In my five years of reporting on the global cannabis and psychedelic industries, I’ve seen this growth happen in real time, as the gap between those who can afford legal access and those who remain criminalized widens.

This tension between the fight for just drug policies and the race to profit from potential new markets is one that Koram explores at length in his book. A global review in The Lancet is among other recent contributions to the debate; it found cannabis-related harms to be higher in jurisdictions with commercialized legalization models than in those with decriminalization or other forms of legalization.

In The Next Fix, Koram travels across the globe, visiting some of these jurisdictions, to ask some crucial questions at what appears to be an inflection point in the debate over drug policy reform: What comes next, when the war is over? And who will the real winners be?

I sat down with him to find out. Filter’s interview has been edited for length and clarity.

Prof. Kojo Koram

Sarah Sinclair: Your reflections on your time as a lawyer at Angola Prison, on a former slave plantation in Louisiana, when the first state legalized cannabis, are such a stark portrait of the injustice at the heart of prohibition. Was that the moment when you first knew you had to write the book?

Kojo Koram: Angola is an extreme example, but the United Nations estimates that around 20 percent of the world’s prison population—2.5 million people—are in prison for growing, selling, or possessing the wrong type of drug. For me, that was the moment I realised this system wasn’t delivering what it promised.

I was working in the US when the first states [Colorado and Washington] legalized commercial cannabis markets in 2012. Seeing people imprisoned on a modern-day slave plantation for doing something that, elsewhere, people were now getting licenses for, I think that was the moment I started studying this. Eventually, it led to the opportunity to write this book, travelling from jurisdiction to jurisdiction looking at what actually changes when you implement different drug laws. 

“We could be entering a world in which criminalization and commercialization are happening simultaneously, and I think that raises some real questions.”

SS: In the book, you argue that the debate around drug laws is shifting, to be less focused on whether cannabis should be regulated and more around how. Does that mean the “War on Drugs” is ending?

KK: During the 20th century, when people debated the idea of legalizing drugs, we assumed it was a simple yes-or-no question. Either we legalize drugs, or we don’t. But what we’re seeing in the 21st century is something much more complicated. The debate is around how we might legalize these drugs and how some of the systems of commercialization actually reduce some of the impact of criminalization. But we’re also seeing the potential for criminalization and commercialization happening simultaneously.

In December 2025, Donald Trump signed an executive order to reschedule cannabis from Schedule I to Schedule III, the biggest change in US federal drug policy in the best part of a century. If you’d told a Republican during the Reagan era—when drugs were framed as public enemy number one—that a future Republican president would be signing an executive order to reschedule cannabis and fast-tracking access to psychedelics, they would have thought you’d been spiked. That’s a massive shift, and I don’t want to minimize that. 

But the same month, Trump seized Nicolas Maduro from Venezuela on charges of narcotrafficking. We could be entering a world in which criminalization and commercialization are happening simultaneously, and I think that raises some real questions.

SS: Medical cannabis legislation has shown how legal markets can coexist with continuing criminalization, where many patients can only access treatment if they can afford it while others remain criminalized. Are psychedelic frameworks at risk of repeating the same mistakes? What could an alternative model look like?

KK: In this new psychedelic industry, we’re seeing biotech companies patenting molecules and monopolizing intellectual property. That’s the traditional pharmaceutical model for raising investment to develop these medicines. I visited Australia, which became the first country to legalize prescribed psychedelic treatments [psilocybin and MDMA-assisted therapy] in 2023, but it costs around A$1,000 to access. 

Psychedelics could be one of the most transformative medical advances of the 21st century, given the scale of the global mental health crisis, but if you pick mushrooms from the ground or grow them in your back garden, you could still face criminal consequences. We need to think carefully about how we shape this emerging market to ensure we’re not reinforcing the same structures of exclusion, criminalization and violence upon the communities who suffered most during the War on Drugs.

Within cannabis, we’ve seen very different models of social equity across the US. Some states have pursued highly commercialized models while people continue serving sentences for trafficking offenses. Others, including Illinois, Massachusetts, and New York, have been much more explicit about embedding social equity into legislation. That means expunging criminal records, not just for people currently serving sentences, but for those whose convictions still prevent them from accessing jobs, student loans or travel visas. It means making sure licenses are available to people who were previously excluded from the market, and committing tax revenues to communities that were over-policed, as well as to education and public health. 

These measures can offset some of the risks as these substances become commodified, and can be put in at the point of transition. It’s in the interests of the industry. A century of the War on Drugs has embedded deep fears and stigma around these substances, and a really aggressive commercialized model is just going to facilitate a backlash.

“We have an opportunity to put policies in place that genuinely benefit those on the ground … I think there’s real value in thinking about how we can do this differently.”

 

SS: Perhaps I’m being cynical, but in an ultra-capitalist society, is commercialization inevitable? Or is there still an opportunity to build these markets differently?

KK: I think there’s an opportunity, but that window is closing. The argument needs to be made now. 

One of the industries I compare the emerging cannabis market to in the book is cocoa. Ghana is one of the world’s largest cocoa producers, yet the farmers harvesting those cocoa pods receive only a tiny fraction of the final product’s value. We need to bring together all those working on fair trade, sustainable development and environmental justice initiatives that are trying to intervene in industries like cocoa, coffee and fast-fashion. Cannabis is an entirely new industry and many of its rules haven’t been set yet. 

We have an opportunity to put policies in place that genuinely benefit those on the ground, such as protecting access to land, preventing monopolies over seeds and genetics, and creating protected geographical designations for products such as Jamaican ganja or Moroccan hash, in the same way that Champagne can only come from the Champagne region of France. That is their cultural and financial inheritance. This might be optimistic, but I think there’s real value in thinking about how we can do this differently. 

SS: Some might argue that there is a strong economic argument for a commercial market that generates tax revenue, and surely commercialization is preferable to criminalization?

KK: In the book, I tell the story of a man called Fate Winslow, who was sentenced to life without parole for facilitating a $20 cannabis transaction in Shreveport [Louisiana]. It was his third non-violent conviction. He eventually won his release after 12 years through a series of appeals, but died shortly afterwards. He spent the final years of his life in Angola Prison for facilitating a $20 cannabis transaction. That represents such a profound failure of human rights.

I absolutely recognize that commercialization is preferable to criminalization, but I think we should aim for something much higher than that. We’re living through widening wealth inequality, the devastation of the climate, and huge swathes of the human population being rendered surplus to the actual mechanics of capitalist production. Let’s not just change drug laws, but do it in a way that can mitigate and even repair some of that damage.

“One of the things I wanted to achieve with this book is to help people understand all the different parts of life that drug policy touches.”

SS: In the book, you set out a five-point plan for more fair and equitable regulation. How do we move these ideas from the fringes into mainstream political debate?

KK: For a long time, drug policy has been treated as a niche issue, and other movements have often been reluctant to engage with it because of the stigma. It took organisations like Amnesty International years to adopt a position on ending the War on Drugs, despite the most vulnerable communities being most affected by prohibition. It hasn’t been connected to environmental justice, racial justice or economic justice movements.

One of the things I wanted to achieve with this book is to help people understand all the different parts of life that drug policy touches, from the economy and medicine to the environment and crime. Connecting it to those broader movements will allow for a much more substantive idea of what drug reform might look like, rather than simply handing over a previously prohibited market to a highly commercialized capitalist model.

This is already happening in jurisdictions across the world, but it’s happening in a world where we have rampant wealth inequality, increasing corporate control over technology and infrastructure, and an erosion of living standards for many people. This isn’t the hippie dream of the 1960s, and we need to recognize that when we think about how we can use this moment to make a broader intervention to shape the economy of the 21st century. 

SS: After travelling the world researching and writing The Next Fix, what left you feeling most hopeful about the future of drug policy reform?

KK: What made me most optimistic was how people are using this moment of transition to rethink our relationship with drugs. Humans have been using cannabis and psychedelics for thousands of years, and if the planet survives, we’ll likely be taking them 1,000 years in the future. We’re not going to achieve the drug-free world the UN once promised, so the real question is how we relate to these substances. 

I was really encouraged by models like the cannabis social clubs in Barcelona, which are now being adopted in Germany. If you want something, you don’t just go and buy it, you learn how to grow it, understand different strains, and develop a more thoughtful relationship with what you consume. 

I was also inspired by the conversations around reparative justice, particularly in Colombia, where the War on Drugs wasn’t a metaphor, but a real war. We need a truth and reconciliation process, almost like they had in South Africa, to ensure that this transition benefits Indigenous communities. It’s really exciting seeing examples of reparative justice in how we use technical, legal and financial tools like intellectual property rights or guaranteed ownership within communities that have been overly-policed, to try and transfer wealth to people who’ve been most devastated by the War on Drugs. I was really optimistic to see people thinking about that—and even starting to put it into practice.

