for a person who is physically dependent on opioids and going through withdrawal. Preventing withdrawal is vitally important for people with OUD who are very likely to resort to illicit opioids to treat unbearable symptoms; it is also important for the medical stability of pain patients physically dependent on opioids.

It’s important to be clear on the high risk of overdose if a person tries to treat withdrawal with cannabis, finds it ineffective, and resorts to a dose of illicit opioids. Or where internalized shame about the use of opioid agonists or “meds” instead of “natural” remedies like cannabis could result in a dependent person pushing themselves to rely on cannabis even if it is not adequately preventing withdrawal.

There have long been anecdotal reports from people who find cannabis helpful in easing specific withdrawal symptoms. “I can say personally that it was extremely helpful for my withdrawal symptoms,” Grinspoon said. “Cannabis works to so many different neurotransmitter systems to [just] the endocannabinoid system that it really is spectacular for opiate withdrawal symptoms.”

Indeed, rates of cannabis use are high among people initiating medications for OUD, especially during the period before dose stabilization. However, in a 2020 systematic review of 43 studies involving methadone, buprenorphine or naltrexone treatment for OUD and cannabis use, Stephanie Lake and her colleague Michelle St. Pierre discovered most studies did not in fact find a statistically significant relationship (either positive or negative) between cannabis use and treatment outcomes, except for withdrawal where evidence at least suggests it doesn’t hurt. 

“In general what I found in that review was that the evidence was very mixed,” Lake said. It would “support working with someone using cannabis to find out why they’re using cannabis.”

Chris Backer, in Halifax, Canada (following High Hopes, a more established program in the Downtown Eastside of Vancouver), supplies free “care packages,” including a variety of donated cannabis products, to people who use illicit opioids. Backer’s East Coast Cannabis Substitution Program is a volunteer program not backed by any independent medical organization (Backer had an association with Direction 180, a Halifax opioid treatment program run by the Mi’kmaw Native Friendship Centre, but said that the medical director withdrew due to a perceived conflict of interest).

“We have spectacular evidence for the efficacy of buprenorphine and methadone. With cannabis we don’t have that data.”

Backer told Filter that the roughly 200 people to whom he and other volunteers hand out the kits, with the goal of facilitating a move off of opioid use, are all experiencing addiction. Backer cited some of the evidence mentioned earlier, and said that providing as much cannabis as possible enables people to reduce the number of shots (heroin or fentanyl) they do each week. He said that he has no concerns about a possible heightened risk of overdose due to abruptly reduced opioid tolerance in a highly dangerous market.

Grinspoon, however, distinguishes between easing withdrawal during treatment with buprenorphine or methadone, and actually attempting to replace these drugs, which he warns is not supported by the literature—yet.

“From the perspective of a doctor, we have spectacular evidence for the efficacy of buprenorphine and methadone, a 50 per cent decrease in overdoses and deaths,” he said. “And with cannabis we don’t have that data.”

The risk of overdose if it doesn’t work is high, he added. “I really do think cannabis should be viewed as an adjunct in this capacity.”

Research Is Still Playing Catch-Up

Gateway theory supposes that the non-medical (or perhaps even medical) use of cannabis can increase the likelihood of moving on to other drugs and ultimately to opioid use disorder. This used to be received wisdom but has now been widely debunked.

The sheer numbers of people using cannabis for both medical and non-medical reasons without concomitant increases in opioid use would seem, in itself, to put paid to the idea. Yes, studies have shown that cannabis use, and particularly heavy cannabis use, often precedes use of other drugs. But that doesn’t demonstrate causation, and is akin to saying that people who use drugs are more likely to use (other) drugs.

Evidence to date seems to support the notion that cannabis should be made more available as one option for patients as part of a hierarchy where a trial of cannabis might be recommended before opioids for certain patients and conditions. It also supports the contention that using cannabis, along with well-evidenced medication-based opioid use disorder treatment, should be considered a legitimate version of recovery from OUD rather than a reason to get kicked out of one’s treatment program.

