A few of us got together to conceive Filter in 2017. Our mission, as we framed it, was “to advocate through journalism for rational and compassionate approaches to drug use, drug policy and human rights.” Our aims included countering dominant, damaging media narratives about drugs and people who use them. We wanted to challenge stigma and misinformation by platforming important voices, stories and issues that are routinely ignored. We wanted to expose the drug war for what it really is—a war on people—and influence the public conversation for the better.

For the eight years since we pushed the site live in 2018, Filter has had the distinction of being a news organization dedicated to covering harm reduction. We have published thousands of articles—investigative reports, news briefs, interviews, essays, opinion and much more—to that end, documenting a period when the movement evolved rapidly and entered mainstream policy discussions in the United States.

We have debunked drug myths, provided information about safer use, highlighted overlooked needs and perspectives, explored the history and culture of harm reduction, and deconstructed policy developments. We have broken news and analyzed it. We have charted the trajectory of the North American overdose crisis, and the harm reduction interventions that have—and haven’t—been implemented to mitigate it, while never losing sight of prohibition’s role in creating the crisis to begin with.

Nationally and internationally, we’ve routinely and in depth covered practice and policies around stimulants, psychedelics, cannabis, alcohol, medications for opioid use disorder and more—coverage often authored, importantly but far too unusually, by people who actually use the drugs in question.

We’ve regularly drawn the links from drug policy to a raft of intersecting issues, from policing to sex work, from mental health to the housing and climate crises. The fact that our heavy focus on mass incarceration has been spearheaded by a group of dedicated incarcerated journalists, one of whom won an award for his work, is a source of pride.

Filter has also stood out by centering tobacco harm reduction—concerning the world’s biggest source of drug-related deaths—and showing why it’s crucial to integrate it with wider public health and human rights causes. Back when we launched, it was highly unusual for “drug” harm reduction organizations to do this, though thanks in part to our advocacy that is now changing.

Filter’s work has been read by many millions of people around the world. It has been picked up and cited by major legacy media; republished and translated by international blogs; referenced in academic papers, court cases, books and more; and praised by many entities and individuals in this space. We’ve achieved this with a staff ranging from just three to five people over the years—but there are so many people we need to thank.

Our extraordinary writers—a diverse mix including professional journalists, advocates and activists, academics, health care practitioners and people whose expertise is based on their lived experience—have been the lifeblood of this publication. It has been an honor to work with hundreds of writers, of all backgrounds, whose passion and knowledge of the issues are such that one of my key roles as editor has been to get out of the way.

I’m also awestruck by the talent and dedication of Filter’s staff, who have produced outstanding work week after week, often in difficult circumstances, because of how much they care about our issues. That’s Deputy Editor Kastalia Medrano, who has helped lead the site since 2020; Senior Editor Helen Redmond, who was deeply involved in its conception; and our honorary team member, Tobacco Harm Reduction Fellow Kiran Sidhu. It has been a privilege to work with them, and the links on their names will give you some idea of how they’ve shaped this publication with their distinctive styles and beats. Others have filled staff roles with great distinction in the past—the likes of Sessi Kuwabara Blanchard, Alex Norcia and Alexander Lekhtman. I’m indebted to them all.

That equally goes for all of Filter’s funders—from large foundations and companies right through to the many individual readers who were kind enough to make regular or one-off donations. Some of them even responded to our recent financial difficulties by increasing their support. It’s humbling when anyone believes in your project enough to part with actual money. Without these generous contributors, Filter would never have existed, let alone grown into what it was.

Something similar could be said of our organizational allies, such as Knowledge-Action-Change, the Drug Policy Alliance, the Global Forum on Nicotine, the National Harm Reduction Coalition, the Law Enforcement Action Partnership and Marijuana Moment, which have collaborated with us or supported our work in various other ways.

All of us who’ve worked for Filter want to express our gratitude to the board of The Influence Foundation, our nonprofit entity—latterly Sheila Vakharia, Diane Goldstein, Morgan Godvin, Christine Rodriguez and Treasurer Phil Hur. We’ve been steered through periods of growth and choppy waters alike by their wisdom and expertise, which they’ve selflessly volunteered. I’ve personally been grateful year after year for their constructive guidance and support. Some of them wished to share a few words at this moment.

“I found Filter when I’d been out of prison barely a year, at a time when I still felt profoundly powerless,” Morgan said. “Filter treated the experiences that had so often been used to diminish people like me as expertise—it turned isolation into community and lived experience into public knowledge. The stories I wrote and read connected me with people all over the country and gave me friendships I still carry. My heart is heavy to lose Filter, but I will be proud of what we built here for the rest of my life.”

One of the board’s final tasks has been to arrange for Filter to stay online for some years after we end our operations, as a community resource. So if you’re here at some unknown point in the future, I hope you’ll dig through the archives and benefit from what you find.

Finally, a publication is nothing without its readers, and Filter’s have been exceptionally intelligent, engaged and committed. We have always appreciated your sharing and discussions, your feedback (of all kinds!) and your loyalty—which says some deeply encouraging things about the strength of support for harm reduction and human rights.

Filter’s journey is ending, but that doesn’t mean the journey wasn’t worth making. And when we look around us, we can only conclude that the ideas that drove it remain in inspiring hands.

“I helped build Filter because I believe people who use drugs deserve to be seen with dignity, not judged from a distance,” Diane said. “I never expected it would also become the place that helped me carry my brother’s memory. Watching it close feels like losing a piece of my own family—but everything it stood for, and everyone it reached, will outlast it.”

Thank you all for coming with us. 

The post A Statement About Filter appeared first on Filter.

It struck me that something similar might be said of civil rights and social justice movements. The drug policy reform conference that I had just left vibrated with debates about the extent to which advocates should work with, or within, systems that inflict harm—criminal justice, law enforcement, Capitol Hill—and the extent to which doing so risks complicity, and civil disobedience is required.

But delegates’ widespread inclusion of public health on that list of damaging systems means that “call the doctor” might not be their chosen emergency response.

The Movement’s Big Goals

The biennial Reform conference, organized by the Drug Policy Alliance (DPA)* and held this year in St. Louis from November 6-9, brought together over 1,200 activists and experts from over 40 countries. Grassroots activists, directly impacted people, hands-on harm reductionists, researchers and lobbyists mingled in the cavernous open spaces of the Union Station Hotel. Organizers offered an array of resources—from drug-checking to safe spaces to an on-call defense attorney—for delegates who use drugs, while noting the threat of applicable laws.

A sharps container in a hotel bathroom.

“The drug war touches just about everything; it has distorted so much,” said Maria McFarland Sanchez-Moreno, DPA’s executive director, in her speech at the opening plenary. She emphasized the common cause drug policy reformers should make with advocates for racial, reproductive, housing and other forms of social justice: “We need to figure out how to reach across movements, because we will build power together.”

“I bring you greetings on behalf of the thousands of African Americans who have been criminalized or incarcerated.”

The opening address had been delivered by Rev. Kenneth McKoy, a St. Louis pastor who founded the NightLIFE Ministry. Conceived as a violence prevention program, it evolved to cover access to housing and affordable treatment, and naloxone distribution—meaning he became a harm reductionist before he knew it. “I bring you greetings on behalf of the thousands of African Americans who have been criminalized or incarcerated because of their addiction,” he said. “On behalf of those children who go to bed crying because their parents are incarcerated.”

Rev. Kenneth McKoy addresses the crowd.

The stakes had also been emphasized by a video message from Rep. Alexandria Ocasio-Cortez (D-NY), calling for changes like decriminalization and “moving money out of the DEA and into overdose treatment programs”—and by an invitation for gathered delegates to call out the names of people they had lost. It took several minutes.

McFarland outlined her organization’s three “big goals.” The first is to “truly expose the array of the harms of the drug war, in all their scale” and “working to document this; working to change those systems.” As well as drug-involved deaths, arrests and mass incarceration, she cited repealing federal bans on college aid for students with drug convictions; ending cannabis testing as a barrier to employment; and exposing harms beyond US borders.

McFarland, whom Filter profiled last year, has a background in international human rights advocacy and scholarship. She spoke of torture and other abuses, of Central American migrants fleeing due to the long reach and consequences of the US drug war, of “children torn from parents’ arms” at the US border: ”Those of us in the US need to recognize that we have a key role here.”

The second goal, said McFarland, is “to ramp up our attention and focus on some of the toughest places in this country.” Mentioning areas of the South and Midwest where reforms are “hardest to implement” but desperately needed, she cited “the devastating rise of overdose which disproportionately affects Black people in Missouri.” She also celebrated “a massive victory in Florida this year, when we got the Republican-controlled state legislature to unanimously support a bill approving needle exchange statewide.”

The third goal, she said, is “to start building out the alternative systems that we want to create—approaches grounded in people’s health, dignity and well-being.” As well as finding the best way to continue legalizing cannabis, she mentioned “finally establishing safe consumption sites in the US” and “finally decriminalizing possession of all drugs for personal use. Possession is the Number One arrested offense in this country—that’s outrageous—almost 1.5 million arrests every year, just for using drugs.”

“How do we respond to people involved in the drug trade? What do we do about safe supply? And what do we do about regulation of all drugs?”

With cannabis now legal in 11 states and rapid progress on naloxone and syringe access and Good Samaritan laws, McFarland could point to “tremendous successes” in the face of these mass violations. “This is no longer a third rail issue,” she declared. “Members of Congress are now engaging in ways that they never had before. Internationally, the conversation has also broken open.”

She focused on the word “compassion” in DPA’s vision statement. This drives, she said, efforts to ensure “meaningful access to treatment” for people with substance use issues, “including access to MAT [medication-assisted treatment] in prisons and jails, and heroin-assisted treatment.” It informs the right to realistic, science-based drug education, like DPA’s recently-launched Safety First high school program. And it means that for new industries created by this movement, “We need to pay attention to how they’re structured, to who benefits from them, and how they’re undoing the harms of prohibition.”

The task ahead, McFarland said, includes “pressing forward and figuring out the answers to the really tough questions: How do we respond to people involved in the drug trade? What do we do about safe supply? And what do we do about regulation of all drugs?”

“The more you look at the drug war, the more it appears like an outsourcing scam.”

A fiery speech followed from Alejandro Madrazo Lajous, a professor at the CIDE law school in Mexico who founded its drug policy program. “In the name of the War on Drugs, we have systematically been curtailing our fundamental human rights,” he said. Detailing atrocities in Mexico, including horrific murders of children and mothers in the past week, he noted that what’s happening there is indivisible from events in the US—with policies interacting and guns going south across the border as readily as drugs go north. “They are Mexico’s dead, and they are the US’s dead.”

Yet the drug war’s impact is fundamentally unequal, he observed. “That trail of blood and suffering disappears when it hits El Paso; it reappears in Ferguson and Black communities across the United States. The more you look at it, the more it appears like an outsourcing scam.”

“We are now in a moment where we cannot keep moving forward without … the people who are being left behind,” he concluded. “We have to make sure that Black men, who were arrested for possession, are not now going to be arrested for jaywalking or walking while Black … No longer can we rely on denial to allow us to sleep well while people are still being imprisoned and still dying of overdose. Push harder and broader: Look at all drugs, look at all countries, look at all the implications of this devastating drug war that is destroying lives, communities and countries’ commitments to human rights … Let’s legalize it, and legalize it right!”

