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News Harm reduction

mr peabody

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What would happen if the US decriminalized drug possession?*

by Jag Davies | Playboy | Dec 17 2019

The drug policies in this country are preposterous. As long as people who use drugs are treated like criminals, mass criminalization and mass overdose deaths will remain two of the greatest ongoing tragedies in the United States.

Accidental drug overdoses are the leading cause of death for Americans under the age of 50, exceeding fatalities from gun violence, car accidents, homicide and HIV/AIDS. According to the Centers for Disease Control and Prevention’s National Center for Health Statistics, more than 68,000 deadly drug overdoses occurred in the United States in 2018 alone.

At the same time, U.S. law enforcement makes an arrest for drug possession every 25 seconds, adding up to well over 1 million arrests a year. It’s the single most common reason for arrest in the country. These arrests do nothing to reduce the use of drugs; in fact, criminalization amplifies safety risks by pushing people who use drugs away from public health services.

What if I told you that decriminalization of all drugs (yes, all drugs) could put an end to that? Under decriminalization, people who are caught using or possessing a small amount of drugs or are found with drug paraphernalia would no longer face criminal penalties, meaning any form of criminal punishment (including arrest, jail and imprisonment) would be abolished.

This idea—to cease to treat drug possession as an unlawful offense—isn’t as outlandish as it may seem. According to a poll conducted by the Cato Institute, 55 percent of Americans support decriminalization. The leading governmental, medical, public health and civil rights groups—including the American Civil Liberties Union and the Global Commission on Drug Policy, plus celebrity activists such as Richard Branson—have also supported decriminalization, arguing that drug-policy reformation would revolutionize how the U.S. handles use and addiction.

Decriminalization has proven to be transformative in other nations across the world. Numerous countries, including the Czech Republic, the Netherlands, Spain and, most notably, Portugal, have had remarkable success with it.

The Portuguese regime, established by António Salazar in 1932, closed the country off from the rest of the world for 40 years. When the suppressive rule abruptly ended in 1974, in came the drugs the country had barely experienced before. By the 1990s, one in 100 people in Portugal was addicted to heroin, and the country’s rate of HIV infection had hit the highest in the European Union. But since 2001, when Portugal became the first country to decriminalize all drugs, the number of people voluntarily entering treatment has increased significantly as rates of addiction and adolescent drug use have fallen. From 2000 to 2015, HIV infections in Portugal plummeted from 104.2 new cases per million to 4.2 cases per million.

Given decriminalization’s successful track record, senior levels of government are attempting to pave the way for it in an array of countries, including Canada, Ghana, Ireland, Malaysia, Mexico, Norway and Scotland. Still, only a handful of U.S. policy makers have embraced the idea.

Some progress has been made in reforming the war on drugs in the United States—but mostly by cities and states, not by the federal government. Alaska, California, Colorado, Connecticut, Oklahoma, Oregon and Utah have reduced drug possession from a felony to a misdemeanor. Dozens of cities around the country have instituted pre-arrest diversion programs, such as Law Enforcement Assisted Diversion. “911 Good Samaritan” laws, some of which limit criminalization at the scene of an overdose for witnesses who call for emergency medical assistance, have been adopted in all 50 states.

Progress has also been made toward cannabis legalization in all 50 states, giving hope that once-unthinkable drug reforms can happen with positive results. Since Colorado, Washington, Alaska, Oregon, Washington, D.C., California, Massachusetts, Maine, Nevada, Michigan, Illinois and Vermont approved measures to legalize cannabis, states have saved millions and are allocating the dollars earned from cannabis taxes to civil sectors. In Colorado, for instance, $225 million in tax revenue was distributed to the Colorado Department of Education from 2015 to 2018. A study published in the journal Economic Inquiry shows compelling evidence that opioid-overdose deaths in states that have legalized recreational cannabis drop by 20 to 35 percent.

"The criminalization that targets lower-income communities would slowly wither, affording those affected an opportunity to support themselves and their families."



The national debate around cannabis has evolved from whether the remaining states should legalize it to how they should legalize it. But even though a 2018 Rasmussen Reports survey found that only nine percent of likely U.S. voters deem the war on drugs a success—and despite positive case studies ranging from Portugal’s decriminalization to cannabis legalization stateside—the Trump administration is making moves to ramp up the drug war. This marks a shift away from modest Obama-era reforms that slowed the growth of mass incarceration. Trump and his ilk have weaponized the overdose crisis in an attempt to demonize immigrants and people of color—even calling for the death penalty for people who sell drugs.

U.S. voters may soon decide on drug decriminalization for the first time: In September 2019, activists in Oregon filed Petition 2020-044, which will likely come to a vote in November 2020. If passed, it will decriminalize simple possession and refer offenders to a range of voluntary services such as evidence-based treatment, harm-reduction programs and housing services. The savings on law enforcement—as well as the revenue from cannabis taxes—would fund these programs.

Some Democratic presidential candidates, such as Bernie Sanders, include far-reaching drug-policy reforms in their platforms. “We are going to end the international embarrassment of having more people in jail than any other country on earth. Instead of spending $80 billion a year on jails and incarceration, we are going to invest in jobs and education for our young people,” Sanders promises on his campaign website. Yet as of press time no 2020 presidential candidate has made a full-throated endorsement of ending arrests for drug possession and implementing Portugal-style decriminalization.

So what would the United States look like if we stopped treating drug users as criminals? Mass incarceration and mass criminalization—which are major drivers of economic inequality, health disparities and systemic racism—would decrease significantly. The criminalization that targets lower-income communities would slowly wither, affording those affected an opportunity to support themselves and their families.

We would no longer fear years like 2018, when law enforcement arrested about 1.43 million people for possessing small amounts of drugs for personal use. The American Civil Liberties Union and Human Rights Watch could work on releasing the 137,000 people they estimate are behind bars in U.S. prisons and jails on any given day for drug possession—many of them being held pre-trial because they can’t afford to post bail. Thousands more currently locked up for failing drug tests as a condition of probation or parole could start working toward their freedom.

