The backlash was swift and brutal. Polanski’s support for the regulation of substances like cannabis and MDMA was “reckless,” according to media commentators. And prescribed heroin on the National Health Service? “State-sponsored drug taking.”

Britain’s prohibitionist drug policies are now so deeply entrenched that it’s hard to believe it was long a world leader in what would now be called safe supply.

From 1926, doctors were legally allowed to prescribe pharmaceutical heroin (diamorphine) and other opiates to patients with dependencies. This followed the publication of a landmark report by Sir Humphrey Rolleston, former president of the Royal College of Physicians and chair of the government Committee on Morphine and Heroin Addiction.

The Rolleston Report framed addiction as an illness and established a framework that placed primary responsibility for it with the medical profession. It allowed doctors to prescribe maintenance doses of drugs to those for whom withdrawal wasn’t feasible.

“Many psychiatrists had the view that the only treatment was to get people off drugs completely,” Dr. John Marks told Filter. Marks is a former psychiatrist who bucked that trend.

But after the adoption of the 1961 UN Single Convention on Narcotic Drugs, which set out the principles of global prohibition, Britain introduced regulations in 1971 that meant only psychiatrists could prescribe heroin at specialist clinics. This effectively ended the so-called “British system.”

“Many psychiatrists had the view that the only treatment was to get people off drugs completely,” Dr. John Marks told Filter.

Marks is a former psychiatrist who bucked that trend. He is renowned for running maintenance clinics in North West England for 13 years in the 1980s and ‘90s, in what became known as the “Merseyside experiment.”

When Marks began working as a consultant psychiatrist in Widnes, a small town near Liverpool, and was asked to take charge of an existing Rolleston-style clinic, he initially shared the view of many of his colleagues.

“It seemed so pointless to me, I wanted to try something different,” he said. “But I was told to leave it alone, that it ‘just works.’”

As time went on and he got to know the patients, his perspective began to shift. 

Mortality fell sharply in Widnes, reflecting people’s access to drugs of known dosage without adulterants.

“There was one patient, Sid, a reasonably smart, working-class ex-docker, with a wife and kids. There was nothing to distinguish him from you or me,” he said. “[Sid] was the opposite of what the public thinks of as an ‘addict,’ and that made me look into this further.”

With research funding from the government, Marks and his colleague, Dr. Russell Newcombe, began investigating the effects of the Widnes Drug Dependency Clinic, monitoring patients and comparing outcomes to those in Bootle, a nearby town where only abstinence-based treatment was offered. 

Mortality fell sharply in Widnes compared to areas where heroin was not prescribed, reflecting people’s access to drugs of known dosage without adulterants. That’s in line with what we know about modern safe supply programs.

“In Bootle, there was a 16 percent mortality rate,” Marks said of that cohort. “In Widnes, we didn’t have a single death.”

But more surprising, Marks said, was the impact on rates of drug dependency. “There was a decrease in incidences of addiction from 207.6 per 100,000 to 15.83. That is an 18-fold, over 90-percent reduction.”

Marks was then invited to set up a similar clinic in Liverpool, which was “as successful, on a much larger scale.”

In addition, when people could obtain drugs legally—and without having to find the means to pay for them, due to the United Kingdom’s universal health care system—they were far less likely to be arrested.

“In the comparison group, there were 6.88 criminal convictions per patient per year,” Marks said. “In Widnes, it was 0.44. That’s a 12-fold reduction.”

Marks was then invited to set up a similar clinic in Liverpool, which was “as successful, on a much larger scale.” So much so that in 1990, the retail chain Marks & Spencer sponsored the world’s first international conference on harm reduction in the city, after seeing a dramatic fall in shoplifting at its local stores.

After his research was published in 1991, journalists began contacting Marks, and he gave numerous media interviews about his work, which was often portrayed as “controversial.”

As Toby Seddon wrote in a 2020 paper about Marks and the Merseyside model, his supporters saw him as a “humane doctor responding pragmatically to an extraordinary social problem,” but to his critics, he was an “irresponsible maverick who risked prolonging addiction careers and expanding the heroin-using population.”

As US influence drove international pressure, the British clinics were closed down in 1995. Marks became “vilified” and left the UK.

A number of senior politicians at the time, including the Conservative Prime Minister Margaret Thatcher and Health Minister Norman Fowler, were supportive of Marks. But political pressure was mounting—including from the United States, where President Richard Nixon’s “War on Drugs,” enthusiastically escalated by his successors, had ramped up enforcement of prohibition.

“It was two opposing political ideologies,” Neil Woods told Filter. A former police officer-turned advocate with LEAP (Law Enforcement Action Partnership), he’s now a prominent British opponent of the drug war he once fought.

“The British system viewed someone with a problem as having an unfortunate medical condition and offered them help,” he said. “The American system saw addiction as a moral failing [for] which people should be criminalized. But after the Second World War, we owed America enormous amounts of money.”

As US influence drove international pressure to establish coordinated global prohibition, the British clinics were closed down in 1995. Marks became “vilified,” as he put it, and left the UK for New Zealand, eventually leaving the field of addiction medicine too.

Yet the Merseyside experiment would be used to inform similar drug policies and regulation pilots around the world, such as Switzerland’s prescribed heroin program, which launched in 1994.

An evaluation of its results found large reductions in illicit drug use and drug-related convictions and significant improvement in participants’ health and social status. No overdose-related deaths were recorded.

Implementing programs like the Merseyside model once again would not necessarily require a major change in legislation.

“Almost all of those in the initial cohorts [of the program] are no longer using heroin,” Woods noted. “As soon as you medically control it, the market shrinks. In Switzerland, there are no children dealing heroin.”

Meanwhile, in England, the Children’s Society estimates that 46,000 children are being exploited by ‘“County Lines” gangs. Over 300,000 adults were registered with drug and alcohol treatment services in 2024, and drug-related deaths are at a 30-year high.

“There are many reasons why [current drug laws] are not working,” Woods said. “Not least of which is that criminalizing people stigmatizes them and makes it harder to get help.”

But implementing programs like the Merseyside model once again would not necessarily require a major change in legislation.

In 2019, a heroin-assisted treatment pilot was launched in Middlesbrough, with a licence to prescribe patients a supervised dose of diamorphine twice a day. 

An assessment by the University of Teesside found that the majority of those who took part in the first year reported improvements in wellbeing and quality of life, with none reporting any new injection-related wounds or infections. Most either stopped or reduced their use of unregulated heroin, and there was a reported 60-percent reduction in criminalized behaviors. There were no deaths among participants over the 12-month period. 

But the program was forced to close in 2022, after its funding was cut. 

Marks is saddened by the current state of British drug policy, and the sense that even if the country is able to move forward once again, it wasted decades by banning a model that “just works.”

The UK government continues to insist it will not revisit laws to allow for overdose prevention centers—though Scotland opened its first in 2025, authorized and funded by the Scottish government—despite recent pressure from the UK Parliament’s Scottish Affairs Committee. 