Front Lines in St. Louis

The drug war is so ubiquitous that any Reform location would highlight local suffering and injustice, and different ways in which people are fighting against them. Yet St. Louis notably stands on several front lines.

One is police brutality. In August 2014, the killing of Michael Brown in neighboring Ferguson sparked protests on the streets and national outcry over police shootings of people of color.

Another is cannabis laws. Missouri, a deep-red state, overwhelmingly approved medical marijuana by popular ballot in 2018, and a 2020 push for adult-use legalization is anticipated.

Yet another is harm reduction. Drug-involved deaths, which may be falling nationally, are climbing in Missouri, and, as Mcfarland noted, “the rate of overdose for Black people is extraordinarily high⁠—it stands out in that respect.” Harm reduction here is severely curtailed, however, with syringes still criminalized and funding scarce.

Inez Bordeaux of Arch City Defenders is an organizer for the “Close the Workhouse” campaign aimed at St. Louis’s medium-security prison. She knows of its conditions first-hand. Bordeaux told a panel audience of “a seven-year journey where I was chewed up inside the criminal justice system.”

“I have been personally impacted by these oppressive systems, by white supremacy … by how traumatic locking people up in a hellhole of a facility is.”

“It began,” she said, “when my ex-husband picked up a hot skillet from the stove and burned me with it … I left, and I took my four children with me.”

With severe financial struggles, “after I lost my second job, I kept on drawing my unemployment benefits. My choices were to do that, to break the law so I could look after my children, or go back to the man who burned me with a hot skillet.”

Then one day, Bordeaux was pulled over in Oklahoma: “You guys know that feeling when it takes the officer a little too long to come back?” They turned up a felony warrant against her for larceny, relating to her claiming the benefits. Bordeaux was arrested and held, then extradited back to St. Louis. Facing prosecution and unable to retain employment, she spent the next three years living homeless and had to send her children away.

Yet she held onto hope. “I knew that I just had to make it through my five years of probation; if I could do that, everything would work out … and that’s the attitude I had until, in March 2018, I was arrested again on a technical violation and sent to the Workhouse.”

“It wasn’t until I went to the Workhouse that I felt hopeless,” she said. “I did 30 days there, the longest, most traumatic 30 days of my life—those 30 days radicalized me.”

Bordeaux said that the public defender who was assigned to her then “saved me.” He fought for her on the basis that the statute under which she had originally been prosecuted was ruled unconstitutional by the Missouri Supreme Court in 2017. Her sentence was vacated.

But rather than celebrate as planned, Bordeaux went home and wept. This despair soon turned to anger. “My life fundamentally had not changed. I have been personally impacted by these oppressive systems, by white supremacy … by how traumatic locking people up in a hellhole of a facility is.”

The unconstitutional statute she was convicted under “affected 12,000 people in St. Louis,” she pointed out. “I was one of 800 people that was able to get my sentence vacated—it was not made retroactive. How many others are in jail or prison, or on probation because of a technical violation?”

“I would love to say that I do this work from a happy, healthy and wholesome place,” she admitted. “But it doesn’t; it comes from a petty, vengeful place! I do this work because I want to make the state rue the day they ever saw my name. I told you guys my story because I want you to be angry too … and I want you to come and fight.”

Her fellow panelist is superficially on the other side of the fence. Wesley Bell is the prosecuting attorney for St. Louis County. But he described his journey in terms that left no doubt of his commitment to reform.

He became a public defender out of law school, and “never even entertained the idea of going anywhere else, because I wanted to make sure people [in my community] got fair representation.” He also taught college in Ferguson a few years before the killing of Michael Brown.

“It didn’t take me long to figure out that real impact came from the other [prosecutor] side,” he said. “When you can make the policies … that’s the kind of impact I wanted to make.” In the aftermath of Ferguson, he considered, “I think there’s a call of duty here; with my expertise I should throw my hat in the ring.” 

He worked with the Obama administration on the Ferguson Consent Decree, before deciding to run for county prosecutor “with the mindset of, we’re going to be collaborative to get these reforms.” When he took office in January 2019, he became the first African American to hold the position.

St. Louis panelists Stephanie Regagnon, T-Dubb-O, Wesley Bell, Inez Bordeaux and Chad Sabora.

T-Dubb-O is a hip hop artist who has worked with Wiz Khalifa and an activist with Hands Up United, a Ferguson-based social justice organization. He described a St. Louis childhood filled with threats. “I was four years old when one of the neighborhood drug dealers approached me and asked me if I would work for him.” 

At 14, “I had my first physical encounter with law enforcement. There was an ordinance back then that if you had more than four people standing on your porch, you could get a citation.”

One officer, who “used to harass us all day,” came and “screamed” at members of his family for standing on their porch. When his grandmother objected, the officer said, as T-Dubb-O related, “I’m not going to talk with you, you old bitch.” 

“I said, who the fuck are you talking to? This is my grandmother, she’s 80 years old; have some respect.” For that, T-Dubb-O recounted how he was handcuffed, taken to the precinct and beaten. “From that moment, I knew that my life was in danger every time I came into contact with a police officer.”

Kicked out of school for having too much “influence” over other students and excluded from jobs, he sold drugs on-and-off for 14 years. “It got to the point where I was only selling to white people because I didn’t want to sell to people who looked like me,” he said. “My best customer was a children’s hospital surgeon!”

“But I don’t regret it,” he said, because everything I did put me in a position where I could have a conversation with President Obama and go into crack houses and negotiate ceasefires with gang members.”

“A lot of people say the system is broken. The system isn’t broken; it’s performing exactly how it was designed.”

Ferguson was a personal catalyst for T-Dubb-O’s advocacy, which includes providing tech training opportunities for disadvantaged youth. But when he first heard about Brown’s killing, he loaded his car with legal guns and drove over there, only to be dissuaded by a friend.

“I can no longer rap about these conditions,” he decided, “without making sure that I am applying myself 100 percent to changing these conditions. I think Ferguson showed that we can do this work.”

“It clicked in my mind that we’re not going to get any change from the system,” he added. “A lot of people say the system is broken. The system isn’t broken; it’s performing exactly how it was designed.”

This last comment prompted debate among the panelists. Prosecutor Wesley Bell said: “I agree that the system isn’t broken; it’s performing as it was designed. The problem is that this is the system that we have, and if you tear it down, you still have the same builders. Let’s do what we can [right now]. There’s someone sitting in jail who shouldn’t be⁠—so we gotta figure something out. If incarceration worked, we’d be the safest place in the world.”

Inez Bordeaux responded, tearfully: “Do you know why they said [the ruling on the statute she was convicted under] was not retroactive? Because it’s too hard to go back and track down all of those people—it’s too hard! How do you reform a system like that? Think about that: When the highest court in this raggedy state said it was ‘too hard’ to fix an injustice.”

“And I’m a fan of Wesley—I’m a big fan,” she continued. But “I’m a big proponent of burning it all down and starting over… The roots are rotted.”

T-Dubb-O identified white supremacy as “the root cause of all of this,” but added: “I’m a chess player. Passions will get you murdered on the chess board. If everybody in the city was ready to burn this down, I’d be the motherfucker holding the blow torch…”

He urged activists to think strategically and work as one. “The fight for Black lives has to come side by side with the LGBTQ community, with criminal justice reform, drug reform, environmental reform …. You got five fingers poking a wall individually. They have to do this.” 

He clenched his fist.

Safe Consumption Sites: Liberation or Control?

An analogous debate arose at another passionate session, where leading harm reductionists⁠—most of whom actively advocate for, or even operate, safe consumption spaces (SCS)—aired concerns about the limitations and appropriations of this model with unusual frankness.

SCS are shown by much evidence to save lives and improve health outcomes. They’re still illegal in the United States, but the first sanctioned site is closer than ever after a federal judge recently ruled that Safehouse, a group in Philadelphia, would not violate the so-called “crack house statute” by opening one.

Responding to a question about what “liberation” for people who use drugs really means, Monique Tula, executive director of the Harm Reduction Coalition, said, “Liberation, to me, is purpose and place and power. I [know people] who are like: Safe consumption spaces? Meh. I don’t want to be supervised in my drug use … For me, that’s why I haven’t jumped on the bandwagon … I think it can work in certain settings. But real talk? Let’s talk about giving people homes.”

“I’m cautious in my support,” she summarized. “I would rather focus our attention on making sure that people are housed …. Keep government in its fuckin’ place—give us the power.”

Zoe Dodd of Toronto Overdose Prevention Society has helped organize a drug user-led space without waiting for government approval, amid high death-rates. (Five people she knew, she said, died within a single week). She reported concerns about some of Canada’s sanctioned SCS. “It didn’t feel like ‘liberation’ for people sitting in a clinical setting with nurses. They feel like sites of surveillance. They feel like they’re adopting a drug war narrative that drugs are bad and you need to be supervised and watched.”

“We wanted to create something that wasn’t all those rules,“ she explained. “I’ve got nothing against nurses, they’re great for wound-care [etc.]. But people who inject drugs have seen other people inject drugs, and people responding to overdoses in the community know how to respond to overdoses.” 

“One [advocacy] tactic I’ve seen that I think, ‘Pease stop doing that,’ is that SCS is a step towards treatment, and will move people to treatment,” she continued. “What the fuck is treatment? It is a profit-driven, non-evidence-based intervention … a bullshit extension of the prison-industrial complex.”

“We are messing up as a movement because we are letting the public health community dictate.”

SCS are “a limited intervention that’s more about public order than it ever was about autonomy or liberation,” said Kassandra Frederique, DPA’s managing director of policy, advocacy and campaigns. “It also shows the limits of our imagination as a movement.”

“Safer consumption spaces is not an alternative, it is an intervention,” she continued. “An alternative would be housing, or a café where people can go in and order what they want. So if it’s not an alternative, it’s not liberation—I can’t understand why we would ever give something regarding drug user health to the medical community. We are messing up as a movement because we are letting the public health community dictate.”

Frederique noted that progress on SCS initiatives is often facilitated by concerns over drug use in public spaces, rather than a desire for people who use drugs to have autonomy. “They don’t want poor people in public space.”

“I will continue to work on SCS because I think it is important,” Frederique made clear. But she also spoke to the importance of gaining community consent for these interventions—and of recognizing the many critical community needs that SCS don’t meet. For example, in New York, “125th and Lexington is a place with a lot of outside drug use, and they want to put an SCS there. They don’t even have a fuckin’ supermarket⁠.”

“Don’t be just dumping programs into Black and Brown communities that are not prepared or may not want them there,” agreed Tula.

“There are lots of people that don’t have space,” noted Miss Ian Callaghan, executive director of the San Francisco Drug Users’ Union. “But I think the drug war in general has touched so many intersections of our lives, that it is hard also [just to give someone a room to inject in and then kick them out].”

“A lot of people have a lot of trauma in settings that look clinical. A lot of harm reduction organizations, we take a health approach first, and then we let people draw pictures with crayons and we put them on the wall: Look, it’s your space! We don’t do enough of asking people what they want.”