Black people, who represent 13 percent of the U.S. population and use drugs at similar rates as other groups, would no longer account for 29 percent of people arrested for drug-law violations and 33 percent of people incarcerated in state prisons for drug possession. Law enforcement would be able to divert resources to serious public safety concerns—such as the 67 percent of reported rapes that went uncleared in 2018 and the thousands of rape kits that went unprocessed.

If mass drug-possession arrests stop in the U.S., the thousands of people currently deported every year for possessing any amount of drugs would no longer fear losing their homes. Permanent residents—many of whom have been in the U.S. for decades and have jobs and families—would no longer live with the anxiety caused by the automatic detention and deportation, often without the possibility of return, for being caught with any amount of any drug.

One may hypothesize that fewer drug-possession arrests would mean more crime on the streets, but the Pew Charitable Trusts reported in 2017 that there is “no relationship between drug imprisonment and drug problems,” because under decriminalization, people would still be arrested for committing crimes under the influence of drugs. Decriminalization would only mean that police could no longer waste taxpayer dollars arresting people for possession.

Decriminalization also makes it easier to ramp up health and harm-reduction services that are known to drastically reduce addiction, overdose deaths and new hepatitis C and HIV infections. Evidence-based drug treatment could more easily be offered to anyone who wants it. For those who continue to use drugs, services to reduce potential harm—such as screening unregulated drugs for adulterants, community-based naloxone distribution, syringe-access programs, supervised consumption sites and other long-proven approaches—could also be made more widely available.

All the pieces are in place for drug decriminalization to take effect in the U.S. Now we just have to demand that our leaders act. To truly end the war on drugs and avoid new public health crises, we need to accept that criminalizing possession offers no solutions or hope for real cultural transformation.

 
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mr peabody

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Truvada is one of two HIV prevention drugs that will
be freely available to qualified individuals.


HIV prevention drugs are available for free: How do you get them?

Carmen Heredia Rodriguez | Kaiser Health News | Dec 4 2019

The government has unveiled a plan to distribute HIV prevention medication free to individuals who do not have prescription drug insurance coverage.

Called Ready, Set, PrEP, the federal program will provide patients at risk of contracting HIV one of the two pre-exposure prophylaxis (PrEP) drugs. Those medications can reduce the chances of getting HIV through sex by more than 90%.

The medications, Truvada and Descovy, are made possible in part by a donation from the drugs’ manufacturer, Gilead Sciences. That would cover the drugs for up to 200,000 uninsured individuals each year for the next 11 years. The federal government, however, is paying the drugmaker for several months to distribute the medications.

Without insurance, a 30-day supply of the drugs runs between $1,600 and $2,000.

The initiative is part of President Trump’s effort to reduce the number of new HIV infections by 90% in 10 years.

If you are interested in signing up for the program, here’s what you need to know:

Am I eligible? How can I sign up?

Potential participants must meet three criteria:

- They must test negative for HIV, the virus that causes AIDS.
- They need a prescription for the drug from a medical provider.
- They must be uninsured or have health insurance that does not cover prescription drugs.

The program is starting immediately. Candidates can get more information online, in person or by phone. Online, go to GetYourPrep.com. Those interested can also visit health providers such as community health centers to enroll. To find the nearest location, visit locator.hiv.gov. The phone number for information is 855-447-8410.

Once approved, patients will receive a 30- or 60-day supply of whichever drug their doctor prescribed. The drugs will be available in at least 21,000 CVS, Walgreens and Rite Aid locations. Both medications are once-a-day pills.

The program will re-verify participants twice a year. They will also need to be tested for HIV every three months.

Patients who have been getting help for the cost of PrEP through Gilead’s medication assistance program over the past 12 months are not eligible for the government-sponsored drugs.

Through the program’s partnership with the three pharmacy chains, patients can receive counseling.



How much will this cost me?

The medication will cost the patient nothing.

However, patients are required to undergo blood tests every three months. Ready, Set, PrEP will not cover the costs of these tests or clinic visits.

To access low or no-cost treatment, Health and Human Services Secretary Alex Azar said, patients can seek care at community health centers.

Dr. Kenneth Mayer, the medical research director at Fenway Health in Boston, a community health center, said the program is a step forward in improving access to the medication for many people. However, he said, the lab tests and clinic visits can cost thousands of dollars per year. While Mayer considers the administration’s reliance on community health centers a “very positive thing,” finding affordable follow-up services requires the patient to know where to look.

“People can pull together various resources and get the costs covered,” Mayer said, “but it’s knowing how to access those programs and services.”

How much will this cost the government?

Even though Gilead is providing the drugs free, other costs are involved in getting the medications to patients. Initially, the federal government is paying Gilead roughly $200 per bottle to cover the cost of distribution and dispensing the drug at pharmacies. By March, Azar said, he hopes federal officials will have set up a more cost-effective distribution channel with the pharmacies.

Additionally, the partnership with CVS, Rite Aid and Walgreens will reduce costs for the government by more than half.

The program will not be affected by a lawsuit filed last month by the federal government against Gilead over patent issues on the PrEP drugs. The suit is part of an attempt by the government to lower the price of the drugs.

Why is the government giving away the drugs?

An estimated 40,000 people are diagnosed with HIV annually.

The federal government is focusing its efforts on 48 counties, the District of Columbia and San Juan, Puerto ― areas that accounted for more than half of the nation’s new HIV infections in 2016 and 2017. Seven states are also being targeted to combat HIV in rural areas. However, the Ready, Set, PrEP program is available throughout the country.

Of the 1.2 million people who could benefit from PrEP, only about 18% had received a prescription for the drug last year, the Centers for Disease Control and Prevention reported.

Dr. Brett Giroir, the acting commissioner of the Food and Drug Administration, said officials estimate that up to 200,000 people who could benefit from PrEP don’t have insurance.

“We certainly believe that this program will supply all those in need who are uninsured,” said Giroir.

Kaiser Health News is a nonprofit, editorially independent program of the Kaiser Family Foundation. Neither KHN nor the Kaiser Family Foundation is affiliated with Kaiser Permanente.

 
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mr peabody

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Mobile addiction treatment center battles stigma, shame, and rising overdoses in South Philly

by Aubrey Whelan | The Philadelphia Inquirer | Dec 28 2019


In South Philadelphia — where opioid overdoses are rising but help for people in addiction is still hard to come by — physicians from the University of Pennsylvania are prescribing free treatment from a van on Broad Street.