Top image shows detail from the cover of The Next Fix: The Winners and Losers Inside the Future of Drugs, to be published by Verso in late July. Images courtesy of Kojo Koram/Verso.

The post Who Will Profit Most When the Drug War Ends? appeared first on Filter.

One of the problems cited by the panel was that the researchers running the trials for the therapy didn’t report “adverse events.” Adverse events are defined as an unexpected, undesired, or negative effect of a drug or other type of treatment. In this case, the unreported adverse events concerned when or if study participants experienced “euphoria.”

Let that sink in for a moment. A study participant experiencing euphoria while on a drug whose street name is “ecstasy” was an undesired or negative outcome. Euphoria, in and of itself, was an adverse event, due to the fact that euphoria threatens to overcome the self-control of individuals, which, according to the FDA, is a highly likely pathway to addiction, which is considered “abuse.”

Thoreau denigrated the debauchery of butter-eating and coffee-drinking and now the FDA pathologizes euphoria.

Our discomfort with pleasure goes back a long way. The philosopher Henry David Thoreau denigrated the debauchery of butter-eating and coffee-drinking and now the FDA pathologizes euphoria. But where has this condemnation gotten us? Reviling the addicted, the euphoric, has only led to catastrophic drug wars and devastating interpersonal damage. All this endlessly recycled judgment calls for a pleasure crusade. 

In 2019, the Black feminist, queer activist, writer, social justice mediator and enchanting singer adrienne maree brown published a manifesto called Pleasure Activism: The Politics of Feeling Good. For brown, pleasure activism asks us to learn from our own pleasure, instead of pushing it away and feeling unworthy of it. Embracing pleasure doesn’t mean we have to ignore the harms of the world, whether those harms are caused by corporations or powerful intoxicating and toxicating substances, like fentanyl or meth, lead or petroleum. On the contrary, celebrating pleasure helps determine “how to make justice and liberation the most pleasurable experiences we can have.” Seeing pleasure as part of that liberatory work insists that we shouldn’t—and can’t—wait to feel good until after the revolution.

And why shouldn’t pleasure permeate the everyday, even within massive inequality? In Pleasure Activism, brown reprints the poet Audre Lorde’s essay The Uses of the Erotic, in which she uses margarine, that petro-chemical proletarian substance par excellence, to describe how her erotic force suffused and strengthened what she brought to the world with others:

During World War II, we bought sealed plastic packets of white, un- colored margarine, with a tiny, intense pellet of yellow coloring perched like a topaz just inside the clear skin of the bag. We would leave the margarine out for a while, to soften, and then we would pinch the little pellet to break it inside the bag releasing the rich yellowness into the soft pale mass of margarine. Then taking it carefully between our fingers, we would knead it gently back and forth, over and over, until the color had spread throughout the whole pound bag of margarine, thoroughly coloring it. I find the erotic such a kernel in myself. When released from its intense and constrained pellet, it flows through and colors my life with a kind of energy that heightens and sensitizes and strengthens all my experience.

Lorde’s and brown’s calls for pleasure are fierce, because they insist on seeking strength and stability, and they refuse to shame the pleasure-seeker.

Lorde’s pleasure-practice of suffusing processed margarine with color—written in the “we”—describes pleasures that are affordable due to unregulated corporate vice, which means these pleasures animate relationships with opulent delight. Why shame those who partake in the pleasures abundantly available to everyone?

Lorde’s and brown’s calls for pleasure are fierce, because they insist on seeking strength and stability through intensive and excessive pleasurable connection, and they refuse to shame the pleasure-seeker.

Anti-pleasure elites and mainstream health experts take their pleasure in disdaining the rest of us for our ravishments, as they demand we maintain our self-control. And, of course, the bulk of their vitriol is reserved for the working classes and people of color. So for instance, while the Aztecs reserved the oblivion of drunkenness for the overlords and esteemed drunkenness as a state that facilitated speech with the gods, now that intoxication is available to anyone, it’s considered vulgar.

And that seems to be precisely the problem for those who seek to distinguish, and separate themselves from those of us avowedly dependent on others and our cheap pleasures. With oblivion and excess abundantly available to the tacky-ass masses, it’s the discerning self-controlled individuals who can forsake ravishment to maintain the pleasures of making invidious distinctions between themselves and others. Euphoria has lost its cachet, left to the mindless gobbling rabble.

Adrienne maree brown faces off against that bloodless respectability and the austerity mandates, which tell us that if we are oppressed and suffering we can’t possibly experience pleasure. Pleasure activism provides a powerful model for what we could all experience, instead of pathologizing pleasure-seeking as only a response to violent histories and impoverished circumstances. In fact, pleasure can be a powerful response to these histories and circumstances, because it defies the soul-crushing violence often intended to snuff out the groups of people who historically have resisted domination. Living addicted in pleasure is a glorious response to this deeply imperfect world, even as we seek to change it. 

This article is excerpted from IN PRAISE OF ADDICTION: Or How We Can Learn to Love Dependency in a Damaged World © 2026 by Elizabeth F. S. Roberts. Reprinted by permission of Princeton University Press.

Photograph (cropped) by Javier Allegue Barros on Unsplash

The post In Praise of Pleasure appeared first on Filter.

In 2021, three years into his tenure, his administration’s Minister of Economy Paulo Guedes filed a bill that aimed to tax books, which have been exempt from taxation since the 1946 constitution. Had the bill passed, books would have been slapped with a 12-percent tax rate. When the bill was filed, the National Revenue Authority sought to justify taxing books by claiming that only wealthy people read them in Brazil—a claim that is not supported by evidence. 

That same year Bolsonaro confessed that he hadn’t opened a book since taking office; he’d had no time to read due to his presidential commitments. While running for reelection in 2022, he attempted to scare his constituents by claiming that if Workers’ Party candidate Lula (who has been president since 2023) were elected, gun-owners would be at risk of seeing shooting clubs turned into libraries.    

So it’s ironic that earlier in 2026, Bolsonaro—who is currently serving a sentence of more than 27 years in prison for plotting a coup d’etat following his 2022 election loss—attracted attention for requesting to join Brazil’s pioneering program Remission Through Reading, in which for each book prisoners read and write a report about, they can shave four days from their sentence. The report is submitted to a committee or to a judge, who must deem it acceptable.

The initiative was first piloted in 2009, in the maximum-security Federal Penitentiary of Catanduvas in the State of Paraná. It was subsequently expanded to other prisons and became a national policy in 2012. The number of books is capped at 12 per year, which can reduce 48 days from a person’s sentence.

Bolsonaro would be one of countless people incarcerated in Brazil to spend more time with books while in prison, but of course not due to any shared background. Bolsonaro was very busy passing two bills passed in 27 years as a congressman, as well as chatting on WhatsApp and insulting women. Of course he had no time to read.

People must have access to books before they are dragged into the criminal-legal system.

Though it is not true that only the wealthy read books, it is the case that almost half of Brazil’s incarcerated population has not completed elementary school. More than one in four—close to 182,000 people—are incarcerated for drug-trafficking convictions, and the majority of them have no prior record and should be resentenced under recent changes to the law.

A 2025 study found that 58 percent of people associated with drug trafficking would prefer not to engage in criminalized activity if they had another way to guarantee enough income. Research shows that many people initially drop out of school because they can’t afford to spend that time not earning money.

People must have access to books—along with housing, food and other basic needs—before they are dragged into the criminal-legal system. Yet the latest data available on the School Census 2025 show that 63 percent of state schools in Brazil do not have a library. This is despite a 15-year-old piece of legislation, enacted by Lula in his second term, that makes it mandatory for every school to have a library. 

The sad reality is that while each year federal and state governments waste over $1 billion—money that would be better invested in education budget—on the Sisyphean task of combating drug use and supply, a huge part of the Brazilian population will only have access to books and time to read once they are in prison.

Image of Jair Bolsonaro (fourth from left) during March 2025 Supreme Federal Court trial, via Wikipedia/Gustavo Moreno

The post Jair Bolsonaro, Enemy of Books, Now in Brazil’s Prison Reading Program appeared first on Filter.

Communities engaged in NIMBY protests against opioid treatment programs (OTP) from New York to North Dakota have a tried-and-true template: They are a threat to children and families, increase crime, attract drug dealers and decrease quality of life. And always, This isn’t the right location for an OTP; somewhere else is. Except there is no somewhere else. No neighborhood welcomes a methadone clinic, and nothing unites a community faster than when one tries to open its doors. 

I met Fab 5 Freddy, the host of Yo! MTV Raps, hip-hop pioneer, artist and filmmaker, at the press conference a few blocks from where I live in Harlem. He wore a black T-shirt that said “Harlem American” and a broad-brimmed pork pie hat. It was a sunny day in August 2018. A Who’s Who group of local politicians, wearing crisp light blue and brown suits and ties, stood behind a podium. About 20 members of the neighborhood were arranged behind them on the sidewalk. The local media set up video cameras on tripods and clipped microphones to the podium. Everyone was assembled to celebrate that they had stopped a methadone clinic from opening in a historic brownstone. 