Metzineres, a harm reduction organization in Barcelona, Spain, sought to avoid that failing. Aura Roig, its director, described how they went about setting up a consumption room for women, “because they were living really isolated, because they were not going to the [male-dominated] shelters because they didn’t feel safe.”

The group asked the women, “Not ‘what do you need?’ but ‘what do you desire?” And “What we tried to do is just say ‘yes’ to everything. We have workshops, we have photography, we have dance, we have free clothes. We try not to put drugs at the center, and just welcome everybody with our heart.”

“We all know SCS is not the solution … I’m also super-clear that these programs will save lives.”

“We all know [SCS] is not the solution, but it is a part, a tool,” said Laura Thomas, director of harm reduction policy for San Francisco AIDS Foundation. “I’m also super-clear that these programs will save lives and they’re worth doing.”

In terms of winning the battles to introduce them, she said, “While no [jurisdiction] wants to be first, everyone wants to be second, third, fourth, fifth. The Safehouse case won these arguments that had never been tested in court before⁠.”

The panelists made many more criticisms of the public health establishment. 

“They want to watch you inject your drugs because they don’t trust you to have autonomy,” said Dodd. “If you’re making partnerships with public health, you’re probably going to fuck it up.”

“We cannot build liberation,” said Frederique, “… in institutions that have not disabused themselves of the commitment to coercion.”

“I struggle with that co-option stuff too,” said Thomas. She mentioned how, in San Francisco, “some of the people who support SCS also support coerced treatment. It’s about trying to figure out how SCS can be part of the liberation narrative, as opposed to part of the control narrative.”

“Once we have [SCS], that opens up these opportunities for us to make them what we need them to be … getting some open is going to be a better step. Different things work for different people; we need to have different sites in different contexts. We need all of these things—and we’re not going to get them until we get the first one open.”

Vaping: “The Great New Drug War of the 21st Century”

Another area where harm reduction and the public health establishment clash is tobacco harm reduction. This has been seen in the public outcry over youth vaping, fueled by misleading messages from the FDA and the CDC and the media frenzy of a classic drug panic.

Almost half a million lives are lost to smoking annually in the US, but the US harm reduction and drug policy reform community has not always centered this issue. Reasons may include perceptions of “turf” and dislike of the industries that make vapes.

It was significant, then, that Reform featured a panel titled: “Are Tobacco and Vaping the Next Frontier of Drug Prohibition?” Among the speakers was Ethan Nadelmann, who founded DPA and led it for over 20 years, until 2017.

Nadelmann joked that this was the issue “that might just tempt me out of retirement,”  and acknowledged to the audience, “I know not all of you are persuaded.”

“Cigarettes are truly deadly,” he set out, “so whatever we can do—short of prohibition and demonizing people in a terrible way—if we can be moving people to a less harmful product, that’s what we should be doing.”

He cited the evidence that vaping is around 95 percent less harmful than smoking—and almost twice as effective at aiding quitting as nicotine patches or gum. And he noted that nicotine, by itself, is not very risky.

“The evidence is clear, overwhelming,” he concluded, that tobacco harm reduction should be a priority. Vapes “may be the best cigarette cessation device ever invented.”

“You’re talking about a massive, massive misinformation campaign … It’s basically public health malpractice.”

Both the efficacy of vaping and its stigmatization, he noted, invite parallels with syringe access, methadone and buprenorphine. “But what does the public believe? Seven years ago, the majority of Americans understood that vaping is safer than smoking. Now, between 60-70 percent believe it’s as or more dangerous.”

The researchers whose work is being ignored or misrepresented by anti-vaping politicians or public health authorities remind him, he said, “of the harm reduction academics out there 30 years ago, doing courageous work and incredibly frustrated at being sold out by the majority of the public health community.”

Noting that the vast majority of recent cases of lung disease were caused by vaping of adulterated THC, not nicotine products, Nadelmann said of the failure to communicate this properly, and the general framing of tobacco harm reduction: “You’re talking about a massive, massive misinformation campaign going on right now … It’s basically public health malpractice.”

“And what do you think happens when you start to ban things?” he asked of the recent spate of threatened and actual flavored vape bans. “Driving more people to the black market and killing more people? How ass-backward can that possibly be?”

“It’s reminding me of the same bullshit they put out there about ‘crack babies’ 30 years ago,” Nadelmann concluded. “My fear is, that not only are we taking a major step backwards [in cutting rates of smoking], but we may be at the beginnings of the great new drug war of the 21st century.”

The audience applause suggested little dissent.

Other panelists illustrated further repressive aspects of the new wave of tobacco and nicotine restrictions. Queen Adesuyi, a policy manager for DPA, discussed the impact of the US Department of Housing and Urban Development’s ban on smoking in public housing, impacting “people with various disabilities, people who are wheelchair-bound, and people who just want to smoke a cigarette in their apartment” but are forced to go outside or potentially face eviction.

“I do believe that folks are doing this around good intentions regarding children, second-hand smoke and health,” said Adesuyi, “but there’s no acknowledgement of how this plays out on the ground.”

“Have we not learned in this country that prohibition doesn’t work?”

Brooke Feldman, manager of the Philadelphia Center for CleanSlate Outpatient Addiction Medicine, described the “paternalistic, marginalizing” ban on smoking in publicly funded treatment facilities in Philly, which increases barriers to care and may result in people being kicked out to face fentanyl-adulterated heroin on the streets. “And it only affects the poorest Philadelphians, people on Medicaid.”

Filter Senior Editor Helen Redmond asked, of bans of flavored vapes and menthol cigarettes, “Have we not learned in this country that prohibition doesn’t work? Where will the NYPD go to enforce the ban? They’re going to go to communities of color—they will not implement it in a race- or class-neutral way. That’s not the way the drug war works.”

Fear and Moral Hazards for Researchers

The distortion, limiting and co-option of drug research were explored in depth at several panels organized by DPA’s Department of Research and Academic Engagement.

Researchers spoke of a climate of fear in their work. This is in part due to the fact that the National Institute on Drug Abuse (NIDA) funds about 80 percent of all drug research around the world, meaning that research into the pleasures of benefits of drugs is often taboo, and harm reduction sidelined.

Author and addiction expert Maia Szalavitz suggested that researchers omit the words “harm reduction” from their proposals, even if that’s what they’re seeking to study.

This climate extends to researchers who use drugs themselves. Ingrid Walker, associate professor of American Studies in the School of Interdisciplinary Arts and Sciences at the University of Washington, Tacoma, has been open about her own drug use. She and others convened a pre-conference gathering of 60 researchers to discuss these issues.

“The majority were young in career, working in community-based research and public health,” Walker told Filter. “And the fear they expressed in terms of wanting to be authentic about their own drug use with people they work with, but knowing the consequences … They knew that job loss would be immediate and felt that pressure.”

It’s a fear shared by so many people in many lines of work.

One panel of academics set out to dismantle the notion of “moral hazard” that has gained such media currency in regard to harm reduction interventions on the back of a couple of recent papers.

“Moral hazard is a term that’s been around in economics for decades,” explained Alex Kral, an epidemiologist and distinguished fellow at RTI International. “It’s the idea that something might have the unintended effect of making things worse than better. For example, driving fast is dangerous, so you invent seatbelts. But if you’re wearing a seatbelt, you might actually drive faster, causing more accidents.”

“There’s no evidence to suggest that people use more drugs or use in riskier ways if they get naloxone or overdose training.”

Translated to naloxone, said Rachel Winograd, an associate research professor at the University of Missouri’s mental health institute, this concept brings “the idea that if we give out more and more naloxone, we’ll have this safety net in society, so people will have no reason not to use heroin or fentanyl.”

However, she asserted, “There’s no evidence to suggest that people use more drugs or use in riskier ways if they get naloxone or overdose training. If anything, they use the same or less,” but are better equipped with knowledge and resources.

Winograd and other panelists critiqued both the flawed methodology of the papers that suggested this idea, and the media’s enthusiasm for them. “Drugs and morals? This is just great!” quipped Kral, who identified moral hazard arguments as another iteration of the old “enabling” trope against harm reduction.

“You really have to dig down … to get at what’s motivating that,” agreed Winograd. “There’s this resentment: ‘Wait a second, all we have against drug use is the potential for death, and if we remove that… then what leverage do we have? People are going to go crazy, using drugs all over the place!’”

That attitude remains entrenched, as researchers’ off-the-record accounts (that fear again) of some high-ranking SAMHSA officials’ positions attested.

Echoing equivalent conference discussions, researchers questioned whether working within a biased, coercive public health framework is justifiable.

“We haven’t really made any gains in drug policy without civil disobedience.”

“The healthcare system—and I can say this because I’m a doctor—it treats people who use drugs like shit,” said Hansel Tookes, an assistant professor at the University of Miami.

Winograd described asking herself every morning if she could continue. But if she quits, “I will be replaced, and who is going to replace me? And that system will go on.”

The researchers present engage in harm reduction advocacy to push back against the routine distortion of their work. But, said Tookes, “I want you to know that’s not the norm in academia!”

“We haven’t really made any gains in drug policy without civil disobedience,” said Kral.

Like others at the conference, Szalavitz asserted that both forms of advocacy—inside and outside the system—are vital. “One of the reasons ACT UP was so successful [in winning reforms to mitigate the AIDS crisis] was they didn’t limit themselves to just outside or just inside,” she said. “They had people out on the streets and they had people in there, talking to people—and that’s what’s going to change things.”

Where the Movement Stands

Fully representing the intersecting issues explored at Reform 2019 would require not an article, but several books. Vital subjects explored at dozens of panels and meetings ranged from the persecution of sex workers under SESTA/FOSTA, to the role of faith in harm reduction, to activating people who sell drugs as a harm reduction resource, to the healing power of psychedelics, to models for legalizing all drugs.

Despite this dizzying diversity, DPA Executive Director Maria McFarland Sanchez-Moreno told Filter that the movement remains coherent—and in fact, more united than ever.

“I feel like people are very open to each other right now,” she said, of the many social justice movements represented at Reform. “A couple of years ago, maybe there was a little more friction. Right now, there’s just a lot of solidarity. I’m thrilled about that.”

Some in the movement have worried about the internal strength of DPA, arguably the most important organization in drug policy reform. Earlier this year, DPA cut a significant percentage of its staff and closed some state-level offices. McFarland has previously explained this as the result of a surge in donations, related to early cannabis legalization efforts, somewhat drying up as more states achieved legalization. She told the New Jersey Globe that by taking these painful steps, her organization sought to become “more flexible” and capable of pursuing campaigns in more states.

Asked whether we could be confident of her organization’s future growth, McFarland replied, “Absolutely.”

“DPA has had to go through a very difficult process of restructuring, and it was incredibly painful for all of us,” she elaborated. “And yet, my colleagues have really dug in and come out of it in many ways stronger, with renewed commitment to the work.”

“You’re seeing people in a movement that’s maturing. That’s exciting to me. Now we’re building from here.”

“I think you’re seeing the outcome of all of that in this conference,” she continued. “The sense of unity here flows from the sense of unity within the organization itself. You’re seeing people in a movement that’s maturing. That’s exciting to me. Now we’re building, from here, something that I think is going to be amazing.”

