Posted on by Nathan Riley

Allow Grown-Ups To Use Drugs

It doesn’t matter if you’re a cosmopolitan sipping a martini after a day at the office or a gourmet tasting only half a serving of dessert, you must exercise self-control. Adults can’t stuff their face without getting fat, and an adult can’t spend an evening chugging beer without getting drunk. Self-control is a critical component of good health.

So it should come as no surprise that heroin users must practice self-control.

The best research confronts the obvious truth that people all over the world get high and that those foolish moralists who would ban drugs and alcohol use cause harm and threaten the liberty of our citizens.

Carl Hart, a Columbia professor who spent years doing biased research to prove that marijuana and other drugs were harmful until he reached a conclusion that a fair reading of the evidence demonstrates that using the illegal drugs with the same self-control that we promote for drinking and eating poses no danger to health and may in fact be a sensible part of a healthy life.

My father died at 91. He had his last martini on a Thursday and died on Saturday. Drinking was one of his great pleasures, and like many of his generation that lived through alcohol prohibition, he was convinced that marijuana and even heroin used judiciously were pleasures that any adult should be free to choose. What he knew from experience, scientists have supported with research.

Professor Hart is just one of a growing chorus of reformers who believe adults should be free to choose their pleasures. It is a well-known fact that moderate consumption of alcohol reduces the risk of heart attack and stroke. Professor Hart extends this same principle to heroin. He uses it. But quite reasonably insists that the user should be prudent and exercise self-control. In his book Drug Use for Grown-ups, based on his research and his personal habits, he demonstrates that using heroin with self-control is fun and can be part of a happy life.

The research is extensive and available to those doubters who want scientific affirmation for what other people discover while growing up. If you aren’t self-aware and don’t control your use, all of these substances can cause substantial harm. But in fact the greatest harm is caused by the government and law enforcement programs to stop illegal drug use.

Perhaps the most important proof and one of the key points that another researcher, Dr. Peter Grinspoon, makes in his book Seeing Through the Smoke is that overeating can be an addiction. That is, what should be a pleasure, when used judiciously, can be life threatening if the eater insists on experiencing the pleasure of food to excess.

Without a doubt, obesity causes more premature deaths than fentanyl, alcohol, and car accidents. A study in the distinguished New England Journal of Medicine, concluded, “We are also simply eating more calories per person: Portion sizes have gone up, and eating outside of the home often means heavier, unhealthier foods, and sugary drinks to wash them down.” According to the researchers, a high body weight contributed to 4 million deaths globally — or 7 percent of the deaths from any cause — in 2015.

Eating unhealthy foods causes more deaths than fentanyl or car accidents. This is a worldwide problem. It is worst in the United States. Put bluntly, Coca-Cola and soft drinks kill more people than any of the illegal drugs. This is of course not a plea to make sugary foods illegal. In terms of policy, it is a plea to give public health officials more authority over the habits of U.S. residents.

Anybody my age, 82, has watched as public health techniques dramatically reduce cigarette smoking. When I was growing up, every house had ashtrays on most tabletops. A fun evening with guests would probably lead to the smoking of almost a pack of 20 cigarettes. Nobody went outside to smoke; it happened in the living room with everybody present. Public health messages, over decades, made smoking uncomfortable, a bad habit. Cigarettes are still with us, but their use is dramatically lower than it was in 1950. The discomfort with smoking is widespread. Among young people, who quite commonly decline not only tobacco but marijuana to protect their lungs. Without arresting anybody, public health policy changed our national habits.

In one of his most arresting passages, Carl Hart argues that the illegal drugs don’t follow this public health impulse because of racism.

Controlling illegal drug use costs billions that pay the salaries of police, judges, prison guards, and even drug treatment programs. The police prison industrial complex is uniformly racist, and encourages public fear, and its arrests threaten personal freedoms. It continues the U.S. history of applying terrorism against black and brown communities. Almost uniformly, white people who use the illegal drugs are given more compassion. They have a problem. Those with a different skin color are dubbed criminals, burdened with a record, and even imprisonment for their supposed moral failings. Sheepishly, Professor Hart admits that at the start of his drug research he believed drug use caused poverty and antisocial behavior in his communities. He has freed himself from these racist delusions.