A woman representing the Sugar Hill Concerned Neighbors Group described how they mobilized a hundred people within two days to attend a meeting with Argus, the corporation that planned to open the clinic and had paid $4.3 million for the property. She asked, “Who would want to live next to a methadone clinic?” 

“We’re not anti the people who need these services. Just not here.” 

Another speaker explained that Sugar Hill was a family community of brownstones and therefore it was the wrong location for a clinic. Speakers were mindful to say they cared about people struggling with an addiction and that it wasn’t “pushing back at the lesser of us.” 

Al Taylor (D), a reverend and state assembly member who represents Harlem said, “We’re not anti the people who need these services. Just not here.” 

Adriano Espaillat (D), a United States representative whose congressional district includes Harlem, asserted, “This isn’t a not-in-my-backyard thing. We need to have empathy.” He added that the neighborhood wanted to keep its quality of life and that Argus should look for another location. Espaillat suggested the Upper East Side of Manhattan. 

Then he smiled and called everyone involved in the fight the “Sugar Hill Gang.” The crowd broke into laughter. 

Several speakers asserted Harlem was oversaturated with methadone clinics, and thousands of people were commuting in from other boroughs. It wasn’t fair, they said. The press conference ended with another elected official commending everyone and cautioning, “We must stay united. One finger you do nothing. With a fist, you can win. We won!” 

After the press conference, I approached Fab 5 Freddy. I wanted to ask him why he opposed the methadone clinic, and he agreed to an interview. In front of the Kingdom Hall Of Jehovah’s Witnesses, Fab explained that for 20 years he has lived in a brownstone about a block from where Argus wanted to open the OTP. Over that time, he saw the neighborhood change for the better. 

I assured him that no one wanted to travel to a clinic in Harlem six days a week … The solution was to let all patients pick up a prescription at a pharmacy in their neighborhood.

He said that Sugar Hill was damaged by open drug dealing and drug use for decades: “The neighborhood has gone through a lot of trauma, and we don’t want to see something that could take us back there.” He was not a fan of methadone and said, “I’m not a doctor, but I don’t think methadone is the best treatment. It keeps them caught up in an addictive state.” 

During the conversation, Fab was easily convinced that methadone was a lifesaving maintenance medication and that the problem was the clinic system. I assured him that no one wanted to travel to a clinic in Harlem six days a week and stand in a line to get dosed. The solution was to shut down OTP and let all patients pick up a prescription once a month at a pharmacy in their neighborhood. It was a light-bulb moment for Fab. 

NIMBY movements use a number of strategies and tactics to keep clinics out. One of Dr. Beny Primm’s greatest frustrations was the community opposition he encountered whenever he tried to open an OTP in Harlem or Brooklyn in the 1970s and ‘80s. 

Primm, the late pioneer in addiction medicine, HIV research and public health advocacy, said, “It seemed that there were people who would use any means to block us … We found a building at 145th Street and Eighth Avenue and began renovations for a clinic. The building was set on fire. We brought guard dogs to the location and they killed the dogs.” Primm suspected that a drug-free organization in Harlem was responsible. The clinic never opened. 

A Lynnwood council member said during a 2023 hearing, “We can’t sacrifice the safety of our children.”

Residents from the city of Lynnwood in Washington State launched a fight against Acadia Healthcare, the largest methadone provider in the state, to block a clinic from opening in 2023. They were angry that it was near the Boys & Girls Club building. They formed a group called Safe Lynnwood and organized a protest march to the site where the OTP would open. 

At a city council meeting, an older woman told a representative from Acadia that he should be ashamed to open a clinic near the Boys & Girls Club. A city council member said during a hearing, “We can’t sacrifice the safety of our children.” Another official added, “If a single child is injured as a result, what is the price for that single child being injured due to the location of this facility?” 

The obsessive focus on “the children” and the perceived harm that a clinic could cause has no basis in reality. There is no evidence that OTPs make a neighborhood unsafe for children. Are the people who promote these hateful ideas aware that thousands of methadone patients are parents? 

As is common when an OTP wants to open a clinic, Arcadia submitted a written response to address community safety concerns and to explain how a clinic operates. They clarified it would only be open six hours a day, about 140 patients per day would be medicated, and all dosing would be completed by 11:30 am. Arcadia assured the community that patients receive counseling. 

To assuage community fears, methadone clinics promise to police and punish patients.

For security, the OTP would employ guards during and after operating hours to deter loitering at the facility or surrounding areas. Patients would be told loitering would not be tolerated and any illegal activity would be immediately reported to the police. 

To assuage community fears, methadone clinics promise to police and punish patients. They hype that security guards and video cameras will surveil them constantly inside and outside the clinic. They’ll only provide narrow windows of time when people can get medicated to assure the community that those people will only be in the area for a short time. If caught lingering, patients will be penalized. 

These carceral concessions to NIMBY groups further criminalize patients, reinforce discrimination and create hardships. For decades, patients have complained about the limited hours OTPs are open, which contributes to missing doses, being late for work or school, and not being able to take care of life responsibilities. 

Clinic owners focus on reducing and penalizing “loitering” because they believe that it triggers community complaints, so they want patients to get medicated and get out—dose and dash! It’s an iteration of the sundown town. 

The Family Guidance Center OTP in Chicago has a sign on the entrance door that threatens: “If you are seen loitering or lingering around the building or the surrounding area, you will immediately be placed on involuntary withdrawal.” The clinic is in a Black neighborhood that has gentrified and it’s a few blocks from Magnificent Mile, a luxury shopping district on Michigan Avenue.   

This article is excerpted with permission from Liquid Handcuffs: Policing and Punishment in Methadone Clinics and the Future of Opioid Addiction Treatment—the new book by Helen Redmond, published by North Atlantic Books. The book is available in paperback and ebook formats as of March 3.

A panel event to launch the book will be held in New York City on March 5. Tickets are free but can be reserved here. 

Top photograph (cropped) by Jaime Fearer via Flickr/Creative Commons 2.0 

Image of book cover courtesy of North Atlantic Books

The post “Would You Want to Live Next to a Clinic?”—Methadone NIMBYism appeared first on Filter.

The book builds on Walter’s years of in-depth reporting for Reveal, the investigative radio show and podcast, which made her a finalist for a Pulitzer Prize. In American Rehab, she exposed how mandated drug treatment forced hundreds of people to work for corporations for no pay! Her riveting exploration of “work-based rehab” programs showed that there is no such thing; it’s slave labor and wage theft.

In Rehab: An American Scandal, Walter describes a world of “desperate and addicted people who had been lured to rehab with the promise of a cure … only to repeatedly falter and fail inside a system that treated them like dollar signs.”

The book follows four individuals, each vulnerable in their own way to a dysfunctional system. Chris Koon and April Lee are trapped inside brutal treatment programs that offer nothing but work for no pay, punishment or prayer. Larry Ley, a physician who prescribes Suboxone, is harassed by the Drug Enforcement Administration. And Wendy McEntyre is a grieving mom turned uber-activist, whose son died of an overdose in a sober living home.

Koon is a young, white man from Pineville, Louisiana, with opioid use disorder (OUD). A drug court judge offers him rehab at Cenikor or five years in prison. It’s an easy choice, so Koon thinks. Cenikor is a program based on the therapeutic community model that uses confrontation and punishment. Soon, Koon has to sit in the “verbal chair,” as Walter writes, “with arms locked, his knees bent at a 90-degree angle, staring at the wall, not speaking, not making eye contact. Anyone could scream at him and he couldn’t do anything about it.”

Why? Because his shirt was untucked. Koon is soon employed, and forced to do back-breaking, dangerous labor for 80 hours a week. His only compensation is a pack of cigarettes each week! Koon can’t complain, because if he doesn’t complete the program and follow all the rules, he’ll go to prison. Walter’s writing about his harrowing two years at Cenikor reads like a horror novel depicting a violent cult. I feared for Koon’s life until he finally got out.

April Lee is a Black mother of three who lives in Philadelphia on a low income. She becomes homeless on the streets of Kensington, but she is tenacious and motivated to stop using drugs. Walter chronicles how Lee faces down one soul-destroying obstacle after another to get into rehab, belying the prevalent idea that “addicts don’t want treatment.”

When Lee enters a 28-day inpatient program, all her belongings are taken and she isn’t allowed to use her cell phone, mouthwash or razors. She attends 12-step groups. Walter writes:

“Look around,” a teacher said during one of her groups. “Only one out of 100 of y’all are going to make it.” Excuse me? April raised her hand. “That’s bullshit,” she said. How good is your fucking program if only one out of 100 make it? she thought. “It’s like you’re prepping people for failure.” 