When I asked whether part of the movement’s “maturity” involved effectively balancing pursuit of the deep structural changes that advocates want, and winning the immediate incremental reforms that can help people right now—a tension reflected over and over again at Reform—McFarland agreed. “It’s something we continually debate internally,” she said, asserting the value of pursuing step-by-step improvements to people’s lives, while also “never losing sight” of the ultimate goals.

And in large or small steps, at every jurisdictional level and despite the Trump administration and other daunting headwinds, the progress does keep coming.

“I have great news!” Chad Sabora, executive director of the Missouri Network for Opiate Reform and Recovery, announced to one audience: “43 minutes ago, St. Louis city stepped up to the plate–we just [submitted] our bill to make syringe access legal as a pilot program.” 

* The Drug Policy Alliance has provided a restricted grant to The Influence Foundation, which operates Filter, to support the creation of a drug war journalism diversity fellowship.

Top photo shows some delegates in St. Louis gathering to show solidarity with people being persecuted and killed in the Philippines’ drug war. All photos by Filter.

The post The Drug Policy Reform Movement Debates Its Next Moves appeared first on Filter.

Health and Human Services Secretary Alex Azar confirmed that the FDA is finalizing plans to “clear” all vape flavors except tobacco flavor. The process of implementing this would be expected to take several months.

I just announced with @POTUS and @FDACommissioner that we will be finalizing policies that will clear flavored e-cigarettes from the market. New provisional data show that youth use continues to rise rapidly, and we will not stand idly by.

— Secretary Alex Azar (@SecAzar) September 11, 2019

The move will be viewed as enormously damaging by people who vape—many of whom relied on flavors in order to quit smoking—as well as scientists and tobacco harm reduction advocates.

According to the FDA’s statement:

Today, the Trump Administration announced that as part of its ongoing work to tackle the epidemic of youth e-cigarette use, the FDA intends to finalize a compliance policy in the coming weeks that would prioritize the agency’s enforcement of the premarket authorization requirements for non-tobacco-flavored e-cigarettes, including mint and menthol, clearing the market of unauthorized, non-tobacco-flavored e-cigarette products.

Despite the reference to “premarket authorization requirements,” observers believe that the operative part is the intent to clear the market of flavors, with no guarantee of their return. “It appears that they wish to ban all flavours,” David Sweanor, an industry expert and chair of the Advisory Board for Centre for Health Law, Policy and Ethics at the University of Ottawa, told Filter. “There are millions of vapers now in the US, and most prefer non-tobacco flavors. So they will be deprived of their preferred product while they are also misinformed about risks, and the Centers for Disease Control is giving a ‘just say no’ message on vaping.”

When Michigan became, on September 4, the first state to ban flavors, Dr. Michael Siegel, a professor at Boston University School of Public Health, told Filter that it was “a potential public health disaster.” Dr. David Abrams, a professor at the New York University College of Global Public Health, said: “It is terrible to restrict a less harmful product that smokers need to help them quit, while leaving harmful cigarettes in every other store. This policy damages [vapers] and makes them want to get their products from illicit sources, or they’ll be forced back to smoking cigarettes.”

A nationwide flavor ban would have an exponentially larger impact, with 12 million Americans estimated to vape. Research has indicated that vaping is about 95 percent less harmful than smoking, and that vapes are about twice as helpful in quitting smoking as nicotine patches or gum. Over 34 million Americans currently smoke, and they suffer almost half a million smoking-related deaths each year.

As Helen Redmond wrote for Filter on September 9, opponents of tobacco harm reduction have recently been emboldened by a knee-jerk, misinformed panic about reports of vaping-associated lung disease and death. A cash injection of $160 million from Bloomberg Philanthropies to fight youth vaping, in part to support a partnership with the anti-harm reduction Campaign for Tobacco-Free Kids, was also announced this week.

But the “think of the children” argument so beloved of drug prohibitionists and repeated by Trump has been integral to the “public health” campaign against vaping for years. Claims that an “epidemic” of vaping exists among non-smoking American youth have been dismantled by experts such as Clive Bates, former director of Action on Smoking and Health (UK).

This couldn’t be a more stupid response to youth vaping or lung disease. It will means a black market in flavoured products – and that opens the way to adulterated, contaminated and dangerous liquids. For many of the 12m US vapers it will be black market or return to smoking. https://t.co/uT5vh52qzY

— Clive Bates (@Clive_Bates) September 11, 2019

Smokers, who disproportionately belong to marginalized groups including people with low incomes, people with mental health diagnoses, LGBTQ people and people of color, will bear the consequences in terms of reduced quitting options if a nationwide flavor ban is implemented. People who have successfully switched to vaping will also be at risk of switching back if they lose their favored flavors.

“The entirely foreseeable consequence is vapers returning to cigarettes, cigarette smokers being dissuaded from switching to a massively lower-risk alternative, and the perpetuation of the health catastrophe of cigarette smoking,” said Sweanor. “Had the same approach been taken on auto safety, people would still be driving cars that Nader long ago pointed out were ‘unsafe at any speed.’”

“I have argued that a flavored e-cigarette ban would drive masses of ex-smokers from vaping back to smoking,” wrote Dr. Siegel on September 12. “This prediction now seems to be confirmed by a number of tobacco financial analysts, who are alerting investors that such a ban would substantially boost the sale of cigarettes.”

“Without the flavors I couldn’t have quit cigarettes,” Michigan resident and vape shop owner Nasser Saleh recently told Filter. “The vape juice without it has a really weird aftertaste. But when you find a flavor you really like, the cigarettes will taste more and more disgusting in comparison. So many of my customers have told me the same.”

“I have received dozens of phone calls [from vapers] who are concerned about their health and lives,” Spike Babian, a tobacco harm reduction advocate and New York vape shop owner, told Filter regarding government scaremongering. “Even those who are educated about the lies we have been told by our government in the past are starting to worry. Many of them expressed intent to quit vaping and return to smoking. It is a tragedy that former smokers who smoked for decades and finally quit will return to smoking tobacco because their government told them that vaping will kill them.”

Opposition to vaping, shared by such bodies as the World Health Organization, centers on opposition to harm reduction itself—the blinkered, patronizing insistence that abstinence from a drug, however much reality might show abstinence not to happen in many cases, is the only acceptable way to keep people safer.

Filter contributor Michael McGrady wrote in March, as a thought experiment, about what would happen if the US instituted a total ban on vaping. Developments are rapidly making the scenario seem less and less far-fetched.

Photo via Wikimedia Commons

The post Trump Announces Disastrous Plan to Ban Flavored Vapes Across the US appeared first on Filter.

Delegates at the Global Forum on Nicotine (GFN) in Warsaw from June 13-15 were left in no doubt of the scale of challenges facing tobacco harm reduction (THR). Despite the potential of safer nicotine delivery to save more human lives than any other harm reduction initiative, the hostility, lies and bad policies⁠—from punitive taxation to severe restrictions to outright bans⁠—being aimed at THR are daunting.

“The death of truth is very real,” said Sweanor, who is chair of the advisory board of the University of Ottowa’s Centre for Health Law, Policy and Ethics. “Not just in the US—but the US has certainly taken a huge lead.”

“In Australia, we have appalling laws about nicotine delivery,” said politician Fiona Patten, leader of the country’s Reason party. “Our reduction in smoking is pretty much stagnating. When I ask the minister of health about vaping regulation, I get told that vapes are ‘a gateway for children’, that they ‘renormalize smoking.’”

As harm reductionists have long known, much opposition is fundamentally due to narrow-minded tenets about what is and isn’t acceptable for other people to do. “We know that it’s not arguments about facts and evidence,” said Professor Gerry Stimson, director of GFN host organization Knowledge Action Change* and a veteran of harm reduction responses to HIV/AIDS. “It runs much deeper than that.”

“For the first time in 120 years, we could eliminate the death and disease caused by the cigarette rolling machine.”

GFN was a diverse gathering of 600 delegates⁠—directly impacted people, advocates and activists, scientists, clinicians and social workers, and industry representatives, who also attended an accompanying tech convention⁠—from 70 countries on every continent except Antarctica. Scores of international journalists also attended the annual event—the biggest yet, which speaks to the movement’s forward momentum.

While climbing a mountain, as Sweanor pointed out, the peak may seem miles away, but you also have to turn around sometimes and look at how far you’ve come. The fact that millions of smokers have already switched to exponentially safer vaping or non-combusted forms of tobacco⁠—to vapes in the UK, for example, to snus in Scandinavia, or to heat-not-burn devices in Japan and South Korea—is to be celebrated.

“For the first time in 120 years,” Professor David Abrams of the NYU College of Global Public Health reminded us, “we could eliminate the death and disease caused by the cigarette rolling machine⁠—and I believe we will.”

David Abrams speaks at GFN 

But with a billion people still smoking worldwide, the barriers to giving them safer choices remain pernicious and pervasive.

Almost everywhere you look, “Think of the children” is the politicians’ and public health establishment’s refrain, as Eveline Hondius of Dutch vaping consumer group Acvoda expressed. The well-worn phrase is familiar to those who have campaigned for cannabis legalization, for example.

“They have used the kids issue absolutely ruthlessly,” said Clive Bates, THR advocate and former director of Action on Smoking and Health (ASH). “Essentially where they’re heading is to treat harm reduction products exactly the same as combustible tobacco. And I hate to say that they’re doing quite well with that agenda.”

“This is a battle we’re losing, and losing badly,” said Dr. Saul Shiffman, a researcher and senior scientific advisor at Pinney Associates. “We’re being outplayed in the US.”

Joseph Magero from Kenya, who is chair of Africa’s Campaign for Safer Alternatives, described problems including ostracization from the public health and tobacco control community, lack of funding and lack of locally applicable research.

In Africa, he said, “The World Health Organization and the Campaign for Tobacco-Free Kids [two organizations that have significantly opposed THR] decide in matters of regulation.”

Joseph Magero receives an Outstanding Advocacy award in Warsaw (Photo via THR Nigeria)

These challenges are mirrored by those of advocates from Mexico to India who spoke at GFN—all as 7 million people continue to die annually from smoking-related causes.

Science Strikes Back

The THR cause is bolstered by the work of many scientists, a number of whom spoke in Warsaw.

“We have massive evidence now that giving nicotine to smokers can help them—over 130 randomized controlled trials,” said Professor Peter Hajek of the Wolfson Institute of Preventive Medicine’s Tobacco Dependence Research Unit at Queen Mary University of London. His own work showed this year that vaping is nearly twice as effective as traditional nicotine replacement therapy, like patches or gum, in helping smokers quit.

“We have a lot of literature on snus, and by-and-large snus has been shown to be not very harmful,” added Professor Neal Benowitz of the departments of Medicine, Biopharmaceutical Sciences, Psychiatry, and Clinical Pharmacy at UCSF, while also cautioning of the need for more research into long-term outcomes of inhaled nicotine products.

At the same time, “Junk science is escalating,” said Professor Riccardo Polosa of the University of Catania, Italy, who also runs the Center of Excellence for the Acceleration of Harm Reduction. He decried widespread methodological flaws and lack of rigor in studies that are deployed against THR, declaring, “We can make tobacco harm reduction research credible again.”

Some heavyweight researchers lined up to debunk the “junk.” Dr. Konstantinos Farsalinos⁠, a research fellow at the Onassis Cardiac Surgery Center in Greece among other institutions, analyzed how, in the media-fanned “epidemic” of US teen vaping, daily use among youth who have never smoked stands at the decidedly non-epidemic level of 0.5 percent.