The simple truth is some of the people who use drugs harm themselves; others, quite possibly a large number of others, get pleasure and relaxation from their drug use. It contributes to their sense of well-being. The drug war and its billions of dollars threaten all users. Public health measures would dramatically reduce the number of people earning good wages to fight the drug war, but will be more effective. Without burdening the taxpayers, public health measures would solve most of the problems associated with drug use, just as it has reduced but not ended the health problems associated with smoking. And cause no threat to our freedoms.

Perhaps the biggest benefit of this approach would be the increase in freedom in the United States. Police intrusions into the lives of our citizens are prompted all too often by suspicions that an otherwise law-abiding citizen may be involved with illegal drug use. At its most extreme, hundreds of Americans have been shot and killed by police officers enforcing the drug laws. Freedom Democrats would end this threat to our liberties.

Posted on by Nathan Riley

Don’t Stigmatize Drug Users

Creating a new politics of freedom doesn’t require constant hostility and opposition. In the case of marijuana, an object is to end stigmatization.

This movement is making telling progress: state after state and local governments are making marijuana legal. As is true of life: do something big and there must be problems.

But telling people that legal pot is especially strong and may not be fun is very different from saying pot is dangerous and shouldn’t be used. In fact, some doctors have a specialized knowledge and prescribe pot to alleviate unpleasant symptoms. Pot, for many people, relieves insomnia or negative feelings like anxiety.

Publications like Marijuana Moment that track news about pot regularly publicize studies that are balanced and even recommend pot. Ashley Bradford from Georgia Institute of Technology recently completed a study showing that “in states where both medical and recreational marijuana are legal, fewer patients are filling prescriptions for medications used to treat anxiety,” like antipsychotics, benzodiazepines, and antidepressants. They found “consistent evidence that increased marijuana access is associated with reductions in benzodiazepine prescription fills.”

In other words, powerful medications that have a potential for addiction are no longer used. Symptoms are treated by pot. Such research is spreading, and it is now commonplace to concede that marijuana has medical uses. Traditional researchers are still trying to tie marijuana use to bad outcomes, but research like that done by Ashley Bradford are finding positive outcomes.

It should come as no surprise that there are good and bad results. That is the way the real world works.

But getting researchers to look at the good as well as the bad is a continuing struggle.

Of course, users still enjoy getting high and find, for example, that pot enhances sex. Although I must admit I have seen no studies on pot and erectile dysfunction. I am quite confident that users can make up their own minds about these pleasures.

At 82, after 65 years of marijuana use, I got stoned over Christmas. It was a disaster. My sense of balance was challenged, and it took over a week for the ill effects to dissipate. Without any physical withdrawal, I concluded no more pot; I had reached a point where it harmed me rather than pleased me.

This is a world of difference from the harsh, even hostile, atmosphere that surrounded pot when I was young. Being mean was not even recognized. Frequently we were told that only dopes do dope. Telling a person that they are stupid undermines confidence and agency. It certainly doesn’t help a person gain control of their lives.

We are in a new era, where it is recognized that some people use it, others don’t, just as at the start of the century it finally became clear that some people are LGBTQ+ and others aren’t. What is important is doing no harm to users and treating marijuana users as sinners is harmful.

In fact, so preposterous were the arguments against marijuana that it became widely assumed that pot was natural and therefore even good for you. It is certainly true that some weed smokers saw their lives improve, but it is equally true that pot can provoke anxiety, vomiting. In other words, don’t turn a pleasure into a general rule for everyone.

The most dangerous drug is obviously alcohol, and we don’t tell everybody, “Drink.”

The big task facing us is helping people who use hard drugs like heroin and meth believe they can face problems however painful without using these drugs. It is equally important to recognize that somebody who gets high on a weekend night isn’t necessarily harmed. They should probably have access to pharmaceutically manufactured drugs where their potency and effects are carefully calculated. Once again, we face the rule that some people take drugs even when it causes them problems while others simply find it a moment of pleasure. In other words, society should give people the freedom to discover.