At the Scottish Green Party’s annual conference in October, members voted overwhelmingly to approve a policy calling for the regulation of drugs in Scotland.

MSP Maggie Chapman

Maggie Chapman, a member of the Scottish Parliament and the Scottish Greens’ spokesperson on drugs, said the country’s “appalling drug death numbers” show the drug war has “obviously” failed. Her party now calls for a “compassionate” and “evidence-led” approach, with all drugs—including alcohol and nicotine—regulated according to risks, alongside a clear prevention strategy.

“It has to sit alongside a preventative approach,” Chapman told Filter. “That includes investing in care and support services that aren’t about punishment or fixing the problem once it’s happened.”

The Greens believe their policy strikes the right balance between strict prohibition and an unrestrained commercial market.

This supposed sweet spot of regulated control is illustrated by a bell curve in Marks’ seminal 1991 paper, titled, “The North Wind and the Sun.”

“Free markets promote consumption, black markets peddle consumption, regulated markets control consumption,” Marks said.

He’s saddened by the current state of British drug policy, and the sense that even if the country is able to move forward once again, it wasted decades by banning a model that “just works.”

Top photograph (adapted) via PublicDomainPictures. Photograph of Maggie Chapman by Sarah Sinclair. Graphic courtesy of Dr. John Marks.

LEAP was formerly the fiscal sponsor of The Influence Foundation, which operates Filter. Filter‘s Editorial Independence Policy applies.

The post The Merseyside Experiment: Will UK Recall Its Heroin-Prescribing History? appeared first on Filter.

Among respondents who used drugs of all kinds, 70 percent said they used to have fun or get high. That was particularly pronounced among MDMA consumers, with 88 percent reporting that they use it for fun. Some different motivations were apparent depending on the drug, however. About 60 percent of people using heroin, for example, mainly used it to reduce stress or relax. Meanwhile around a third of people using amphetamines, powder cocaine or MDMA did so to socialize.

Delivered across May and June 2024 by the European Drugs Agency, a European Union monitoring body, the survey gathered insights about drug use in the past year from over 67,000 people in 35 countries, including most EU members and nearby places like the Western Balkans, Ukraine, Lebanon and Palestine. Its results were published in late February. 

The multi-national coverage paints a hugely valuable picture, though with some limitations. The self-selecting nature of respondents and variability of countries’ implementation mean the survey is not necessarily representative of national drug prevalence rates. This edition, for example, had a disproportionate number of responses from Sweden and Spain. However, the results have been aggregated with other national measures of drug prevalence to provide more accurate insights.

Almost three-quarters of respondents used drugs at home. This finding is particularly informative for future harm reduction work.

The web-based, time-consuming nature of the survey also means that certain groups of people who use drugs, especially the most marginalized, may be underrepresented.

The last edition was in 2021, and depicted Europe’s post-COVID drug landscape. The latest edition offers more granular insights into people’s habits, and reflects wider recognition of the normality of drug use.

Many of the results uncovered are not groundbreaking: Alcohol and tobacco/nicotine—an aggregation of tobacco with non-tobacco products like vapes and pouches—were consistently the most used drugs across all nations (the survey did not include caffeine). Among the “illegals,” cannabis was by far the most popular, with almost 60 percent of respondents reporting its use. Second came MDMA, with 30 percent of respondents using it, followed by powder or crack cocaine (29 percent).

For many, home is where the drugs are: Almost three-quarters (73 percent) of respondents used drugs at home. This tracked with the 2021 survey, although it was then unclear whether this preference was due to ongoing pandemic restrictions. 

This finding is particularly informative for future harm reduction work. With so many resources and interventions focused on social settings, developing projects or techniques to keep people safe when using in private settings, potentially alone, is increasingly important.

There were some predictable exceptions to the general preference for the home setting. MDMA was primarily used (79 percent) at music festivals or parties, with 45 percent of users opting for clubs or bars. Powder cocaine was primarily used (68 percent) in clubs or bars. Cannabis, crack cocaine and heroin were the drugs most likely to be used in nature or in public spaces like streets and parks.

The most likely combinations of criminalized substances were methamphetamine and cannabis, and heroin and benzodiazepines.  

This edition of the survey also drilled down on the reality of polysubstance use. This should be a given: If you ask people who use drugs whether they use more than one substance, “mono use” is likely to be the exception. 

The results clearly reflected this, with 96 percent of respondents reporting that they used more than two drugs on the same occasion in the past year. 

Alcohol and tobacco/nicotine were consistently the substances most often mixed with other drug groups. The most likely combinations of criminalized substances were methamphetamine and cannabis (mixed by 31 percent of respondents) and heroin and benzodiazepines (30 percent). But powder cocaine was overall the criminalized substance most likely to be mixed with other drugs. Notably, 30 percent of people using cannabis said they would not mix it with other drugs. 

While polysubstance use has long been known as typical, capturing it in the survey represented a big methodological challenge, according to the researchers. 

“I can say that defining [polysubstance use] was one of the things that took the longest and generated the most discussions,” João Matias, scientific analyst at the EUDA and the survey’s lead designer, told Filter. The survey’s format—from what to ask, to which drugs to include or group together—had to be agreed across all 35 participating countries.

As for what “polysubstance use” should be taken to mean, “These are substances you take at the same time, or in a row, or with a few hours in between,” Matias said. “It’s complicated. What’s really a ‘use session’? Methodologically, it’s a challenge.” 

The survey decided to define polysubstance use as “the use of two or more substances on the same occasion,” leaving respondents to interpret that for themselves.  

Alexei Lakhov, the executive director of the European Network of People who Use Drugs (EuroNPUD), was not surprised by the findings—or the researchers’ difficulties.

“I think that poly-drug use accurately reflects real-world trends,” he told Filter. “In addition, some people just don’t perceive certain substances, such as alcohol, benzos or tobacco, as ‘drugs’ per se, and can use them even without wanting to ‘get high.’” 

“In a fatal overdose, it’s rare for just one drug to be in someone’s system. So we need to integrate the concept [of polysubstance use] into all our work.”

Despite the challenges, Matias underscored that it was essential to capture this finding. “We have data for the first time confirming what people have said, that it’s rare for people to just use one drug.”

“We need to work on definitions, as it’s a field with little consensus,” he continued. “We need to apply a poly-use perspective not only in data collection but also in how we interpret drug use and interventions. In a fatal overdose, it’s rare for just one drug to be in someone’s system. So we need to integrate the concept into all our work.”

Studies on polysubstance use are relatively rare, and much of the research that exists has a narrower focus on just two drugs. Only a handful of examples—like a 2006 study looking at alcohol and prescription stimulants, painkillers and sedatives, or a 2022 study examining motivations for poly-drug use—have made broader attempts to widen our understanding.

As British researchers stated almost 20 years ago, polysubstance use is “poorly defined” and “frequently overlooked”—and this partly still holds true. But the benefits of engaging in this work have the potential to be felt across all drug-using communities.

