Posted on by Nathan Riley

Addiction, Everybody Does It

One of the strangest promises Donald Trump has made is stopping fentanyl. The notion that being mean will stop drugs has never worked.

Freedom Democrats would be familiar with the iron law of prohibition: a more aggressive enforcement brings even more dangerous drugs to the market. When oxycodone was widely available, its safety had been demonstrated to the satisfaction of the Food and Drug Administration (FDA). That many users would experience withdrawal was an unfortunate side effect. That the drug was widely available also meant many persons used it who had received no prescription.

Freedom Democrats believe that the relationship between doctors and patients should be respected, especially by politicians. They have no expertise, and the doctor and the patient should develop their own course of treatment. No drug enforcement agency. No rules about dosage or where the drug’s may be used. That is up to doctors, their patients, and agreements about best medical practices.

Freedom Democrats, had they been in charge, would not have blood on their hands. The politicians who played the blame game are responsible for hundreds of thousands of deaths. Lawmakers blamed the pharmaceutical companies for trying to expand their market. In this one sided view, the users had no responsibility; they were simply victims of addiction, had no intelligence, and no will power.

Elected officials accepted the discredited idea that drug users aren’t citizens, have no rights, and are trapped. A nefarious evil captures the user’s soul and deprives them of choice. It’s malarkey; similar ideas have existed for centuries. Witches after all were supposed to exercise control over their victims. Back then, the witches were killed.

Centuries later Democratic and Republican politicians adopted policies that killed the users. They were denied any moral culpability; the drug users were trapped by their “habit.” The politicians dismissed the possibility that drug users were rational and able to control their lives. The way they handled their habit was comparable to the way millions respond to alcohol, food, and caffeine.

The only difference is this group isn’t stigmatized and dehumanized. The effort they put into controlling their habits receives positive reinforcement and often drug treatments.

But the closed-minded lawmakers offered oxycodone users no support; in fact, their one-sided view simply killed hundreds of thousands of users. It should take no brains at all to realize that if a person regularly uses oxycodone you don’t simply say, “You can’t have it. The law says stop.” The law offered habitual users no comfort and legal ways for changing their habits at their own pace. All too often, judges thought it reasonable to tell users you must stop now, a decision that should be made by doctors and their patients.

To nobody’s surprise, Stop Now was a gift to cartels and ingenious people who created alternative illegal supplies. History had repeated itself. Banning marijuana, cocaine, and amphetamines had produced illegal markets. In fact, they offered economic stimulus to criminals, and more work for the police. The criminal justice system will thrive.

Not so the drug users. They were too often conned into believing that a pill was oxycodone when in fact it contained a strong dose of fentanyl. The number of victims of the politician’s callousness soared to over 100,000 a year dead from overdoses. More people died in one year than died in the Vietnam War. Freedom Democrats would damn lawmakers for their callousness and cruelty.

This time the witches didn’t die; it was their victims.

Trump displaying the ignorance that is a trademark simply argued that drugs were reaching America because we weren’t really trying. He slammed tariffs on Mexico.

The iron law of prohibition suggests that fentanyl will be replaced by even more dangerous drugs that kill quickly. That drug has already surfaced—nitazenes. Being mean kills drug users.

The very idea that a societal habit like ribald humor can be banned is a joke. For one thing, and Freedom Democrats are an example of this, there is no agreement that drug use is criminal. Another problem is people make money selling banned substances. Banning alcohol in the 1920’s made many fortunes.

Trump’s effort to try harder in the silly hope that the drug will stop reaching the U.S. doesn’t recognize that law enforcement and drug smugglers all too often find ways to share the wealth. Mexico is famous for its ties between law enforcers and drug cartels. Nothing Trump does will change this reality, but we do know that a new drug is here—nitazene.

Democrats of course join Republicans in chasing the impossible goal of stifling the drug trade.

We are still looking for the charismatic and verbally fluent political leader who will support doctors being able to treat drug users without strangers violating their privacy and setting rules that harm a successful treatment.

Obesity is universally recognized as a major U.S. health problem. Doctors understand that many people eat for pleasure; in other words food acts like a drug. It was my habit and mastering it made my weight drop from 270 to 195 and brought a happier life. Dr. Peter Grinspoon’s book Up in Smoke and website makes sensible arguments for allowing doctors to treat patients who use drugs without outside interference.

He makes the point that using drugs is normal. We refuse to recognize that gambling, eating, and caffeine also have addictive impacts. In my case, my addiction to food started in elementary school. I fit Dr. Grinspoon’s theory that “suffering, often alone, feeling bad about myself, in the shadows” drove my eating and explained why diets did not work.