Freedom is about letting doctors and the public find a healthy path. One rule doesn’t fit everybody. In short, we must spread knowledge and avoid setting rules that harm people who are doing nothing wrong.

Posted on by Nathan Riley

What to Make of Heroin Deaths

THIS IS AN OLDIE, BUT I’M QUITE PROUD OF THE POINTS I MADE AND THE DESCRIPTION OF NALOXONE IS MY ATTEMPT AT ELOQUENCE. FOUR YEARS LATER WE ARE STILL WAITING FOR SAFER CONSUMPTION SPACES. THIS ARTICLE APPEARED ON THE GayCityNews.com website on March 5, 2014.

BY NATHAN RILEY | Philip Seymour Hoffman’s end was no anomaly. Overdose deaths have risen dramatically in New York City and the nation. He is one among thousands.

The fact that he was the object of critical accolades was also not unusual. Hoffman was a high-performing heroin user — Charlie Parker, Billie Holiday, John Belushi, and Robert Downey, Jr., are other celebrities who spring to mind in that regard. Famous yes, but perhaps more to the point, they have all been acclaimed for their exceptional artistry.

Hoffman’s death reminds us that drug use cannot be attributed solely to poverty. It’s not just a Bronx problem. It may affect homeless members of the transgender community, but it also has its impact on affluent gay white men. In fact, the rate of drug poisoning deaths involving heroin among white New Yorkers (8.9 per 100,000) in 2012 was higher than among Hispanics, at 6.2, or blacks, at 4.6. Well-to-do neighborhoods in the city experienced a 300 percent increase in heroin deaths between 2010 and 2012. It is a racist myth to say that the black and brown are plagued by drug use, which in turn drives crime. People — including criminals — like their drugs, regardless of skin color or socioeconomic status.

Stigmatizing of users, crackdown on prescription pain meds aggravate a problem for which progress is possible

Nor is it unusual that Hoffman’s death is used to reinforce the misleading legend that heroin causes misery. It is likely that Hoffman took drugs seeking relief from some form of misery in his life. You will seldom read a word about the pleasure Hoffman might have found in heroin or the attractions of opioid use generally — an allure that persists in the face of government sanctions and social hostility.

Ignoring the pleasures people find in taking drugs hampers drug education. The relentless focus on the harms doesn’t really help the group that matters the most — those individuals who experience a revelation when they use drugs, a moment that tells them this is something they want in their lives. The exclusive focus on harm makes it harder for users to relate those warnings to their own experiences and, in turn, to devise strategies for coping. And it makes it harder for the rest of us to understand the pleasure these individuals experience and to develop any feeling of solidarity with them.

For health workers, Hoffman’s death offers 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 typically a bystander must inject the antidote. An ingenious innovation now permits injection without using needles. A piece of plastic with a foam tip, attached to a syringe, fits into the nose. Injecting half the solution into each nostril allows normal breathing to resume within two to five minutes.

With training anyone can use Naloxone, and Dr. Sharon Stancliff, a physician at the Harm Reduction Coalition, believes the treatment should become more easily accessible. That’s the goal of new legislation in Albany that would allow people who might observe an overdose to have Naloxone at the ready and be trained in its use. According to a memorandum prepared by the bill’s legislative sponsors, the measure would make Naloxone available to “a family member, friend, or other person in a position to assist a person experiencing an opioid-related overdose and allow them to store and dispense” it. People close to drug users are in the best position to be on hand when an antidote needs to be administered.

Unlike the uncertainty that surrounds so many efforts at drug law reform, it’s a good bet this bill will pass. Even before Hoffman’s death brought heroin overdose foursquare before the public, Republicans and Democrats had reached agreement. “Strengthening access is the best tool we have to prevent overdose deaths,” according to Bronx Democratic Assemblyman Jeffrey Dinowitz, the measure’s sponsor. Dinowitz is optimistic; the Senate sponsor is a Republican and the chair of the Health Committee, Long Island’s Kemp Hannon.