“Recognizing that people who use drugs may seek specific combinations to achieve desired effects, cope with personal issues, or enhance social experiences can inform more empathetic and tailored harm reduction strategies,” Lakhov said.

The survey’s reflection of people’s pleasure in using drugs is also important. It’s another area that research largely ignores—contributing to harmful policies, when drugs are often viewed purely through a pathologizing or negative lens.

Drug use is as messy, complex and diverse as life itself. It is crucial to have a body of research that reflects this reality, so that we can develop more pragmatic and effective support for people who need and want it.

Image (cropped) by Pixabay via Stockvault/Public Domain

The post Latest European Drug Survey Highlights Pleasure, Polysubstance Use appeared first on Filter.

In the years since, there have been further developments in the intervention. In 2008, for instance, some of the country’s clinics began making oral tablets of pharmaceutical-grade heroin (diacetylmorphine) available for participants who either wanted to discontinue injecting or who weren’t injecting in the first place.

However, these options don’t always meet every participant’s needs, according to Marc Vogel, head of Addiction Medicine at the University of Basel Psychiatric Clinics, which has a heroin-assisted treatment outpatient program. While some people may want to avoid injecting, they may still desire the “rush” or rapid onset that injecting provides—but which is missing if you use the tablets.

Vogel and colleagues across Switzerland developed a new way of providing heroin-assisted treatment: a nasal spray.

“You don’t have the same feeling—no rush, [the high is not] the same high as you get from injecting,” Dr. Vogel told Filter. And some people who don’t want to inject nonetheless “need this high in order to stabilize.”

To meet this need, Vogel and colleagues across Switzerland developed a new way of providing heroin-assisted treatment (HAT): a nasal spray.

Vogel, along with his colleagues and their associated out-patient clinics, recently released a paper, published in the Harm Reduction Journal, showing the results of a four-week observational study in which interested HAT participants were able to access the spray.

The team had first considered different options for a new route of administration for HAT. An early idea was taking the available heroin tablets and crushing them so participants could snort them—which many people were doing anyway, Vogel noted. However, there are various other compounds that go into the pills, he said, such as silicates, which could get into and damage the lungs if snorted. “From the point of harm reduction, this is not optimal.”

The team then turned its attention to the injectable formulation of heroin used in Swiss HAT. And in 2018, they tried adding atomizers to the syringes. The atomizers they used simply screw on the top of the syringe. You just need to push the plunger, then the liquid is forced through the atomizer into a fine mist that you can inhale through the nose.

The atomizers are totally mechanical, rather than electric, Vogel said. They are similar to those used to turn naloxone into a nasal spray to reverse opioid overdoses.

Some of the clinics involved started providing this option to a few people between 2018 and 2019 and saw that it worked quite well for some of them. From there, they worked with other treatment centers around Switzerland to do the observational study described in the paper, which the centers began in late 2020.

In all, around 20 centers agreed to be involved in the study. Across these facilities, 52 participants agreed to take part. The research team provided them with the spray and observed how it changed their heroin consumption over four weeks.

One of the main reasons the team heard for wanting to try the spray was that long periods of injecting had damaged some people’s veins. Another reason was that many of the participants simply preferred snorting heroin over other methods. Yet another was that the oral tablets did not have a strong enough effect. Others wanted to switch away from, or reduce, their injecting in favor of a potentially less risky consumption option.

After the four weeks, 47 respondents, or a little over 90 percent, were still using the nasal spray. Further, the weekly average of injections among participants decreased by 44 percent compared to the month prior. The paper also noted that no “severe adverse interactions were reported.”

“We think it’s a useful tool. It’s just one tool in the toolbox, right?”

“We think that for a subgroup of patients, this is a very attractive means of opioid agonist treatment,” Vogel said.

He added that in theory, this route of administration could expand to include other opioids, such as fentanyl. To his knowledge, fentanyl-assisted treatment programs like Swiss HAT do not exist—though he and other researchers have proposed it as an option. Fentanyl is not found in the Swiss heroin supply to anything like the extent of North America, so Vogel said that it wouldn’t realistically be possible for his team to study a nasal fentanyl spray. But he noted how some people in North America seek fentanyl and its analogs—and fentanyl safe supply programs do exist in Canada—so a spray formulation could be an option to consider there.

Vogel also cautioned that the results from the new study are just “preliminary,” meaning there’s room to learn more about how the spray impacts people accessing HAT. The clinics involved are currently recruiting more interested participants to gather more data, he said.

But in all, the nasal spray appears to be a success at this moment. To remove barriers to accessing programs like HAT, Vogel said, practitioners need to take steps that include offering a variety of routes of administration, so people can find what works for them. “We think it’s a useful tool. It’s just one tool in the toolbox, right?”

Photograph via FreeImagesLive.co.uk/Creative Commons 3.0

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The research, published in the Harm Reduction Journal, was a team effort between the People’s Harm Reduction Alliance (PHRA), the Urban Survivors Union (USU), and researchers from the University of Washington in Seattle along with other institutions.

To study the impact of the pipe, which is sometimes known as the “hammer,” due to its appearance, the team surveyed people participating in a large PHRA-operated syringe service program in Seattle between March and December 2019. Dr. Tom Fitzpatrick, one of the authors and an infectious disease fellow at the University of Washington, and his colleagues collected responses to establish the number of people using and injecting heroin both before and after the pipes were handed out in a pilot program.

The number of people who exclusively injected heroin decreased—from 43 to 32 percent—after the pipes were distributed.

In all, the team gathered 360 surveys from the pre-implementation stage and 430 post-implementation. More than half of respondents in both periods used heroin: 56 percent pre-implementation and 58 percent post-implementation. But the research found that the number of people who exclusively injected heroin decreased—from 43 to 32 percent—after the pipes were distributed.

Meanwhile, the proportion of people who both smoked and injected heroin, suggesting that they may have injected less than before, rose from 36 percent to 45 percent. Just under 44 percent of the respondents who had used heroin after receiving the pipes actually used the pipes; of this group, 34 percent said that the pipes reduced their injection frequency.

“The proportion of SSP clients who exclusively injected heroin was lower after implementation of heroin pipe distribution …” the researchers wrote. “This pilot highlights the potential for organizations led by people who use drugs to develop, implement, and evaluate novel public health programming.”

Though the research describes the harm reduction products as heroin pipes, heroin certainly isn’t the only thing that passes through them, given the rise of fentanyl, other potent synthetic opioids and further adulterants in street supplies. It should also be noted that “smoking” here doesn’t mean combustion (which would destroy heroin and other opioids), but rather vaporization, which happens at lower temperatures.

An option for people who inject opioids to “give their veins a break.”

Shilo Jama, a Sacramento-based harm reductionist who previously co-founded and ran PHRA, was one of the coauthors on the study. Recalling how he designed the heroin pipe along with members of the Urban Survivors Union, he told Filter that he did so, in part, as an option for people who inject opioids to “give their veins a break.”