Despite roughly 20 years of accumulating data, it seems that in some respects cannabis research has not yet caught up to the ways it is enthusiastically used, and in others, clinical practice has some catching up to do. With time, science should provide us with data to better define the ways in which cannabis may indeed act as an “exit drug” for opioids, and where its use is not borne out by evidence.

Top photograph courtesy of elsaoloffson/Pixabay. Inset photograph of Tyler and Samantha Prock courtesy of Yaka Jefferson

R Street Institute supported the production of this article through a restricted grant to The Influence Foundation, which operates Filter. Filter‘s Editorial Independence Policy applies.

The post The State of Research on Cannabis as an Opioid “Exit Drug” appeared first on Filter.

With my head forced forward and down, my pelvis forced forward, I suck in my stomach in an attempt to imitate a normal spinal curve and hold myself up. My legs move stiffly. My spine feels unstable. All in all I feel lumbering, ugly, deformed. Monstrous. Every second involves concentration to stay upright. Suffering, what it does to my body, what it does to my mind, and the effort required to transcend it: All of these things make me feel like a monster.

Monsters: They live in books, under beds, and, to my mind, in museums. These days, museums are often bright, slick edutainment machines. It was different when I was a kid in the ’80s. Back then, going to the Royal Ontario Museum in downtown Toronto involved a thrillingly dark subway trip that brought us to a romantically dusty collection of mysterious artefacts from both the natural world and human culture.

As an adult I studied biology and got to know the range of hominid skulls very well in a physical anthropology class. In comparative vertebrate anatomy I came to enjoy dissections, where you can actually see and compare the intricate, individual inner workings of the creatures endowed with mu-opioid receptors (all the creatures with backbones, as you’ll recall). And then I married into a Mexican family and learned to see joy in merry depictions of skeletons and skulls. But as a child then, my fear of monsters and most especially skulls was very real.

In fact, most likely it was to challenge the remaining traces of that fear that I enrolled in the kind of biology courses where you get your latex-gloved hands sticky. And well that I did, because bones have become very significant in my life.

By the time I stepped into a rheumatologist’s office, I’d lived a summer of secret horror.

The ankylosaur is a turtle-shaped dinosaur with armoured plates and, in one species, a spikey club for a tail. At some point in my teens, I happened to see a picture of an ankylosing spondylitis patient in a book somewhere. I have a knack for remembering random, useless stuff. And I had seen the ankylosaur at the museum. The dinosaurian name of the disease, the monstrous way the patient was bent over by his condition, back hunched, the bones ankylosed, or fused, just like the dinosaur’s.

When, after my first child was born, I experienced the very distinctive AS pattern of stiffness and pain relieved by exercise, and when lab results suggested a form of inflammatory arthritis as a likely cause, the twin images of that ankylosed patient and the ankylosed dinosaur rose up from my memory vault.

By the time I stepped into a rheumatologist’s office, I’d lived a summer of secret horror, using the internet to retrieve endless images of patients deformed by the bone disease I already knew I had. That September, I held my breath as the rheumatologist diagnosed me with AS in a matter of seconds, told me irritably when I tried to ask questions that, “Well, it’s not going to kill you,” and walked out of the examination room, leaving me reeling, and with a prescription for anti-inflammatories that ultimately burned a hole in my esophagus. 

Over the years, I’ve adjusted a lot. And now, in the same way I make a pilgrimage to Frida Kahlo’s house when in Mexico, I visit the museum here in Toronto—no longer dusty and romantic, but still full of wonders—on a special pilgrimage to see Zuul crurivastator, “destroyer of shins,” a beautifully preserved skeleton representing a new species of the beast who nearly shares the name of my disease.

Like Zuul, I try to stand up straight but instead curve forward as if my vertebrae were already fused into one bumpy carapace. I try to push my rib cage forward where it belongs but it sinks back, instead bulging into a curve at the back where no curve should be unless your name is Zuul. The gentle C-curve of my neck is flattened out, as an X-ray confirms. Still, the slow deformation of my spine appears to be sparing me the full question mark shape of the untreated AS patient, for whom surgery may be required to allow for a forward rather than downward gaze.