Dr. Larry Ley loves to prescribe Suboxone (buprenorphine). He sees how the medication transforms and saves the lives of his patients with OUD in Carmel, Indiana. The DEA does not love his prescribing practices. Ley bristles against patient caps—first it was 30, then raised to 100—and prescribes Suboxone off-label for pain, in order to treat more patients. The DEA sends an undercover agent into his clinic to find evidence that he’s running a “pill mill.” Ley is eventually arrested and goes on trial. 

Vitally, readers will be left with an understanding of how drug treatment fails people with addiction—not the other way around.

Walter explains in granular detail how the DEA at every turn makes the prescribing of Suboxone a bureaucratic nightmare. How doctors’ fear of losing their license means many refuse to prescribe it, and how patients pay the price with their lives. This section made me so mad that my margin notes read, Fuck the DEA!

If you own a sober living home, watch out for Wendy McEntyre—she could be coming after you. The overdose death of her son Jarrod, 20, at Safe House in Van Nuys, California, triggered her years of investigation into these facilities. Walter explains how McEntyre discovered, “Safe House was part of a growing industry of sober-living homes … Anybody could buy or rent a property, and then stick three or more people into a bedroom at $600 a month each. There were virtually no regulations or oversight … clearly, it was a moneymaker.”      

Rehab is a must-read whistle-blower, demonstrating how many rehabs and sober living homes in the United States offer punishment for profit, not treatment. Vitally, readers will be left with empathy, and an understanding of how drug treatment fails people with addiction—not the other way around. 

Filter’s interview with Shoshana Walter has been edited for length and clarity.

Helen Redmond: What shocked you the most as you did the reporting to write this book?

Shoshana Walter: I’m an investigative reporter and I’ve been doing this kind of reporting for many years now, but I’m also an optimist. But I’m still shocked when I discover that people are being mistreated. It’s horrible. I think the other thing that I was shocked by is reading these studies that show that someone who completes a 30-day treatment program is much more likely to overdose and die in the year following treatment than someone who failed to complete a program. It’s even worse for people who are formerly incarcerated.

It really shocked me because that is by and large how we’re treating addiction in the United States, with these short-term bursts of treatment that are actually placing people at higher risk of relapse and death. It’s just not working.

HR: Can you explain the difference between a rehab facility and a sober living home?

SW: A rehab is where someone goes to get treatment for their addiction and related services. It might include therapy or detox where they might receive medications to help with the withdrawal symptoms. It might include group therapy sessions, coursework, often based on the 12 Steps. A person learns the skills they need in order to enter recovery. And then a sober living home is a place where the person goes to live, ideally among other sober people, where they learn to use those skills that they have learned in rehab.

Rehabs tend to be licensed by the state and have staff who have been certified or qualified to provide services. In sober living homes there’s no oversight or regulation. There could be some programming, church services, Bible study or vocational training, which in many cases, involves uncompensated work by the participants.

“The DEA called Larry the ‘Pablo Escobar of Suboxone.’ All his patients were suddenly cut off. Some died. Larry went to trial and was acquitted.”

HR:  In your book you talk a lot about buprenorphine. Can you explain the politics and the problems people experience in accessing the medication?

SW: France was experiencing a heroin epidemic and the country made Suboxone as widely accessible as possible, and that had significant results. Overdose deaths declined by more than 79 percent over four years. When the United States was considering making Suboxone available, the conversation was totally different. There was a lot of interest among certain lawmakers, particularly Senator Joe Biden. He referred to the medication as a cure. The interest among lawmakers was in finding a magic pill that will just end the problem.

When lawmakers were considering making this treatment available they had to pass legislation, and there was a huge amount of resistance from the methadone industry and from the Drug Enforcement Administration. The DEA was concerned about the drug being diverted or misused and sold on the black market. The legislation that ended up getting passed significantly restricted access to buprenorphine. Doctors had to get special training, apply for permission, and they were limited to 30 patients. And then, once they did all these things, they were subject to surveillance by the DEA. When Suboxone first came out in the United States, you had this perfect storm of scarcity caused by patient limits and law enforcement oversight.

Dr. Larry Ley, one of the characters in my book, was one of the earliest Suboxone prescribers. He had a history with alcohol addiction. Larry was one of the first doctors to get that special permission to prescribe Suboxone. He was an interesting, nuanced person. Larry passed away a couple years ago, so unfortunately, he wasn’t able to see this book come to print. He wanted to help people. He saw that there was this tremendous unmet need for addiction treatment for people struggling with opioid addiction. There were so many people banging down his door to get this medication, and he found a loophole to prescribe more medication to people than was technically, legally allowed under the law. 

That drew the scrutiny of local law enforcement and the DEA. At that point, the DEA was doing regular, routine inspections of Suboxone prescribers and that led to a criminal investigation and eventually the DEA raided all of his clinics, shut them down, and arrested Larry and his entire staff. They had a press conference where they called Larry the “Pablo Escobar of Suboxone.” All his patients were suddenly cut off from their medication. Many of them couldn’t find alternate prescribers and many of them relapsed. Some of them died. Larry went to trial and he was acquitted.

“She’d poke her head into his room after a long day at work and say, ‘How are you?’ He’d say, ‘Fine.’ Then she’d mark that off as a counseling session.”

HR: Cenikor exploits people experiencing addiction. Can you talk about how the program operates, and Chris Koon’s experience?

SW: When Chris went into the program, he learned it would be for two years and there was counseling and medical care available. He’d be able to live and work there and save up money for after he left. And then, soon after he arrived, he discovered that actually the vast majority of his time would be spent working, sometimes up to 80 hours per week. And really, really tough, excruciating manual labor like laying asphalt in the broiling Louisiana heat, building scaffolding at chemical plants, cleaning up after LSU football games. And he wasn’t going to get paid for this work, except for a pack of cigarettes per week.

There were hardly any counselors on staff for the number of people who were at the facility. There was barely time for him to attend counseling because he was working so many hours. I remember speaking with his counselor at the time, and she told me she would poke her head into his room after a long day at work and say, “How are you?”

He’d say, “Fine.” And then she’d mark that off as a counseling session. That was called treatment. 

HR: It really scared me when I read about how Chris was treated. I thought: Oh my God, he’s going into a cult and he can’t get out! He’s court-mandated, and if he leaves he’ll go to prison, and that makes him extremely vulnerable to all kinds of abuse.

SW: What you’re describing is also one of the most chilling aspects of this for me, too. Chris felt like he was a fuck-up. Then he comes into this program that is really designed to just break people down to their very essence and then build them back up into model citizens. But the building back up just was not happening for most people, and for Chris. These practices designed to break him down really gave him this feeling of complete worthlessness, like he had no future, he had no power, no sense of control.

That made it much easier to exploit Chris for unpaid labor. He was totally at the mercy of this program. I’ve learned about treatment and recovery, and there is one essential element for recovery and that is for people to feel a sense of self-efficacy, that they have the power and control to make changes in their lives and the confidence to execute those changes and envision a future for themselves. And I think that is one of the most disturbing things to me in learning Chris’s story.

“April just wanted to stop using and to be there for her children, and she was just stymied in so many different ways.”

HR: It was infuriating and heartbreaking to read about April Lee’s many attempts to get treatment.

SW: April experienced a lot of childhood trauma and ended up developing an addiction. She had three children and was taking care of them when she was sexually assaulted. April could have attended therapy at that time or gone into treatment, but she faced the predicament that so many single mothers face—which is that she has three children who are counting on her, she is their sole means of financial support and she couldn’t just take time off from doing that. Who would take care of her kids? There are few drug treatment programs that accept women with children.

So for various reasons she was unable to enter treatment at that time, and things just got worse. Child Protective Services came and took April’s children away, and then her addiction just escalated. She gave up after her children were removed, and ended up homeless on the streets of Kensington.

The only way that April could find to stop herself from using was to get arrested. So that’s what she did. She got taken to jail, and then from there she begged to be placed in a treatment program. By a stroke of luck, a person at the jail that she talked to heard of a program that might have room for her, and she jumped at the chance and made her way there. And it was just an incredible uphill battle for April every step of the way. She just wanted to stop using and to be there for her children, and she was just stymied in so many different ways.

This is one of the bigger takeaways that I had when reporting this book. I thought that I was writing a book about our addiction treatment system. But ultimately, what I found is that it’s often what happens after treatment or surrounding treatment that is more important than the treatment itself. For example, if April had child care, that would have allowed her to attend treatment and her addiction might not have escalated in the way that it did.