The program, called Project RIDE (Rapid Initiation of Drug treatment Engagement), launched in July, and aims to get people who need it started on buprenorphine, an opioid-based medication that helps ease withdrawal and curb cravings. Such medication-assisted treatment has been shown in studies to result in more durable recovery than abstinence alone.

Project RIDE is part of a two-year study looking at how to get addicted patients into treatment as quickly as possible.

The van parks at Broad Street and Passyunk Avenue on Tuesdays, Wednesdays, and Thursdays, and provides free treatment for 30 days, or until patients enter a longer-term treatment program.

The staff has helped connect others who don’t want buprenorphine, or can’t take it, to other services or treatment programs, and offers testing for HIV and hepatitis C — both common perils for injection drug users. The van also stocks naloxone, the overdose-reversing drug credited for much of the decline some areas have seen in drug fatalities.

Though the city has worked to expand the availability of medications like buprenorphine, convincing people to enter treatment can be difficult. For people in active addiction, avoiding the pain of withdrawal is paramount, and can make long waits for a prescription or a spot in a treatment program impossible.

"The nurse practitioner, the case manager, and the peer recovery specialist who work on the van can have a patient’s first dose of buprenorphine delivered within a day, sometimes even earlier," said David Metzger, the director of Penn’s HIV Prevention Research Division, who’s running the program.

They’ll even make house calls to patients who fear their neighbors will see them going to the van.

That’s a key accommodation in communities like South Philly, where opioid use tends to be hidden behind closed doors, and stigma against addiction runs deep. A few miles northeast in Kensington, where open-air drug use and sales are pervasive, the public health organization Prevention Point runs its own mobile buprenorphine program in addition to services at its brick-and-mortar headquarters.

There are a few buprenorphine clinics in South Philadelphia — the long-running Wedge Recovery Center sits down the street from where Penn’s van parks on Passyunk Avenue, just blocks from the neighborhood’s iconic restaurant row. And CleanSlate, a nationwide outpatient addiction treatment program, just opened a second South Philadelphia location farther south on Broad Street.

But the stigma against seeking help persists, even as overdoses in the neighborhood have risen steadily for the last several years.



'I don’t know a single family that hasn’t been affected’

Overdoses in the 19148 zip code in South Philadelphia increased by 20% in 2018, from 44 deaths in 2017 to 53 deaths the following year.

The problem is far more pronounced in Kensington and Port Richmond — where the 19134 zip code saw 160 people die in 2018. But that total represented a 23% drop from the year before, a sign that the city’s efforts to flood the neighborhood with naloxone and harm-reduction services has had some positive effect.

Advocates in South Philly say those efforts need to be replicated in their neighborhood, where the opioid crisis is less visible — but no less dangerous.

Many people with addiction in tight-knit South Philly hold down jobs, use at home, and hide their addiction, ashamed to seek treatment, said Destinie Campanella, a harm reduction specialist for the city health department who grew up in the neighborhood and still lives there.

“I don’t know a single family that hasn’t been affected [by the opioid crisis in South Philadelphia]," Campanella said. On her regular rounds through the neighborhood to hand out naloxone, she’s learned to avoid certain corners where people use drugs: Too often, she’ll see people she knew in high school there, old friends who are now too ashamed to speak to her and won’t accept her help.

“I can see the look on their faces when I come by — like, oh, no,” she said. “People are so embarrassed. It’s something I’m constantly struggling with."

The Penn van staff have similar struggles.

About 60 people have visited the buprenorphine van since it launched in July. Only 15 have opted to receive buprenorphine. “We’re still looking for the most effective ways to communicate with people,” Metzger said.

"The patients who have come through the van demonstrate the need for more harm-reduction and treatment services in South Philadelphia," the staff says.

One patient told nurse practitioner Jody Gilmore that her boyfriend had died of an overdose in her arms because she didn’t have naloxone. Another brought her mother to an appointment, so Gilmore could teach her how to administer the drug.

“What happens in the home stays in the home in South Philly," said Susan Corrigan, the van’s peer recovery specialist, who lived in the neighborhood for 15 years. Despite the stigma against addiction, she said, families are eager to help their loved ones.

“Every participant in the family system steps up to help. The whole family is affected,” she said.

Building relationships

"That community spirit can also help outreach workers build relationships with people in addiction and their neighbors," said Carol Rostucher, founder of the outreach group Angels in Motion, which started operating a needle exchange in South Philly earlier this year.

Initially, the needle exchange had trouble attracting participants, just like the van. So Rostucher tried to make residents more comfortable with what she was offering.

“We put chairs out and let people sit down and talk. We started getting residents who came by, and asked us about how to clean up needles left on sidewalks and in parks," she said.

“It’s all different people now who stop by to talk. And it helped people sign up for the exchange, because now it’s hard to tell why someone’s stopping to talk to us. You have privacy.”

In recent months, Metzger and his staff have pushed harder to get the word out about the van. They’ve monitored overdose clusters in the neighborhood to see where the program might be needed most, and have been using a Twitter account to promote the program.

“We’re meeting people where they are, without any judgment about medication,” Gilmore said. “And this is a community that really needs this service.”

 
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mr peabody

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NorWest Community Health Centre's supervised injection site in Thunder Bay, Ontario.

Tainted drugs fueling Canada's opioid deaths*

by Padraig Moran | CBC Radio | Jan 08 2020

Inside the only supervised injection site in Thunder Bay, Ont., nurse practitioner Josh Fraser has reversed so many opioid overdoses that he says the lives saved are "too many to count."

"It's not about trying to stop it," Fraser said of drug use in the northwestern Ontario city. "I think it's about providing a safe place and meeting people where they're at."

There were 44 opioid-related deaths in Thunder Bay in 2018. A 2019 Ontario Public Health report analyzing 2017-2018 data says "Thunder Bay had the highest per-capita rate of fatal opioid overdoses in the province. For every 100,000 people, there were nearly 23 deaths," the report found.

There were 1,474 deaths across Ontario in 2018, and 4,614 across Canada. From January to June 2019, deaths in Ontario increased 48 per cent to 937, up from 633 in the same period of 2018.

