If I had been 12, and he’d been Leonardo Dicaprio, maybe making a collage would have been cute. But I was in my twenties, and he was a celebrity to no one but me.

***

Of all the books about infatuation, I have one favorite that is curiously overlooked: Love and Limerence—The Experience of Being in Love (1979) is one of the best guides for feeling in the grip of uncontrollable, unbearable passion that I’ve found.

In this book, psychologist Dorothy Tennov (1928-2007) coined the word “limerence” to describe “an involuntary interpersonal state that involves an acute longing for emotional reciprocation, obsessive-compulsive thoughts, feelings, and behaviors, and emotional dependence on another person.”

She chose the word because “it was pronounceable and seemed to me and to two students to have a ‘fitting’ sound.”

It’s the word to describe a crush when it becomes…intense.

The book, which combines the best of the literary, psychology and self-help genres, opens with the lines: “You think: I want you. I want you forever, now, yesterday, and always. Above all, I want you to want me. No matter where I am or what I am doing, I am not safe from your spell.”

And that’s just the beginning.

Limerence, Love and Addiction

Limerence seems to be having a moment. It can be found, for example, in the innovative TV show Crazy Ex-Girlfriend, which subverts and explores its eponymous concept to produce, in the words of star and co-creator Rachel Bloom, a “realistic portrayal of someone using love as an escapist drug.” Limerence was also name-checked in Season Two of Transparent: Amy Landecker’s character, Sarah, uses the word to describe her mother’s new state of infatuation. The cult twitter account, SoSadToday, spouts pithy lines of existential angst; self-aware limerence is a favorite subject of its author, poet Melissa Broder, who also describes the state in her recent book of essays.

Limerence, of course, is hardly a new phenomenon. In her book, Tennov describes the central role it has played in art, literature and music throughout the ages, using examples like Anna Karenina, Madame Butterfly and Shakespeare’s sonnets. Limerence, she writes, “inspires even ordinary persons to verbal excess”—to refer to “the pleasure that makes life worth living” and “the experience that takes the sting from dying.”

Despite these supposedly panacean properties, Tennov notes that limerence seems to have a correlation with murder, suicide and other impulsive acts of violence.

But whether limerence leads to agony, ecstasy or some combination of the two, Tennov says that it has been considered “woman’s province” and overlooked as a field worthy of serious study—largely and wrongly omitted, for example, from the fields of depression and suicide research, where it would seem highly relevant.

Tennov’s attempt to give the stereotypically female subject of limerence the serious attention it deserves is in keeping with her feminist agenda. She was involved in New York feminist circles in the ‘70s, and also published a book called Psychotherapy, the Hazardous Cure, a critical feminist examination of psychotherapy, and Super Self: A Woman’s Guide to Self-Management. She was a professor of psychology at University of Bridgeport, where she introduced the first women’s studies course.

When limerence has been given attention in the past, says Tennov, it’s been in the service of castigating women for it. “I am astonished and disconcerted by the blatant misogyny I have so often found in literature,” she writes, “even in recent essays and research reports. Not only is love women’s province, but she is blamed for it mightily.”

Women experiencing limerence are typically seen as sick (as in the case of Freud’s conception of female hysteria), or evil (women have often been punished more harshly for adultery than men). When men evince limerence, women are seen to have maliciously evoked it, and are punished once again; one of Webster’s definitions of “witch” Tennov notes, is “charming or alluring woman.”

Nearly 40 years since Tennov discussed it, limerence still seems to be considered “women’s province” and women still seem to be blamed for it, even as the framing of love as an “addiction” has been increasingly studied and present in popular discourse, as Lynn Parramore has examined. 

Tennov herself refers to a spate of books about love and addiction that came out before hers in the ‘70s, including Filter contributor Stanton Peele’s 1975 book, Love and Addiction. These variously categorize passionate romantic love as an addiction, as a sign of immaturity, and/or a mark of of excessive “dependence.”

Tennov calls these views, notably all offered by men, “disparaging.”

“It cannot be concluded,” she writes, “that none of these writers has ever experienced limerence; only that they view it as both illogical and pathological. What my studies suggest is that while it is illogical, it is also normal, and therefore normal human beings can be illogical. For some,” she writes, allowing herself a bit of snootiness, “this seems a difficult idea to accept.”

Peele however, rejects the “disease model” of addiction and rather sees addiction as a part of “normal” human experience, so his conception may not truly be as different from Tennov’s as she seems to think.

Regardless, she holds a general wariness for psychotherapists who attempt to cure their patients of limerence (or a lack thereof); she sees them as the latest in a long line of those who attempt to control women’s bodies.

Today, Tennov seems to have lost out to a dominant view that limerent love is pathological—see the Judd Apatow show Love among others, which depict people (usually women) despairing over their disease-model-type “love addiction.” It would appear that when it comes to limerence, we are still, as Tennov writes, “exposed to a kind of pro-therapy propaganda promulgated by television sitcoms, advice columnists, and various kinds of popular reading material.” Parramore notes that there are 40 Sex and Love Addicts Anonymous groups in New York City alone.

But the semantics of what limerence is or isn’t aren’t what make the book such a unique and fascinating read. Rather, it’s Tennov’s accumulation and organization of hundreds of pages of Studs Terkel-like first-person testimony about the intimate details of being under another person’s spell.

A Thousand Limerents

Tennov interviewed and surveyed over a thousand people formally and informally about their experiences with (or without) limerence. Some people she interviewed—”nonlimerents”—had never experienced such a thing and could hardly understand what she was talking about. Of those who had experienced it, their limerence “ranged in duration from a three-day spree in Naples to a fifty-year unrequited yearning.”

Among “limerents,” all had experienced certain features; symptoms include “intrusive thinking” about the “Limerent Object,” (or LO as they are referred to in the book ), “acute longing for reciprocation,” an “aching of the ‘heart’ (a region in the center front of the chest) when uncertainty is strong,” and “buoyancy (a feeling of walking on air) when reciprocation seems evident.”

Limerence, Tennov writes, “is ignited by a set of conditions” that include two important criteria:

1. A sign of hope that the person might reciprocate.

2. Uncertainty.

“Then you reach the final torment: utter despair poisoned still by a shred of hope.”-Stendhal

Tennov references The Second Sex, in which Simone De Beauvoir discusses the first feature—hope—in the context of a psychiatric condition called “erotomania.” A “normal woman,” De Beauvoir writes “sometimes yields in the end to the truth and finally recognizes the fact that she is no longer loved.” But in the case of erotomania, the “patient’s mania always succeeds in breaking through the resistance of reality…she always cheats a little” and retains a crumb of hope.

Another feature of limerence is that the subject lives to some extent in a world of fantasy, one that may have little-to-no relation to any true interactions with the object of affection, yet is consumed by them. Limerence’s manifestations range from a secret obsession where the LO literally does not know the limerent person exists, to a fixation on one’s own spouse.

But always there are intrusive, obsessive thoughts. As a limerent person, Tennov writes, “You wonder or imagine what LO would think of the book in your hand, the scene you are witnessing, the fortune or misfortune that is befalling you. You find yourself visualizing how you will tell them about it, how LO will respond, what will be said between you and what actions will—or might—take place in relation to it.”

A Funhouse Mirror

Another commonality is limerence’s solipsistic nature—limerence is not the kind of love prescribed by Kierkegaard in his Works of Love: “to love precisely the person one sees. “ Rather, the LO is a funhouse mirror onto which your own fantasies and fears are projected.