When my doctor wrote a letter to the federal tax agency on my behalf, describing the worsening deformity of my back, the word weighed on me for days. I catch my reflection behind the dance instructor as I move stiffly through a Zumba class and see myself as Quasimodo.

When tramadol is not at its peak effect, I project tension, anxiety, or discomfort—and constant frustration—making me quiet, edgy, and drawn. I don’t know how to tell people what I need, and my many attempts to do so clearly and gently have rarely improved my relationships, instead leaving me more exhausted and more alienated.

Because I’m able to not only walk but run, it is hard to translate the fact that I cannot stand in one spot for more than a few minutes without discomfort curdling to pain into an understanding that I am dealing with a disability. Acknowledging this, as I am gradually beginning to do, means I can start to see that which enables me to do things despite pain as a tool or accessibility aid, and my ability to access it as an element of disability rights. Still, I often feel misunderstood and shut out of regular life because even though I can enter it, I can’t do it with the constant smile that lets others feel comfortable.

The Casual Demonization of Drug Users

It occurs to me that in journalism, and in casual speech, we often “monsterize” human beings, conflating the physically non-conforming with perpetrators of morally unspeakable acts, by describing both as monsters. Zuul, like other artefacts of nature, is a morally neutral monster, but he or she shares the term in popular thinking with serial killers, animal torturers, child abusers, and people who use drugs.

On Twitter, I have found other monsters: pain patients like me who are all too often characterized as strident, demanding, grotesque, and difficult, gross stereotypes of the barely literate, endlessly consuming American. And then, despite the fact that a psychoactive substance, like a dinosaur, is morally neutral, when certain people use drugs they get the full monster treatment, making it impossible to recall that we are describing a human being, and often one in pain. Drugs journalism, or pulp horror fiction? It can often be hard to tell. Take this real news article, for example: 

OPIOID HELL: The Zombies of a USA City with a Hopeless Addiction That’s Set to Come to UK 

A city ravaged by an opioid epidemic last night gave a chilling warning to the UK.

And indeed, you can find these zombies—monsters by definition—lurching in the street; you can find them skulking in the doorways. You can find them crowded into shelters or loitering in parks.

The stereotypes we hear about people who use illicit drugs are atrocious. Like all stereotypes, they are malleable, changing through the years. Rather than the drug being criminalized, it is actually the people who use it who are maligned, defamed, and criminalized through drug laws.

My friend “Joe” is a convicted felon who at 19 spent eight months in the clink, followed by house arrest and probation. We have talked about that, but these days spend more time—through detailed, nearly daily emails, mostly—discussing homelessness, cats, the way Toronto is changing in tandem with other big North American cities, and our shared experience of chronic back pain. We first discovered an affinity on Twitter and began chatting privately.

Joe never asks me direct personal questions, although he’s a good listener who seems to really care about the answer when he asks how I am. Nor does he ask to meet once we discover that we both live in Toronto. But he’ll check in discreetly, if I disappear for a few days, with a gentle “how’s by you?” Nothing more. He answers all of my questions, though.

Joe’s life story has been a nightmare, with many terrible details I won’t share here, because he has become my friend, not my subject. There is no romantic or sexual subtext here: He is in a very committed relationship which, after a decade when his beloved cat was his only companion, has given meaning and purpose to a life previously shot through with despair.

Over the course of months of sporadic conversation, Joe becomes my most regular correspondent after my mom. We meet in person for the first time, at my suggestion, in a café where I used to hang out during university. I moved into my university residence the year Joe moved into the Don Jail, a now-defunct, notorious Toronto institution that looked, he says, like the set of a horror movie. I remember standing outside it for some article I wrote years ago and he is right, but of course I never saw it from the inside.

Joe knows this café too. He spent time here when he was a teenage drug dealer, selling marijuana and LSD at his high school around the corner. That school happens to be where my son has just started grade nine. We are exact contemporaries, born a few months apart, and so we have shared cultural touchstones and memories of the city.

“We’re the junkies,” he writes to me. “Doesn’t that say it all?”