I learned while reporting this book about a concept called recovery capital. It’s a mixture of external and internal resources that people need in order to enter and sustain recovery. That could include community support and social networks, housing and financial security, transportation, a job, food, all the basics that everyone needs in life in order to survive. And I think this is where structural inequality just places people like April at a huge disadvantage, because she went into treatment lacking a lot of these basic necessities, and then once she entered the most serious phase of her addiction, she lost even more.

I think the longer someone remains in their addiction, the less recovery capital they have and the harder it is to accrue it. And so the punishment and marginalization that accompanies addiction can become almost as much of an obstacle to recovery as the addiction itself. And I think that is something April faced again and again, and it’s why it made it so much harder for her to enter recovery.

Top image shows detail from the cover of Rehab: An American Scandal, published August 2025 by Simon & Schuster. Photographs used with permission.

The post Blowing the Lid Off the Scandal of US Rehab appeared first on Filter.

One of the younger guys asked, Who’s Dorian?

We really have got to get these kids more access to the facility’s general library. The problem is, these days it’s even harder to get into than the law library. 

We’re allowed to visit each library once a week for two hours, but if you have an active case you get an additional two hours each week in the law library, in theory at least. No such allowance for the general library.

“Access to libraries is another thing the pandemic changed,” Polo said. Prior to the COVID-19 pandemic, “we had night education, counseling groups and library call … for the people who worked during the day. But with no officers, there was no one to open the education building. Add to that the contraband being thrown over the fences, and night movements ceased.”

Library access never recovered from COVID, or rather from the staffing exodus prompted by COVID. And people have been throwing us packages over the fence ever since tobacco became contraband, but the uptick of this practice during the pandemic became a pretext for canceling all evening programming, as if that’s what was responsible for all the contraband coming in.

Maybe 20 percent of the books we’re allowed to check out are useful for something other than killing time.

So now, even with the pandemic behind us, we still have no evening programming and everyone who works during the day can only get their two hours of general library time on Friday mornings. Only 25 people are allowed in the library at one time. Each Friday morning there’s about 50 people lined up outside the door. It’s a tense line, not the kind you’d want to try to cut into, though that’s true of pretty much any line in this place.

Assuming a facility is running on schedule to begin with, which this one usually isn’t, then during your two hours you can check out three books. Except not from the reference station, which is where they keep the dictionaries, encyclopedias, photography collections, history books and other books everyone wants. With those you have to just commit whatever you can to memory during your two hours. Of the books we are allowed to check out, maybe 20 percent are useful for something other than killing time.

Which doesn’t mean the other 80 percent are without merit. But you want at least one of your three books to be teaching you something—otherwise you’re just killing time for years, or the rest of your life.

During the couple of years when we all had tablets, the electronic libraries were like the general libraries in that they were a bit lacking in current material, or rather current material that was interesting. They did have a lot of the great and wondrous books that were written a long time ago,  except we were being charged a dollar per download. For books that outside prison were already free through Project Gutenberg. 

People do pay to quietly check out the reference books, and that works fine as long as they don’t lose them.

“Yeah, greater access to the [reference] library is what drove me to obtain one of the library clerk jobs,” Polo said. “Renting books isn’t a good hustle.”

At every prison job there’s a built-in hustle based on whatever that position gives you access to; some are not as lucrative as others. But people do pay to quietly check out the reference books, and that works fine as long as they don’t lose them, which they generally don’t. A person who’s inclined to pay for extra time with an encyclopedia is generally a person who’ll remember where they put it.

Prison libraries are often cited in the context of literacy and reading comprehension, and of course those are worthwhile in and of themselves. But general library access is also how a lot of people get better at connecting with their loved ones in the free world.

Handwritten letters are the backbone of inside-outside communications, and the more books people read, the more their spelling improves. They become more aware of how punctuation changes the tone of what they’re trying to say. As time goes on and they read genres they wouldn’t have otherwise—just due to being hungry for material they haven’t already read—their vocabulary expands, too. It would be nice if they were allowed to read as much as they wanted to.

*Name has been changed to protect source

Image (cropped) via City of Alexandria, Virginia

The post It Shouldn’t Be Quite This Hard to Get Into Our Prison’s Library appeared first on Filter.

Staff did not object to our repurposing a hallway broom closet. Folks working maintenance built some shelves. The first donated books we placed on them were ours. But once I shared the news with Kay, a pen pal who mailed books to starving minds behind bars all over the country, she immediately set about making sure we had a broad selection.

To date, Kay has donated 302 books to our unit library, not including dozens of dictionaries anyone could keep for personal use. We call the library “Books by Kay.”

Monday through Thursday and on Saturday, from 8 am to 10 am, anyone in our unit can check out one book at a time from Luther, our librarian, who maintains a log of who has what. The closet is a small walk-in with just enough room for a chair, so Luther sits and passes out books to those who come by. We pay him $5 per week out of our eldercare fund, but he would have done it for free.

“I get to talk to folks I wouldn’t normally talk to, about something I love. Which is books. I’ve always loved books,” Luther told Filter. “These are precious gifts that some kind lady sent us, and we thank her by treating them like the treasures they are.”

He puts our reviews on index cards tucked behind the back cover, including how many stars we gave the book, to help him make recommendations.

Over time, Kay’s donations have inspired prisoners to donate many of their own books too. Today there are 400 to 500 books on the shelves, except for the bottom one where Luther keeps his paperwork.

I spent an entire year fighting to receive The New Jim Crow, after the mailroom rejected it for “promoting racial bias.”

Kay’s first prison pen pal was a woman she wrote to once a week for 20 years. Kay was working at a large independent book store in Seattle, so she sent her books all the time.

“The prison sadly became more restrictive as time wore on, but I sent hundreds and hundreds of books to her in that time and she gobbled them up like candy,” Kay told Filter. When she left the book business, she decided that instead of spending more money to buy books for herself, from then on she’d read books from the library and use the money to send book into prisons.

At this facility, the only books we’re allowed to order ourselves must come through approved vendors like Barnes & Noble, which is expensive and severely restricts the selection. But outside contacts are allowed to send us books from Amazon and other publishers, as long as they’re new copies shipped directly from the publisher.

I spent an entire year fighting to receive The New Jim Crow, which I’d ordered through the proper channels, after the mailroom rejected it for “promoting racial bias.” I had to escalate the grievances all the way up to the Tennessee Department of Correction commissioner.

Tennessee prisons are in the process of getting tablets, which many fear will be used to ban books entirely because we’ll be able to download electronic books, even though they’ll still be expensive and limited to a pre-approved selection. CoreCivic did not respond to Filter‘s inquiry about future restrictions or the decision-making process for rejecting titles.

Here’s a book rejection that we just received from a prison in Tennessee: “Malcolm X not allowed.”

This is part of an insidious pattern of targeted bans by prisons against Black authors and against literature critiquing the prison system and power structures in this country. pic.twitter.com/eqC6Sn1qOu

— Books to Prisoners (Seattle) (@B2PSeattle) January 5, 2022

“When my wife passed last year, I didn’t think I could go on,” Bennett, 72, told Filter. She was in a nursing home, and he had not seen her for eight years. “I got a book out of the closet called Living When a Loved One Has Died. It saved my life.”

I’ve been incarcerated close to three decades. Books have kept me sane. They have shown me other places. They have taught me new skills. They have allowed me to cry and laugh, and have occasionally protected me from shanks.

Living in prison means living in constant fear. There is no place or time or situation where we are safe from violence. And we have fewer and fewer outlets for the toll that takes on us emotionally. The brief escape of meeting new characters, getting lost in new worlds—this allows us to go on.

If you want to know what people in prisons are most desperate for, look at the books they’re trying to get.

My buddy Ryan used to ask me to read his daughter’s letters to him. He’d run away from abusive parents as a kid, and was mostly homeless before coming into the prison system in his twenties. After 18 years, he was too embarrassed to tell his daughter that he’d never really learned how to read.

A freeworld friend of mine is a retired teacher, so she mailed in some elementary school-level books designed for teaching students how to read. Before long, Ryan was reading his daughter’s letters himself, the way he’d always wanted to.

Over the years, and especially since the pandemic, prisons have quietly taken away the educational and recreational programming opportunities that are supposed to help rehabilitate us. In some facilities, including South Central, there are none at all. But we still have the desire to learn, to grow. Like other prisoners across the country who’ve been cut off from state-funded programming, we’ve worked to create it ourselves.

The types of books Kay sees most often on wish lists, and that Luther sees being checked out the most at the library, have an obvious theme.

If you want to know what people in prisons are most desperate for, look at the books they’re trying to get: Dictionaries. Almanacs. Self-help books. Books from the “For Dummies” series. Books about learning to draw. Books about learning to speak Spanish. Books about origami and chess.

The woman Kay sent books to for 20 years used them to tutor women around her who were studying for the GED. (She has since been released, and she and Kay remain in touch.)