One interview subject commented that Tennov’s choice of the term “Limerent Object” was particularly apt, because the other person really is treated as an object. They are “essentially invisible to me. I see my own construction.”

Another subject shared his diary with Tennov, in which he had written: “The attraction is my invention. It is ugly because it is impersonal. How can I say that I really like Laura when she so clearly is not the sort of person who could really be part of my life?… It is a disservice to the person not to perceive them the way they really are.”

Tennov also interviewed people who had been on the receiving end of limerence. One of them, in response to a confession of limerence, reported: “I was…deeply insulted. Steve didn’t seem to be talking to me. He didn’t seem to know or to care what my intentions were or what I was interested in doing. On the one hand, he was declaring eternal love, and on the other, he showed no concern for my life, my job, my friends, or what I wished. He was a stranger to me.”

Tennov says that “probably the most prevalent” type of limerence interaction is “between a limerent person and an LO who does not reciprocate with limerence”—unrequited love. But mutual limerence, Romeo and Juliet-style, is possible. Unless continued obstacles from external sources, such as parents or society, stoke the limerence, “reciprocity is usually followed by a decline in limerence.” This can be replaced by love, given the right circumstances, and even a happy marriage.

But beware: “To marry your LO is to experience the ecstasy of ultimate reciprocation. Or so you feel.” But when one person is limerent and the other is not, no matter how much they like or love the other, if there is an imbalance, then there may be little relief.

As one limerent person told Tennov: “Okay, so we were married. I still didn’t believe Ed loved me. There was something about the way he acted, little things he did or forgot to do.”

Even the “ecstatic bliss of mutual love” can be on the fine line between pleasure and pain when limerence is involved. Tennov references the book Love Between Women, a 1971 study of lesbian sex, in which one young limerent writes that while embracing her love, she “felt so wonderfully happy,” “that I wanted to kill us both, so that there should be no anticlimax!”

Is There a Gender Divide?

Is the feeling of limerence really more common in women? Tennov suggests that it may be so—but not because of any inherent propensity.

Women, she writes, “are expected and allowed to be ‘shattered’ by love; for a man, however, it is unmasculine.” Even with that internalized pressure, though, she found in her research that about 40 percent of both men and women endorsed the statement: “I have been deeply in love with someone who did not love me or know of my feelings.”

Additionally, 45 percent of men agreed that they “often lie awake at night thinking about being with X” (66 percent of women did) and 48 percent of men said they “have been very depressed about a love affair” (60 percent of women did).

Tennov also touches on the approaches of critical feminist writers like Simone de Beauvoir, who pointed to socio-political forces, rather than biological ones, to explain the gender discrepancy.

She writes: “Forced to depend on men for status, security, and survival itself, women have been and are still subordinate to men in society…If love were not a major concern, she might find herself literally left out in the cold.”

It’s not so different from the feminist critique that emerged in response to Freud’s idea of penis envy. Feminist psychoanalysts patiently explained that maybe women weren’t literally envious of a penis, but of men’s power in patriarchal society. (Psychoanalyst Karen Horney took it a step further, and theorized that in diagnosing women with penis envy, Freud was in fact only projecting his own womb envy).

Tennov does not much discuss the stereotypical framing of masculine desire as “sex” and feminine desire as “love,” something reflected in 12-step programs for sex and love “addicts” which tend to skew along those lines. She calls the relationship between sex and limerence “baffling” and “extremely complicated.”

Sex, she concludes, “is neither essential nor, in itself, adequate to satisfy the limerent need…Limerence is a desire for more than sex.”

“To love another person is to see the face of God.”― Victor Hugo, Les Misérables

Another low point in my own experience of limerence occurred when a therapist said I had to change his name in my head to “Santa Claus,” because that’s how much of a fantasy he’d become. Calling him “Santa Claus” every time I thought of him would remind me I was thinking about a pure illusion I’d created (and hopefully snap me out of what had become a painful obsession). It didn’t really help, though it did make me attracted to Santa Claus.

The pain remained, partly because of one of limerence’s cruel paradoxes: It makes you obsessed with a person, but also terrified of ever speaking to them.

https://twitter.com/search?q=idk%20how%20much%20more%20obvious%20i%20can%20be%2

0to%20my%20crush&src=typd

Tweet:

Idk how much more obvious I can be to my crush..I‘ve:

-avoided all eye contact

-never spoken to them directly

-pretended they don’t exist

As Tennov reports: “Awkwardness, stammering, and confusion predominate at the behavioral level. And shyness. When limerent, you are fearful, apprehensive, nervous, anxious—terribly worried that your own actions may bring about disaster.”

Philip, a 28-year-old truck driver, told her: “It was like what you might call stage fright, like going up in front of an audience.”

This behavior begins to make sense, once you start to realize that, as psychoanalyst Robert Seidenberg has written (quoted by Tennov): “love is a human religion in which another person is believed in.”

If your LO is your God, it is far better to never get too close—to never reveal your true self—than to risk being actively rejected by God. Would you have the courage to face, much less speak to God, if you were truly in their presence?

It seems to be much easier for the limerent to text God, however. Often repeatedly. Even when the texts go unanswered. Unfortunately, writing in the 1970s, Tennov was unable to address this point.

Why Tennov’s Work Still Matters

There are a few other aspects of the book that read as outdated. Tennov touches on what she calls “homo-limerence” (and interviewed multiple gay subjects about their experiences), but she is overwhelmingly concerned with heterosexual relationships. And I was surprised to read her mention of “computer dating,” until I discovered it wasn’t much like Match.com or Tinder.

But Love and Limerence feels contemporary in that it functions as both a scholarly work of qualitative research and as a self-help book. It certainly provided this limerent some semblance of clinical distance from which to analyze and challenge the mania.

I hadn’t known, for example, until I read Love and Limerence, that it was a very common limerent fantasy to imagine a death or tragedy that would somehow spur the mutual confession of love. And how did Tennov know that I dreamt of “a scene on a Caribbean island…with you and your LO”?

Lastly, she nailed the part about not having much to dish about to your friends. When an “acknowledged relationship exists,” there are things to tell friends and family—“real events,” she writes. But the “state of unreturned limerence is one of relative (and often self-imposed) isolation” because the only things to tell are “reports of emotional upheaval generated by the subtleties of what limerents imbue with meanings not visible to the listener.”

Reading the book is like being with the least judgmental therapist ever, to whom you don’t even need to confess your shameful secrets, because they already know them.

This may be because Tennov, too, has experienced limerence, though she never goes into the details.

On page 273, she finally admits: “Though like anyone else, I am loath to talk about my own experiences in this sort of context, I feel it is necessary that I do so, and thereby lay the thing to rest. Had I not known the experience of limerence, it would have been harder for me to have discovered it in others.” One may have already assumed from her hundreds of pages and hours of study devoted to limerence, that she just may have had a personal interest in the subject. But it’s still nice to know for sure.

Is There a Cure for Limerence?

Tennov herself finishes the book still unsure exactly how to end limerence. (Despite her insistence that it is not “pathological,” she clearly sees that it causes pain and understands why someone would want to escape its grasp).

At one point she writes: “Limerence can live a long life sustained by crumbs. Indeed, overfeeding is perhaps the best way to end it.” If you enter a relationship with your LO, a regular “[l]ove can replace limerence given the right circumstances.” But that’s not a guarantee: “Limerent fantasies,” writes Tennov, “do not necessarily cease when an actual relationship begins. They may diminish or increase in frequency.”