Joe lives now, with his partner, in Toronto’s Gay Village. They live in rent-controlled Depression-era red-brick housing that he describes as a revolving door of “dead-ender” tenants and the odd student from smalltown Ontario, stunned to have ended up smack in the midst of urban decay. “We have some wild tenants around here,” he writes. “I mean wild as in feral, barely domesticated, probably struggling with housebreaking.” His neighbour on one side calls the rooming house on the other side the Murder House. Joe keeps a large combat knife by the door in case someone breaks into their unit.

He recently helped the property manager cart a deceased tenant’s possessions to the curb. Joe suspects the tenant died of an overdose. He describes drug deals taking place nightly in the alley behind his house and picks up discarded methamphetamine and fentanyl needles (he can tell the difference) to keep the place clean and safe. They have had bedbugs. The apartment is actually falling apart, and whenever it rains Joe and his partner must run around plugging holes. They’ve flooded so often they now store their possessions in plastic containers. There’s nowhere else to go. 

“We’re the junkies,” he writes to me. “Doesn’t that say it all?”

Joe has not, however, ever injected drugs. His partner is a younger trans man who was injecting heroin when they became neighbors, and who transitioned to the addiction medicine buprenorphine after friendship sweetened to love. Having survived abandonment, domestic violence, dislocation, incarceration, and poverty, so far, Joe’s main focus now is on keeping his little family—which still includes the great orange cat he rescued from under a truck as a tiny ball of fluff—well and whole. 

Joe may have dabbled in drug dealing as a very troubled teenager, but he did not come to opioids until adulthood. Upon leaving prison, the only work he could get was manual labour. This exacerbated back problems and, as was common in the ’90s, he was prescribed opioid painkillers. They not only allowed him to continue to work his backbreaking job, but he quickly discovered that, especially when insufflated (snorted) rather than swallowed, they also provided a calm he’d never experienced, a normalcy. With OxyContin, he was at last able to manage his debilitating symptoms of chronic post-traumatic stress syndrome.

Punishing People on Addiction Medications

When prescription opioids became impossible to obtain, Joe made a fateful decision to avoid the unpredictable illicit market. By seeking a safe source of (non-euphoric) opioids through the addiction treatment system, he has been made to take on the stereotype of the junkie, the monster in flesh and blood.

“People think of methadone patients,” Joe tells me, “as dirty, zombielike shuffling semi-humans already crawling with disease. They have a poor sense of who actually goes through clinics.”

To get the medication that keeps him well, Joe must travel to a distant Toronto suburb, where his methadone clinic is hidden behind an auto body shop. By the time he arrives there in the morning to stand in line or squeeze into little waiting area, he is in serious withdrawal, sweating and shaking. Every week, he must provide urine samples. Joe sends me photos that he took from inside the bathroom where he must pee in a cup (in the US, this process often involves observed screening). Although at least he is allowed to lock the door, there are four cameras, some fixed at groin level, to ensure he does exactly what he’s told.

Piss tests are just one, emblematic example of the way vulnerable people are routinely dehumanized and re-traumatized in the name of treatment.

The writer Elizabeth Brico, in Florida, experiences a similarly dehumanizing process when she undergoes witnessed urine drug screening as a requirement for receiving buprenorphine, one of the two most evidence-based treatments for opioid use disorder: “She watched, annoyed, while I pulled up my panties, tugged down my skirt, and sidled past her out the bathroom, empty cup in hand.” 

Ultimately Brico relapsed with heroin as a result of her inability to pee under scrutiny.

Although some clinicians claim there is a safety value to patients in knowing what’s in their urine, the tests are notoriously unreliable and easy to mess with despite the punitive precautions, and there is no evidence that they improve patient care in any way. They allow doctors (even in singlepayer-healthcare Canada) and laboratories to bill, often exorbitantly, for provision of the test, and in fact constitute an entire industry devoted to surveillance and reporting of the contents of people’s piss and marketing of ever-more-creative ways to monitor human fluids. These include new, privacy-shredding ventures such as apps4 that allow for observed, recorded alcohol and drug screening.