"There's a lot of potentially contaminated drugs that are causing harm to people," Fraser told The Current's Matt Galloway.

In the first six months of 2019, government statistics estimate that 95 per cent of nearly 1,000 opioid-related deaths in Ontario were accidental.

The NorWest Community Health Centres' supervised injection site, where Fraser works, is part of a wider call by the Alliance for Healthier Communities — a network of community-governed health-care providers — asking the federal government to address contaminated drugs in the illicit market, and provide a safe supply for opioid users.

NorWest CEO Juanita Lawson says "people who don't access their services are continuing to inject alone, by themselves, with substances that they don't know what's in them."

In the first six months of 2019, the provincial coroner recorded 21 opioid-related deaths in Thunder Bay, but Lawson says from what she has observed, "the rest of the year could yield a record number."

"A safe supply would mean less death, but would require the federal government to collaborate with the provinces on a national strategy,"
Lawson said.

In a statement to The Current, the AHC says it will submit a budget proposal to Queen's Park later this month advocating for the expansion of safe supply.

The statement added that while the AHC meets with the provincial government regularly to discuss supervised consumption sites, their "work with the ministry on safe supply is really just beginning."

Lawson said given the severity of the epidemic, advocates "would like to see action on safe supply take place sooner than later."

Safe supply saving Vancouver lives: doctor

There are already several clinics offering safe supply schemes in Canada, including the Crosstown Clinic in Vancouver.

The clinic started offering the opioid hydromorphone in 2014, and diacetylmorphine — prescription heroin — in 2017. It now treats 110 patients with injections daily, and another 15 orally, 365 day a year.

Dr. Scott MacDonald, who runs the clinic, says "the program has shown to improve care, reduce societal costs, reduce mortality, and reduce crime."

"Patients have reconnected with families, completed schooling programs and many are working now, some even full time,"
he said.

The Crosstown Clinic is funded by British Columbia as part of its health budget (similarly, NorWest is funded by Ontario). Federal exemptions under the Controlled Drugs and Substances Act permit supervised consumption or safe supply.

MacDonald says provincial governments should provide more funding for safe supply.

"If we've shown that this is better care, at reduced societal costs, it should be funded," he said.

"We need every tool in the toolkit."

Minister of Health Patty Hajdu says the Liberal government is working on finding "community-based" safe supply solutions.

"The safer supply piece is really important, and we're taking steps, and strong steps with communities that are ready to do that, that have the support to do that," she told Galloway.

In November, Vancouver Mayor Kennedy Stewart said Prime Minister Justin Trudeau appeared open to the city's application for $6 million to fund a safe supply for heroin users.

"Trudeau wants to work together … and is open to having a conversation and then looking to us to lead, with health-care professionals, to try and figure out the best solutions to these problems," Stewart told The Canadian Press.

"Decriminalization not a 'silver bullet,'" says minister

Alongside the push for safe supply, advocates have called for the decriminalization of all drugs.

During last year's federal election campaign, Trudeau rejected the Conservatives' claim the Liberals would decriminalize all drugs if re-elected (the party previously discussed the idea, but rejected it in favour of focusing on cannabis.)

Hajdu told Galloway that the legalization of cannabis showed that conversations around drugs can be shifted to being "much more based in health … rather than in criminality and in law enforcement."

When asked if it is inevitable that wider decriminalization will eventually be discussed, she said "society's always evolving, so I wouldn't rule anything out."

But she warned that "decriminalization would not eliminate all of the problem."

"It is not the silver bullet that I think many advocates are saying that they think it would be,"
said Hajdu, the MP for Thunder Bay-Superior North.

Before entering politics in 2015, Hajdu worked in harm reduction in Thunder Bay, and was the executive director of a shelter in the city.

"I don't think we can talk about the decriminalization or legalization of all drugs without also having a corresponding system that has adequate, if not, excellent supports for people in the aftermath of whatever comes next," she said, referring to supports like shelter beds or job skills training.

Answer the call for help

Lawson and her team strive to offer those supports at NorWest's Rapid Access Addiction Medicine (RAAM) clinic. Clients are encouraged to to see physicians, nurses and counsellors who are available upstairs.

"We don't want that individual to be turned away, or have to come back tomorrow, because they might not come back tomorrow," Lawson said.

"There's been probably many times that they've asked for help and haven't received it, so I think that's a really important piece."

Since its opening in 2018, the clinic has had roughly 700 clients, with 80 per cent coming back for repeat visits. The average patient visits the clinic nine times.

Amanda Rusnick has been sober for a year, and credits the clinic with helping her to turn her life around.

"They actually help you to get clean, and once you're there, they help you to stay there."

Rusnick became addicted to prescription painkillers after a violent assault in Edmonton in 2004. She turned to illicit street drugs when she moved from Alberta to Ontario (medical prescriptions are not transferable from province to province, and no doctor was willing to write a new prescription.)

Her opioid dependency lasted nearly two decades, during which she resorted to crime and served time in jail. She told Galloway she kept crushed opioids nearby as she slept, as she couldn't get out of bed without them.

But when a NorWest nurse practitioner asked her if she would like to visit the RAAM Clinic, everything changed.

"I have a counsellor there who I can contact 24 hours-a-day," Rusnick said.

"If I didn't have that, I don't know how many times I probably would have slipped."

Rusnick thinks people could benefit from other centres offering the same services as RAAM, but Lawson warned that in the opioid crisis, success can be relative.

"It's not necessarily stopping, and moving into housing, and having a family, or all those things," she said.

"It's the fact that they actually went upstairs, and they met with a physician to talk about different options. That's success."

*From the article here:

 
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mr peabody

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Ukraine paves the way for innovative harm reduction in the Eastern Europe/Central Asia region

Talking Drugs | Alliance for Public Health | 14 Jan 2020

A little over a year ago the first harm reduction initiative of its kind was opened in the Ukrainian city of Sumy. The initiative, a safe injection site, demonstrates an innovative approach to harm reduction in the region, and was opened with the support of municipal authorities. By the end of 2019, plans to open a second site in Sumy were in place, with the hope that a similar approach to harm reduction would be implemented across other Eastern European and Central Asian countries.