At one point she muses, “Perhaps the best cure you can administer to yourself is to remove all contact and all possibility of contact between yourself and your unresponsive LO.”

But unless she’s advocating suicide or murder, she knows as well as anyone that this “cure” would be nearly impossible (especially with today’s social media). As long as you both are on this earth, there is the possibility that you could meet again.

Many people I’ve spoken to do seem to grow out of a certain type of limerence (just as many experience “aging out” of addiction). Tennov agrees that “some evidence exists that after the first experience(s), usually in youth and early adulthood, certain coping strategies may be learned that reduce the risks.” One such coping strategy may be the ability to distill the traits of the LO that you once felt so passionately about, and reframe them as traits you envy, and wish to develop or accept in yourself.

The sentiment tweeted by comedian Jess Kahnweiler rings true:

All I ever wanted was to be some dudes muse until I realized I’m the dude.

— Jessie Kahnweiler (@jesskahnweiler) March 12, 2016

Any of us, whatever our gender, may need to realize that we are “the dude.”

After recognizing and categorizing your limerent experience(s), the next step is to turn your limerent energies in a new direction (or sublimate them, as Freud might have said).

Perhaps you might reframe the idea of being humiliatingly obsessed with someone into the idea of being “creative.” You’re not a pathetic loser, you just have a great imagination.

After all, spending all that time and energy imagining conversations could be called “crafting dialogue.” And fantasizing about what another person might be thinking, what they like and dislike, desire and fear—couldn’t that be conceived as character development?

But it may take time to realize you’re not hopelessly in love with that comedian; you just want to get up on stage and tell jokes yourself. Obsessed with that professor? Maybe you’d like to be the one standing in front of a class sharing your insights. Maybe you’re not only attracted to authority, anger, risk-taking, silliness, or whatever other trait you so admire in your LO; maybe you want them yourself.

It can take a while to realize that their confidence and intelligence and talent is not going to magically rub off on you. You’re not going to feel like you actually accomplished something just because you’re dating someone who did. Instead, you may have to find your own path to self-esteem, if that’s what you’re looking for, by working hard and doing the things you want to do yourself.

Though Lorin Stein*, editor-in-chief of The Paris Review, is a notable fan of this book (he calls it “wacky but wise”[link]), I don’t think it’s an accident that no one talks much about it these days, or that it lost out to a different formulation.

It’s embarrassing to talk about our neediness, our desire, our raw hunger for meaning, purpose, love,  perfection, authority, for absolutes, for power. Easier to disavow or pathologize.

Tennov acknowledged the taboo around talking seriously about romantic love—while working on the book she found herself “assuming a certain lightheartedness when referring to my subject, calling it my ‘ha-ha’ research on ‘ha-ha’ romantic love.”

Maybe “addiction” (which doesn’t feel gendered) seems like a safer way these days of conceptualizing our (quite normal) existential longing.

But learning more about it on its own terms can also be helpful. And you can always read Love and Limerence on your phone or something, so no one on the subway has to know.

*In December 2017, Stein resigned in light of accusations of sexual harassment.

The post Love and Limerence appeared first on Filter.

So why is it taking so long—and costing so many thousands of lives—to make naloxone accessible to everyone as an over-the-counter (rather than prescribed) medication?

On December 17 and 18 the FDA held a public advisory committee meeting that was intended to “solicit input and advice on strategies on increasing availability of naloxone to reduce opioid overdose deaths,” according to FDA Commissioner Scott Gottlieb.

Yet the only question up for a vote at the end of the two-day meeting was whether the FDA should recommend that naloxone be co-prescribed for “all or some” patients who are prescribed opioids. The committee members voted 12-11 in favor of this recommendation. At best, this step is the bare minimum of what we should be doing. Given that most people who become addicted to opioids didn’t start with a doctor’s prescription, it’s completely inadequate.

Then on January 17, FDA Commissioner Scott Gottlieb announced what the FDA called “unprecedented new efforts to support development of over-the-counter naloxone to help reduce opioid overdose deaths.” This means that the agency has conducted one part of the time-consuming process that a pharmaceutical company would have to go through to submit an OTC naloxone product for approval. The FDA has developed a model Drug Facts Label (DFL) with “easy-to-understand pictograms on how to use the drug” (below) and conducted testing to ensure that people would be able to understand the instructions.

[An excerpt from the FDA’s new model DFL for OTC naloxone nasal spray; there’s also one for use with an auto-injector.]

The FDA’s naloxone DFL has been a long time coming; it was first announced in August 2016. So what now?

“FDA’s development work here is extraordinary, and reflects their longstanding desire to see a pharmaceutical company take naloxone OTC,” says Amy Arthur, director of public and government relations at Harm Reduction Therapeutics, a non-profit trying to develop an over-the-counter naloxone product. “The development of a DFL and testing of its comprehension is of course usually the responsibility of the sponsor, and considerable time and effort usually goes into meeting the FDA’s standards for these critically important communication tools.”

Arthur says that Harm Reduction Therapeutics will be using the FDA’s naloxone DFL in their own OTC development program.

“Responsibility now falls squarely on the shoulders of industry,” she says.

Naloxone was first patented in 1961. It was approved in injectable form by the FDA in 1971, and has been off-patent since 1985. A decade ago, a lifesaving dose of naloxone cost $1. Today, two naloxone products currently have FDA approval for use outside medical facilities by people without medical training. A dose of naloxone in the nasal spray, which was approved in 2015, costs $150. A naloxone auto-injector, approved in 2016, costs $4,500.

As Michael Hufford, PhD, CEO of Harm Reduction Therapeutics, and Donald S. Burke, dean of the Graduate School of Public Health at the University of Pittsburgh, wrote recently in an op-ed for Stat: Naloxone’s “high price and restricted availability—despite its low production costs and excellent safety and effectiveness records—betray our collective ambivalence about the millions of Americans with opioid use disorder.”

[Timeline via Michael Hufford’s presentation to the FDA]

Pharma’s Self-Interest

Significantly, the companies that manufacture these expensive naloxone products were represented at the December FDA meeting.

In addition to presentations from FDA employees, and researchers and activists from places like the CDC, Boston University School of Medicine, the VA, the San Fransisco Department of Public Health, the Harm Reduction Coalition and the Drug Policy Alliance, the meeting featured presentations from three Pharma representatives.

These included Robert G. Kramer, president and COO of Adapt Pharma/Emergent Biosolutions, which makes Narcan® Nasal Spray; and Omar Khalil, general manager of Neurology and Addiction for Kaléo, which makes the Evzio® auto-injector.

Dean Mariano, senior director of clinical development/medical affairs for Insys Therapeutics, also presented. Insys is developing a naloxone nasal spray and it has announced plans to submit a New Drug Application (NDA) in 2019.

The three companies released a 23-page joint briefing note for the meeting. Its only mention of “over the counter” was a small section on one slide called “OTC Challenges.” The slide identifies a “challenge” of OTC as: “Risk higher financial barrier for many without improvement in access or awareness.”

That’s pretty rich, considering that they would be the ones setting the price. When meeting attendees asked industry reps “why they oppose OTC access at this time,” they again claimed that they were concerned about cost to consumers—since insurance wouldn’t cover OTC drugs. Yet proponents of OTC naloxone say that going over-the-counter could make it more affordable. Flonase, a nasal spray for allergies, dropped from up to $100 to less than $20 once it became available on store shelves, Mark Kantor, a pharmacist who signed an Oregon petition to make naloxone available OTC, has noted.