The input and effort of Urban Survivors Union was “vital and important,” and the work wouldn’t have been successful without it, he added. Filter reported in 2019 on the process of developing the pipe.

There previously hadn’t been a widely available pipe to meet the needs of people who use opioids. Back around 2015, Jama began trying to address this. He began looking into old-school opium den pipes, but they tended to be ornate and impractical. He then began looking at dab pipes, commonly used with cannabis concentrates. However, he ultimately decided that he needed to develop a different pipe that was both effective and cost-effective.

In all, Jama and his colleagues tested 10 different designs. The final result is made out of Pyrex because the pipes need to be heat-resistant. It allows people who inhale opioids to operate it in two ways. One is simply slowly heating the thick bottom until the drugs vaporize. The other is to put heroin in tar form on the end of a paperclip, heat the edge of the pipe with a lighter, then place the heroin near the hot glass and inhale. In all, it took two years to develop the pipe. It’s manufactured by a glassblower whom Jama did not wish to name.

The PHRA and Urban Survivors union began handing out the pipes around 2019, and Jama reached out to various researchers about investigating their harm reduction impact.

The “gold standard” for the test, researcher Tom Fitzpatrick told Filter, would have been a randomized trial including both people who wanted and did not want the pipe. However, that was not practical. For one thing, there was no way to account for people buying, selling or sharing the pipes. And offering a new service only at random to people who come into an SSP didn’t seem totally ethical.

“[The PHRA] didn’t want to deny people access to a service,” Fitzpatrick said. Because the research did not use a randomized sample, the authors call it a “quasi-experimental study.”

“There’s a need for more research to pin down what the benefits are and how beneficial they are.”

There are many theoretical medical benefits to smoking heroin over injecting it, Fitzpatrick said. It avoids the risk of injection-related skin and soft-tissue infections. The risk of overdose might also be lower, he said, simply because opioids are less bioavailable when they are smoked compared to when they are injected. Relatedly, Fitzpatrick said that smoking opioids can also result in a less intense high, helping people to navigate their lives.

Jama agreed that smoking could lower a person’s risk of overdose, particularly considering the presence of fentanyl in unknown amounts in most batches of opioids. It can help people better control their doses, as past research has indicated. With smoking, people can take smaller hits and adjust their high a bit more easily than with injecting, which hits harder and faster, he said.

However, we still have more to learn about the differences between inhalation and injection. “There’s a need for more research to pin down what the benefits are and how beneficial they are,” Jama said.

Photograph of the “hammer” courtesy of Shilo Jama

The post After a Program Handed Out Heroin Pipes, Some People Injected Less appeared first on Filter.

Over the past year, I’ve been moving away from using drugs. One factor is that now that I’ve finally found a sleeping medication I can safely take on a regular basis, I no longer rely on illicitly acquired opioids to sleep through the night. Being able to medically transition has also helped, by making my default level of anxiety and distress far less intense.

I was never addicted to drugs. I always maintained control over my use. From the very start, I took breaks, though these breaks were often quite miserable due to my sleep troubles and various traumas—which were another reason for my using heroin in the first place.

This isn’t to say that my drug use didn’t come with downsides. The price certainly caused issues for me. This was one of the primary reasons I took breaks, even though I was much less functional when doing so; I needed to prevent myself from spending more than I could afford by keeping my tolerance down. And despite being as careful as possible, buying drugs from the dark web and utilizing harm reduction practices, I was not immune from risks. I experienced some physical ill-effects due to prohibition’s impact on supply and the associated difficulty, at times, of obtaining sterile injecting equipment.

My attempt to fight stigma had a heavy personal cost.

Social stigma certainly harmed me, too. I “came out” about my use to everyone in my life and beyond, through YouTube vlogs and a series of articles. My attempt to fight stigma had a heavy personal cost. I was trying to combat negative stereotypes, but many people made clear that they saw me as eccentric at best and irresponsible at worst. People who didn’t even know me assumed that I must be lying when I called myself functional. Few people, I found, wanted to work with someone who openly used heroin. Strangers insulted me online, which occasionally caused me to despair, sometimes to dangerous degrees.

Phasing opioids out of my life, now that I have reliable sleep meds, was not anything I did purposefully or intentionally. Rather, it just… happened. The breaks between periods of use become longer and longer. At some point in late 2021, I didn’t bother going back to using because the potential issues that went with it didn’t seem worth the trouble.

This wasn’t as big a deal for me as you might imagine. Unlike the lads from Trainspotting, I never considered opioids to be the best feeling in the world. I found exercise significantly more pleasing. Sex, too, made for a more enjoyable diversion than shooting up.

Instead of using drugs to escape the pain of my past, to forget the abusive relationships and the involuntary commitments and the sexual assault, I poured my time into writing fiction. Social distancing in my childhood bedroom, I spent whole days in front of my computer typing.

This new occupation soon took on unhealthy aspects. I neglected hygiene and relationships. I failed to reply to text messages or answer phone calls, leading me to fall out of contact with most of my friends. I wrote from the moment I awoke to the moment I went to sleep, leaving time for nothing more. I managed to pump out a number of manuscripts in this manner, the majority of which I never finished.

Miraculously, one of my few complete projects, a historical fiction novel narrated by an autistic girl, somehow caught the eye of a manager, who now represents me. My near-addictive relationship with story-spinning was thus rewarded.

When high, I could do other things. I could maintain relationships and attend events. Now, my attempts to escape take up the majority of my time.

Still, I couldn’t help but feel that it had become more disruptive than my drug use ever was. I wrote partly out of a desire to create, to build something, but mostly because I wanted to avoid being bothered by the past. If I don’t divert myself, I find myself ruminating endlessly on painful incidents. During my opioid-using days, I managed to suppress these memories, keeping myself in a calm and dreamy state. But now I revisit them constantly, albeit through the lens of fictionalized situations based on my experiences. I mull them over in my mind, dissecting what I can remember, assessing it from different angles, trying to understand the effect it had on me psychologically.

Quitting heroin, in short, has removed some inconveniences but not solved my problems. I still feel as haunted as the protagonist of some dreary old gothic novel, now dealing more directly with my inner turmoil. When high, I could do other things. I could maintain relationships and attend events. Now, my attempts to escape take up the majority of my time. I’m far more antisocial. I am chilly and gruff, particularly with my family. The closest of my remaining friends has expressed concern, though he insists that he’d rather I write compulsively than use drugs that I could overdose on. I both agree and don’t.

I haven’t been able to handle Christmas since I was 16. That year, I spent the winter break in a mental health hospital after reacting poorly to a medication I’d been prescribed, leaving me confused and self-harming. During this time, I had a meltdown (as an autistic person, I experience this when I’m overwhelmed emotionally). The nurses, who had no experience dealing with autistic patients, failed to distract me—something that would’ve calmed me down instantly—and instead locked me in the ward’s Quiet Room. When this failed to soothe me, they gave me a chemical restraint that caused me to lose about 24 hours of memory. Every year since, I have dealt with the dreaded holiday by hiding or getting high.