During its first year, the harm reduction initiative in Sumy was visited by municipal delegations of Poltava, Odessa, Kyiv, Chernigov (Ukraine), Balti, Chisinau (Moldova) and Kazakhstan across a series of meetings with the aim of sharing best practices in harm reduction and paving the way for innovative approaches in the EECA region.

Safe injection sites and other harm reduction facilities for controlled drug use

Safe injection sites, also known as safe consumption rooms, drug consumption rooms, or overdose prevention sites, are generally understood as harm reduction facilities where the use of controlled drugs is permitted with supervision.

Such centres address overdose cases with almost 100% efficiency, evidence overwhelmingly suggests. Some reports point to the economic efficiency of such initiatives for national and municipal budgets, since services such as ambulances and emergency healthcare provision are called at lower rates and the likelihood of HIV, TB and hepatitis spread is significantly reduced.

Other repeatedly evidenced positive aspects of such harm reduction initiatives are: reducing crime, improving overall health and quality of life throughout society, reducing the number of “relapses” and improving the socialisation of patients (by supporting the likelihood of a regular job, place of residence and helping to strengthen and restore family ties).

The first harm reduction facility for controlled drug use that was officially approved by municipal authorities and supported by health professionals opened in Bern in 1986 and continues to operate its services.

Back in the early 70s, a community center allowing controlled drug use opened in the Netherlands, providing resources including basic information about health and drug use, food and clothes and clean syringes. The local administration and the police at the time supported the project, but the centre only achieved its official status much later, in 1996.

Today, more than one hundred injection rooms are officially operating in the world: in Switzerland, Germany, France, Canada, Australia, Spain, Luxembourg, Norway, the Netherlands and now in Ukraine.



Harm reduction in Sumy

Global experience shows us that where harm reduction rooms are introduced as state facilities in societies with a high level of discrimination and criminalisation of people who use drugs, it can be difficult for centres to gain the trust of people for whom the service is operating. In Sumy, this problem was successfully addressed through the involvement of social workers from a non-governmental organisation.

“The approaches to harm reduction in Ukraine have not changed dramatically for 20 years, so the most challenging task now is to gain the trust of people who use drugs so that they are not hesitant to use in this municipal space. Everything here is built on trust,” said a public activist and the facility launch initiator, Oleksiy Zagrebelnyi.

“The result of our activity at the moment is that there are more and more visitors, we began to receive feedback from them, which means that the room is in demand. The services we provide are unique, they are in demand, and it is a success, because the social side of this project has significant benefits for the public.”

A significant example of the benefits of harm reduction rooms is a considerable improvement in the security atmosphere in society and a decrease in the number of complaints to the Sumy authorities regarding the negative consequences of drug use, in particular: littering with used syringes and other means in and around hospital facilities, house entrances, playgrounds and just on the streets; use in public places, etc.

According to Maksym Galitskyi, the deputy mayor of Sumy on health and safety, such appeals have become scarce since the room was opened. “Previously, there were several appeals every week, now we receive one complaint per month. This is an obvious success,” he said.

According to the chief doctors of the Sumy Regional Narcological Dispensary, Taras Zlydennyi, approximately 50-70 people visit the harm reduction room every day, and the number of registered patients at the drug dispensary is up to 600 people.

The room provides preventive counseling services to reduce the potential harms of drug use in general and provides information on the consequences of using unregulated controlled substances, offers tests for HIV and hepatitis, counselling services for relatives and family members of people who use drugs, runs a syringe exchange, as well as offering protective and preventive measures for harm reduction.

Political will and the municipal authorities’ consensus are a prerequisite to success

The Sumy approach to harm reduction is unique, because the city managed to dispel stereotypes regarding methods of combating drug dependency. Instead of stigmatising and persecuting people who use drugs, the representatives of the city authorities, law enforcement agencies, the medical sector and NGOs united their efforts and provided the conditions for supervised, hygienic controlled drug use.

Moreover, the harm reduction room is funded exclusively from the city budget - financial assistance from international organisations, the ICF “Alliance of Public Health” and the International Renaissance Foundation was needed only at the start of the project to repair and prepare the premises.

“There are 2 options to fight against any problem – this is either tough prosecution and looking for ways to eradicate, which are often too expensive and do not achieve effective results. The other way is the policy in which we try to reduce harm, thinking about the safety of our citizens,” said Maksim Galitskyi.

“In Ukraine, various officials, often having different mindsets, are responsible for protecting health and safety. This is a national scale problem throughout the country, since there is no single policy-maker in the field of counteracting drug trafficking, and the Ministry of Health has no influence on the Security Services. In Sumy, I am an official responsible for safety and health […] we managed to create a communication platform on which NGOs, together with authorities, reached a certain consensus on this issue.”

The importance of having political will and consensus among different branches of government is also recognised by the regional administration.

“Sumy region was lucky to have officials who are able to understand, realise and support such an initiative,” said the ex-head of the staff of the Sumy Oblast State Administration, and the current first deputy Minister of Development of Communities and Territories of Ukraine, Dmytro Zhivitskyi.

“We had political will, and the Head of the oblast administration supported us. Non-governmental organisations took up the function of awareness raising, expert examination and providing international experience for the administration, for the deputies, whose support we managed to gain.”

“Taking off in this direction, we realised that we have a well-developed mechanism for making and implementing joint out-of-the-box decisions, which was lacking before this,”
he said. “Back in 2017, we created the oblast Public Health Center, the first full-fledged regional facility. Now we have created a working group, and in mid-July we will adopt the oblast public health program, which will take into account the experience with drug users. That is, our task today is to implement a philosophy of prevention and addressing the causes rather than eliminating the consequences.”



Where in the EECA region are the next harm reduction rooms about to open?

The Sumy harm reduction room was opened at the regional drug dispensary. Local authorities and international organisations provided the startup support for the facility. The success of the initiative, according to representatives of the city’s authorities and non-governmental organisations, has proved its efficiency and expediency.

Public activists from the Moldavian city of Balti showed interest in opening such a room in their city. Moreover, the mayor has previously said that it would be much easier to implement such programs in Balti, because for this you would only need to “copy” Bern’s experience initiated 33 years ago. Now the experience of the Ukrainian city of Sumy will become a best practice.