The Harm Reduction Coalition’s recommendations at the FDA meeting included “Approve an OTC form of naloxone that will be available to programs doing community-based distribution at low cost (<$1):

.@harmreduction‘s recommendations at today’s FDA adcomm pic.twitter.com/iwvLQFqkYH

— SAC Tracker (@FDAadcomm) December 18, 2018

A Human Rights Watch representative also supported OTC naloxone, calling it “necessary and overdue.” And other experts say that the actual cost of a naloxone dose should be less than $1. In fact, industry insiders say it costs about a nickel.

As it is now, the companies that make naloxone can charge astronomical prices. Comments from Emergent BioSolutions CEO Daniel J. Abdun-Nabi in August made clear that he sees naloxone in profit terms. Announcing that his company was acquiring Adapt Pharma, he described US high schools and colleges as an untapped market. It’s a “growth opportunity,” he said, according to Bloomberg.

Kaléo, meanwhile, made recent headlines when it lowered the cost of its naloxone product to $178 for two injectors. But that was only after a Senate investigation found that it had hiked the price of its drug Evzio to $4,100 for two injectors, an increase of more than 600 percent between 2014 and 2017.

Harm Reduction Therapeutics Leads Quest for OTC Naloxone

“We offer a different solution,” Hufford says. “Make naloxone available over the counter, in much greater quantities and at lower prices.”

Proponents say that naloxone meets the criteria needed to be OTC. OTC drug products have these general characteristics:

*Their benefits outweigh their risks

*The potential for misuse and abuse is low

*Consumer can use them for self‐diagnosed conditions

*They can be adequately labeled

*Health practitioners are not needed for the safe and effective use of the product

Harm Reduction Therapeutics anticipates its OTC naloxone product will be developed, approved and distributed in 18–24 months. (Given the nature of this grant, no revenues or royalties will be paid to Purdue.)

In the meantime, there are two ways for the FDA to make naloxone available OTC, Hufford explains. The FDA “can’t dictate by fiat that a certain drug is approved over the counter.” Instead, pharma companies must come forward with an application. A “Citizens petition,” like the one filed in Orgeon, is a second potential route.

The non-profit consumer rights group Public Citizen, which was also present at the FDA meeting, says the federal government should procure generic naloxone kits under Government Patent Use law (28 USC Section 1498). Others have argued the same—or at least that the government should use this statute to “bring [pharmaceutical companies] to the negotiating table.”

“The most recent use of § 1498 in the pharmaceutical context was in 2001,” stated Public Citizen in a letter to the FDA committee, “when then-Secretary of Health and Human Services, Tommy Thompson, publicly considered using the authority to procure generic ciprofloxacin during the post-September 11th anthrax scare. The ciprofloxacin patent holder, Bayer, quickly cut its prices in half.”

The “high price of naloxone treatments is neither inevitable nor insurmountable,” Public Citizen continued. “Instead, the high price reflects a set of policy choices by the federal government to refrain from using its existing authority to increase access to affordable generic treatment. These choices must change.”

The fastest way for naloxone to become available OTC, according to Hufford, is for a company with an existing product (like Adapt Pharma/Emergent Biosolutions or Kaléo) to file to take it OTC.

Filter asked the FDA whether they believe the new DFL will motivate those companies to actually develop OTC naloxone. A representative responded: “We hope that by conducting the consumer testing and developing the model DFL, which takes time, that companies will view this as removing a barrier to development.”

Given the strong past opposition to OTC of the companies currently charging sky-high prices for naloxone, it seems unlikely that they will be swayed by the FDA’s DFL move. But they aren’t the only game in town.

“If they won’t,” says Hufford, “we will.”

Main image via Libreshot

The post What’s Taking So Long for Naloxone to Be Made Available Over the Counter? appeared first on Filter.

“A leave of absence is potentially useful to the student,” author Miriam Heyman, PhD writes. “[S]tudents can use the time away from academic demands to focus on well being and recovery. However, schools may also use the leave of absence as a tool for discrimination, pushing students out of school who are entitled by law to receive accommodations and supports which would enable them to stay.”

The schools’ leave of absence policies received grades according to 15 indicators, including: their level of transparency (whether students know what to expect if on leave, and under what conditions they will be allowed to return); support (whether students know how to access campus resources while at school and during their leave); and inclusivity (whether leaves of absence are used in a discriminatory way).

Yale received the lowest grade of “F”—the only school to receive such a grade. (Having attended Yale as an undergraduate, I was coerced to take a “voluntary” leave of absence there. Like one student from Princeton profiled in the paper, I was told by Yale administrators that if I did not take a voluntary leave, I would be placed on an involuntary one.)

Harvard didn’t do much better at a “D-minus.” Princeton, Brown and Columbia led the pack with “Ds.”

Particularly cruel, Yale, Dartmouth, Cornell and Columbia all prohibit students on leave from even visiting the campus. “This means that students who are taking time away from the academic demands in order to focus on their own well being become socially isolated, as they are banned from coming to campus even to share a meal with friends,” writes Heyman. “We call on these schools to remove this prohibition from their leave of absence policy.”

The tables below show the full rankings, as well as some of the reasons for the grades:

The report focused on the Ivy League schools “because they represent the most elite institutions of higher education in our nation.” They should therefore, writes Heyman, “lead the field in practices that promote inclusion and support for students with mental health disabilities.”

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Photo via Yale Daily News

The post Yale Gets an F for Student Mental Health (Harvard Got a D Minus) appeared first on Filter.

An article published December 7 by the Brookings Institution, a prominent Washington, DC think tank, is under fire for promoting the idea that harm reduction approaches—like syringe exchange and naloxone—may encourage “riskier opioid use” and increase rates of opioid-related deaths.

The focus of the criticism is the choice of which articles to cite—and which not to cite—by the authors of the Institution’s “research roundup.” The paper was written by Jennifer L. Doleac, an associate professor of Economics at Texas A&M University, Anita Mukherjee, an assistant professor of Risk and insurance at the University of Wisconsin-Madison, and Molly Schnell, a postdoctoral Fellow at the Stanford Institute for Economic Policy Research.

“New work by Packham and Wells (2018) suggests that syringe exchange programs—a staple of harm-reduction efforts—reduce HIV rates as intended but unintentionally increase opioid-related mortality by making it easier, cheaper, and safer to use heroin” the authors state.

But as many readers pointed out, the Packham and Wells article is a working paper—meaning it has not yet been subjected to peer review, nor published in any journal. The authors simultaneously don’t cite decades of existing peer-reviewed studies that show syringe exchange programs do not increase mortality rates.

“Urge @BrookingsEcon to RESCIND this piece and have it undergo peer review by subject matter experts,” tweeted Leo Beletsky, associate professor of Law and Health Sciences at Northeastern University. “It ignores much of the empirical evidence base on the topics it purports to analyze. This is not a balanced, informed analysis and will do public health harm if left uncorrected.”