Philadelphia harm reduction advocate Bill Kinkle, a former nurse who was addicted to heroin, also describes the trauma of this dehumanizing practice, in which he has regularly been forced to relive the helplessness of past sexual trauma and incarceration, including being raped in prison, as part of mandated addiction treatment. Never, he says, has his urine screening been witnessed by an observer of the same gender. He wrote to his case manager under Pennsylvania’s nurse monitoring program, 

I want to be as clear as possible here so there is no confusion. What happens every time I am selected for a screen is intense anxiety, cold sweats, an overall psychological heaviness. While I am preparing to go into the restroom I begin to shake and sweat more, most times I joke with the staff to cover the growing impulse to cry and leave the facility, while in the restroom I can smell the jail cell the night I was raped. I can feel the texture of the wool blanket over my face and hear the muffling of sound. My heart races, my voice cracks, and I have to work extraordinarily hard not to spill the specimen as I hand it over because I shake so profusely. 

Piss tests are just one, emblematic example of the way vulnerable people are routinely dehumanized and re-traumatized in the name of treatment. As it turns out, whether in treatment or actively using, to most people, you’re a junkie for life, or at least for as long as poverty keeps you neatly slotted into their mental category of the worthless, untrustworthy, unredeemable drug user.

A Violently Racist Narrative

The media-propagated narrative has been that innocent, naive (white) people are prescribed a painkiller and quickly find themselves hooked, ultimately turning to heroin, the true maker of monsters. But people like Joe complicate the reality. So too do statistics on prescription opioids and heroin use. Or the fact that, despite common denial of appropriate opioid pain care to Black patients with serious conditions like sickle cell anemia and other pain conditions, the rates of overdose are now increasing more quickly in the Black community than anywhere else.

It is perhaps natural that pale and privileged people like me would have trouble separating the cause of suffering and its effect. We have a vested interest in not doing it very well. The language of monstrosity that exists so often around drug use reflects the position that certain drug users hold in society and tells us that drug use is deviant, unmanageable, foreign or even alien, and frightening.

The tight connections between white supremacy and the War on Drugs run the gamut from the scapegoating of Chinese immigrants in Canada by means of the first opium prohibition laws, to targeting of Indigenous people for enforcement of minor drug crimes today, or the persecution of Black heroin users. The vocally anti-racist jazz singer Billie Holiday, for example, was hounded by Harry Anslinger, the notoriously racist head of the US Federal Bureau of Narcotics in the 1930s and prime mover of the War on Drugs that endures today in much the same form he first laid out.

More recently, media are quick to report the drug status of Black people killed by police, and police are just as quick to cite drug use or sales or suspicion of either as justification for indefensible and apparently racially-motivated violence.

Since the very start, prohibition, or harsh enforcement of it for certain drugs but not others, have targeted racialized minorities with stereotypes and exaggerations, monstrifying different ethnic groups.

In 2020, for example, we were told that drugs were relevant in the death in Minneapolis of 46-year-old George Floyd, who had a non-lethal dose of fentanyl in his system when a police officer knelt on his neck for nearly nine minutes, as he called for his mother and repeated that he could not breathe; or in that of 26-year-old Breonna Taylor, who was shot six times in her own Louisville apartment during a drug investigation.

Over and over since the very start, prohibition or harsh enforcement of it for certain drugs but not others—often even versions of the same drug, as with the chemically identical drugs crack and cocaine—have targeted the racialized minority associated with it, with stereotypes and exaggerations monstrifying different ethnic groups: crack babies, Yellow Peril, drunken Indians—these are all racist constructions that have nothing whatsoever to do with the actual harms of the drug in question.

The racially associated danger of the drug often has to do with either loss of control or insidious control. Where ruthless Colombian and Mexican drug lords mastermind the enslavement of innocent Americans with cocaine, sly Jews control the legal pharmaceutical opioid industry.

In Robert Louis Stevenson’s story of Dr. Jekyll and Mr. Hyde, a medical doctor “swallows a potion that transforms him from a rational, intelligent human into an evil monster,” write two veterinarians with PhDs in American Veterinarian magazine. The article where this appears is about how to recognize the pet owner who is using their dog or cat to score opioid painkillers—for themselves. “Opioids—the modern equivalent of the doctor’s potion—can create dependency, transform people into strangers sometimes given to harmful deeds, and bring on the distinct possibility of death,” they continue.