When I was grossly fat, I used to tell people I was addicted, and it was completely visible. Only a few people recognized that I was speaking about my eating habits. People didn’t associate eating with addiction. Addiction is the all-too-common habit of confronting other problems by repetitive behavior that brings no real relief.

Freedom Democrats recognize that drug use and overeating are sister phenomenon. This humane response is alien to Trump’s angry “stomp it out” mentality. It is one reason why Trump is malicious and cruel.

Posted on by Nathan Riley

Overdose Deaths Are Proof That the U.S. Fails To Provide Healthcare to Drug Users

With a drug overdose, a person gradually stops breathing and while it is not true for marijuana, opioid use can be dangerous.

Crossing the street is dangerous—vehicles kill. That is why we have traffic lights and look both ways before crossing. For the illegal drugs we also have “traffic lights:” Don’t do drugs alone. Be sure there is someone there who can help if the user becomes helpless and could die. Have naloxone nearby to interrupt an overdose.

In cities all over the world, drug users inject, inhale, and snort in facilities where a healthcare specialist is on duty and able to interrupt the overdose, or some other health crisis that threatens the user’s well-being.

But not in the United States.

Such facilities are rare and subject to legal sanction because U.S. law can’t distinguish between a crackhouse and a healthcare facility. It’s not just stupid; it’s cruel and all too often murderous.

New York City should have dozens of these programs. Almost every needle exchange program would like to become a healthcare facility where drug users ingest drugs while a healthcare specialist oversees, ready to protect the user if things go wrong. Even with severe limitation the two facilities in New York City have interrupted 1,000 overdoses.

Needle exchange programs set up to stop the spread of H.I.V. faced opposition. “This neighborhood already has too many programs.” Or providing sterile needles and stopping the spread of disease, “Encourages drug use. There is only one message, and that is ‘Just say no.’” Drug use is wrong, accepting the conclusion that illegal drugs must be demonized. Thanks to the public health community and ACT UP’s demonstrations that delivered pithy messages supporting them, needle exchange programs can be found in metropolitan areas all over the United States. Safer consumption facilities should also become widespread.

The neighborhoods survived needle exchange, and the lives of the general public stayed the same. By and large, only drug users and local officials paid attention to the programs. Adding Supervised Injection Facilities would also neighborhood health.

Drug users should have a place to inject drugs away from public view. Many members of the public are disgusted when users take their drugs on street corners or under bridges. A city with drug consumption rooms protects the neighborhood and the privacy of drug users.

The arguments in favor of safer injection facilities are overwhelming. All over Europe, cities have adopted these programs for decades. But not here. A federal judge in Philadelphia has actually found that U.S. law prohibits these programs. Laws intended to close drug dens also stopped health programs.

This situation is more than stupid. It’s deadly. In New York City, on the average, there are about eight deaths every day from overdoses. In 2014, the state comptroller’s researchers reported 2,300 deaths. In 2021, 5,841 New Yorkers died.

Unless something positive is done, 58,000 New Yorkers will die every ten years. The number of deaths in the United States is equally startling. In 2021, 106,719 died in the U.S. That’s a million deaths every ten years.

Nothing, it seems, will persuade U.S. officials to give drug users “traffic lights” to improve their safety. During this time, fentanyl use spread and increased the risk of an overdose.

Fentanyl is easier to smuggle because just a little bit provides a powerful high. If, as Freedom Democrats advocate, these drugs were manufactured by drug companies and prescribed by doctors, only rarely would the prescription authorize fentanyl. There would have been few, if any, overdose deaths from fentanyl-laced drugs.

But because the United States gives illegal operators a monopoly, they are able to add fentanyl. But facts are facts; in the United States people were using opioids when George Washington’s troops were fighting the British, when the Union was battling the Confederacy, and when the United States entered World War I. Opioid use has a long history and will not go away. Policy makers must recognize this reality.

Opioid use is here. And if Freedom Democrats get their way, it will be a safe drug to use. Obviously, some users will want the drug every day; that has always been true, but so what.

Anybody who knows drug users knows that there are depressed people who depend on it. Others want their high right after they’ve been released from prison, forcing them to go “cold turkey” didn’t stop the memories. Indeed, one group who suffer overdose deaths are recently released persons.

Some drug users live disorganized lives, but there are others who support positive change.

Recent news reports describe such a person. Cecilia Gentili founded Trans Equity Consulting, served as director of policy at GMHC, and was board co-chair of the New Pride Agenda. The details of her death are silent on whether she was by herself when the overdose occurred, or whether she was only an occasional user and unused to the potency of fentanyl-laced heroin.

She was in the news in late September 2024 because the two dealers who sold the drugs pleaded guilty in federal court. They face prison sentences well in excess of ten years, an outcome that would probably sadden Cecilia Gentili, who spent her life helping sex workers and transgender persons live with pride. She fought laws that punished persons for their life choices.