This publication doesnt comport w basic standards of scientific balance. It completely ignores, nevermind engage, body of evidence disproving its about harm reduction programs. Policymakers trust @BrookingsInst to provide information they can use to make decisions. Please RETRACT https://t.co/eqPdYdPfEx

— Leo Beletsky (@LeoBeletsky) December 10, 2018

Others in the medical and public health communities agreed:

I wrote to @BrookingsInst outlining my concerns with their opioid research roundup (https://t.co/FPqAzuL4oQ). At the core of my argument against the article is a fundamentally flawed study regarding the impact of naloxone access legislation (https://t.co/GEKRzSHtSb). pic.twitter.com/O2wVx8Di2m

— Lucas Hill, PharmD (@HillPharmD) December 11, 2018

Couldn’t agree more @LeoBeletsky. This is not up to @BrookingsInst standards. As simple as that https://t.co/CcrJs68Gne

— Alex Wodak (@AlexWodak) December 11, 2018

I am hurt. And angry. How is this laziness acceptable and able to get a platform when people are actually out there dying?!?! And while people are out there saving lives and doing the real work?!?! I…just…can’t. https://t.co/RxQRWdj50x

— Sheila Vakharia PhD MSW (@MyHarmReduction) December 11, 2018

“The most shocking claim in the article is that harm reduction increases risky drug use behavior, even though there is no evidence of this,” tweeted Alex Gertner, an MD-PhD candidate at University of Chapel Hill. “The whole point of harm reduction is to help people to reduce risky behavior.”

In addition to the Packham and Wells article, the authors also cite their own paper, “The Moral Hazard of Lifesaving Innovations: Naloxone Access, Opioid Abuse, and Crime,” published earlier this year by IZA Institute of Labor Economics, a German think tank, to support the idea that increased access to naloxone increases opioid use, opioid-related crime, and, in some places, deaths from overdoses.

That article was also confronted by a barrage of methodological criticism when it was published. For example, as Gertner pointed out at the time, “the authors find that naloxone access laws lead to more opioid-related emergency department visits, the premise being that naloxone access laws increase opioid overdoses. But there’s a far more likely explanation: People are generally instructed to seek medical care for overdose after receiving naloxone.”

Filter reached out to Jennifer L. Doleac, the lead author of the paper, through Brookings, and was instructed to email questions. Shannon Meraw, Brookings’ media relations manager, responded to questions with the following: “Worth noting—we’ve received several questions related to your numbers 1 and 2. The authors will be updating the piece to clarify why some of the findings cited are different from those supported by many public health advocates (economists tend to think about these issues differently than folks in other disciplines). I’m not sure when that will be finalized, but we will include an editor’s note when it is.”

Doleac has also tweeted: “Sincere request: If you think our post on opioid has missed relevant studies from public health or any other discipline, please email them to me. Vague allusions to decades of evidence aren’t persuasive but I do like reading good research, & am willing/able to change my priors!”

Putting this here for max visibility. I’m genuinely curious what amazing studies people think we’ve missed. Email is the best way to contact me — don’t assume I will see your tweets. https://t.co/SKs8IQ2PrZ

— Jennifer Doleac (@jenniferdoleac) December 10, 2018

Doleac seemed to be referring to a tweet thread of Gertner’s that referenced “decades of evidence.” But in the same thread, Gertner provided a link to a literature review of studies on this exact topic.

Plus, as many pointed out, looking into previous research on a topic is generally done before a lit review is written, not after.

Meraw added in her email: “Brookings of course doesn’t take a position on any issue, but as we provide a platform for individuals to do so, we do want to make sure the debate is properly contextualized.”

Brookings may not officially “take a position,” but many policymakers look to the the think tank to form their views. The New York Times called Brookings “the most prestigious think tank in the world.” So by choosing who to give a platform to (and who not), Brookings effectively does take positions.

7/ It’s hard to overstate how shocking it is for mainstream organization like @BrookingsInst to host a view that harm reduction increases risk. This is in line with arguments during HIV crisis that we shouldn’t provide condoms and anti-virals since it’d increase risky behaviors.

— Alex Gertner (@setmoreoff) December 8, 2018

Meraw said that she would pass Filter‘s questions along to lead author Jennifer L. Doleac, and this article will be updated if we receive a response.

In the midst of the overdose crisis, harm reduction ideas have been making their way into mainstream discussions. That’s a good thing—but it also means more people than ever are talking about harm reduction with very little familiarity with what it means. It’s likely that vigilance from researchers and experts with deep knowledge of harm reduction methodologies will increasingly be required to prevent damaging inaccuracies being received as fact.

UPDATE – December 12:

Filter received the following response from Doleac by email:

“I find it utterly disheartening that a discipline as important as public health is filled with so many people who collectively have so little understanding of rigorous research methods. Advocates should acknowledge that many of their strongly-held priors are not evidence-based. Anecdotes and personal experience are valuable but are not a substitute for the rigorous causal inference methods used in the studies that our post highlighted.”

On December 11, the Brookings Institution’s article was also updated “to contextualize and clarify its discussion of harm reduction policies.” A few paragraphs have been added that read:

“The results of the Doleac and Mukherjee study suggest that broadening access to naloxone can unintentionally increase opioid abuse by reducing the cost of overdose. That is, while naloxone saves lives in the moment—which is clearly a priority for policymakers and public health officials—it may increase rates of drug abuse and possibly even mortality.

These findings suggest that harm-reduction policies—like policies in many contexts—involve tradeoffs. Economists have found evidence of similar unintended consequences in other public health settings, so the idea that such tradeoffs are possible is not new or unique to opioid-related legislation.

We recognize that these findings strongly contrast with previous work by public health researchers that suggested few, if any, trade-offs that result from harm reduction policies. We believe that the research described above credibly establishes a causal effect, but given the stakes at-hand—and the impact drug abuse can have on individuals, their families, and society at-large—this is clearly an area that needs further study. In the meantime, policymakers should acknowledge and work to mitigate any potential unintended consequences when implementing harm-reduction policies.”

The new paragraphs do not link to any of the referenced “previous work by public health researchers.”

The post Public Health Experts Call for Retraction of Brookings Institution Opioid “Research Roundup” appeared first on Filter.

Yet even all of these are not enough; there are still many people who can’t access them.

“What about someone who lives in a small town?” asks Favaro. “They went to high school with their pharmacist, maybe people know they have a history of drug use… If they’ve relapsed, they’re going to be using in secrecy because of shame and stigma, they’re using one syringe 20 times until the tip breaks off.” Some people may not feel comfortable openly walking into a syringe exchange or obtaining needles from a pharmacy.

That’s where Next Harm Reduction comes in. The nonprofit, based in New York City, was founded in October 2017. It distributes free harm reduction supplies, like syringes and naloxone, to people throughout New York State, and provides online educational resources for people who use drugs. Next Harm Reduction runs two programs: NEXT Distro, which aims to replicate some of the resources and support of a typical syringe exchange program; and Next Naloxone, which exists to provide the overdose reversal drug to people in rural and suburban communities.

Next Harm Reduction is developing an encrypted online system. In the meantime, Favaro explains, “the method for folks to access supplies now is to reach out to me via the ‘contact us‘ link or via email, text, Signal, Whatsapp or social media: Reddit, Instagram, Facebook, etc. I send them an anonymous enrollment via an unlisted URL.”

Next Harm Reduction is the first official state-wide operation of its kind. Although naloxone is now available without prescription in many states, the FDA still classifies it as a prescription drug—and federal law prohibits mailing prescription drugs and syringes except in certain specified circumstances. One loophole is if the project is part of a state-sanctioned program: Next can legally mail naloxone because it is a registered Opioid Overdose Prevention Program in New York State; it run its peer delivery syringe distribution service through VOCAL-NY. Anyone who accesses those services from Next is enrolled as a participant in VOCAL.