But the bill is not a panacea; barriers remain. Methadone and buprenorphine are highly regarded substitutes for heroin, but patients using them are typically drug-tested. If other drugs are found, they might be forced to leave the treatment program, an irrational response similar to a weight control program forcing a person out for going off their diet. In general, the obsessive search for drug abstinence creates difficulties for programs offering services to users — and a person cut off from a heroin substitute is likely to become an injecting user once more. The use of drug testing also generates suspicion between the program and its clients, making it difficult for them to take charge of their health. Program members typically want to be non-judgmental but the rules may force them in the other direction.

Another significant factor in the current heroin picture is the recent crackdown on prescriptions of Oxycontin and other drugs containing opioids. From 2006 until 2010, overdose deaths declined an average of 22 percent a year, but after 2010 a dramatic reversal occurred. By 2012, deaths had risen from 541 to 730. By then, Staten Island had become the center of the Oxycontin epidemic, with the highest rate of overdoses in the five boroughs. Education meetings in the borough were welcomed enthusiastically, but the level of ignorance, while understandable, was scary. Audience members had no idea that Oxy was related to heroin. That a “good drug” prescribed by a doctor shares traits similar to those of a “bad” drug like heroin was a revelation.

Supplies of such prescriptions have since been restricted. This may reduce overdose deaths from Oxycontin, but it also means users will switch to heroin, use of which was already on the rise when the prescription curbs took effect.

Shutting off access to Oxycontin no longer seems an obvious solution. A drug that is created in an underworld where potency varies radically and is injected by users replaced a pharmaceutical pill that delivers a uniform dose. And, going from pills to injection is a social initiation into a community of hard-core drug users. The newbie has to identify suppliers and then be taught how to inject. According to Joyce Rivera, the executive director of St. Ann’s Corner of Harm Reduction in the Bronx, this process changes a person’s social life and increases their health risks.

The displacement of prescription opioids by heroin may be undercutting the drug education efforts and outreach in Staten Island. An effort that was directed at pill users must now be adapted for needle users. Staten Island is already the part of the city where needle exchange programs are least available.

Though trading reduced use of opioid prescriptions for increases in needle intake of drugs has little to recommend it, greater heroin use is something that must now be confronted. St. Ann’s (where, full disclosure, I formerly served as the chair of the board of directors) has drafted a report called a drug users’ need assessment that found injecting users in the Bronx no longer have access to abandoned buildings. With economic conditions improving in the borough, users are once again shooting up in public — in hallways, alleys, and parks. The conditions are unsanitary, infections are up, and a hazard is created from needles being discarded in public places.

St. Ann’s is asking the New York State AIDS Institute to support safer injecting facilities (SIF), rooms with a nurse present where a user, after purchasing their drugs in the illegal market, can inject in a peaceful and sanitary environment. Rather than being rushed, a shooter can use the alcohol wipes and clean syringes that reduce infection. SIFs are entry points for education and assistance in helping drug users manage their lives. More than 90 SIFs are in place in Europe, Canada, and Australia, where they are a part of the overall repertoire of harm reduction options, as discussed in a publication by the European Monitoring Centre for Drugs and Drug Abuse available at emcdda.europa.eu. According to the Centre, “the facilities reach their target population and provide immediate improvements through better hygiene and safety conditions for injectors.”

“Immediate improvement.” How often can we say that about a drug program?

No one is saying Hoffman would have been saved, but if somebody in his situation had the opportunity of using such a facility, an overdose might turn out to be an incident not a fatality.

Posted on by Nathan Riley

No New Money, No New Ideas in Trump’s Opioid Response

This article appeared on GayCityNews.com on Oct. 30, 2017

BY NATHAN RILEY | Donald Trump’s declaration of a public health emergency to end the epidemic of opioid overdose deaths wraps itself in virtue, but avoids the burning question about the nation’s drug policy: What works?

During the 1990s, Switzerland and Portugal were among the nations that experienced the growth in opioid use seen here in the US as well. In those two nations, however, the response was radically different than in the US.

Switzerland and Portugal asked public health officials to solve the problem and minimized law enforcement activity in response. As a result, there, drug use seldom involves criminal sanctions and services are provided by health and social workers comfortable in working with drug users. The Swiss offered medically-assisted therapy with methadone, and for a smaller group of users medical heroin itself. Programs were geared toward aiding drug users in managing their habit. There were never grand declarations to “end” drug use.