We don’t know anything about a person if all we know is that they get high. The U.S. hostility to drug use rests on witchcraft, not science. The United States attributes magic powers to drugs like opioids, but in fact some users have no problems with their drugs, while a smaller group experience fatal consequences.

Freedom Democrats, I believe, should recognize the dangers of many illegal drugs, like heroin and methamphetamine, but society should recognize, with medical care, these drugs are and can be used safely. It makes no more sense to interfere with the doctor patient relationship by prohibiting the medical profession from prescribing drugs that help a person get high than it does to interfere with the doctor-patient relationship surrounding pregnancy.

In fact, the number of deaths from illegal abortions plummeted once government allowed women to consult and work with doctors during the difficult decision about abortion. The same positive results would happen if society allowed doctors the freedom to work with patients who use drugs, leaving it up to the doctor whether the patient will have access to pharmaceutical drugs whose purity has been verified.

It is critical to end the stigma attached to drug use that often forces users to take their drugs secretly and alone. There is no more chance of the United States becoming a nation of drugs users than lifting the stigma attached to homosexuality made everyone gay.

In fact, working with public health specialists it is possible to control drug use and prevent dangerous outcomes. Sixty years ago, on a hot summer day millions of Americans drank beer to quench their thirst. Today they drink water. That is a positive public health result, achieved with a minimum of criminal sanctions. Making drug use a crime causes deadly results. It’s time for us to welcome drug users into society rather than punish them for their habit. The law also ruins the lives of drug sellers with long prison sentences. The only reason they have a market is because the law makes drugs illegal. If drugs were legal, doctors and patients could make their problems manageable.

 Overdoses are proof that society is failing to provide healthcare.

Posted on by Nathan Riley

Fentanyl Doesn’t Kill, Bad Laws Do

Fentanyl keeps cropping up on the edge of the presidential election campaigns. Some Republicans claim Biden’s permissiveness has flooded the nation by allowing immigrants to bring this deadly drug across our borders.

This is nonsense peppered with half-truths. Each year over a hundred thousand drug users die an accidental death from a drug overdose. A major cause of these fatal events is tied to fentanyl. One reason people keep using it is that they don’t drop dead after getting high. This is always true. The deadly drugs that newscasters and politicians use to justify authoritarian laws kill some people while others survive.

The law and law enforcement give users a small choice of drugs. Then, in an extraordinarily vicious act of social ostracism, the drug users get damned for using the drugs. They are dangerous because they are potent, in other words, a little bit goes a long way. When trying to avoid the cops, a drug that gets many people high but is easily hidden becomes advantageous. This is the exact opposite of what doctors and public health officials would want from a drug.  The notion that illegal immigrants supply U.S. drug users would be silly if people weren’t dying. There are thousands and thousands of people who don’t want to get high from alcohol, nicotine, and caffeine and therefore are pushed into the illegal market. Americans were using opium during our revolution. And guess what? They are still using it.

Fentanyl is an extremely potent form of opium that is manufactured, whereas opium and heroin are plant based. As the newspapers have reported, the fentanyl epidemic started when the United States cut off legal supplies of oxycontin.

Drug companies and pharmacies, responding to new laws, vastly reduced the supply of this relatively safe pharmaceutical painkiller. These companies are law abiding, and when the law restricts supply they comply. Their business is legal, and they want to keep it that way.

It will come as no surprise to students of U.S. drug enforcement that no provision was made for the thousands who made oxy part of their lives. Some bit the bullet, obeyed the law, and stopped using. Others, as always happens, went to the illegal market. Evading the law makes potent drugs like fentanyl a good idea.

The notion that illegal immigrants victimized innocent Americans by supplying them with fentanyl is absurd. Drug users were looking for an alternative to oxy. Fentanyl could be purchased by mail from China. Drug syndicates in Latin America avoiding U.S. law enforcement by smuggling fentanyl into the United States. Immigrants crossing the border are no significant suppliers.

Congress and state legislators could have simply accepted the fact that some users didn’t feel able to give up oxy. It would take longer but would put fewer people in jail and drastically reduce the number of overdose deaths if the law showed some patience and worked with users, even those who kept using oxy.

It requires no special act of genius. This is what we do with people who want to give up drinking or become dangerous when they drink. The problems are similar. Drunk driving laws give law enforcement an entry point without authorizing the harsh and intrusive drug laws.

Drinking is controlled. Younger people have developed the habit of drinking water. At parties, they and their friends who do drink can hang out together without a problem. The same thing can happen with drugs that we label dangerous. What makes them dangerous is the bad laws governing their use. The control is exercised voluntarily, which is the way it should be in a democracy that is governed by the consent of the governed.