Dr. Roberto Sussman, a researcher and lecturer in physics at the National University of Mexico who also runs the advocacy organization Pro-Vapeo Mexico, deconstructed alarmist claims about the particles produced by secondhand vapor—suggesting that if we must have a moral panic, it might be more rational to apply it to candles or vacuum cleaners.

Roberto Sussman in an interview (Photo via GFN)

The People, the People, the People

Yet for all the importance of the scientific evidence underpinning THR, advocate Samrat Chowdhery, who leads Association of Vapers India, noted that quite often, “research simply validates what consumers already know to be true.”

And as Prof. Abrams declared: “It’s about the people, the people, the people.”

GFN heard from many who conduct groundbreaking research or hands-on tobacco harm reduction delivery with the marginalized, low-income groups who smoke at far higher rates than the general population—the people who will be harmed the most if we fail to drive policy forward.

“This group isn’t hard to reach. We’re just not reaching out.”

“Tobacco harm reduction is a social justice issue,” declared Professor Kevin McGirr of the UCSF School of Nursing.

“Empower people to lead,” exhorted Rebecca Ruwhiu-Collins of her holistic THR work in her Māori community, which she said has been “decimated” by smoking harms.

“The most important group to do research in is pregnant women who smoke,” said Dr. Marewa Glover, whose work also centers on Indigenous populations.

Marewa Glover (photo via Addiction Research UAE)

“People take part,” said Dr. Sharon Cox of London South Bank University’s Centre for Addictive Behaviours Research, who is conducting research focused on THR for homeless populations. “This group isn’t hard to reach. We’re just not reaching out.”

“People with serious mental illness don’t live long enough to get cancer,” said Dr. Sarah Pratt, a clinical psychologist and an assistant professor of Psychiatry at Dartmouth University’s Geisel School of Medicine. “They die of [smoking-related] heart attack and stroke.”

She also reminded delegates: “It’s great to listen to so many smart people here, but what we all need to do more of is listen to consumers, listen to members of these vulnerable populations.”

A plenary session on vulnerable populations with Kevin McGirr, Sharon Cox, Sarah Pratt, Rebecca Ruwhiu-Collins and Deborah Robson. (Photo via Fiona Patten)

With the clock ticking on too many lives, there’s huge pressure on THR advocates to deliver. Clive Bates’s advocacy tips included: “Get organized” and build networks; “Don’t be too clever, but communicate your lived experience;” and “Be inclusive: You are not in competition with people on the same side as you … be advocates for the entire category of non-combustible products, rather than highlighting differences between them.”

“Money talks,” stressed Fiona Patten of Reason. “If you can talk about the health economics of new nicotine delivery systems … particularly for conservatives, it is those messages that can work.”

The need for THR to learn from the winning strategies of the wider harm reduction movement was another point made by many.

When it comes to politicians and officials who refuse to recognize THR’s massive potential to save lives, suggested David Sweanor: “Challenge them, ridicule them, get people to laugh at them is what’s necessary.”

GFN 2019 was a powerful display of the fast-growing scale, drive, talents and diversity of the tobacco harm reduction movement. With many enemies, the movement’s ability to effectively leverage all of these things is something that Filter will follow closely over the coming year.

*Knowledge Action Change has previously funded The Influence Foundation, which operates Filter, through a scholarship.

Top photograph via Global Forum on Nicotine

The post Global Forum on Nicotine Asserts Urgency of Tobacco Harm Reduction appeared first on Filter.

The Drugs Monitoring and Information System (DIMS) in the Netherlands can proudly claim to be the oldest drug checking service in the world. It began unauthorized operations back in 1989, a time when use of “club drugs” was increasing in the country, and was formalized in 1992.

By 1999, it was receiving funding from national and local governments. Today, DIMS is operated by the Trimbos Institute, a government-funded agency, and runs over 30 offices around the country, serving tens of thousands of people every year.

Its purpose is twofold: to protect the health of individual drug users by informing them about what they plan to take; and to compile information about Dutch illicit drug markets for wider protection of public health.

“This specific tablet became completely unsellable. It was off the market almost immediately.”

This is illustrated when DIMS issues “Red Alerts” to the nation about high-risk drug supplies—something that’s now done, among other means, through an app which sends push-up messages to people’s phones.

Daan van der Gouwe, a drug researcher and sociologist at the Trimbos Institute, was closely involved in DIMS’ most recent “full-blown Red Alert” in December 2014. “We identified through our weekly system a pink tablet with a logo in the shape of Superman,” he told Filter at the International Harm Reduction conference in Porto, Portugal.

Sold as ecstasy, this pill contained no MDMA; instead, it contained PMMA—a drug with higher toxicity—in a “lethal” concentration. “We also had intelligence that there was a huge amount of these pills already on the market.“

DIMS sprang into action. “We went all-out to alert the public to this danger through the media,” van der Gouwe related. He himself appeared on national television, and many other media reported it. DIMS also conducted a large-scale social media campaign.

This effort was astonishingly successful. “This specific tablet became completely unsellable in the Netherlands,” said van der Gouwe. “It was off the market almost immediately.”

It was exactly the outcome that such national alerts—of which there have been 10 so far—were designed to produce.

Unfortunately, few other countries enjoy such protection. A “huge batch” of the Superman pills had already been produced, according to van der Gouwe, and so their manufacturers, no longer able to find Dutch buyers, looked for an alternative market. “In the UK, at least three people died after taking exactly the same tablet, just days after we warned for this specific pill.”

DIMS tests every kind of illicit drug, and shares its data—in aggregated form, so it’s not traceable to individuals—with the government. “Measuring is knowing,” said van der Gouwe. “It’s a win-win situation—for drug users because they gain knowledge about the substance they’re about to use, and for us researchers and prevention workers because it gives essential information.”

While the Netherlands has its share of risky drug use, the landscape differs significantly from the US, van der Gouwe explained. “Use of ‘designer’ [“synthetic”] drugs in our country is very limited.” In addition, “there is still very little or even no fentanyl in the Dutch heroin supply,” although, given what’s happening in the US and Canada, “we are very alert to it.”

Daan van der Gouwe

An Office-Based Model

DIMS differs from many other drug checking services in that it is entirely office-based. Until 2002 it operated at clubs and parties, but was then required by the government to switch over.

While van der Gouwe said DIMS regarded this as a step backwards at the time, he pointed out that there are many advantages to the way it now operates. “We now think office-based testing is better.”

Clearly, on-site checking services—such as those conducted at festivals and other events by organizations like the Zendo Project, The Loop and DanceSafe—are also essential and must be expanded. The International Harm Reduction Conference additionally heard from drug checking providers from Canada, Colombia, France and Ukraine, operating with different levels of political and law enforcement cooperation.

“We are lucky; we have a very luxurious position funded by the government.”

However, “a lot of [particularly on-site] services have to limit themselves, budget-wise, to simple reagent tests,” said van der Gouwe. DIMS offers a range of different forms of checking from its many locations, of which lab testing provides the most accurate and detailed information. If a pill contains nothing but MDMA, for example, but a dangerously high dose of it, lab testing will reveal that, whereas a reagent test would not. “We are lucky; we have a very luxurious position funded by the government.”

The environment of DIMS offices is another factor. Van der Gouwe said that being able to have detailed conversations with service users about drug safety is important. He noted that people who bring their drugs to DIMS offices, unlike those who check their drugs at parties, are unlikely to have already been drinking or using other drugs, which facilitates careful decision-making.

And although people typically have to wait a week to receive lab results, the fact that they’re not already at an event when they receive them means “they have time to buy something else; people at a club or party might not have that chance and some just take the drug anyway.”

Takeaways From the DIMS Experience

Van der Gouwe stressed several factors that are key to DIMS’ effectiveness. One is making certain that DIMS results can always be depended upon, and that Red Alerts are as specific and concise as possible. “We have to be seen as fully reliable.”

Another is building broad support for DIMS—including from law enforcement, so that people can bring in their drugs without fear of reprisals; from the communities where DIMS operates; from media; and from politicians at all levels.

This last aspect has been so successful in the Netherlands that van der Gouwe describes political support for DIMS as universal. “Recently, we were visited by our secretary of state, from the conservative Christian Union, and he was doing drug checking himself in our office. What more can I say?”

Asked what he would say to people or governments who think that drug checking services “encourage” drug use, van der Gouwe took a deep breath.

“Our 27 years of research and experience shows that there’s no sign of drug checking encouraging drug use at all. Most likely the opposite is true.” Van der Gouwe has been struck by just how many people are willing to throw away unsatisfactory drugs.

He also emphasized, “We never say, ‘This drug is safe, please take it.’ Even, for example, a lab-tested pill containing nothing but a standard dose of MDMA, he pointed out, might have very different outcomes for different individuals.

One of the many harms of prohibition is that illicit markets deny people information about the drugs they use. A great deal of evidence—of which DIMS’ experience forms an important part—shows that people who use drugs will protect their health if given the tools to do so.

Photo by Erwan Hesry on Unsplash

The post How the World’s Oldest Drug Checking Service Makes High-Risk Pills “Unsellable” appeared first on Filter.

But that’s a stretch. Rui Coimbra Morais, president of CASO, the local drug users’ union, emphasized that underserved, so-called “hard-to-reach” populations exist here, too. “We don’t want these people to be forgotten; no one should be left behind,” said the psychologist, who is open about his own drug use. “We feel that so many speeches are being made about inclusion; we want to bring some kind of reality … However, I am very grateful to live in Portugal in this model!”

Safe consumption sites (SCS) are a crucial way to help such populations, and Porto doesn’t have one. In the late afternoon of April 28, Rui Moreira, the city’s mayor, took the podium in the cavernous riverside museum venue of the Harm Reduction International Conference, a stern-looking figure in black-framed glasses in front of a sea of harm reductionists. Whispers from Portuguese activists suggested that he was opposed to a mooted SCS, and that his reception was uncertain.

He said that he would need to make a statement in Portuguese, due to the many Portuguese officials and politicians present. After doing so, he translated: “We will be supporting a mobile unit that will assist consumption in the city,” in partnership with the health department and NGOs. “Believe me, it’s not a very easy decision—I’m not more popular than I was five minutes ago!”

The rapturous reception belied this, and the news added to some from Lisbon—which this month implemented its own mobile SCS unit, and “will in the future, next month probably … have two fixed sites,” according to João Goulão, director-general of SICAD, Portugal’s service for intervention in addictive behaviors.

Photo by Nigel Brunsdon [NigelBrunsdon.com]

Challenges and Abuses

This 26th iteration of the conference is “one of the largest international gatherings of harm reductionists ever,” said Naomi Burke-Shyne, Harm Reduction International’s executive director. It involves over 1,200 activists from almost 90 countries, exploring myriad harm reduction issues through plenary sessions, panels, meetings, workshops and side events scheduled over four days.

In her opening speech and at a press conference, Burke-Shyne contrasted real international progress since the first conference in 1990—when a few hundred gathered to learn how HRI founder Pat O’Hare and others had turned a bathroom into Liverpool’s first needle exchange—with continuing frustrations and challenges.