Our crochet club owes Kay for sending us Crocheting in Plain English. Luther says there’s always a wait list for that one.

South Central stopped letting in used books earlier in 2024.

The warden here liked “Books by Kay” so much that he had closets in the other units similarly converted. But it’ll be harder and harder to stock them, because there are more and more restrictions on what books prisoners are allowed to receive.

“I am sad that there have been so many restrictions,” Kay said. “That it is no longer simple to write snail mail to people inside, and used book are banned in so many places.”

Early in the pandemic, Kay began mailing one used book each day to prisons that still allowed them. Something we all appreciate about Kay’s donations is that she always sent hardcover copies that were used, but in great condition. I’ve always loved used books. I’d flip through looking for notes written in the margins or passages that had been underlined. Someone else had already found the book worth picking up, but sometimes you could see when they had really read it.

South Central stopped letting in used books earlier in 2024. Many prisons across the country have done the same, claiming they’re being used to smuggle in contraband. It’s the same justification being used to restrict more and more forms of mail. Rejected books are often destroyed without either the sender or recipient being notified.

“There are over 45 organized books-to-prisoner programs. I wish I could send you more research material on this important subject but those damned mailroom rule[s] prevent this,” Kay said. “It makes my blood pressure rise every time I think of restricting words and education from those [who] crave more learning and have time to absorb it.”

I mourn for us, that we have lost the magnificence of used books. I mourn for the books, too. They have lost so many of the people who wanted to read them.

Photograph via Washington State Library

The post To See the US Prisons Crisis, Look at the Books We’re Trying to Read appeared first on Filter.

Born in 43 BCE, his blush-making poems ultimately aroused the ire of the first Roman emperor, Augustus Caesar—a traditionalist who sought to instill values like monogamy and chastity in his subjects. In 8 CE, Augustus personally banished Ovid, who lived out the end of his days in rural exile near the Black Sea. All because of, in the words of the poet himself, “carmen et error”: a poem and a mistake.

Ovid frequently referenced poppies and opium in his work, and his personal relationship with the drug has drawn speculation in recent years.

The nature of the mistake has been a matter of debate for centuries, while the poem is generally agreed to be his somewhat skeevy Ars Amatoria, a kind of bisexual guide to courting.

Ovid frequently referenced poppies and opium in his work, and his personal relationship with the drug has similarly drawn speculation in recent years. As a classics student who previously used opioids, I am not wholly immune to this game.

Famously, his depiction, in Book XI of his Metamorphoses, of the cave of Somnus—a deity who personified sleep—relies heavily on heady imagery, which to a modern reader almost suggests a fantastical opium den: 

Near the Cimmerians, in a deep recess there is a cave, home and innermost chambers of idle Sleep, which neither rising, nor midday, nor falling Phoebus [i.e., the sun] could reach by his rays.

[…]

Beyond the entrances of the grotto fertile poppies and innumerable herbs flourish, through which the night gathers the sleep-draught from the poppy-milk and scatters it through the shaded lands. And no door produces shrill squeaks by oft-turned hinges, no guard stands at the threshold nor through the whole house.

But in the middle of the cave is a single-colored, ebony, elevated, downy bed covered by a dusky veil, in which sleeps the god himself, with languor of loose limbs. Here, in every direction lie empty dreams imitating varied shapes, as many as there are ears of harvested corn or leaves carried by a forest, or scattered sands upon a beach. 

[Lines 593-595 & 605-615, my translation] 

Yet there is no evidence that dimly-lit dens devoted to the pleasures of opium were a feature of Ovid’s Rome. In his day, the papaver somniferum, or opium poppy, more swiftly brought to mind religious and mythological associations.

Members of the Cult of Ceres, the Roman goddess of agriculture and fertility, may have used opium in their initiation rituals. To the ancient reader, these verses likely evoked the brief ritual sleep of devotees or the temporary “death” of winter more than hedonistic pleasures. To Romans, opium represented death, rebirth and fertility.

But what, if anything, does this tell us about his life? Some have argued that Ovid used opium for pleasure, and perhaps even experienced addiction.

Poppies were associated not only with Ceres, but also with the fictitious, infernal river Lethe, whose waters bring amnesia to those who drink them. As Ovid writes in the same section of Metamorphoses, “silent repose dwells here. The waters of the river Lethe flow forth from the depths of the stones, their gliding waves inviting sleep with a murmur through rustling pebbles” (Lines 602-604, my translation).

Given Lethe is located in the underworld, Hades, rather than above amongst the Cimmerians, this may suggest that Ovid wished to portray the cave—and sleep itself—as straddling the border between life and death.

But what, if anything, does this tell us about his life? Some have argued that Ovid used opium for pleasure, and perhaps even experienced addiction.

Researcher Paolo Necini notes the regularity with which opium appears in Ovid’s work, as well as referencing the poet’s “suspected opium addiction.”  He stops short of explicitly opining on this question, instead suggesting that Ovid likely “had a personal interest in poppy derivatives,” rather like his famous contemporary Virgil. As Necini notes, Virgil’s interest seems related to the religious symbolism of the plant.

D.C.A. Hillman, meanwhile, writes, “Ovid’s description of the precise effects of opium is proof that he was no stranger to the power of the drug.” Perhaps he wasn’t. But to suggest, as Hillman goes on to do, that this, together with references to other substances, forms compelling evidence that Ovid himself used opium seems a stretch.

Ovid’s other references to the psychoactive properties of papaver occur, for example, in works like his more autobiographical Tristia, which depicts in moving verse his despair in exile. Yet even these examples are too vague to prove his own use.

Nencini argues that despite widespread use of opium in antiquity, addiction to it was likely uncommon because of the context in which it was consumed.

We’re never entitled to assume that an author who displays understanding of a practice or state of being in their fiction experienced it personally. Poetry, in particular, is not necessarily factual, even when autobiographical. While Ovid’s apparent fascination with opium could be a sign that he partook regularly, it could just as easily be seen as a tool to illuminate the psychology of his characters. We have no clear evidence that Ovid ever consumed opium, let alone often.

Even if he did, the possibility that he might have experienced addiction seems remote, considering the lack of demonstrated impacts on his life and the culture in which he lived. Nencini, for example, argues that despite widespread use of opium in antiquity, addiction to it was likely uncommon because of the context in which it was consumed. Addiction, after all, is not determined by drug use per se but by the relationship a person has with their use.

“It was Zinberg who helped us realize the impact of any drug not only depends upon the substance, but crucially the ‘set and setting,” Professor Julian Buchanan, a drug policy researcher in New Zealand, told Filter. “So the person, their disposition, mood and expectation, play an important role, as does the culture and the environment where the drug is taken.”

These “contextual factors,” Buchanan added, also affect the level of risk.

I would argue that his artistic output matters far more than the question of whether the “poppy-milk” flowed through his veins.

In antiquity, opium use occurred largely in a ritual or medicinal context—the latter described, for example, by Pliny the Elder, who lived shortly after Ovid—and not so much a recreational one. Today, we know that only a tiny proportion of people—less than 1 percent of those with no history of addiction—experience substance use disorder related to opioids prescribed to them by a doctor. Drug prohibition, which makes use significantly riskier, also didn’t exist in ancient Rome. Buchanan emphasized that some societies can be structured in ways that decrease the risk of problematic drug use.

We cannot deny the prominence of opium in Ovid’s poetry. But despite the temptation to speculate about the lives of long-deceased luminaries, any personal relationship he may have had with the drug remains unknown and unknowable. And I would argue that his artistic output matters far more than the question of whether the “poppy-milk” flowed through his veins.

Ovid’s flair for psychological realism and gripping interpersonal drama have ensured his lasting influence. Opium user or not, he remains a fascinating and significant poet whose elegantly composed verses are still widely read. I prefer immersing myself in these enthralling poems to engaging in unwinnable debates.

Image of the John William Waterhouse painting Sleep and his Half-brother Death via Wikimedia Commons/Public Domain

The post “Sleep’s Cave”—The Speculation Around Ovid’s Opium References appeared first on Filter.

The book was put together by her mother, Sheila Ellin (pseudonym). It combines letters, poems and other documents written by Elizabeth with her mother’s commentary. The published work has an important purpose: not only showing the damage caused by our current systems of incarceration and rehab, but also how science-based harm reduction interventions, such as medications for opioid use disorder, could have saved Elizabeth’s life.

I have known Sheila Ellin, who lives in New Jersey, for some years through harm reduction circles. I recently had the opportunity to interview her about her daughter’s story. Our interview has been edited for length and clarity.

Kenneth Anderson: Who was Elizabeth, and what happened to her?

Sheila Ellin: Elizabeth was gifted in so many areas—writing, art, music, fashion design—but she also struggled with social anxiety, depression and low self-esteem, made worse by childhood sexual abuse. She started self-medicating with several substances, and at age 19 she was arrested for possession and entered the criminal-legal system.