For family members whose loved ones have become “strangers sometimes given to harmful deeds,” it can be seductive to describe the drug as such a potion, creating a split personality and turning a beloved child, sibling, or parent into a monstrous creature who exemplifies characteristics like selfishness, manipulation, deceit, and unreliability. “When she’s on drugs she’s just a monster,” says A.Y., mother of a young woman who uses methamphetamines. An FBI feature film purportedly about drug users’ experiences includes a composite user musing on his experience with oxycodone 80s.

It just turned me into a monster. I never thought any of this would happen to me. I’m a criminal. I’m an addict … the minute that chemical hits your bloodstream, you lose control of what it does in your body. You can’t control it. Nobody can control it. And I ask them, of all the drugs they’ve ever tried, what’s the most addictive drug. And without a doubt it’s oxycodone. 

Others have said the most addictive drug—without a doubt—is heroin; cocaine; crystal meth; or nicotine. Time magazine reports on a scary new drug (it’s always a scary new drug) based on the opioid codeine. It’s called krokodil, or the “zombie drug” (there are many zombie drugs). It comes from “Siberia and the Russian Far East,” and it is the “world’s most dangerous drug,” causing necrosis of the skin. And, of course, “There are now alarming stories that the monster could be at large in the US.” Other scary “new” drugs that have each had their turn in the tabloid sun have included flakka, bath salts, monkey dust, jenkem, Tik, and Gray Death.

Inevitably, reports like these prove to be nothing but alarming monster tales: moralistic, based on fantasy, intended to scare. When I was a child, we feared that our Halloween candy was laced with LSD (it was not). Now, drug users are apparently giving away cannabis edibles in order to get our children stoned or psychotic (they are not).

The Real Monster

With monster language comes suspicion, vigilance, xenophobia, and fear. Monster language serves, repeatedly, as the scaffolding that holds up discrimination and routine rights violations. The moral of the story is that monsters are not to be trusted: They must be quarantined, killed, institutionalized, silenced. Exterminated. Reporter Susan Zielinski quotes Alberta resident Symantha DeSchiffart on a drug user: 

He’s walking like he doesn’t have any bones. He’s right messed up. It’s scary. He’s trying to talk. You don’t know what they’re going to do when they need money. This right here is a zombie apocalypse in this area. It’s not safe for anybody. 

The result of commentary like this in this particular community has been closures and defunding of existing supervised consumption sites, moving drug use from a safe, supportive location to alleys, parks, and Burger King bathrooms and resulting in preventable death.

At its worst extreme, framings that effectively reduce people who use drugs to zombies propel regimes like that in the Philippines, where President Rodrigo Duterte openly questions whether drug users are human (his drug war policies and support for extra-judicial killing have resulted in the deaths of tens of thousands of members of the urban poor, with poverty and drug use being repeatedly conflated and subject to similarly hateful and dehumanizing descriptions by the president). Shortly after coming to power in 2016, Duterte told reporters that “Hitler massacred 3 million Jews. Now, there are 3 million drug addicts … I’d be happy to slaughter them.”

According to French economist Thomas Piketty, inequality in the United States is “probably higher than in any other society at any time in the past, anywhere in the world.”

Donald Trump, an open admirer of Duterte’s approach to drug policy, and his militarism and authoritarianism, likewise advocated capital punishment for drug dealers, while using both “animals” and “drug dealers” to refer to Hispanic migrants and renewing the truly undying global War on Drugs. The cost of media recklessness in reporting on drug use without picking apart the racism and poor-bashing inherent in these framings is the cost of human lives.

We—or rather, the wealthy minority who control access to land, resources, services, perspectives—have put together a Frankenstein’s monster of a society. In North America, the gap in incomes between rich and poor is worse than in 1913 Europe; globally, the wealthiest have commanded a greater share of incomes, as well as overall wealth, since the 1980s, and market forces play the tune to which we must all frantically dance. According to French economist Thomas Piketty, inequality in the United States is “probably higher than in any other society at any time in the past, anywhere in the world.”