“Many governments and decision-makers continue to sit on their hands,” she said. “Globally, support for harm reduction services has stagnated and is failing to adapt to overdose deaths, new trends in drug use and public health crises,” with lack of funding in low- and middle-income countries a particular problem. And “globally, 99 percent of people who inject drugs face limited or no harm reduction services.” She decried near-universal high spending on law enforcement, “instead of harm reduction policies that have been shown time and time again to save human lives and protect public health.”

Michelle Bachelet, the United Nations high commissioner for human rights, who served two four-year spells as president of Chile and ran the UN Entity for Gender Equality and the Empowerment of Women in-between, quantified this shortfall in national terms. Of 179 countries identified by the Lancet where injection drug use takes place, she noted, only 86 have syringe service programs, while the same number (a slightly different list) have MAT such as methadone.

Worldwide results have been grim. “Between 2000 and 2015, there was a 60 percent increase in drug-related deaths,” said Bachelet. There were 400,000 such deaths in 2015 alone.

“People do not lose their human rights because they use drugs.”

In addition, she said, “We are continuing and in some places increasing human rights violations” in the name of drug control, referencing, like Burke-Shyne, examples such as the Philippines and Bangladesh. “Criminalization of drug use deters people from accessing treatment and other health and social services. The number of people incarcerated worldwide is reportedly at an all-time high of 10 million”—of whom one in five is incarcerated for drug-related reasons, mostly just personal use. And “although prisons represent high-risk environments” for the transmission of blood-borne diseases, “there are even fewer harm reduction services available here” than to the general population.

Bachelet condemned a litany of human rights abuses fueled by the drug war: executions; extra-judicial killings; arbitrary detention; abuses by law enforcement agencies, including targeting of “members of minority communities, LGBT people, people of African descent;” and compulsory “drug detention” centers. She also criticized abstinence-only prevention messages, which “very little evidence” shows to be effective, and denial of pain relief, which “may constitute ill-treatment amounting to torture.”

She brought the house down when she stated, simply: “People do not lose their human rights because they use drugs.”

“When a set of policies clearly fails to achieve its goal,” concluded Bachelet, “it is time to change them.” Of harm reduction policies, she concluded: “The evidence is clear—where they exist and receive adequate funding, they have been markedly successful.”

Michelle Bachelet

A Stunning Success Story

“We’re deeply privileged to be here to learn” from the host country’s example, said Burke-Shyne. “Of course there is continued room for progress, but the world still looks to the reforms that Portugal made nearly 20 years ago.”

It was fitting, then, that the opening day of the conference front-loaded many of those who had instigated and maintained this model, which has been praised for its integrated public health approach, on top of decriminalization.

Jorge Fernando Branco de Sampaio, who was president of Portugal from 1996-2016 and now serves on the Global Commission on Drug Policy, gave the final speech at the conference’s opening session.

“In this very specific issue of drug control, Portugal has a lot to share with other countries and partners,” he said. “Why? Because we have a solid bedrock of evidence to provide about the outcomes of the changes made in our drug policy since the ‘90s, when Portugal was facing a serious opioid epidemic that sparked alarm across all social groups … In these rather dark times dominated by failures and regressions in many fields, it is good to have a success story to tell!”

And how. As he described it: “The number of drug-users decreased; the number of drug-users who entered into voluntary treatment increased; the number of newly reported cases of HIV and AIDS among drug addicts has declined substantially every year since 2001; drug-related mortality rates have decreased as well.”

“Our decriminalization model was based on relationships … on creating common ground between drug users, professionals, law enforcement, politicians,” said José Queiroz, executive director of APDES, a Portugues agency which promotes access to health, education and employment for vulnerable populations, and is co-hosting the conference.

Nodding to earlier examples of harm reduction seen in Switzerland, the Netherlands and parts of the UK, Queiroz said that Portugal’s approach was “based on the ideas of pragmatism, humanism, participation, inclusion.”

“The voyage of discovery has less to do with finding new landscapes than looking with fresh eyes.”

Professor Alexandre Quintanilha, former president of Portugal’s Parliamentary Committee on Education and Science and former director of the Institute of Molecular and Cellular biology at the University of Porto, chaired the commission that produced Portugal’s famed National Strategy on drugs in 1998.

Drug policy wasn’t his specialization. “I was the person who had least knowledge about drugs [on the commission],” he told the crowd. When Portugal’s deputy prime minister called to ask him to chair it, “I laughed!”

But his lack of preconceived ideas about the field was a positive, as Quintanilha illustrated by quoting Marcel Proust: “The voyage of discovery has less to do with finding new landscapes than looking with fresh eyes.”

Having a multi-disciplinary mix on the commission was essential but not easy, he said: “Each discipline has its own specialized words, which they try to make as incomprehensible as possible to show everyone that they’re intelligent.”

But working with open minds and widely consulting the public, they proved that it “is possible to have public policy conceived, based on knowledge and evidence coming from different domains.”

They rented large cinemas to hold public consultations about the new approach. They were so packed out that people were sitting on the floors. “People would come up to us at the end of the meeting, in tears, thanking us … It was very touching, it was very motivating.”

The government accepted the commission’s strategy without changing “a single comma,” publishing it on April 22, 1999—20 years ago almost to the day.

Where Next for Portugal?

Quintanilha acknowledged that the reforms, developed rapidly in the face of a drug-related public health crisis, were not perfect—people who use drugs in Portugal can still be summoned to a “dissuasion committee,” which can impose civil penalties, such as fines or restrictions on freedom of movement.

And Jorge Sampaio echoed this message: “Make no mistake. Successes are not timeless. What was innovative in the past and produced change for the better has to be kept under permanent scrutiny, evaluation and review. Public policies have to adapt to new trends and address emerging and long-term challenges.”

Naomi Burke-Shyne, José Queiroz, João Goulão, Ricardo Baptista Leite [Photo ©Steve Forrest/HRI/Workers’ Photos]

So it’s encouraging to see a new generation of Portuguese politicians take the reins. Ricardo Baptista Leite is a member of parliament for Portugal’s opposition Social Democratic Party—which, despite the name, is a center-right party. He’s also a physician and the founding president of UNITE Global Parliamentarians Network, which works to eliminate HIV/AIDS and other diseases. Quoting one of the conclusions of UNITE’s April 27 Joint Action Policy Day, he told delegates: “Harm reduction and love must have a shared common denominator—they must be unconditional.”

“I couldn’t be happier to endorse the efforts pushing for harm reduction, decriminalization and a people-centered approach that has saved lives in our country,” he said, in words that would be startling if uttered by someone considered right-of-center in US politics. “Drug policy is a fundamental angle to be able to end stigma and discrimination.”

He observed at a press conference, “Twenty years ago, when we were seen as an experiment—now we have proven experience—not all of parliament was in favor of decriminalization … If we were to submit the bill today, we would have unanimous support from all parties.”

Asked about Portugal’s prospects for continuing its drug policy leadership, by advancing in areas like cannabis legalization and SCS, he noted that negotiations with city governments have slowed down implementation of SCS, and added, “Portugal has been leading, but that should not be our main motivation to move forward—our motivation should be to do what is based on evidence to help people.”

Baptista Leite cited his own past opposition to cannabis legalization, before reviewing the evidence about outcomes in other jurisdictions like Uruguay and US states convinced him that it was “all in favor of legalization with a strong regulatory framework.” His party has now adopted this position.

In general, he noted, “the law is not enough,” agreeing with comments from Rui Coimbra Morai that “tailored” harm reduction implementation is additionally crucial to reach marginalized populations on the ground.

“I think that Portugal has a moral duty and a moral responsibility to go further.”

João Goulão, whose role could be described as Portugal’s “drug tsar,” said, “Last year we had an initiative to pass [legalization of] medical cannabis; that was approved. Then we had a proposal for social use—it was not even admitted for discussion.” He cited “political context” as the reason for this—“there is an election coming”—but also expressed, “I believe that we have the tools to fine-tune. I think we do not need further legislative steps as completely necessary to address those new challenges.”

“I think that Portugal has a moral duty and a moral responsibility to go further,” said José Queiroz at a press conference.

And on the stage, Rui Coimbra Morais looked pointedly at Portugal’s secretary of state for health, his fellow presenter, while urging politicians to say “yes” to reform, and to take “the risks that each person can manage.”

Rui Coimbra Morais

“People Before Politics”

Whether or not Portugal continues to advance rapidly, it remains an outlier in world terms. “There are still lots of places where users are living the same war that they were living in the ‘80s and the ‘90s,” said Coimbra.

It is these people who will be the focus of the next few days, with the conference theme “People Before Politics.”

Naomi Burke-Shyne, citing practices like the denial of freedom to NGOs and people being forced from the streets or excluded from housing on the basis of their drug use, described drug policy as a “convenient tool” to harm marginalized people.

She noted that harm reduction is “inextricably linked with issues of race and health” and therefore closely aligned with broader social justice movements. But she also pointed out that “many of these movements are limited by being fed decades of misinformation on drugs”—and that this distinction is what makes the global harm reduction movement unique and essential.

“The most important message—to believe and not to stop—has been achieved.”

One of a number of awards presented at the conference’s opening ceremony went to Andrey Yarovyi, a Ukrainian harm reductionist and advocate for drug users.

In August 2018, he was detained by authorities in the self-styled “Luhansk People’s Republic,” a Russian-backed enclave in eastern Ukraine. They found him in possession of 10 days’ supply of prescribed buprenorphine for his own use. Charged with “large-scale drug trafficking,” he was sentenced to long-term imprisonment and remains incarcerated.

His message to the conference was read out: “Dear colleagues, dear friends … I’m sure we will achieve our goals. The most important message—to believe and not to stop—has been achieved.”

The post Huge Harm Reduction Gathering Allows Portugal to Teach the World appeared first on Filter.

When she discloses how, in the year after taking the DPA reins in September 2017, she not only published a book and parented a three-year-old, but also underwent treatment for breast cancer, another key quality is apparent: grit.

McFarland, 42, comes across as dedicated and resolute when I visit her at DPA’s Manhattan offices—attitudes that reflect both her previous work amid horrific human rights abuses in Colombia and her current challenge of driving drug policy forward, as a Latina leader, in the Trump era. A gleaming smile occasionally surprises you.

As we rapidly run through a range of America’s drug issues, her enthusiasm for DPA’s big coming initiative to decriminalize all drugs is tangible.

“I’m really excited about designing an all-drug decrim campaign, and getting that off the ground,” she says. “I think it could be transformational. I don’t think we’re going to see results in the immediate future, but that’s where we need to go.”

“What’s right for marijuana is surely not what’s right for heroin.”

Such progress would evidently have a dramatic impact on mass criminalization and incarceration in the US. “The latest FBI data shows that you have over 1.4 million people a year in the US being arrested for simple drug use and possession. That’s the single most-arrested offense by far.”

Decriminalization versus legalization is a long-held area of DPA policy agnosticism (cannabis aside). “We haven’t taken a formal position on regulation of all drugs,” confirms McFarland. “I think the challenge is describing what that would even look like. If you regulate, you’ll have to take into account the specific characteristics of different drugs, and the risks associated with that. What’s right for marijuana is surely not what’s right for heroin. What about meth? And where does cocaine fall? They’re all different, and the challenge would be to find a system that protected human rights, reduced the abuses related to prohibition, but also didn’t create a whole bunch of new problems. We haven’t come out and said, ‘This is what you should do.’ But we do think it’s important to have a healthy debate and not close off possibilities.”