Since I didn’t want to use, and had temporarily run out of the energy to write, I ended up spending most of the week of this past Christmas studying Latin. I read from Orberg’s Lingua Latina per se Illustrata while listening to the audiobook. I listened to some Latinist YouTuber read Ovid and Virgil for hours upon hours.

I didn’t manage to interact with my family, because doing so would distract me from my “studies” and cause me to remember why I loathed the holidays. On heroin I would’ve been able to politely join in, making small talk and behaving ordinarily. But given that I’d long since lost my tolerance, I opted against buying drugs. I wasn’t going to risk death to make my family happy.

I got through it. But looking back at my Christmas-avoidance strategy helped me to recognize the similar roles that months of writing obsessively and years of using heroin had played in my life.

These issues could yet be addressed, but for now, abstinence has only served to make the wounds raw and painful again.

Perhaps this year I will finally work up the nerve to seek formal treatment for trauma. Although I am already in therapy for the purpose of receiving letters to allow me to transition medically (both surgeons and insurance require documentation from a mental health professional), I don’t yet feel entirely comfortable speaking openly with my therapist. I’ve had too many unpleasant experiences with incompetent or hurtful mental health professionals to really trust her, and these have weighed, too, against my seeking further help.

Either way, I want to be clear that phasing out my opioid use hasn’t solved any of the underlying issues that led me to use in the first place. These issues could yet be addressed, but for now, abstinence has only served to make the wounds raw and painful again.

I plan to remain abstinent from opioids for a number of practical reasons, including, unfortunately, my chances of establishing a career. I am able to abstain and have reason to, so I will. But many of the factors that cause me to abstain are the products of a society that creates barriers to health care and hates drug users. Pressuring people to quit drugs is fundamentally wrong, as well as likely to fail—particularly when nothing is done to alleviate psychological or socio-economic circumstances that may have led a person to use in the first place. Quitting drugs didn’t fix my life, though finding alternative coping mechanisms did allow me to quit drugs.

Photograph by Eliot Phillips via Flickr/Creative Commons 2.0

The post How I Quit Heroin and Why That Hasn’t Fixed My Life appeared first on Filter.

The study, conducted by researchers from California and Washington state, was published in the journal Drug and Alcohol Dependence. Its 395 participants were recruited from local organizations working with drug users in San Franciso. Over 24 months between July 2018 and June 2020, the researchers interviewed participants—in person and by phone—and also asked them to complete written surveys. They paid the participants for their time.

The researchers found that over the course of the study, participants began injecting (any kind of drug) much less. An average of 92 monthly injections at the beginning of the study eventually fell to just 13 monthly by the end—a drop of over 85 percent. For opioids specifically (typically tar heroin, which due to its properties is most commonly injected), the participants were injecting about 50 percent less frequently by the end.

The researchers did not find an increase in the number of people who smoked fentanyl over the study period. But people who already smoked it did so more frequently as time went on. In the first half of 2020, those who smoked fentanyl reported doing so on nearly twice as many days per month compared to the first half of 2019. In the same time period, the percentage of people who had smoked fentanyl every day of the past month doubled.

As the researchers make clear, “smoking” fentanyl means heating it on foil and inhaling the vapor, rather than combustion. When they interviewed one local syringe service provider, they learned that the clinic was handing out free aluminum foil so fast that it had trouble keeping it in stock.

“It’s more of a controlled way of getting—you’re not just taking one … big amount and just having it hit you all at once.”

The participants who were smoking fentanyl more often reported fewer opioid injections over time. Between January 2019 to June 2020, fentanyl smokers increased their average frequency of smoking from fewer than 10 days to more than 20 days per month; their average number of opioid injections simultaneously fell from 60 per month to 12.5.

Why did this happen? “Qualitative interviews revealed that people who inject drugs’ main motivation for switching from injecting tar heroin to smoking fentanyl was related to their difficulties finding easily accessible veins,” the researchers wrote.

Participants who were interviewed gave additional reasons for their patterns changing. One described how injecting heroin had always required help from friends. “It was just easier for me to go and buy some fentanyl and smoke it and get high as fuck and not bother anybody to [inject] or have to pay anybody to [inject] me or whatnot,” they said.

Another participant said that smoking shorter-acting fentanyl allowed them to better control their consumption. “It’s when you smoke it, it’s more of a controlled way of getting—you’re not just taking one, like big like amount and just having it hit you all at once,” they said.

One woman said that switching to smoked fentanyl, which is about 30 times more potent than heroin, was a great financial decision for her, because with fentanyl you get more doses for the same price. “So it lasts a lot longer and I can use it a lot more frequently and share it also with my friends more because the [injected] heroin I could only use it for just one time and that’s it,” she said.

“I don’t have the track marks. I don’t have to hide those or anything.”

Participants said they were glad to avoid some of the worst health risks from injecting—which can include abscesses, bacterial infections and the risk of spreading HIV or hepatitis C if needles are shared—as well as the stigmatization and discrimination imposed on people who inject. “And also no more scarring, like I don’t have the track marks. I don’t have to hide those or anything,” one person said.

The researchers cautioned that their study is limited for a few reasons. It only looked at one city, San Francisco. And, California’s unregulated drug market, where tar heroin, for example, has been prevalent, is different from those elsewhere. The fentanyl that researchers observed in the Bay Area was mostly in colored powder form, and easier to smoke. They didn’t see the pressed pills and patches common in other parts of the United States.

And there’s a huge question the study doesn’t answer: Does the switch from injecting to smoking fentanyl have any effect on the risk of overdose? During the time the study ran, San Francisco experienced a 270 percent increase in opioid-involved overdose deaths, and fentanyl has quickly become the primary drug involved in these deaths (72 percent in 2020).

“Yes, the two happened during the same time-period,” Dr. Alex H. Kral, the lead study author and an epidemiologist at RTI International, told Filter. “It is just that fentanyl entered the drug market in a major way in San Francisco (and California in general) about three-to-four years after it did on the East Coast and in Appalachia. We can’t know whether the huge overdose mortality increase would have been less if people had not started smoking fentanyl.”

“Many of the study participants overdosed, some of whom died during the study period,” he said. “Some of these smoked fentanyl and others did not. The sample sizes are too small to make scientific claims.“

The researchers recommend that future studies should examine what effect, if any, fentanyl smoking has on overdose rates. They also caution that smoking fentanyl has its own risks, like lung illness and spreading viruses like COVID-19 and hepatitis C. Harm reduction measures for opioids should include sterile smoking supplies and supervised smoking rooms, they recommend.

Photograph via pxfuel

The post Why San Francisco Drug Users Are Injecting Less, Smoking Fentanyl More appeared first on Filter.