That’s the society we live in, a true monster with every condition necessary for poor mental and physical health, physical pain, addiction, and misery. Like Dorian Gray, whose face remained pristine while his hidden portrait accumulated all the monstrosity of its subject, or like Frankenstein’s monster, the creation is thought to have all the bad qualities that are in fact the worst qualities of its maker—in fact, if anyone were to listen, it is more eloquent and humane than its creator. We punish this poor beast of a society for lumbering around, seeking shelter, medicating its pain, worrying its own tail, doing its best to live and find its own meaning and beauty.

Really, who is the monster?

Photograph of an anklyosaur skeleton by Thomas Vandenberghe via Wikimedia Commons/Creative Commons 2.0

This article is an adapted excerpt from On Opium: Pain, Pleasure, and Other Matters of Substance, which was published in Canada by Goose Lane Editions in September. An audiobook will be available worldwide in 2022. You can read more about the book, and the author’s other writing, at www.carlynzwarenstein.com.

The post The Ways We “Monsterize” Drug Use, Pain and People appeared first on Filter.

The exemption, if granted by Health Canada, would allow the Drug Users Liberation Front (DULF) and Vancouver Area Network of Drug Users (VANDU) to run a 200-person, 15-month pilot project to purchase, test and distribute drugs. They would test the supply for potency and composition using Fourier-transform infrared spectroscopy (FTIR) drug-checking services, and fentanyl and benzodiazepine immunoassay test strips. 

The groups have simultaneously requested CA $268,947 in funding for the project through a Substance Use and Addictions Program grant from Health Canada. It’s a funding stream specifically intended to support community-led projects to reduce harms associated with drug use, including through safe supply.

“The illicit variant of our project, anyone could do,” Eris Nyx, one of DULF’s founding co-organizers, told Filter. “Can you please just give us a licit path to this?”

Indeed, as I reported in Filter in 2019, drug users have for years operated similar clubs, including in British Columbia and Ontario, to collectively purchase and check the composition of drugs, obtained from sources including the “dark web.” Yet the advantages of being able to do this work without fear of arrest and with vastly increased resources would be obvious.

“I’ve lost two-thirds of the people I know in the Downtown Eastside.”

Equally obvious are the benefits of such clubs to members seeking to avoid the risks of adulterants widely present in the supply, including fentanyl.

“I’ve had some very weird moments with fentanyl. When I see it, I see tombstones in my mind,” Hugh Lampkin, a long-time member of VANDU, told Filter. “I’ve lost two-thirds of the people I know in the Downtown Eastside.”

Lampkin explained that trauma dating to his childhood led him to use heroin, while racism (“walking while Black”), along with criminalization of drug users, brought him years of unwanted interactions with police.

“You spend most of your time hustling to get a paper or a point,” he said of his addiction. “If you could stabilize people and you could just go and get it, as long as they have [access to checked drugs], their lives will change. It’s always a positive thing you see.” 

Lampkin describes himself as stabilized on a form of time-release morphine—and on the comradeship and empowerment he’s found through VANDU—after many years depending on the ever-more-dangerous illicit market. 

“People try to, but they can never find a reliable source of heroin,” Jeremy Kalicum, DULF’s other founding organizer, told Filter.

Since 2019, DULF, with VANDU members and other volunteers, has carried out a number of widely publicized events at which they handed out free, tested, DULF-branded and ingredient-labelled drugs (so far they have spent about CA $15,000 on drugs). 

The recent exemption request asked for a government decision—or even an emergency, temporary decision—by October 15. But the recent federal elections mean that no one is surprised that the date came and went without a sign.

In fact, there’s no required or expected timeline for Health Canada to respond to a section 56 exemption request (a number of such requests are pending or expected across the country right now, including requests for decriminalization from the City of Toronto to be submitted this fall, and one from the city of Vancouver that was submitted in May). 

If the government ever responds, the exact details of the compassion club model will depend on what sort of stipulations Health Canada places on the proposal. 

Kalicum is realistic about this; while he acknowledges that a known supply of prescription fentanyl for people who choose to use it would save lives, “I just don’t think the public’s ready for that.” The consensus decision was therefore to leave fentanyl out of the exemption request for strategic reasons, he explained. 