The focus includes the criminalization of people who sell drugs. “We’ve been having a conversation about low-level drug sellers, because it really doesn’t make any sense to lock people up for minor distribution offenses when the reality is, they’re probably just a person who uses drugs, and who is selling small quantities to support their habit.”

The current spate of drug-induced homicide prosecutions—“An Overdose Death Is Not Murder,” DPA’s impactful report released in November 2017, helped bring that issue to national attention—like so many other areas of drug criminalization, is loaded with racism. Innocent-white-victim narratives contrast with portrayals of dealers.

“That’s something we’ve been watching with concern,” says McFarland. “Reducing sentences is important, and defelonization initiatives are something to look at as well. You can talk about defelonizing just personal use and possession, which has already been done in a few states, and could be viewed as a step towards all-drug decrim, but you could also talk about defelonization for low-level sales or transportation—the mule, the driver of the car, and so on.”

“There are things that you can push for successfully in Congress.”

Broadly, McFarland sees opportunities for national drug policy reform alongside progress in individual states, despite the current federal landscape.

“We’re playing defense in some ways” at a federal level, she notes, citing DPA’s work to block the SITSA bill, which would have increased federal mandatory minimum sentences for synthetics. “But we’ve also managed to help shape the opioids legislation, so you have streams of funding going to medication-assisted treatment and other better things. There are things that you can push for successfully in Congress.”

Increasingly, marijuana legalization is one of them. “In a few years, I really think we could achieve federal legalization.”

Legalization in 10 states and counting has been DPA’s (and many allies’) most high-profile success to date. With Canada having fully legalized and major corporations getting into the business, McFarland’s thoughts about the future path of legalization focus on fighting for accompanying social and racial justice provisions.

“There needs to be a recognition that the War on Drugs has been an excuse for targeting Black and Brown communities.”

“We’ve been pushing hard for legalization measures to be modeled after Prop 64 in California [which DPA had a large role in crafting],” she says. “Legalize marijuana; but do it in a way that also attempts to repair the enormous harm that was done. It’s very important for measures to include record expungements. All these people who have criminal records who have to live with that hanging over their heads, they have trouble getting housing, employment, all sorts of other difficulties—they should not have to live with that.”

Tax revenues, she urges, should be reinvested in programs to help communities most harmed by prohibition—disproportionately communities of color. “There needs to be a recognition that the War on Drugs has been an excuse for targeting Black and Brown communities, and so you need to do something to make amends, right?”

Access to the cannabis industry is a related point. “You don’t want a situation where the only people who can be in that market are wealthy corporations that already have a huge advantage, and you exclude the people most harmed or who previously were in the market illicitly. So we need provisions to allow for market access for low-income people, and those most affected. Those are all part of the Marijuana Justice Act, which Senator Cory Booker has introduced, and there’s a version of it in the House as well. And they’re part of what we’re pushing for in New York and New Jersey.”

“I think we’ve made tremendous progress at the federal level,” she concludes, “with three bills in the Senate this year that would either legalize or decriminalize marijuana. Who would’ve thought that, even two years ago?”

Another area of interest for McFarland is psychedelics, including their medical uses. Praising the work of MAPS in this area, she notes that allowing medical use of these drugs, while valuable in its own right, can also “open the door to decriminalization, as it has with marijuana.”

“I think the crisis is sensitizing some people to the fact that existing drug war policies don’t work.”

The dominant drug policy narrative right now is of course opioids and overdose, and the situation presents a mixed picture to McFarland. “The overdose crisis is a big opportunity and challenge at the same time.”

The negatives are daunting. “It’s terrible that you have over 70,000 dead just last year from overdose, and really problematic that the narrative has focused so heavily on white victims, and the pharmaceutical companies’ role. The rise in overdose also lends itself to politicians spreading fear, to blaming migrants for overdose. It lends itself to Trump saying that he wants the death penalty for drug sellers.’

On the other hand, “I think the crisis is sensitizing some people to the fact that existing drug war policies focused on cutting off supply don’t work—and, in fact, got us to this place. We’ve invested all our resources in criminal justice, instead of access to effective treatment and harm reduction measures that would save lives. It is because of the drug war that you have massive misinformation, and very little information about the real risks of drugs and how you can minimize them.”

She’s also acutely aware of how restricting the medical supply of opioids creates risks in terms of pain patients turning to the illicit market, and suffering. “It is inhumane to cut off access. There have been stories about people committing suicide because they couldn’t deal with the pain after their supply was cut off. That’s unconscionable.”

McFarland senses an opportunity, in this context, to tell the story of the crisis—for example, through the powerful narratives of bereaved parents—in ways that deconstruct the current approach and prioritize harm reduction.

DPA’s Role in a Polarized Landscape

I’m curious about how Maria McFarland Sanchez-Moreno sees the role of her organization in the new political reality. A few years back, when I interviewed her predecessor, DPA’s founder and longtime leader Ethan Nadelmann, he described the breadth of drug policy reform despite its foundations in the civil rights movement and the left, and how it included people of diverse political persuasions united by a common cause.

But a lot has changed since. Powerful, identity-oriented movements like Black Lives Matter and #MeToo, along with white nationalism on the right, challenge Americans to consider whether they’re with or against them. And Trump arrived at a time when polarization in US politics was already growing, and accelerated that.

Does McFarland, I ask, see DPA’s primary role as fortifying the barricades, or reaching across the political aisle?

She answers without hesitation. “I think we have to reach across the aisle.”

“Libertarians [for example] are very much a part of the movement,” she continues, noting that DPA has employed libertarians and would do so again, “as are people who care deeply about all sorts of social justice issues.”

“I mean, we want to make sure that people are committed to our values,” she continues, “and to us, the War on Drugs is a problem not only because it infringes on freedom, but also because of its dramatic impact on rights, of the serious harms that it’s caused. There are lots of different ways that people come to this work and to our movement, and some people care more about one piece than another. But as long as we have agreement about those basic values—grounding drug policies in science, compassion, health and human rights—that remains the core. Those are principles that people from very different backgrounds can agree to.”

How Peru and Colombia Shaped a Mission

That message contrasts with the preferred emphases of some drug policy reformers, but it’s also true that resistance and reconciliation don’t have to be mutually exclusive. It’s likely, as McFarland sometimes hints, that the perspective of her background informs her level of political tolerance.

Her American father was a US Foreign Service Officer, working in many countries, who became a sculptor after retirement. He and McFarland’s Peruvian mother met during a posting. McFarland is a dual US-Peruvian citizen, and spent her formative years, between the ages of eight and 20, in Peru.

In more ways than one, her upbringing planted the seeds of her later mission. Her father was always “a fierce critic of the drug war, even though he had worked at the State Department. I grew up hearing that it was ridiculous, and that we should just legalize everything. Also in Peru, you heard about fumigation and the US trying to go after coca crops, and it just didn’t make sense to me.”

She was raised in a country of extreme inequalities that was also ravaged by war. “We had an internal armed conflict between the Maoist insurgency of the Shining Path and the military. So we had had bombs in my neighborhood frequently. But probably more striking was the massive influx of internally displaced refugees coming from the Andes, where they were being slaughtered by both sides. Lima, my city, was full of desperately poor people who didn’t speak Spanish; they spoke Indigenous languages. It was a striking thing to witness that damage from war.”

Another formative influence was seeing, in 1992, President Alberto Fujimori shutting down Peru’s congress and taking complete control of government. “That turned into nine years of autocracy and extreme corruption. He took over control of the media, effectively, by buying off the heads of news outlets. He took over the courts.”

McFarland avoids explicit comparisons—“I don’t want to sit here comparing what’s wrong here with what’s happening in other countries”—but her descriptions suggest differences between the repressive, racist and deadly consequences of the US War on Drugs and the outright massacres of a military war; and differences between the literal autocracies of the world and a US government that seems to want to become one.  

Don’t mistake that perspective, however, for any downplaying of drug policy harms in the US. “There are a lot of things in the US that are horrible, a lot of injustices that are awful in their own right.” Attending law school in the US, she was already “figuring out, how do I work on these issues of social justice that I care about?’”

“Prohibition had so distorted what was already a war in Colombia, because it had created this profit motive.”

After clerking on the US Court of Appeals, for the Fifth Circuit, in Texas, and a teaching fellowship at Fordham Law School, McFarland worked for a spell at a law firm, “representing Argentina in these lawsuits by vulture funds trying to basically collect on debts after their economic crisis.” But she’d been in touch with Human Rights Watch and knew she wanted to work in that space. When that organization offered her a position as their Colombia researcher, it was an easy decision.

The six years she spent in Colombia cemented her commitment to drug policy reform. “I had always been skeptical of the War on Drugs, but I really got to see up close the very dramatic impact of it in that country.”

“Prohibition had so distorted what was already a war in Colombia—an internal war between left-wing guerrillas and the then-government—because it had created this profit motive,” she explains. “You had right-wing paramilitary groups claiming to be self-defense forces, in fact being drug-trafficking groups seeking to control territory, fighting over that territory with the FARC, which is also taxing growers and making money off the drug trade. Civilians were caught in the middle.”

Some of her experiences were hard to bear. “I documented so many massacres, I talked to so many survivors, relatives who had seen their family members dismembered alive in front of them, lost their children, really horrific stories of torture and rape and so on, and so much of it because of these turf battles, and also seeing how the money from the drug trade gave organized crime this immense power in the country, gave them the ability to buy off just about anyone they wanted.”

The police and military, she adds, heavily funded by the US, were guilty of much the same in terms of abuses and corruption, driven by the profit motive of the cocaine trade. “And so, to me, it became very clear that, if I wanted to really address the human rights abuses in Colombia, it’s essential to end the War on Drugs, and find a different way of dealing with all of this.”

“People should have control of what they do with their own bodies, and the decision to consume drugs fits within that space.”

Her work in this environment took its toll on McFarland personally. “It was an incredible experience. It changed my life, and I’m grateful for it. But I was kind of burned out and dealing with trauma, and I needed to do something different.”

Her experiences in Colombia inspired There Are No Dead Here, her award-winning book about an activist, a journalist and an investigator who risked their lives to reveal collusion between right-wing paramilitaries with cocaine-trade involvement and the Colombian military and political establishment. Six years in the writing, it was published in February 2018.

She switched to working for Human Rights Watch on US foreign policy—which, of course, “has such an influence in Latin America.” Her varied work took in the Middle East during the Arab Spring at the start of the decade, and many other countries.

She retained her commitment to drug policy reform, and it was substantially thanks to McFarland’s work and internal advocacy that in 2013, Human Rights Watch became the first major international human rights organization to call for drug decriminalization and broader, global drug policy reform.

She also worked on reviewing HRW and the ACLU’s important 2016 report, “Every 25 Seconds,” which laid out the vast extent of US drug criminalization and the grotesque racial disparities and abuses involved, and made the human rights case for decriminalization.

“The fundamental principle underlying all human rights is the notion of human autonomy,” she says. “People should have control of what they do with their own bodies, and the decision to consume drugs fits within that space.”