The Vancouver Area Network of Drug Users (VANDU) and Drug User Liberation Front (DULF) submitted an open letter to Health Canada, the national public health department. It requests a formal exemption from federal criminal drug law—specifically, under Section 56 (I) of the Controlled Drugs and Substances Act (CDSA)—so that no one is prosecuted for possession or trafficking over a “compassion club” model to purchase, test and distribute drugs to members without profit.

“The DULF Fulfillment Center and Compassion Club model is saving lives right now,” the letter states, “and will save more if we are permitted to continue our work with federal authorization.” It describes the mission of DULF, a coalition of people who use drugs and their allies, as having “historically meant operating episodic [cocaine, heroin and methamphetamine] compassion clubs.”

“We are prepared to undertake such action, and hope that you will support our efforts. Lives depend on it.”

DULF and VANDU have also on several occasions organized direct actions in which they handed out small quantities of free, checked drugs through direct actions in the Vancouver area. They did this on the day they sent the open letter.

The compassion club model is supported by researchers. In 2019, the BC Centre on Substance Use released a white paper calling for heroin compassion clubs. It noted that the model is “inspired by cannabis compassion clubs and buyers clubs, both of which emerged in the 1980s and 1990s in response to the AIDS epidemic.” 

How It Would Work in Practice

DULF purchases heroin, methamphetamine and cocaine from dark web sellers. “Purchasing online has the benefit of reducing interactions and potential violence from buying in-person, and due to the nature of these darknet markets, vendors would remain anonymous,” the letter states. It expresses the hope that the government itself will begin purchasing the drugs and sell them to DULF through pharmaceutical sources.

The group would then store these drugs in a secure, double-locked site, and keep close inventory records of when drugs are added or dispensed. Importantly, organizers would test the drugs themselves using FTIR spectroscopy technology, plus fentanyl and benzodiazepine strips. FTIR is a sophisticated drug-checking tool, unavailable to most drug users, to which DULF has access through the BC Centre on Substance Use.

After confirming purity, DULF would package and label the drugs to clearly identify the content. “In a similar fashion to tobacco labeling, the packaging is also plain,” the letter continues, “with warnings of the highly addictive nature of the substances and impairing effects, and with warnings to not operate any vehicles or machinery.”  

DULF would then distribute the supply to local drug-user groups. The groups would in turn purchase the drugs and sell them to their eligible members. All members of participating drug-user groups would have to be over 18 years of age.

It will represent a historic milestone in international efforts to roll back the drug war. More importantly, it will have an immediate impact on safety.

In order to pay for drugs and other costs under this system, DULF and the smaller drug-user groups might choose to charge membership fees or raise donations. At the same time, according to the letter, “with increased consumer purchasing power through the collective it is expected that costs will be drastically reduced and the financial harms of the war on drugs on people who use drugs will be drastically reduced.” 

The letter requests a decision from Health Canada by October 15. If DULF and VANDU’s request is granted, it will represent a historic milestone in international efforts to roll back the drug war. More importantly, it will have an immediate impact on the safety of compassion club members.

“We are prepared to undertake such action,” the letter states, “and hope that you will support our efforts and provide the necessary federal exemptions needed to operate our program in a sanctioned manner. Lives depend on it.”

Photograph by DULF via Facebook

The post Activists Call on Canada to Back Heroin, Cocaine, Meth Buyer’s Clubs appeared first on Filter.

Maracaibo, Venezuela’s second-largest city, isn’t far from the Colombian border. In my heyday, starting in the mid-’90s, there were four or five different places you could go to buy heroin. Today, there is only one left. Head to the Cerros de Marin sector—not far from downtown—and walk to El Milagro Avenue at the end of 77th Street.

Maracaibo is at sea level for the most part, so it’s always hot and humid. Since we have almost no elevation, it feels poetic that the last place in the city where you can buy heroin is surrounded by foothills. It had been five years since my last journey there—since I stopped using. I wanted to go back. Not to buy, but to see what had changed.

Chicha, the lady who does the actual selling, received me like a prodigal son.

I was greeted warmly by neighbors—friendly acquaintances from my former life, surprised to see me. Chicha, the lady who does the actual selling, received me like a prodigal son. Perhaps a mixture of sincere tenderness and the prospect of regaining a formerly superb client.

Now in her early 60s, Chicha’s eyes watered when she spoke about her daughter and grandchildren who had migrated to Colombia. I had known them all well. Now, she’s in a house too big for the few family members who are left. It’s an uncommon burden in a place where most houses are crowded with families too poor to leave. 

Chicha confided that business is not booming. Where she’d once had dozens of regulars, only six or seven remain—in a city with a population of more than 1.5 million. 

In recent years, as hyperinflation worsened and job opportunities dried up, the majority of her former customers have emigrated in search of a better life. While there aren’t really any credible statistics, to me emigration feels like the main explanation for how the city’s heroin-using population has been whittled down to almost nothing. When someone who hasn’t seen me since my using days bumps into me on the street, the most common thing they say to me is, “I thought you left the country.”

Heroin was always more expensive and less readily available than many other state-banned drugs.

A few of the former heroin users who remain were probably forced into abstinence. Others have shifted to substances like bazuco or crack, which have remained not just cheaper than heroin, but exponentially easier to obtain. Even in better times, heroin was always more expensive and less readily available than many other state-banned drugs. Never that dominant in Maracaibo to begin with, heroin is now disappearing the fastest. 

Hyperinflation and Diminishing Returns

Venezuela is enduring its fourth year of hyperinflation, amid a worsening recession. In 2016, when I stopped using, a 0.1 g bag cost 35,000 bolívares. Today, 5 million bolívares.

In US dollars, though, it’s a very different story. While in my day you could get four bags for $12, today you can get four for just $5—that’s what a sorry state the bolívar is in now.

Four bags a day will not hold many long-time users. Eight would be no party, but it wouldn’t be bad—if every day you could keep coming up with the money. A few days before my visit with Chicha, Venezuela increased its minimum wage by nearly 300 percent—from the equivalent of 64 cents per month to $2.40 per month.

The value of the bolívar is so ludicrously low that even a huge wad of bills is mostly worthless, unless of course they’re USD. Most Venezuelans who need to buy anything these days, including Chica’s heroin, use wire transfers in bolivares of whatever that day’s equivalent is in USD.

Chicha may be the only access point for retail heroin in Maracaibo, but she’s not the one making the profits. She is, in fact, dramatically underpaid. 

Chicha’s son Enrique and daughter-in-law Ana live on a small potato farm in an Andes state about six hours away. Chicha’s customers haven’t seen them in years, but they’re the ones pulling the strings because they’re the ones with the contacts; Chicha just handles the retail end. She’s done this for the past eight years, though she’s been in the business in one way or another for decades.

Customers transfer the money to Ana, texting or calling her at the mercy of power outages or slow internet, and then wait for the notoriously unreliable Ana to greenlight the transaction. Chicha cannot hand over the bags until Ana gives the go-ahead. Even if Venezuela didn’t already have the worst internet service in the region, most of Chicha’s customers don’t have reliable access to smartphones. Nor, by the way, does Chicha. The process can take several hours.