“Syringe exchange programs often encounter nimbyism and other obstacles to their existence,” says Favaro. “We skirt that issue by providing services online for people to access in the comfort of their own home.”

Her grand vision? “Syringe exchange for all.”

 

View this post on Instagram

 

Donations for dayzzz #nextdistro #nextisharmreduction

A post shared by NEXT Distro (@nextdistro) on Jul 27, 2018 at 6:52am PDT

That’s not to say that Next wants to replace on-the-ground programs. “I believe that in-person services are always best,” Favaro says. So another component of Next is helping connect people to physical harm reduction centers near them—and not just state-sanctioned ones.

Favaro is constantly “doing investigative work” to connect people to all sorts of services. “Walking into a syringe exchange program when you haven’t been before, or don’t know anyone involved can be a daunting experience.”

Favaro brings nearly two decades of harm reduction experience to the project. After working at Tapestry Health in Massachusetts and Citywide Harm Reduction in New York, she founded Washington Heights Corner Project in 2005, a community health center that offers supportive services, including syringe exchange, to people who use drugs. Until recently she worked as a senior advisor at the Harm Reduction Coalition, before leaving to work full-time on Next Harm Reduction.

She isn’t just a social worker, and activist; she’s also a person who uses drugs, which gives her valuable insight into the needs of the people Next serves.

I think it’s very scary for people who don’t know that syringe exchanges are warm, supportive, caring environments.”

“As someone who has walked into a syringe exchange … it’s really nerve-racking,” she says. “Every time I walk into an NEP as a participant, I am scared—my heart is racing. I’m afraid someone is going to call me out, or confront me. And that’s as someone who has run a needle exchange program. I think it’s very scary for people who don’t know that syringe exchanges are warm, supportive, caring environments.”

 

View this post on Instagram

 

Can you hear us shrieking with joy? Thank you to you-know-who-you-are who crammed four boxes of naloxone atomizers in one package to #nextdistro We needed these. Love to our harm reduction family. This project is thriving on donated time, donated supplies, and donated funds. #nextisharmreduction #harmreductionfamily #harmreduction #naloxonesaveslives

A post shared by NEXT Distro (@nextdistro) on Aug 9, 2018 at 7:40am PDT

Right now, Next is working with all the official needle exchange programs in New York State, as well as many underground ones, seeking to break down barriers and increase access for the most vulnerable people.

But Favaro wants to expand nationwide. The hope is that Next is creating something in New York for other states to adopt. In 2019 Next will be expanding to Maryland, which requires county-by-county approval. After that, Favaro wants to roll it out to “Eastern Kentucky and Tennessee, where the overdose rates are phenomenal and the resources are not available to people who use drugs.”

Operating in each state requires its own tailored approach. “The drugs you use in different regions and different states are different. An educational video for someone who receives supplies in upstate New York is not the same as for someone in Tennessee, or Nevada.”

As Next Harm Reduction’s website explains, “Mailing harm reduction supplies isn’t new. People who use drugs, organizations that serve [them], and community activists have been mailing syringes and naloxone for longer than we can say.”

Next was particularly inspired by the work of Tracey Helton, a woman once described by CNN as the “heroine of heroin.” Helton works in public health in San Fransisco and is now on Next’s board. During the 2016 Harm Reduction Conference in San Diego, Favaro heard Helton speak about the work she was doing, mailing naloxone from her living room to people across the country, operating outside the law.

“My brain exploded,” Favaro says. “I became very interested in how we could scale up and formalize the work she had been doing, in order to ensure that people across the country who live in communities wheres there’s no syringe exchange programs can still receive harm reduction services.”

“What that means,” she continues, “is not just the supplies that someone would walk into an SEP and receive, but also the education, resources and support that come along with being a program participant in a syringe exchange.”

“There are people who don’t have access to naloxone who are actively using drugs.”

Sending harm reduction supplies by mail is a service that’s clearly needed. “We’ve had over 20 naloxone reversals in the past three months,” Favaro says. And she points out something that is obviously true, but still shocking in 2018: “There are people who don’t have access to naloxone who are actively using drugs.”

According to the most recent data from the Centers for Disease Control and Prevention, 70,237 people died of drug overdoses in 2017—the highest number recorded for a single year in US history. The number of drug overdose deaths in the US was so high that it significantly contributed to an overall drop in life expectancy. Yet according to Next Harm Reduction, 93 percent of US counties have no syringe access program.

Given the crisis we are in, it’s frustrating to Favaro that “people are still stuck in old ways of thinking about needing to create brick-and-mortar programs.” She says that “with caution,” though. That’s because, she explains, she doesn’t want to encourage or condone “folks who don’t come from the school of harm reduction and drug user health,” who “are looking to capitalize on the opioid epidemic by creating ‘solutions’ that are not based in supporting people who use drugs.”

“Right now there’s so much funding around the opioid epidemic, folks that don’t have experience in on the ground work are capitalizing and exploiting resources that would be better utilized if they went towards harm reduction and syringe access and low-threshold buprenorphine access.”

“A lot of the money is going toward law enforcement and abstinence-based services.”

It’s good that there is money for services, yet Favaro is concerned about how that funding is getting allocated. “A lot of the money is going toward law enforcement and abstinence-based services.”

“Harm reduction folks and people who use drugs know what we need to do,” Favaro says, “but we don’t have the money to do it.”

She has raised enough money to build the infrastructure of the project, but still needs funding to carry out daily operations, and to purchase and mail supplies.

Next is hoping to partner with state programs, and is applying for a SEP-waiver in NY state so it can operate independently, rather than just through VOCAL. They’re also raising money through a gofundme account.

“We believe everyone who uses drugs should have the resources and ability to keep themselves as safe and as healthy as possible,” says Favaro. “This includes physical and emotional health.”

Photos via https://nextdistro.org/home/ and https://www.instagram.com/nextdistro/ 

The post Jamie Favaro’s Quest to Bring Online Naloxone Access Nationwide appeared first on Filter.

One of the very exciting things to come out of my meeting with President Xi of China is his promise to me to criminalize the sale of deadly Fentanyl coming into the United States. It will now be considered a “controlled substance.” This could be a game changer on what is…….

— Donald J. Trump (@realDonaldTrump) December 5, 2018

…..considered to be the worst and most dangerous, addictive and deadly substance of them all. Last year over 77,000 people died from Fentanyl. If China cracks down on this “horror drug,” using the Death Penalty for distributors and pushers, the results will be incredible!

— Donald J. Trump (@realDonaldTrump) December 5, 2018

People immediately pushed back against that figure of over 77,000 supposed fentanyl deaths. It’s incorrect. It seems likely that Trump got “70,000” from federal data released last week—the number of people who died from all drug overdoses in the US last year, not just fentanyl—and added 10 percent for good measure, to hype up support for his inconsequential “deal” with China.

Synthetic opioids like fentanyl were in fact involved in approximately 30,000 deaths in the US in 2017—still a staggering number, but less than half of the figure that Trump blithely shared with his 56.1 million followers.