Procuring Safe Drugs

Another major detail relates to the source of the heroin, methamphetamine and cocaine to be used in the project.

“I’m officially labeled as a ‘drug dealer’ by some,” Jean Swanson, the city councillor and long-time social justice activist who advanced the city council motion, told Filter.

Back on July 14, Swanson openly joined DULF and VANDU in an action in the Downtown Eastside, the Vancouver neighborhood that has been hit hardest by overdose and where there is probably a greater concentration of harm reduction services than anywhere else in the world. At this action, volunteers handed out free, tested heroin, methamphetamine and cocaine to drug users who pre-registered for the event. No overdoses were reported following this or other DULF actions.

“It was the easiest decision I’ve made since I got elected,” Swanson said, citing the need to overcome stigma against people who use drugs and the fact that both people with addictions and casual users are dying from an essentially poisoned drug market.

In a significant, shift-signaling win, Vancouver city police formally declined to lay charges against the councillor in response to an anonymous complaint after the event.

The police department wrote, “While the VPD does not condone drug trafficking and, in fact, does arrest for drug trafficking, it is recognized that the actions of the other protesters were not motivated by profit and were not the actions of organized crime groups, but rather, were grounded in harm reduction and raising awareness to the need for urgent action to the overdose crisis […] Given the totality of the circumstances as they relate to this event, including the need to maintain public peace during the protest, officers used their discretion and chose not to take enforcement action.”

Research specific to Vancouver suggests that diversion provides respite from the risks inherent in the illicit market.

A common concern raised about safe supply is that “diversion” may result. Although Nyx carefully designed DULF’s packaging to resemble cigarette packaging and not appeal to children, she points out that diversion of pharmaceutical-grade opioids and stimulants would prevent the overdoses she sees daily when she opens her front door in the Downtown Eastside. 

Indeed, new research specific to Vancouver suggests that diversion provides respite from the risks inherent in the illicit market, while illicit fentanyl, not prescription opioids, continues to drive overdose deaths in the province of BC.

The motion as written requires that city council support for compassion clubs is conditional on them procuring their drugs from “a legal regulated source that does not benefit organized crime.”

This may be a challenge to achieve at scale—although Canada does, for example, have a very new, not-for-profit company dedicated to domestic prescription heroin production. DULF has yet to reach out to potential producers of pharmaceutical-grade cocaine or methamphetamine.

In a precedent of sorts, federally permitted safe consumption sites across the country do, of course, permit the use of drugs from which people who sell illicitly have profited. But harm reductionists would argue that’s not the point, when these sites unequivocally save lives. 

A National Stalemate

The national situation around drug policy is a weird and dangerous stalemate. The Liberal government has persistently refused to consider decriminalization of all substances, although it did legalize cannabis for recreational use in 2018 and has repeatedly solicited drug users’ and other experts’ input on how to respond to overdose. In fact, at its 2018 convention, Liberal Party of Canada delegates passed a resolution in support of reclassifying low-level drug consumption and possession as administrative offenses, a form of decriminalization. 

“There’s something sinister to the government’s behavior in this situation,” said Nyx, who intends—somehow—to run the compassion clubs project illegally if it is not funded and authorized by the feds. As Swanson noted, “Vancouver has a long history of having people do illegal things to get the government to make them legal, starting with supervised injection sites.”

Compassion clubs are intended to take control over what people put in their bodies away from both the medical and policing professions—giving it back to the people who use these substances in a supportive environment.

In this way, they aim to address failings of existing safe supply programs: an overly medicalized model, high barriers to participation and drugs that aren’t what people are actually seeking—which reduces their effectiveness as a safer replacement for illicit drugs.

“That’s why we want it out of a medicalized system,” Kalicum said. “All these regulations, it doesn’t work for people. That’s kind of the reality of the situation.”

Most of all, compassion clubs—whether or not they’re authorized and funded by the government, evaluated and scaled to the true level of need—offer empowerment because they’re a drug user-led response.

“People can say what they want about drug users,” Lampkin said. “But the other part is we are saving each other’s lives. We have each other, and we’ve found people that listen to us.”

Photograph via Drug User Liberation Front

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