According to Oleksiy Zagrebelnyi, building works for the second harm reduction room in Sumy are currently underway, and it is planned to open another harm reduction room at the opposite end of the city imminently.

For this, there is already the first successful case study, and all the necessary procedures that have been developed in the course of the current harm reduction room’s progress. Regardless, other cities will have to make some efforts to implement such a project that suits that particular context.

Where to start: expert advice

Experts emphasise that opening a harm reduction room in a new city will involve two important aspects: regulatory and economic issues.

First, it is necessary to analyse the adoption of programs involving work with people who use drugs and the key impacted populations.

“As a rule, local program packages already exist in many cities,” said Yelena Koval, consultant for the International Renaissance Foundation on the availability of pain management medications and drug policy.

“Among local programs, we need to look for those that have a harm reduction component, analyse at which healthcare facilities such programs work, who is involved there. And then – just imagine that a contaminated syringe can be dropped at the building entrance, on the playground, and calculate how much post-exposure prevention will cost for a person who is accidentally exposed to the contamination. Which resources will be needed in order to deliver medications, how much a treatment regimen will cost?”

In recent years, cities have demonstrated leadership in improving people’s health and effectively combating HIV, TB, and hepatitis. This trend is crucial at the global level, because today, 55 per cent of the world’s population lives in cities, and it is expected that by 2050, two-thirds of the world’s population will be urban dwellers.

Cities in the EECA region can benefit from the decentralisation of programs and resources, expert community input and best practice from around the world.

 
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Philadelphia's proposed safe injection site—the country's first

How Philly plans to combat the nation's worst big-city opioid crisis in 2020

by Aubrey Whelan | Medical Xpress | 22 Jan 2020

Philadelphia is home to the worst urban opioid crisis in America. More than 3,000 people have died of drug overdoses here in the last three years, and the city health department estimates that tens of thousands of Philadelphians are addicted to opioids. As the epidemic has worsened, city officials, hospitals, and outreach workers have scrambled to address a complicated public health crisis with few easy answers.

The city has spent more than a year pouring resources and initiatives into Kensington, the neighborhood at the epicenter of the crisis. Two years after fatal overdoses hit an all-time high—claiming 1,217 people in 2017—it appears that the 2019 toll will be similar to 2018's, when 1,116 people died.

"The numbers haven't been finalized, but the preliminary numbers—I'm not particularly pleased," said Brian Abernathy, the city managing director. "It's about the same as last year. But I'm not happy with that. The amount of devastation that's happening on so many different levels is just not something we as a city should think is okay."

Getting that still-staggering number to budge in 2020 will mean much more work, especially outside Kensington, in areas like South Philly, where drug use usually happens behind closed doors, away from the reach of health workers.

Here's what the city—and its partners in local hospitals and outreach organizations—have planned for the year ahead.

More peer specialists in and out of hospitals. People who are in recovery from addiction have long been part of the treatment industry. But "peer specialists," as those who have gone through a state certification process are called, are taking on bigger roles in Philadelphia hospitals, connecting with patients in ways physicians and nurses say they cannot. They are meeting patients in emergency rooms, helping people with addiction navigate the days of early treatment and doing street outreach around the city. Since Penn Medicine began sending peer specialists into its emergency rooms in 2018, seven in 10 of the department's patients with opioid use disorder have stuck with treatment for at least 30 days. Other hospitals are eager to replicate that success and are looking to expand their peer programs in the new year. The city is trying to hire nearly four dozen peer specialists, as it helps hospitals improve their "warm handoffs" of patients directly into long-term treatment.

The Temple hub. With help from a large state grant, Temple University Health System has expanded its treatment programs and referrals, acting as a "hub" that sends patients to community treatment programs. This is especially key at Temple, because the health system's Episcopal Hospital in Kensington deals with more overdoses than any other hospital in the city. Temple increased its buprenorphine prescribing—medication-assisted treatment proven to yield more lasting recovery—by 70% and increased its outpatient treatment slots from 11 new patients a month to 116.

The next generation. At Jefferson Health, MATER, the long-running treatment program for pregnant women with addiction, is incorporating women's families into their treatment. Instead of requiring a 30-day "blackout" from all contact with the outside world, like many treatment centers do, MATER is hosting family dinners twice a month, offering family therapy, and helping mothers plan to reunite with their extended families,” said Kim McLaughlin, the program's director.

Bending the rules to keep people in treatment. In the past, if someone missed three treatment appointments in a row at Jefferson, they were out of the program, said McLaughlin. But now, for example, if someone is missing fewer appointments than they used to, that's considered an improvement, and not a reason for punishment. She says it's a key change in the middle of a crisis where leaving treatment can mean death.

Getting naloxone where it's needed. Last year, when Penn Medicine launched large-scale, staff-wide giveaways of Narcan, the overdose antidote, employees from around the system came by to pick some up, said Jeanmarie Perrone, the director of the division of medical toxicology in the University of Pennsylvania's emergency department. “Often, staffers knew family and friends in their communities who might need a dose of Narcan. They were really personally affected and wanted to be better prepared for their community," she said.

Better leadership in neighborhoods. Kensington is no longer under the emergency declaration prompted by chronic public drug use and homelessness that had people in addiction living in encampments under bridges. But some programs used during the declaration will continue there and in other parts of the city. Some examples: More mobile addiction treatments in neighborhoods without many treatment options, like the van that prescribes medication-assisted treatment in South Philly. The city is also looking to add more supportive housing for the chronically homeless. Former deputy director of emergency management Noelle Foizen will lead an "opioid cabinet," where the officials who oversaw the emergency declaration will meet regularly to address opioid-related issues all over the city.

Work to earn. This month, the city launched a program where people can help clean streets in Kensington, and be paid the same day. Two days a week, 10 people will be selected by lottery to earn $50 for about four hours of work. "The goal is to provide people with a more productive way to earn money rather than petty theft or panhandling," said Abernathy. (People who aren't selected in the lottery will be offered treatment, other help finding jobs, and links to social services.)