Could Trump have been referring instead to some kind of global figure? Well, no. It’s impossible to find accurate global estimates of fentanyl-related fatalities, as definitions and reporting vary so much by country. The UN Office on Drugs and Crime states in its 2018 report: “Some 450,000 people died in 2015 as a result of drug use. Of those deaths, 167,750 were a direct result of drug use disorders [mainly overdoses], in most cases involving opioids.”

Worse than statistical innaccuracy, by describing fentanyl as a “horror drug,” Trump continues to exploit the US overdose crisis to rationalize brutal policies—whether advocating for the death penalty in China or the US, or for human rights abuses against refugees arriving from Mexico. “STOP THE DRUGS,” Trump tweeted on December 3, as a rationalization for building “the Wall.”

We would save Billions of Dollars if the Democrats would give us the votes to build the Wall. Either way, people will NOT be allowed into our Country illegally! We will close the entire Southern Border if necessary. Also, STOP THE DRUGS!

— Donald J. Trump (@realDonaldTrump) December 3, 2018

Trump’s gleeful celebration of death is surreal, though not new. UN Secretary-General António Guterres has called the death penalty “barbaric,” and demanded that the US—the world’s eighth most enthusiastic executioner—abolish the practice. “The death penalty has no place in the 21st century,” he said in October 2017. Among US citizens, support for the death penalty is at an all-time low.

China carries out the highest number of known executions in the world—thousands in 2017, although exact figures are hard to come by due to state controls. Four other countries—Iran, Saudi Arabia, Iraq, and Pakistan—accounted for 84 percent of the confirmed executions in the rest of the world in 2017.

With no regard for the American people or the UN’s perspectives, Trump has repeatedly said that he “loves” the idea of the death penalty for drug dealers. He has also expressed an affinity for Philippines President Rodrigo Duterte, whose murderous drug war has resulted in the killings—without trial—of over 12,000 people suspected of drug-law violations. In 2017 Trump reportedly congratulated the Philippine president for doing an “unbelievable job on the drug problem.”

Despite Trump’s inaccurate number, he’s correct that the fentanyl overdose crisis is real. His sadistic strategies, however, will only make things worse.

The post Trump’s Latest Rabid Tweet: “Death Penalty for Distributors and Pushers, the Results Will Be Incredible!” appeared first on Filter.

The song takes us through Grande’s previous relationships—with rapper Big Sean, comedian Pete Davidson, and Miller, who fatally overdosed at age 26 from fentanyl and cocaine in September. Grande finally arrives in a “new” relationship—one that she knows will last. Her new love interest is herself—“Her name is Ari”—and, Grande reassures us, she is “so good with that (So good with that).”

Grande acknowledges that she has loved and lost (her most recent relationship, a whirlwind with Davidson, broke up after they had gotten engaged), but says it was all worth it for what she learned about herself, such as “How she handles pain (pain).”

Reflecting on herself and her current situation, Grande expresses happiness—“That shit’s amazing (Yeah, she’s amazing)”—and says that right now, she “ain’t worried ’bout nothin,'” particularly because she can be confident that “this song is a smash (song is a smash).”

To my ears, the song displayed Trump-like levels of callous narcissism from the petite pop star. Perhaps that’s why this collaged parody of Trump singing “Thank U, Next” seemed to resonate. Making someone else’s death all about him and how “amazing” he is doing is exactly something Trump would do.

Grande’s dismissal of Miller, who died less than two months ago, along with her other exes with a glib “thank u, next” was bad enough. But the video rubbed salt in the wound by pairing the song somewhat nonsensically with silly homages to four fun comedy movies from the early 2000’s—Mean Girls, 13 Going on 30, Legally Blonde and Bring It On—and seemingly random celebrity cameos by Kris Jenner and Australian pop singer Troye Sivan.

This is not at all to suggest that Grande deserves any blame for Miller’s death, as some of his fans cruelly claimed in the wake of the news. Nor is it exactly to say that Grande is “milking” Miller’s death, as one person tweeted in response to a Thanksgiving post by Grande about missing him.

It’s more that it seems like his death just didn’t register with her as something categorically different than, say, her break-up with Davidson.

In response to the “milking” accusations, Grande emphatically responded that “everything i feel is valid and safe. everything i do is genuine and honest. there is no right or wrong during this period.”

Most people seem to agree with her—”Thank u, Next” generated a storm of glowing press and social media reactions.

“i cant stop watching this video… her mind… her fucking mind…” tweeted one fan. “[T]he message being pushed is empowerment,” announced Vice. “Honest and vulnerable…ultimately a beautiful piece of music,” wrote a Forbes reporter.

The lack of concern about the way the song and video actually dealt with Miller’s death made me wonder if the disturbing thing wasn’t (just) Grande’s narcissism. Perhaps, amid an overdose crisis, a fatality like Miller’s is now common enough that to many people it doesn’t actually register as all that different from a break-up—a mundane occurrence prompting grief, but not, ultimately, that much of a surprise.

But if that’s really what’s going on, it’s not only a reflection of the devastating overdose toll. It’s also a concerning sign that people are accepting the seeming inevitability of such deaths—when in fact, we know how easily these deaths could be reduced, if we embraced the harm reduction strategies that are proven to save lives.

Shouldn’t people be up in arms about these preventable deaths, not simply saying “thank u, next, bitch” to those who die?

The post Is Ariana Grande’s “Thank U, Next” Disrespectful to Mac Miller? appeared first on Filter.

It’s intended to educate experts and organizations who want to involve directly impacted people in their work. Here are a few of the key takeaways:

“We have a lot of experience,” the handout says, “so please:”

DO invite several of us

DO listen to our answers

DON’T invite just one of us

DON’T hand-pick always the same user you know and are comfortable with

DON’T only invite people who formerly used drugs – it is OK to invite them and they have lots to offer, but they are not the same as people who are actively using drugs, who also have a perspective that is valuable and needs to be heard as well

“We may not be used to your style of meetings so please:”

DO show flexibility with meeting styles

DON’T hold a meeting at 9am, or on welfare cheque issue day

DON’T think that we cannot do more, such as work for you in a paid position

“We are NOT very mobile or wealthy so please…”

DO hold a meeting or consultation in a low-key setting or in a setting where users already hang out

DON’T hold it in a government building

DON’T assume that we don’t need an honorarium or would just spend it on drugs (or that it wouldn’t be justified even if we did)

DO give us money in cash

“We do value our privacy so please…”

DO guarantee and protect confidentiality

DON’T require disclosure of HIV or other health status

“If you want us to travel please…”

DO help with arranging methadone carries

DO arrange for advice from a local person who uses drugs – drugs may be more dangerous in a different city and traveling puts us at risk

Some of the tips—like “Don’t ask us to come and meet you in Ottawa”—are clearly specific to this group. And of course, it’s not the case that all people who use drugs are not “mobile” or “wealthy.”

But these tips are a useful resource and conversation-starter for any organization seeking to capitalize ethically and effectively on drug users’ knowledge.

The pamphlet was produced by “Toward the Heart,” a part of the British Columbia Centre for Disease Control dedicated to harm reduction, for an initiative aiming to “establish peer engagement as the norm in BC and expand the opportunities for voices of peers who have been missing from our table.” Their website offers a directory of harm reduction sites, naloxone training materials, and other resources for people who use drugs and professionals.

Photo via The Poverty Truth Commission

The post How to Involve People Who Use Drugs in Your Organization appeared first on Filter.

Kristof writes that he’s “not sure just where we’ll travel, and I’m not even sure that it’ll be abroad. One possibility is India or Bangladesh, another is American Indian reservations in the United States, or perhaps somewhere else entirely like Haiti.”