Elizabeth attended six 12-step rehabs, and was locked up in three county jails, the New Jersey state prison and several prison halfway houses. Elizabeth died from endocarditis at age 29.

“The 12-step model was useless to Elizabeth. In fact, it made her feel like a failure. That system, and most of the world, judged her.”

When did you first learn about Elizabeth’s drug use?

In January of Elizabeth’s junior year of high school, I found a lighter when I was cleaning her bedroom. I knew Elizabeth was strongly anti-smoking [of cigarettes], so I concluded that she was smoking marijuana. When I asked her about it, she told me she was “just experimenting,” and so that was that.

Three and a half years later, when she was 19, she called me in tears, and told me she was addicted to heroin.

What did you expect would happen when she first entered rehab?

When we arranged for Elizabeth to go to rehab the first time, after she told me she was addicted to heroin, I believed that she would spend 28 days in rehab [and that] she would have to go to AA/NA meetings, and she would no longer be able to use any drugs or alcohol. I thought after 28 days, her life would be back on track—as if her heroin use had never even happened. A minor blip.

What was the actual result of her going to rehab?

The actual result [was] that Elizabeth, and all the people around her, started viewing her as a “drug user” and college drop out.

She did meet her soulmate in her first rehab, and I am happy that she experienced true love in her shortened life. But the rehab did nothing for her.

They diagnosed her with an eating disorder and depression, but did not give her any medication, because they required a person to be abstinent from all substances before they would consider medication.

The 12-step model was useless to Elizabeth. In fact, it made her feel like a failure. She did not go to meetings after she left rehab; she did not get a sponsor. She just did not buy into the whole abstinence, 12 step-based system.

That system, and most of the world, judged her for that—they judged her a failure for her relapses, and for her not buying into what they were peddling.

How did her involvement in the criminal-legal system affect her?

Her involvement with the criminal system, obviously, affected Elizabeth in many ways, all negative. Elizabeth struggled with anger all her life, and being in prison increased her anger and resentment towards those who mistreated her in prison and out of prison. Her mental health suffered in prison, because she was separated from her baby, from her family, her friends, and everything she loved.

Upon leaving prison, Elizabeth was not eligible for assistance with housing because she had drug [convictions]. And because of her drug possession felonies, Elizabeth’s job options were limited.

“There are many things I believe could have helped Elizabeth. None of them are rehab or prison.”

How was her continuing experience in the treatment system?

The treatment system did not help Elizabeth. Elizabeth was always an “A” student, and she was an excellent student in 12-step rehab programs as well. She tried her best. She did all the work sheets; she worked the Steps. She was always optimistic—but that is because Elizabeth and I and so many others believed the culture of 12-step rehabs. We believed they would do what they said they would.

No matter how hard Elizabeth tried inside rehab, as soon as she was out, her issues led her to begin immediately self-medicating and using again. She was kicked out of two or three rehabs for “fraternization”—even though she always told the rehabs she had a sex addiction.

I think the main effect of the rehabs was to make Elizabeth feel like a failure. She wasn’t a failure; 12-step rehabs were just not a fit for Elizabeth. But they made her feel she was a failure. It was kicking her when she was down—over and over, with every relapse or arrest for possession.

We know that help with injection techniques and availability of alternatives could have reduced Elizabeth’s risk of endocarditis. What else do you think might have helped her?

There are many things I believe could have helped Elizabeth. None of them are rehab or prison. I would say harm reduction, [including] treatment with methadone or buprenorphine. Trauma-informed therapy—for her PTSD, the loss of her son [he was removed rom her care, and she was not allowed to see him], domestic violence, multiple rapes, childhood sexual abuse—evidence-based treatment such as cognitive behavioral therapy or dialectical behavioral therapy.

Something that would really have helped Elizabeth, and all people who use drugs, is reducing the stigma towards drug users. Elizabeth talked about herself as a criminal, loser, deadbeat mom, college dropout, etc. For people who are using drugs because they are struggling, stigma just makes them feel so much worse about themselves.

How has your loss affected you in the years since?

I’ve dealt with mental health issues since I was a child. Elizabeth was the light of my life. My mother died of cancer when I was 15. My mother was a wonderful person. Losing her, and then losing Elizabeth, who was the best thing by far to ever happen to me, has been a nightmare.

But almost worse than losing Elizabeth was seeing/feeling the pain that she went through and not being able to help her. It has changed me in ways too complicated to get into here, but I believe I am more compassionate, and I believe I am more open to new ideas and different ways of seeing the world.

“Harm reduction has changed the way I view the world.”

 

How did you come to learn about harm reduction?

I came to know about harm reduction in 2016, two years after Elizabeth’s death. I was in the Facebook group GRASP (Grief Recovery After a Substance Passing) and I made a post. An admin said my post wasn’t right for GRASP, but was perfect for their sister group Broken No More, which dealt with harm reduction, medication-assisted treatment, advocacy etc. I went to Broken No More. For several months, I read every single post, every single day.

Later that year, I attended the GRASP/Broken No More conference. The next year, the Reform conference, and the following year, the National Harm Reduction Conference.

How has harm reduction changed you?

Harm reduction has changed the way I view the world. I guess, growing up, I was relatively conservative, and I believed drugs were illegal because they were “bad.” I thought if people were arrested for possession of drugs—well, they broke the law.

After learning about harm reduction, I believe people should be able to use whatever substances they want, as long as they’re not hurting other people. I participated in advocacy groups in New York State for several years, and I spoke in Albany several times. I did not ever think I would be the type of person to have the desire or the capability to do that, but I felt very strongly, and I continue to feel very strongly about advocacy.

What would you say to other moms in the situation you experienced?

To moms in this situation, I guess what I would suggest is: One, be a support and love your child unconditionally and without judgment. Don’t believe what treatment centers tell you and don’t try “tough love” unless it’s a serious safety issue.

And two, educate yourself. The internet was not as big when Elizabeth was alive, and maybe things would’ve been different if I had learned about harm reduction and medication-assisted treatment when she was alive. Back then I read a lot of books, but most of the books were written by people in recovery through the 12 Steps, so they were pretty much useless.

“Harm reduction does not require abstinence as a condition to help a person make positive change in their life.”

What is wrong with the way the US treats people who use drugs?

Everything. Criminalization is wrong, mass incarceration is wrong, drug courts are wrong—because they punish participants by putting them in jail—stigma is wrong….

Our whole culture’s belief and fixation on 12-step rehabs, then AA/NA meetings and abstinence for the rest of your life, is just wrong—because it does not work for the majority. The $35 billion per year (several years ago) rehab industry is just not working. People need to understand that it is not working.

Another thing people need to understand is that most people who use drugs never have a problem. They just stop on their own or continue to use in a functional way. That’s something I learned through harm reduction, and most people don’t understand that. Before Elizabeth struggled, I just assumed that everyone who used heroin, crack, meth, etc., would get addicted and would have problems. No. Wrong.

What is wrong with the US treatment system?

I guess the main thing wrong is that no single treatment type will ever work for everyone. Individuals need different types of help with finding a safe place to live [with] poly-substance use, mental health issues, trauma—and everyone is different. There’s no way one type of treatment is going to work for everybody. And abstinence is not gonna happen for everyone.

If Elizabeth had lived, maybe she would’ve stopped some substances or moderated, but with all the trauma and her issues and her genetics, I do not believe she ever would’ve been abstinent, and I certainly would not have expected her to be. Substances were Elizabeth’s coping mechanisms, and I believe they work better than current psych medications for the most part.

Why is harm reduction a better way?

Harm reduction is a better way because it meets the person where they are at, without judgment. Harm reduction considers all aspects of the human condition and tries to help in any way to make a person’s life better, and reduce the harm of the substances they’re using or the behaviors they’re doing. Harm reduction does not require abstinence as a condition to help a person make positive change in their life.

Detail from the cover of Addicted and Convicted: Letters from a Lost Daughter, showing Elizabeth Elliot, courtesy of Sheila Ellin

The post A Daughter’s Life and Death, Seen Through a Harm Reduction Lens appeared first on Filter.

Not all of that history was bad. Even ideas as outlandish-sounding as a strychnine “cure” were sometimes developed with a sincere belief in the efficacy of the treatment. Yet greed, and the willingness to disempower and punish people with addictions, have been key drivers of the story. Sound familiar?

Those themes are prominent in Sanitariums, Hospitals and the Belladonna Cure, by Kenneth Anderson. It’s the third volume of his Untold History of Addiction Treatment in America. Filter previously interviewed him about the first two: Strychnine & Gold (2021, in two parts) and From Inebriate Asylums to Narcotics Farms (2022).