The Swiss program — designed by doctors in tandem with users — conflicts with basic American attitudes toward drug use. A cardinal principle is that the user picks their dose. Overdose levels, of course, bring intervention, but the program design is clear that the user must determine their comfort level. After 20 years without a major backlash, heroin users, over the long run, tend to abandon their habit. And, crucially in the context of the link between drug use and other criminal behavior, most live without relying on illegal activity to pay for their habit.

Drug users have easy access to medically-assisted treatment. Those users permitted access to medical heroin in Switzerland must stop over a three-to-10-year period. The number of Swiss narcotics-related deaths in 1995 was 376; by 2012, it had fallen two-thirds to 121.

These nations have housing and psychological services available to all, one of the key demands of drug reformers. The presidential commission appointed by Trump and headed by New Jersey Governor Chris Christie endorsed that idea, but there is no money in Medicaid for these services.

Donald Trump had two ways to go — finding more money for health services or making bold but empty promises. If he had declared a “national emergency” — as he initially pledged — it would have created claims on a $53 billion federal fund. For the “public health emergency” he declared last week, there is currently $57,000 in the kitty. Hence the Times’ headline: “Trump Declares Opioid Crisis a ‘Health Emergency’ but Requests No Funds.”

A swift warning came from Gay Men’s Health Crisis about the “potential efforts under the Public Health Emergency Declaration to redirect funding from HIV/ AIDS programs.” The Daily News also voiced suspicion that money would be siphoned from AIDS/ HIV services.

But the biggest howl of fury came from the new executive director of the Drug Policy Alliance, who blasted the president’s speech saying it showed “a profound and reckless disregard for the realities about drugs and drug use.” Maria McFarland Sánchez-Moreno, a human rights activist who replaced Ethan Nadelmann, challenged Trump, poopooing his recommendation that drug prevention programs revive the “just say no” evangelizing of Nancy Reagan and his faith that public service announcements would “prevent” drug use.

“He made a big deal” about taking a pharmaceutical opioid off the market, she scoffed, noting that such a strategy is years out of date. “The opioids involved in overdoses are mostly coming from the illicit market” today, McFarland Sánchez-Moreno said. Drug users have gone from the gray market to a wholly criminal underground market of drugs laced with fentanyl — a transformation that is a damning indictment of the prohibition and the criminalizing of drug use. Drug deaths have been rising for years. Last year, there were 64,000 overdose deaths — roughly equal to all Americans killed in the Vietnam, Iraq, and Afghanistan conflicts combined.

Trump also showed his ignorance about how drugs enter the US, when he spoke lovingly of how his Mexican border wall would halt the inflow. McFarland Sánchez-Moreno was unconvinced; the illicit drug trade, she said, “always” finds ways to “get around the walls and barriers the US has put up to block it,” with many drugs smuggled inside freight containers as part of our heavy border commercial traffic with Mexico.

Pointing his finger at immigrants, she added, has a sinister motivation. Trump blames “immigrants for bringing drugs across the border, ignoring that immigrants are overwhelmingly more law-abiding than US citizens,” McFarland Sánchez-Moreno said. The entire presidential declaration, she said, provided yet another excuse for “talking about criminal justice answers to a public health problem, even though the war on drugs is itself a major factor contributing to the overdose crisis.” Trump is still trying to use a hammer to smash the drug problem, with immigrants hit with a special ferocity.

The president’s plan, McFarland Sánchez-Moreno charged, will spread pain and misery, “condemning even more people to death, imprisonment, and deportation in the name of his war on drugs.”

Sadly, as if on cue, Chuck Schumer, the top Democrat in the US Senate, answered Trump’s call, finding $12.5 million to fund a new DEA team to focus on the smuggling of fentanyl at Kennedy Airport. Look for the arrest of black and brown baggage handlers.

Nobody expects this one unit to make a real difference, but it points up drug reformers’ fears that in a nation that refuses to give up its belief that criminal law protects its young from drug addiction, law enforcement will get the bulk of any new funds identified. A public health approach, based on strategies that “work,” remains the low man on the budget totem pole.