Posted on by Nathan Riley

Health Department Gives Peer Support to OD Survivors

The article was posted on GayCityNews.com on March 15, 2018.

BY NATHAN RILEY | Once she received the call, Cathy Kelleher dashed to the emergency room at Columbia Presbyterian and asked the man whose overdose had been reversed, “What can I do to help?” Hesitantly, he mentioned his need for a birth certificate, but the office in Puerto Rico closed after the hurricane. From this simple request, she knew a successful intervention might be possible.

Kelleher is a trained peer, a person with “lived experience with substance use” as the city health department characterizes her job description. And when the department is alerted that an affiliated hospital is treating a non-fatal overdose patient, Kelleher and her co-workers travel to meet the patient. The goal is to be in the ER in less than an hour. The program is called Relay because the workers only show up after information has been relayed to them that there is a patient recovering from an overdose.

Kelleher knew she could help the man get a birth certificate. Unlike emergency room personnel, her duties include personal contact in the days following an overdose. And what can be more helpful than accompanying a stigmatized person when they go to strange places? She called the city Department of Human Resources and arranged for the birth certificate’s retrieval and, with this critical document, she helped him obtain vocational training as a food service worker.

City moves to prevent fatalities but remains skittish on safe consumption spaces

The overdose also gave Kelleher a chance to talk about naloxone. That drug is to overdoses what a defibrillator is to heart attacks. Take it and in a matter of minutes breathing is restored. Opiate poisoning leaves a person incapacitated, so another person must administer the medicine. An ingenious innovation now permits injection without using needles. A piece of plastic, with a tip like the one used in cold medicines, fits into the nose. Squirting half the solution into each nostril allows normal breathing to resume within two to five minutes. This medicine is the key ingredient for averting fatal overdoses.

It is carried by emergency medical personnel, some police, and members of the public. With an hour training, anyone can administer naloxone. The city aims to distribute 100,000 of its kits, especially to family members and other people who know drug users. Already, 45,000 kits have been disbursed, so officials believe the goal is realistic.

Kelleher has nearly 25 years experience in the field. In her last job, she ran a for-profit sober house, but she prefers the emphasis on helping people offered by the non-profit Relay Program. With her experience, empathy comes naturally and this, combined with her shared understanding of living with a habit, helps her establish trust with drug users who survive an overdose. The patient she met at Columbia Presbyterian had heard of fentanyl — a common additive to opioids that increases the risk of overdoses — but she introduced him to naloxone.

Another service that the Relay worker can offer is medically assisted treatment where a user’s life is stabilized with the help of methadone or buprenorphine to wean them from opioids. Only specially trained doctors may prescribe buprenorphine, the most convenient form of treatment because the medicine is taken in pills. New York City has 14 clinics where people on Medicaid or without insurance can access it. Relay workers call ahead and get a user an appointment at the appropriate clinic.

The Relay Program is an effort to get care to people who are at the highest risk of having a fatal overdose.

Dr. Hillary Kunins explained that after a person has an overdose, “they are at a higher risk” of having another and possibly fatal OD. The Relay Program is “also an opportunity to provide peer support” that hospitals can’t. The assistant health commissioner for the Bureau of Alcohol and Drug Use Prevention, Care and Treatment, Kunins expects that the program will “reduce the risk of a reoccurrence” and introduce more naloxone kits to drug users, who themselves are the most likely people to be near someone becoming unresponsive after drug use.

This is harm reduction done patient by patient, and it should save lives but it is doubtful that this program alone will turn the tide. Step by step by step New York City is dispensing naloxone kits. Homeless shelters also have naloxone kits and train residents in their use.

One obstacle is that about half the patients decline Relay help. After an overdose, they just want to get away. Isolating is their immediate reaction.

Naloxone is only effective if it is in the right place at the right time. The city is close to releasing a feasibility study on allowing needle exchanges to permit users to bring the drugs they purchase on the street and ingest them on the premises in the presence of an overdose prevention worker. It’s a program that brings the user to the naloxone.

There are such programs in 100 cities across the globe, and Canada is expanding its program from Vancouver to cities from coast to coast. Philadelphia and San Francisco will initiate programs this year.

Kunins said that the health department’s feasibility study would be made public soon. But there is trepidation among city officials, with a fear of neighborhood backlash. She abruptly ended the interview when I moved the discussion toward safer consumption spaces.

Unlike the AIDS crisis where gay men and their allies united into a politically potent force, drug users remain stigmatized and usually don’t come out to fight for the programs that will save their lives. The lack of a powerful voice from drug users and their allies leaves city officials worried that people who want drug users punished and not coddled will grab center stage, damning their good intentions.