Anderson is the founder and executive director of HAMS (Harm Reduction, Abstinence and Moderation Support), a group of 20,000 members worldwide who are changing their drinking through harm reduction methods. He’s also the author of How to Change Your Drinking (2010), and he and I co-authored Better is Better: Stories of Alcohol Harm Reduction (2022).

I caught up with him to ask what he discovered in researching and writing Sanitariums, Hospitals and the Belladonna Cure.

April Wilson Smith: What do you think might most catch people’s attention out of the material in your latest book?

Kenneth Anderson: Your readers might be most interested in the belladonna cure at the Towns Hospital in New York City. The Charles B. Towns Hospital and his belladonna cure became famous because Alcoholics Anonymous founder Bill Wilson had his vision of God while under the influence of the belladonna there. 

What is belladonna?

Belladonna is another name for the deadly nightshade plant. However, some helpful medications still in use today are extracted from belladonna. One of these is scopolamine, a medication for motion sickness. Another is atropine, which is what your eye doctor puts in your eyes to dilate them. In higher doses, such as those used in the “belladonna cure,” it is a hallucinogen.  

So I’m not going to get my eyes dilated and think I see God?

Not quite. It’s all in the dosage.  

“The formula was given with heavy doses of mercury-based cathartics, until the ‘characteristic liquid green stool composed of mucus and bile’ appeared, which Towns said was a sign the patient was cured.”

What’s the story of how the Towns Hospital was founded?

It was founded by Charles B. Towns, who was an insurance salesman from Georgia. Towns was a very successful, high-pressure insurance salesman. He had an eighth-grade education and never studied science or medicine. In 1899, he moved to New York City and went into the stock brokering business. Shortly afterwards, he was convicted of embezzling funds from his clients and given a suspended sentence.

After that Towns disappears until 1905, when he shows up advertising a cure for the “opium habit,” using a secret formula. Towns partnered with a physician named Dr. Mariette McGinnis for a couple of years, operating an opium cure business in New York City. Then, from spring of 1908 to 1909, he moved to China to operate an opium cure business, because he thought he would find many people addicted to opium there. Towns told a lot of tall tales about facing down warlords with his trusty six-gun while in China.

Although later promotional materials state that the Towns Hospital was founded in 1901, there is no evidence that it was in operation prior to a January 29, 1905 ad in the New York Times. At this point the Towns family was sharing an apartment with Dr. McGinnis, and the Towns Cure was operating out of her private office. In late 1905, the Towns Cure moved to 119 West 81st Street; in 1914, it moved to 292-293 Central Park West, which had 50 rooms.

After he got back to the US in 1909, Towns decided he could make more money with his hospital if he made his secret formula public.

How did he do that?

He enlisted the aid of Alexander Lambert, who would later serve as president of the American Medical Association, to help him publish the formula in the Journal of the American Medical Association.

Lambert was an interesting fellow. He favored universal health care and health insurance on the European model, and he’d read a lot of medical articles in French and German. Unfortunately, Lambert was also very gullible and not familiar with the addiction literature in the US. Thus he published Towns’ questionable cure.

The formula was two parts tincture of belladonna leaves, one part fluid extract of prickly ash, and one part fluid extract of henbane. This was given together with heavy doses of mercury-based cathartics for several days, until the “characteristic liquid green stool composed of mucus and bile” appeared, which Towns said was a sign the patient was cured.

What happened next? 

Immediately after the Towns formula was published, a doctor named Jacob Albright came forward to say that he had published that formula in a book in 1900, years before Towns and Lambert published in 1909. There’s nothing new here, Albright said. In fact, Albright admitted that he didn’t invent it either; another doctor gave it to him.

Next, a Dr. George Pettey also objected, writing, “I have been using scopolamine which is extracted from belladonna since 1901 to treat the opium habit and the Towns formula that uses belladonna is inferior because you can’t give exact doses the way you can with the alkaloid extracts that I use.” 

“Bill Wilson went there due to its reputation. Its reputation was not backed up by the evidence, however.”

 

How did Towns say that he got the formula? 

At first Towns claimed that he had invented the cure himself. But later he said that he had bought the formula from a mysterious stranger he later identified as Robert Steele, and that he had spent years painstakingly perfecting it.

This is contradicted by the fact that the final published formula, published in 1909, was nearly identical to the formula published by Albright in 1900. It seems equally likely that Towns got the formula from Dr. McGinnis, but would never admit to being indebted to a woman for anything.

Despite all this, Lambert continued to endorse Towns, and the Towns Hospital continued to be in operation until 1965. Although details are scarce, the hospital appears to have phased out the belladonna cure and switched to more modern methods around 1950. Throughout its history, it specialized solely in addiction treatment.

How did the Towns Hospital get so famous? 

Due to endorsements by people like Lambert, who was not only a president of the AMA but also Teddy Roosevelt’s personal physician, the Towns Hospital became quite respectable among the general populace. Most of the medical world, however, did not respect it and viewed its founder with contempt. But Towns’ high-level endorsements gave it good standing in the eyes of the general public.

So that’s why Bill Wilson went there to detox? Was the Towns Hospital actually effective in curing people’s addiction problems? 

Bill Wilson went there due to its reputation. Its reputation was not backed up by the evidence, however. In 1920, the New York City Commission on Addiction reported a follow up of 200 opiate-addicted patients treated with the Towns cure and found that only 5 percent were abstinent during the intervening 11 years since taking the cure. Moreover, most physicians said that belladonna was contraindicated for alcohol withdrawal.

Eventually the Towns Hospital closed, because by 1965 there were a number of facilities offering free treatment and it couldn’t keep making money.  

“He literally advocated for exterminating people—that ‘these people’ should be put out of their misery.”

What else should we know about Charles B. Towns?

In an article titled “How to Eliminate the Alcoholic as an Insane Problem,” published in the 1917 Proceedings of Sixth Annual Meeting of the Alienists and Neurologists of America, Towns advocated for the creation of death camps for people who resumed use after undergoing his addiction treatment. He called these hypothetical camps “the pound.” He literally advocated for exterminating people in this category—he did not specify how, just suggested the camps, and that “these people” should be put out of their misery.

Towns also helped to draft the 1914 Boylan Act in New York City that criminalized syringes and opiates. It was sometimes known as the Towns-Boylan Act. This was before the federal Harrison Narcotics Tax Act, which took effect in 1915 and effectively outlawed opiates and coca products, and it was something of a model for that national legislation.

The Boylan Act had a mandatory treatment provision and allowed the state to pay for treatment at private treatment centers—such as the one that Towns owned.  

Another character you introduce in the book is Harry Hubbell Kane.  Who was he, and why was he important to the history of addiction treatment?

Harry Hubbell Kane opened the De Quincey Home, which offered addiction cures, in 1881, in Washington Heights, New York City. Kane was very well known as the author of a number of books about opium. These included: The Hypodermic Injection of Morphia (1880), Drugs that Enslave (1881) and Opium Smoking in America and China (1882). The De Quincey Home was named after Thomas De Quincey, author of Confessions of an English Opium Eater (1821). It was not in business for very long, only about two years.

Kane liked to live high. He was involved in horse racing and owned his own race horse. He soon needed another source of cash. After the home closed down, he started selling a patent medicine of his own devising, called “Scotch Oats Essence.”

“Kane was arrested because his business was a scam: His patients had taken the medicine to be analyzed, and found that it contained no radium!”

Soon, this concoction was exposed in the Druggists’ Circular and Chemical Gazette. It was one-third alcohol, and each ounce contained half a grain of morphine. Kane advertised it as “safe for everyone from infants to octogenarians.” He claimed that it cured everything from paralysis to impotence to insanity to the morphine habit. After Scotch Oats Essence was exposed, Kane filed for bankruptcy.

But he then started a business operating a radium cure, which was very popular because in 1903 Marie Curie won the Nobel Prize for her pioneering work in radioactivity, and for a time radium was considered a cure-all. In 1905 Kane was arrested because his business was a scam: His patients had taken the medicine to be analyzed, and found that it contained no radium!

Kane and his business partner, William Henry Hale, pleaded guilty to swindling a patient, John McCallum, out of his life savings. They had told him he was dying of kidney disease, although there was nothing wrong with him. They sold McCallum medication which they said contained extremely expensive radium, but he sent it for analysis, which showed no such thing. Kane was sentenced to four months in prison and Hale to eight—their sentences were lighter because they returned the money.

Kane died in 1906. Hale was last reported as being the personal physician to Francisco “Pancho” Villa, the leading figure in the Mexican Revolution. 

These are fascinating stories. But what do you think they tell us about addiction treatment today?

What they tell us is that nothing has really changed: It’s still a crooked and corrupt business, the same as always.

Photograph of Atropa belladonna (“deadly nightshade”) by GT1976 via Wikimedia Commons/Creative Commons 4.0

The post Belladonna and Bad Actors: The Telling History of Addiction Treatment appeared first on Filter.