“More than once she’s been tricked by someone who swears they already cleared everything with Ana.”

Chicha’s customers are technically allowed to pay in cash USD, rather than wire bolívares to Ana. But even as the US dollar becomes an increasingly common currency in Venezuela, it’s very hard for most people to find the small bills—$1 and $5—needed to buy heroin.

It’s easier if you have a US bank account, but few if any of Chicha’s customers are so lucky. Buying USD bills on the illicit market can be burdensome. Converting on-hand bolívares can be expensive. The end result is that Ana’s convoluted and erratic wire transfer system is, for most remaining customers, the only viable option.

Chicha told me that she often fronts her dope-sick customers because she sees the desperation in their eyes. But more than once she’s been tricked by someone who swears they already cleared everything with Ana, and is later screamed at by Ana and Enrique over the phone. “All of them have fucked me,” Chicha said of her customers.

In Maracaibo, like pretty much anywhere else in the world, people who use drugs can often bring their sellers personal items, or merchandise they’ve stolen or pawned, to offer in trade. But while here this works for acquiring other drugs like bazuco, it does not work for heroin.

I used to be able to pay all my heroin sellers with food from home—including Enrique and Ana, back when they lived in Maracaibo. But now trades are worthless to them, since they live hours away. Rice or flour or rum wouldn’t be worthless to Chicha, but she can’t accept such offers—it’s not up to her.

At one point during our conversation, I accompanied Chicha to a road near her house. Along with several neighbors, she was waiting for a water truck that was supposed to come through. Their zone of the city had been without running water for months, and people had begun building makeshift roadblocks to force passing water trucks to stop, whereupon they’d hold them up Wild West-style.

I had given Chicha a small bar of chocolate when I greeted her. After a while, I jokingly said, “Next time instead of chocolate I’ll bring you some water.”

As I was leaving her I ran into Humberto, one of the last heroin users I know of in the city. He recognized me from the old days but, still trying to hide his addiction, said: “You didn’t see me here.”

All I could think was, “No one sees you. No one sees you at all.”    

Photographs courtesy of Antonio Matheus Suárez

The post The Last Heroin Seller in Maracaibo appeared first on Filter.

According to Mark Haden, who co-authored the paper with Brian Emerson and is a professor at the University of British Columbia’s school of Population and Public Health, both the prohibition of opioids and the commercialization of opioids for medical use have contributed to the overdose crisis. Because of this, and the other societal ills that prohibition brings, it’s important that governments find new ways to regulate the drugs.

“What we believe is that medicalization of opiates may not be the best way to improve public health,” Haden told Filter.

Harm reduction experts speaking to Filter about the paper say it could represent a step forward. But some people who use drugs may not want to engage with their country’s medical systems—to the extent they would still have to under the frameworks. And it’s vital that people who use drugs are engaged in any decisions surrounding potential legalization.  

The first model involves a process of mandatory training and personal licensing for people who want to use opioids.

The paper deals explicitly with Canada, but, Haden noted, the US and other jurisdictions sometimes take cues from the country when it comes to drug policy. The paper further proposes changes in prescribing for medical use—like the creation of multi-disciplinary teams able to prescribe a broader range of opioids for issues like pain or addiction—but its main focus is on non-medical use.

Haden emphasized that the paper—which cites and analyzes scores of articles on opioids, addiction and public health—doesn’t claim any one of its three suggested frameworks is better than the others.

The first model involves a process of mandatory training and personal licensing for people who want to use opioids. Functionally, a person would learn the ins and outs of opioids and how to use them safely and unproblematically. During this period, they could only use their money to buy the drugs from staff in supervised consumption zones—Haden suggests existing medical clinics and safe consumption sites could fill in here.

After this kind of probationary period, if a person demonstrated they can use opioids safely, they could begin to take the drugs home. This model also comes with some government oversight—each person’s opioid use would be tracked, and there could be government interventions if it is deemed to become too problematic.

The second model is similar to the first, but without the government tracking. However, a person’s license could be “deactivated” if a staff member at the place of purchase notices their drug use is negatively impacting other aspects of their lives—like employment, or friends and family. The person would then be directed to the medical system to access their drugs and other resources to get the other elements of their lives functioning again. 

The third model is roughly the same as the second, but the training to get a license would be optional. There would be no government tracking, but a person could still get referred to the medical system. 

The authors say that the different levels of health care or government oversight could help ensure people using the drugs get the supports—employment, housing, health, etc.—they may need during their use. Haden also noted that the government oversight option doesn’t include the government telling people to stop using opioids outright.

“There are different levels of oversight,” he said. “It’s about how functional a person is in this world.”

The paper also notes that there could be a difference in terms of regulation between weaker opioids, like poppy tea, and stronger ones, like heroin. It further suggests that a licensing model could potentially also allow people to grow poppies for the sake of making their own poppy tea. (It should be noted that the amount of psychoactive alkaloids can vary from plant to plant.)

According to Haden, these models would allow people access to opioids of a known source and dosage, which, as a form of safe supply system, could reduce the number of opioid-related deaths. By simultaneously providing access to sterile syringes and other supplies, these strategies could also reduce transmissions of HIV and other blood-borne diseases. He also said that this strategy could help stem the flow of money to organized crime, though for this to work, the opioids would need to be priced as cheap as, or cheaper than, illicit sources.

“A lot of the criminal behaviour around drugs has nothing to do with drugs,” he added. “It has to do with the fact that drugs are illegal.”

Feedback From Harm Reductionists

Filter reached out to some harm reduction experts to ask for their reactions to Haden and Emerson’s proposals.

According to Steve Alsum, executive director of the Grand Rapids Red Project, a harm reduction provider in Michigan, their models have merits, but there are a few gaps. For one, people in rural areas who use opioids regularly or have an opioid use disorder would experience logistical problems if required to get to a clinic or other location frequently.

Further, the people who end up accessing opioids through the paper’s proposed medical channel might get left behind, Alsum said. People who use drugs regularly face stigmatization when interacting with the health care system, he added. 

The paper notes that the multi-disciplinary teams involved in the medical pathway would include “allied health professionals,” and should be “guided by a trauma-informed approach.” All the same, Alsum said, people might be hesitant to get drugs from health care workers, and could end up buying unchecked drugs from illicit sources instead.

“Certainly, this is a step in the right direction from what we have right now,” Alsum concluded. “But I think there could still be big gaps in that because of the stigma … folks experience when they’re accessing medical services.”  

Some people may be wary of obtaining or carrying a license that identifies them as a recreational opioid user.

According to Jess Tilley, executive director of the New England Users Union and the co-founder of HRH413, some people may also be wary of obtaining or carrying a license that identifies them as a recreational opioid user. But she also noted that having a legalized form of non-medical opioid use might decrease stigmatization. 