Taking Leadership of a Movement

McFarland’s predecessor, Ethan Nadelmann, led DPA for two decades. I ask her how it felt to step into his shoes after three rounds of interviews.

“I have my own shoes!” she laughs. “They’re prettier!”

“Look, I remember attending DPA conferences before, and just being blown away by how cutting-edge everyone was, and these fascinating conversations and diverse people from across the spectrum. And Ethan was such a powerful speaker, and so smart and inspiring. So yeah, I jumped at the opportunity of taking on this role. I have a totally different style, which is fine.”

Many of us might be intimidated to take over such a prominent organization from its founder, I venture, especially in a period of staff changes in several key DPA positions.

“That’s not intimidating!” she exclaims. “Intimidating is the stuff I did in Colombia, going off and talking to paramilitaries. You have to stretch yourself. I’ve always tried to keep stretching myself, otherwise, I get bored.”

“It’s been a very steep learning curve,” she concedes. “I have expertise in some areas of drug policy, but DPA covers a huge range, and so it’s been learning the issues and learning the organization itself, with all of its idiosyncrasies. It’s getting to know 70 staff members. It’s getting to know how to manage at this level, because previously, I had managed a team of 13 people. And also, the challenge of being a leader, the face of the organization, and how to speak, how to hold myself out. It’s all challenging, but it’s all exciting. I want to get better at it, and I’m looking forward to that.”

Courage and Optimism

It’s then that she shares a different kind of challenge she’s faced. “In February, right before I released my book, I was diagnosed with early-stage breast cancer. I released my book on February 27, and on March 1 I had surgery. Then I had almost four months of chemotherapy over the summer, and now I’m about to complete radiation. Then, it’s just hormone therapy.”

“It’s been quite the juggling act,” she says, with understatement. “But my prognosis is good, and I feel good. The summer was rough; I plowed through it. I wasn’t able to travel because I had to stay for the chemo, and because of my weakened immune system. With radiation, I’ve also had travel restrictions. But after chemo, I took vacation for the first time in over a year, and went and spoke at the 25th anniversary of the Drug Policy Forum of Hawaii.”

Was that really a proper vacation? “But I took 10 days off, and came back from that and did this amazing green smoothie diet that my integrative medicine doctor recommended, which gave me a whole lot of energy! So I feel very good right now.”

McFarland’s ability to travel for work once again allows her to schedule a trip to Mexico in the new year, where she plans to cross-fertilize with some exciting drug policy developments.

“I’m going to be watching Mexico very closely,” she enthuses, “because you have a president there talking about regulating all drugs. I doubt that that’s what’s going to happen, but you may see marijuana legalization. You may see something happening with poppy. You may see low-level offenders being released. So I think there’s movement.”

As she talks about many other examples of international policies that should inspire the US—as well as her plans to expand DPA’s national footprint, for example in the South—Maria McFarland Sanchez-Moreno displays more of the passion, expertise and optimism that she and her movement will need on the long road ahead.

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The post DPA’s Leader Shares Her Roots, Health Challenge and All-Drug Decrim Agenda appeared first on Filter.

Yet leaders painted a mixed picture—one of a movement blessed with extraordinary power, imagination and humanitarian values, but simultaneously assailed by external threats to its success and internal threats to its integrity.

“This year’s conference is different for a lot of reasons,” said Monique Tula, executive director of the Harm Reduction Coalition, which organizes this event every two years.

[Monique Tula. Credit: Harm Reduction International.]

The last conference was in San Diego in 2016. It ended two days before the election of Donald Trump struck a bitter blow.

“It was a really dark time,” said Tula. “In San Diego none of us thought we’d be in the place we are today …. where our rights and our well-being are being steadily eroded.” She referenced the confirmation of Brett Kavanaugh to the Supreme Court, new laws targeting sex workers, and racial injustice as cases in point.

She also spoke, in the context of a crisis of an estimated 72,000 drug-related fatalities last year and soaring suicide rates, of “deaths of despair—Americans reacting to stressors with desperation.” The Trump administration has worked to re-ignite the devastating War on Drugs, even as many state- and local level harm reduction initiatives have advanced.

“Harm Reduction with a capital ‘H’ and ‘R’—this is the movement, one that shifts resources and power to the people who are most vulnerable to structural violence.”

“This conference is an example of how we hold space for each other,” Tula declared, having identified as a person who uses drugs. And indeed, to those who have regularly attended this event, its strong, inclusive sense of family has always been apparent.

This inclusiveness is reflected in an open panel application process, resulting in myriad perspectives and areas of expertise among scores of panels, roundtables and workshops squeezed into four hyper-stimulated days. Session titles include: Safer Washrooms Save Lives; Kwe to Kwe—A Harm Reduction Support Group for Indigenous Women Who Use Drugs; Let’s Queer This Up: Housing Disparities for the LGBTQ Community; Negotiating Sex Work and Client Interactions in the Context of a Fentanyl Crisis; and Disrupting the Great White Hope: Harm Reduction of Color. But no snapshot can capture the dizzying range on offer.

Whether this apparent diversity and breadth of application is enough, however—whether it is more than window-dressing amid systemic harms stretching far beyond those related to drugs—is a question this movement has long asked itself.

Tula, the first woman of color to lead her organization, framed these tensions thoughtfully. “When we talk about harm reduction, we often reduce it to a public health framework, [one of] reducing risks,” she told the crowd. “That’s harm reduction with a small ‘h-r’. Harm reduction is meeting people where they are but not leaving them there.”

“But Harm Reduction with a capital ‘H’ and ‘R’—this is the movement, one that shifts resources and power to the people who are most vulnerable to structural violence.” She went on to describe its aims as including: building community for and empowering directly impacted people, or “people who are not seen;” disruption; changing narratives; solidarity; and fighting for social justice.

Quoting author and civil rights advocate Michelle Alexander’s recent New York Times op-ed, Tula evoked the “revolutionary river” of which harm reduction is part, and placed Donald Trump and those who support him—”for whatever fuckin’ reason they do”—as “those who are pushing back against this new country struggling to be born.” Not that the current political and social climate is as new as some portray it. As author and activist Adrienne Maree Brown put it: “Things are not getting worse, they’re getting uncovered.”

Later in the day, Tula stressed to Filter that she remains “extremely optimistic” about the movement’s long-term prospects. Wrongs being uncovered are better than their continuing to exist unseen. “Compared with the elite one or two percent, we are legion,” she said. “We are incredibly powerful, and that’s what this movement really is; it’s about the 99 percent. And [the political reactions] we’re seeing now is the elite pushing back—because they’re feeling threatened.”

Back in the ballroom, having addressed these external threats, Tula turned to some closer to home. She warned those present of the dangers of “losing faith” or “lashing out” at each other, as family members might, rather than focusing on the bigger picture. She noted that “for a movement that espouses non-judgement, sometimes we can be really judgemental. Forgiveness and compassion—isn’t that the core of harm reduction?”

She closed, however, with some challenging questions. “If harm reduction is going to remain relevant and deeply accountable to those most harmed, how do we talk about racial injustice within our movement? Or misogyny? Or ageism? Or the very real trend that people with lived experience are being de-centered by this movement?”

“It’s appalling to me to see the ways that Black folks and our experiences are devalued.”

The plenary panel that followed her speech expanded on these themes. Black leadership within the movement—and its suppression—was a central focus. (The establishment of the Black Harm Reduction Network, which held its inaugural meeting here on October 17, is one part of efforts toward change.)

Erica Woodland, director of National Queer and Trans Therapists of Color Network, spoke of quitting the harm reduction movement 12 years ago, without mincing his words about why. “It’s pretty appalling to me to see the ways that Black folks and our experiences are devalued,” he said. “I don’t want to leave here with more empty promises.”

That Tula persuaded him to appear could be taken as a hopeful sign. “I got divorced from y’all,” said Woodland. “I came back; we’re dating!”

Black women, and in particular panelist Deon Haywood, lead Women With a Vision, a New Orleans-based nonprofit that applies harm reduction principles to drug use and sex work, but also to wider areas of racial, social and reproductive justice.

Haywood echoed Tula’s demand that harm reduction be more than a set of public-health risk management strategies. “Harm reduction may have been founded in sex and drugs and related things,” she said. “But the future … is: We have to see harm reduction as broadly as it is, as wide open.”

Further discussion included issues like labor exploitation in the “non-profit-industrial complex,” where thousands of peer workers and volunteers do lifesaving work for little or no pay.

The panelists also expressed resentment at how harm reduction has been co-opted by the public health establishment in ways that limit and misapply its potential. Haywood recalled being invited by a local public health body to a meeting to address “our new public-health approach of harm reduction”—this, when she and her colleagues have been applying harm reduction in the area for almost 30 years, and were previously denied requested meetings with public health officials. She pithily summed up her feelings at the time: “Bitch…!”

Shira Hassan, an advocate for sex workers, University of Chicago lecturer, and former director of the Young Women’s Empowerment Project, added that harm reduction’s history has also been co-opted by public health. “Who was it started by? It was started by us, by drug users and sex workers, street-based people, trans people of color. Because we have been saving our own lives for centuries.”

In a call to “reclaim our reality,” she referenced her lived experience in noting that “intersectionality is a big word to describe the truth of our reality. It’s what it is to wake up queer and Arab every day, and be involved in the sex trade.”

Hassan described harm reduction as “this incredibly beautiful thing” in urging the movement to link better with others (“What is harm reduction without prison abolition, without transformative justice?”). She also emphasized her gratitude. “Someone handed me a clean syringe when I was sleeping under a bush in New York City … and you all saved my life … Thank you!”

Dan Bigg provided naloxone and sterile syringes but also love and inspiration to many people who use drugs.

One giant figure behind this kind of lifesaving work was Dan Bigg. Described as the “godfather” of harm reduction, Bigg co-founded the Chicago Recovery Alliance and for decades provided naloxone and sterile syringes—whether the law allowed it or not—but also love and inspiration to many people who use drugs. He died in August. His presence—with his faced printed on a drape above the stage—loomed over this event.

“This year’s conference is different for a lot of reasons,” Monique Tula had said at the beginning of her speech. “But perhaps the most important is that for the first time, we’re having it without Dan.”

In tribute, his widow, Karen, and the staff of Chicago Recovery Alliance assembled on the stage. Several were in tears—not a rarity at a conference where so many lost lives are remembered. Bigg was lauded for his boldness, his “general badassery,” his compassion, and for “asking forgiveness rather than asking permission—taking risks to save lives.”

A regular award—the “Any Positive Change” award—has been established in his honor, and the inaugural winner was an equally inspiring figure: Louise Vincent. She is the national director of the Urban Survivors Union of drug users, runs a syringe exchange in Greensboro, North Carolina, and has been involved in saving hundreds of lives—again, whether or not laws permit the tools required to do so, and despite DEA raids.

Aspects of Vincent’s story exemplify the passion to fight for humanity which the harm reduction movement—for all its flaws and self-doubt—still embodies.

“It’s been harm reduction and this work that sustained me when my daughter died,” she told us. “It’s been harm reduction and this work that sustained me when my leg was gone. And it’s harm reduction and this work that keeps me alive and going forward every day.”

Photo credits (unless stated): Filter.

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