Protecting schoolchildren. Despite all the work that's been done in Kensington, open-air drug use and dealing continue, and smaller encampments remain on Kensington Avenue. Schoolchildren often have encountered dealers, needles, and people injecting heroin on their way to school, so one of the most popular improvements has been "safe corridors." These neighborhood volunteers help children get to school safely. "I greet them, and say good morning, and kind of get between them and any negative aspects in the community," volunteer Mike Noton said.

Stemming gun violence. For police officers who patrol Kensington, the biggest challenge is getting drug-related shootings under control, said Inspector Michael Cram, who commands the department's East Division. Cram said intense demand for drugs in the neighborhood has prompted dealers from other parts of the city to "rent" corners to cash in on the highest profits. These outsiders carry guns for protection—and to keep up, Kensington dealers are doing the same. All those guns, he said, lead to more violence.

Treatment, not arrest. The city hopes to expand a police diversion program in Kensington and North Philly, where people with addiction are offered treatment and social services, instead of being arrested. In all, 951 people were referred to the program from Kensington alone in 2019, the city says.

Keeping a closer eye on pill sales. The city plans to create a local data reporting system for pharmacies, because it's often hard for local entities to access statewide and national data on pill sales. The system, aimed at monitoring sales of prescription opioids to spot illicit use, should be in place within three to six months, city officials say.

The country's first supervised injection site. Safehouse—the non-profit founded to open a space for people with addiction to use drugs under medical supervision, be revived if they overdose, and access treatment—is still in the midst of a federal court battle over the legality of the site. A federal judge ruled in Safehouse's favor last fall, but U.S. Attorney William McSwain has said he'll arrest anyone who uses the site if it opens before an appeals process is complete. Safehouse's backers, some of the city's most prominent advocates for people with addiction, say they will open as soon as they're legally able. They've asked the judge to issue a final order cementing his decision in their favor, but said this month they still need more funds before opening.

 
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Naloxone implant would release naloxone—and even place a 911 call*

by Alexander Lekhtman | Filter | 28 Jan 2020

Researchers in Illinois are developing a novel device to rapidly and automatically administer the opioid overdose antidote naloxone. Smaller than a pacemaker, it is to be implanted in a person’s body. When it detects signs of an overdose, it would release naloxone—and even place a 911 call.

The device is a small, wireless implantable system that monitors blood oxygenation, and upon detection of a drop in this parameter below a threshold value for a certain time period, automatically releases naloxone and initiates a call to first responders,” John Rogers, a biomedical engineering professor at Northwestern University who helped develop the device, told Filter. “To our knowledge, there is no existing device with such capabilities.”

The implant is good for four doses if a single dose doesn’t do the trick, and uses Bluetooth to connect to the person’s cell phone. It would be inserted just below the skin, near the lower back or next to the collar bone.

Rogers leads the research team at Northwestern University, with assistance from Washington University in St. Louis. They received a $10 million grant from the National Institutes of Health, which is trying to find better solutions to the opioid-involved overdose crisis. The team will begin testing the device on animals this year and, if successful, move onto clinical trials with humans by 2023.

While Narcan can prevent deaths, it is not always readily available, and even if it is available, there is not always another person around to administer the medicine,” said Robert Gereau, a professor of Anesthesiology and Neuroscience at Washington University who also helped develop the device. “This device could fill that void, helping to ensure that if a person relapses and gets into trouble, there would be a fail-safe way to deliver the drug that could save them.”

While the device is innovative and exciting, its wider effectiveness will rest on how affordable and accessible it is to people who use drugs. For comparison, a pacemaker costs an average of about $6,250 for newer models, or $4,000 for older models. Medicare covers up to 80 percent of the cost of pacemakers because they are deemed “medically necessary.”

There’s no answer yet to the questions of how much this naloxone device would cost, and whether insurance would cover it. “We don’t perceive any financial barriers, and the cost should be low,” Rogers said. “The cost of the electronics and fluidics systems are low, and so is the naloxone itself.”

Gereau added that it is difficult to know yet what the device would cost, because of the novel technology used. However, he speculated that if it isn’t covered by insurance, both the device and the surgical procedure to implant it could be fairly expensive.

The low-tech alternative to this device—regular, intramuscular or intranasal naloxone—is certainly much cheaper. If purchased from a pharmacy, generic naloxone costs $20-40 per dose, while brand-name Narcan costs $130-140 per kit. If you are fortunate enough to live near a local harm reduction or public health agency, you could obtain a kit and get trained to use it for free. But naloxone that needs to be administered by another person doesn’t help if another person isn’t present.

Nevertheless, until this device becomes available, if you or your peers use opioids or other drugs and are at risk of overdose, carrying naloxone and making sure your friends and family know how to use it is the best thing you can do. Avoiding using drugs alone, and trying to have at least one sober buddy present while you use, are highly advisable. Pacing your dosing so you don’t do too much at once is another harm reduction strategy.

An even more effective preventative measure is testing your drugs. You can obtain fentanyl test strips from a local harm reduction agency if you have one, or buy them online. This is particularly important when fentanyl is being found in various illicit drug supplies throughout the US.

*From the article here:

 
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Buprenorphine, often sold on the streets, may be preventing overdoses

by Aubrey Whelan | Medical Xpress | 4 Feb 2020

It's a refrain dealers chant every day up and down Philadelphia's Kensington Avenue, the city's largest drug marketplace: "Subs—subs—subs!"

They're referring to Suboxone, one of the brand names for the opioid-based addiction treatment medicine buprenorphine, prescribed by physicians and shown to produce more lasting recovery from opioid addiction than abstinence-based therapy. As with so many prescription medications, there's a robust black market for it on the avenue.

But drug users, advocates, and researchers say that many people aren't buying buprenorphine to get high. Rather, they're using it to protect themselves from overdoses, to get through the pain of withdrawal, or even to engineer their own do-it-yourself addiction treatment.

With more than 1,000 people a year dying of overdoses in Philadelphia—the worst big-city opioid crisis in the nation—city and state officials have scrambled to help more people get into treatment programs. They've eliminated ID requirements and insurance pre-authorizations and even launched mobile treatment centers where doctors can prescribe buprenorphine to patients on the street.

Yet entering treatment can still be difficult and daunting for some drug users. For those without Medicaid or generous health insurance benefits, treatment itself is costly.