Tilley also floated the idea of extending the training described in the models to friends and family members of people who use opioids. “I don’t think the training should just be for the individual using drugs. That’s going to break down the stigma,” she said.

Tilley said that the frameworks outlined in the paper could be modified in ways that might work better for people who use drugs. 

First, all of the decisions surrounding a legalized framework—like creating the training process—should at every stage involve people who actually use drugs, she said. As part of this, different demographics within the population that uses drugs—sex workers, people without homes, etc.—should be involved. Tilley also said that hosting any supervised consumption at different harm reduction operations, rather than in wholly clinical settings, might help put people at ease.

Official Silence, But a Growing Conversation

Filter reached out to the US Food and Drug Administration about the new paper, but the organization declined to comment. “Generally, the FDA does not comment on third-party research, but evaluates it as part of the body of evidence to further our understanding about a particular issue and assist in our mission to protect public health,” an email from the organization read.

Health Canada also declined an interview, but sent an emailed response to Filter, noting some of the government’s strategies in reducing overdose deaths, such as the Good Samaritan Overdose Act, and allowing and funding safe supply programs.

“Substance use is a health issue, not a moral one,” wrote Cole Davidson, spokesperson for Minister of Health Patty Hajdu. “The COVID-19 pandemic has compounded the impacts of the opioid crisis, and we cannot forget how it has impacted thousands of families in communities across Canada. We have lost too many Canadians to overdoses and all levels of government must redouble efforts to save lives.” 

“This is a conversation that really needs to happen. There’s a lot of room for creativity and innovation.”

It’s unlikely that Canada, the US and other countries around the world will legalize opioids any time soon. But Jules Netherland, managing director for the department of research and academic engagement at the Drug Policy Alliance*, said she thinks that the paper is an interesting step forward. The big advantage of a legal, regulatory system, she noted, is that it creates a supply of drugs of a known dosage and purity. And governments and drug policy experts should start thinking about as many different options as possible, and conduct “interesting, healthy debate” about which may or may not work.

“It’s kind of amazing that we’re at a time where we can start to talk about the specifics of different models,” she said.

Other researchers and organizations have previously released reports on how to legalize and regulate other drug classifications. For example, the Transform Drug Policy Foundation published a document about regulating stimulants.

Netherland also suggested that, besides focusing on any particular model, policymakers and researchers should consider what kinds of principles should end up guiding regulation. Further, more study should be performed on the successes and failures of other forms of drug legalization, like cannabis, tobacco and alcohol.

“There’s a lot of room to explore options of models,” she said. “This is a conversation that really needs to happen. There’s a lot of room for creativity and innovation.”

* DPA previously provided a restricted grant to The Influence Foundation, which operates Filter, to support a Drug War Journalism Diversity Fellowship.

Photograph via Flickr/Creative Commons 2.0

The post Legalizing Opioids: Three Proposed Models for Non-Medical Use appeared first on Filter.

On February 22, Seattle-based conservative talk-radio host Jason Rantz published an article attacking the Downtown Emergency Service Center (DESC), an organization serving unhoused people. He claimed, falsely, that their distribution of heroin-smoking pipes and booty-bumping kits—two strategies for reducing injection’s potential harm to the veins and skin, as well as its risk of disease transmission—was contributing to the historic overdose crisis and the mass deprivation of stable housing. That same day, Rantz was interviewed by Fox News talk-show host Tucker Carlson—who has repeated the racist and widely debunked myth that George Floyd, who died under the knee of a cop as the world watched, was killed by a fentanyl overdose.

A homeless shelter uses Seattle city funds to feed an addicts deadly disease. Tax dollars are used to buy heroin pipes, syringes, and “booty bumping kits,” which allow users to rectally inject drugs for a more intense high. I discussed my exclusive on @TuckerCarlson Tonight. pic.twitter.com/QhbiK46ydp

— (((Jason Rantz))) on KTTH Radio (@jasonrantz) February 23, 2021

In both the interview and in his original article, Rantz failed to cite a single piece of evidence to support the claim that harm reduction actually causes harm. Telling Carlson that harm reduction is “glorifying” drugs, he appeared unaware that syringe service program (SSP) utilization in his very own city is associated with reduction in drug use and entry into substance use disorder treatment. The Centers for Disease Control and Prevention has repeatedly verified those findings.

Rantz also failed to cite the overwhelming evidence that US-based harm reduction interventions like community naloxone training, substance use disorder medications and unsanctioned safe consumption sites save lives. He also ignored the evidence that the overdose crisis is driven by politically determined factors—including criminal justice system involvement; income and employment status; lack of social support; lack of health insurance; being unhoused; and education levels. Nor did he acknowledge that COVID-19 has exacerbated the crisis, making harm reduction services like SSP all the more necessary.

Rantz’s and Carlson’s positions are supported by bigotry, rather than by evidence. Carlson claimed that the distribution of harm reduction equipment will “degrade and destroy” people who use drugs. “It’s a diseased mind that’s responsible for this.”

Their conversation encapsulated an enduring American pastime: racist moralizing around drug use. The emphasis on drugs as “degrading” their consumers is a long-standing white supremacist trope, dating back to the 19th century and sexualized fear-mongering portraying Chinese men as using opium to prey on white women. Similarly, the “reefer madness” history of cannabis frames the unsuspecting smoker as a victim of a substance brought to the United States by dangerous Mexican migrants.

The Carlson segment emphasized what he perceives to be the ridiculous nature of administering drugs rectally—a route of administration associated with queer and trans people, communities frequently attacked and slandered by Fox News. He believes that making use of one’s God-given anus is a taboo topic. “The junkies can inject drugs rectally. For real,” he scoffed. His rhetoric is dehumanizing and unethical.

“I do want to stigmatize the act of shooting up or smoking heroin,” Rantz claimed. “We should be making sure everyone thinks [harm reduction and drug use] is unacceptable.”

The idea that the US is even anywhere close to having everyone think drug use is acceptable is risible. Rantz’s bigoted and ignorant opinions are the US standard, both politically and culturally.

“The addicts in DESC care have caused considerable harm to the community,” he wrote in his article. He cherry-picked local crime data on police responses to DESC’s main shelter, citing 253 reports of assault and 174 of theft from 2019—while conspicuously failing to mention that the same data included “[b]y far, the largest number of calls, 612,” to be to “the Seattle Fire Department in their response for medical assistance.”

“When you start to look at the numbers and group the different kinds of reasons for the calls, it tells a story largely of people in crisis,” DESC Executive Director Daniel Malone told KOMO News, the organization behind the reported data.

Rantz wrote that “you wouldn’t feel safe” if you were to “walk past [DESC] on any given day, at any given time, pre-pandemic.” Clearly, he’s not thinking of, let alone speaking with, DESC participants.

Whose lives matter to Rantz and Carlson?

Screenshot of Tucker Carlson interviewing Jason Rantz via Twitter

The post Without Evidence, Right-Wing Media Smears Seattle Harm Reductionists appeared first on Filter.