How fun! A free trip with a two-time Pulitzer Prize winner.

But as a new book reminds us, Kristof is pretty much the last person anyone should be listening to when it comes to poverty or cultures other than his own. In Feminist Accountability: Disrupting Violence and Transforming Power (December, NYU Press), Ann Russo, associate professor of Women’s and Gender Studies at DePaul University, offers an intersectional analysis that includes chapters on “Disrupting Whiteness,” “Shifting Paradigms to End Violence,” and “Disentangling US Feminism from US Imperialism.”

In the last section, “Resisting the ‘Savior’ Complex,” Russo recalls how Kristof—in his 2009 book, Half the Sky: Turning Oppression into Opportunity for Women Worldwide, written with his wife Sheryl WuDunn—”portray[s] the men from the global south as either inherently brutal and violent, or lazy and irresponsible (both constructions synchronistic with the portrayal of men of color and immigrant men from the global south in the dominant culture of the United States).”

Numerous quotations from Kristof’s book, which catalogs the oppression of women and girls in the Global South, illustrate Russo’s assertions. Indeed, it’s easy to imagine Trump heartily agreeing with some of Kristof’s ideas about the inherent vice of certain people from certain countries.

“If poor families spent only as much on educating their children as they do on beer and prostitutes,” Kristof writes, “there would be a breakthrough in the prospects of poor countries.”

“Many African and Indian men now consider beer indispensable and their daughters’ education a luxury,” reads another line. “The service of a prostitute is deemed essential; a condom is a frill.”

As Russo points out, Kristof continually locates “the roots of violence, like poverty, in isolated pathological cultures,” while studiously avoiding “any discussion of the historical and geopolitical context of colonization, imperial interventions, and transnational conflicts.”

“In many poor countries, the problem is not so much individual thugs and rapists but an entire culture of sexual predation,” Kristof asserts. Kristof and WuDunn describe Ethiopia as “where kidnapping and raping girls is a time-honored tradition” and Congo as the “world capital of rape.”

“No doubt the widespread rape and sexual violence against women in the Congo is horrific,” Russo counters, “but [Kristof and WuDunn] explain it as a cultural problem, rather than a social and political [one].” With this myopic focus, they “obscure the role of the United States in fueling this endemic violence and the ongoing instability of the country and thus avoid any consideration of US accountability. For example, [when they discuss the Congo], Kristof and WuDunn do not tell us that our deep dependence on these mineral resources is, in part, what fuels the ongoing conflicts and violence in the region.”

In his win-a-trip contest announcement, Kristof writes that applicants who “don’t look like” him are “welcome.” That may be so. But a pro forma “welcome” can’t erase the impact of the broad strokes with which he has painted whole swaths of people.

This was a problem in 2009. Now, with Trump in the White House, it’s more important than ever to get rid of the myth of the good white liberal savior for once and for all, and stand in opposition to what Russo describes as Kristof’s “ethnocentrist, racist and imperialist logic.”

Photo: Nicholas Kristof in Africa

The post As Nicholas Kristof Recruits Students for His Global Poverty Tour, a New Book Exposes His “Racist and Imperialist Logic” appeared first on Filter.

“FDR may have had ‘fireside chats,’ but AOC has ‘cooking black bean soup on instagram live’ and guys, it is ????????????” wrote one viewer.

The live feed was a powerful example of willingness to engage in a new—for Democrats—mode of political operating. President Trump leveraged his Apprentice-honed command of the TV medium to hijack Republican debates, and uses Twitter to communicate with the American people at all hours of the day and night. But Ocasio-Cortez was using Instagram—a medium through which her generation channels everything from pornography to celebrity-worship—to deliver an opposing political message.

I am completely absorbed by @Ocasio2018‘s live story on Instagram right now. She’s cooking dinner, answering questions, and talking policy. Something is happening here that we haven’t quite seen before in politics…

— Adam B. Golub (@adamgolub) November 19, 2018

Now that she has committed to making her live-streamed dinner preparation a “weekly-ish” thing, will other politicians be able to ignore the power of the live feed for much longer?

Not that many will currently be able to match her. The 29-year-old’s millennial fluency on social media and her talent for delivering concise, accessible explanations of politics alongside playful and relatable mundane moments give her a compelling edge.

Last night, for example, she spoke of why critics who focus on how we should pay for things like universal healthcare are not asking in good faith—they’re trying to create a distraction. She compared it to making a personal budget; if you really want something, you cut back on other areas of spending. No one, she pointed out, asks how we would possibly find money to pay for wars.

Moments later, she asked what exactly was supposed to be in the “Italian seasoning” that her recipe called for. When the person operating the camera teased her for referring to “thyme” as “thymes,” she smiled easily: “I learned English second y’all” she protested.

It’s also inescapable that her appearance plays a role in her appeal. Centuries of male-gaze perspectives decree that any time a young, traditionally attractive woman looks deep into a camera and does anything, it carries a near-sexual edge. By embracing Instagram Live, she’s harnessing that reality as a powerful tool.

Others have picked up on the mesmerizing quality to her Instagram appearances. “Whenever you read the comments,” a viewer wrote, referring to Ocasio-Cortez’s stare, “you are looking into my soul.”

Ocasio-Cortez read the comment out loud, laughing, clearly aware of the effect she was having.

The writer Andrea Long Chu compared watching Ocasio-Cortez to interacting with a romantic partner:

tfw yr gf had to go out of town for her job but instead of canceling yr date she skypes in for dinner and later you watch a movie together by pressing play on netflix at the exact same time pic.twitter.com/xaTND69Xix

— Andrea Long Chu (@theorygurl) November 18, 2018

The public’s eagerness to reduce politicians to love and sex objects can be off-putting to some (see the reactions to last week’s infamous viral “Beto sex tweet“).

But Ocasio-Cortez, like Trump and other Republicans, is willing to embrace every available weapon in a political war. Many other Democrats seem unwilling to do so. This also represents a departure in gender terms—as Stella Bugbee said recently on The Cut‘s podcast, Ocasio-Cortez uses her beauty in a way that no US female politician has ever really done. (Sarah Palin doesn’t count, she said, because she didn’t have a legitimate social agenda to further with her good looks).

Ocasio-Cortez’s charisma is of course frightening to those who disagree with her policy aims. That’s why she’s getting attacked by Republicans who are, as she put it, “drooling over every minute of footage of me in slow-mo,” thirsty for the slightest slip-up.

But it’s exhilarating to those of us who agree that election day should be a federal holiday, ICE should be abolished, and everyone should be able to get healthcare.

In between mincing garlic and chopping onion, Ocasio-Cortez answered live questions posed by Instagram followers, ranging from “Did you have an Ani DiFranco phase?” to “Can you tell us about federal jobs guarantee?”

Asked for thoughts on Canada’s recent legalization of marijuana, she didn’t miss a beat. Marijuana prohibition is “a tool” used to oppress black and brown people, she said. And we have to get rid of that tool.

She went on to discuss how marijuana should be regulated so that the product would be safer, and other policy considerations. But the simplicity and clarity of her argument—and the ease with which she delivered it—epitomized her whole vibe, and the new kind of potency she is bringing to politics.

The post Alexandria Ocasio-Cortez Explained Why Marijuana Should Be Legal on Instagram—But the Live Feed Also Had Wider Significance appeared first on Filter.