Cynthia Kerbaugh, of Berlin, Camden County, said she had been doing well for years in a suboxone treatment program, until her insurance stopped covering the medication about a year ago. "Ever since then, I've been back on dope," she said. But she has bought buprenorphine on the street a few times since, with the aim of getting off heroin. "It costs more to go to the doctor," she said.

Buprenorphine is an opioid. But it's a partial opioid agonist, not a full agonist, such as heroin or methadone, another addiction treatment drug. Like the full agonists, for people who aren't used to opioids, it can be used to achieve a pleasurable high—and it can cause respiratory depression, according to the federal Substance Abuse and Mental Health Services Administration.

Because buprenorphine is a partial agonist, though, the effects—and the risks of overdose—are much weaker. For people who are already used to taking opioids, buprenorphine blunts the powerful cravings and pain of withdrawal that send people in addiction in search of stronger opioids.

The brand-name drug Suboxone combines buprenorphine with naloxone, the overdose-reversal drug, which cuts down the potential for misuse: the naloxone blocks the effects of the opioid if Suboxone is injected or snorted. Other brand names such as Subutex and Butrans contain only buprenorphine. Generic Suboxone retails for up to $160 for fourteen 8 mg doses at pharmacies. Generic Subutex can cost up to $128 for 14 doses. On the street, a single Suboxone strip sells for about $15, and cheaper in bulk.

Approved for clinical use in October 2002 by the Food and Drug Administration, buprenorphine is generally prescribed as part of a treatment regimen with counseling and behavioral therapies, and the drug can be taken at home—unlike methadone, which has to be dispensed daily from a specially licensed clinic.

However, physicians must have special certification to prescribe buprenorphine—even though they don't need this extra level of training to dole out the opioid painkillers that got many people addicted in the first place.

And in Pennsylvania, despite the state Health Department's efforts to help more people access buprenorphine, a number of lawmakers have proposed—but not yet passed—even more restrictions around its prescribing, precisely because it ends up on the black market so often.

Because buprenorphine carries a significantly lower overdose risk than prescription pain pills such as oxycodone or illicit drugs such as heroin and fentanyl, advocates say it can be a form of "harm reduction"—a way to make addiction less dangerous to those who are struggling to stay in recovery or aren't quite ready for treatment.

At the very least, it can keep withdrawal symptoms at bay so people don't resort to drugs of unknown origin.

"It's certainly much safer than fentanyl," said Shoshana Aronowitz, referring to the powerful synthetic opioid that has replaced most of the heroin in Philadelphia and largely accounts for the city's spike in fatal overdoses.

Aronowitz, a nurse practitioner and a postdoctoral fellow in the National Clinical Scholars Program at the University of Pennsylvania, also is a community organizer for the harm-reduction organization Save Our Lives (SOL) Collective.

"People are trying to keep themselves safe, and people want (buprenorphine)," she said. "They need it. Ideally, people would be able to very easily access health care for all their health needs, but we know that people have trouble with that for lots of different reasons."

Researchers who interviewed 20 drug users in Pennsylvania's Allegheny and Dauphin Counties last year found that nearly all of the study's participants had bought buprenorphine off the street to get through withdrawal when heroin was unavailable—or when they didn't want to use heroin. A "significant minority" of the participants had bought buprenorphine to try to wean themselves off other opioids, the research, published in the International Journal of Drug Policy, found.

To that end, a handful of prosecutors around the country have stopped prosecuting people for illegal possession of buprenorphine without a prescription. Last week, Philadelphia District Attorney Larry Krasner became the latest. (He has largely stopped prosecuting drug possession for personal use in the last several months.)

In 17 years running a drug-treatment program in Burlington, Vt., Tom Dalton, executive director of Vermonters for Criminal Justice Reform, said that he came to view buprenorphine as a "survival drug," whether purchased on the street or through a prescription.

"We were explaining to people that to the extent you can limit your drug use to buprenorphine, with or without a prescription, you're vastly improving your chances of survival, your chances to transition into sustained recovery," he said. "Eventually I thought, Why would we be punishing someone with a criminal code for making a rational choice to move toward safety and recovery?"

Dalton and other advocates began pushing local officials to decriminalize the drug in Chittenden County, Vt. A year after decriminalization, the county reported a 50% drop in fatal overdoses. “More research is needed to determine what caused the drop,” Dalton said, but he believes decriminalizing buprenorphine had a significant effect. In Philadelphia, officials think that the ready availability of naloxone has helped nudge down fatal overdoses a bit, but much more needs to be done.

People interviewed on the street in Kensington said they had used buprenorphine for a number of reasons. “Some, particularly newcomers to drug use who lack tolerance for opioids, or people whose tolerance has decreased after a period of abstinence, can use it to get high,” said Jay, a 28-year-old from New Jersey, who declined to use his full name because of privacy concerns.

But many others buy it to get through withdrawal. For people deep in addiction, the goal is to avoid that intense pain—to simply feel normal.

"It helps me not get sick," said a man who said he went by the name "El—like the train." He says he wished he had a more reliable supply of buprenorphine, but wasn't ready to enter a demanding treatment program.

Cynthia Kerbaugh was thrilled to hear that Krasner would stop prosecuting the possession of buprenorphine.

"It's awesome, incredible. It should have been started a long time ago," she said. "If people are trying to do the right thing, just let them live."

 
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Haisla man working to save his own from Vancouver's opioid crisis

by Wawmeesh Hamilton | The Current | 13 Feb 2020

Harry hopes his model can be used by other First Nations whose members are living in the Downtown Eastside.

On a cold, damp winter Thursday morning, James Harry walks the grimy charcoal pavement of Vancouver's Downtown Eastside.

Harry moves effortlessly among drug users and cigarette hawkers, never peering too long at anyone. He seems at ease on the street and in the alleys, and it's not without reason.

The Haisla First Nation member once smoked crack cocaine during binges in the neighbourhood's alleys.

"I can still see that person struggling, lost, alone and feeling they don't deserve a good life — I know how that feels," Harry said.

Harry still comes here daily. But now he is an outreach worker with Haisla Outreach, a unique program underwritten solely by the Haisla First Nation to find its own members who are struggling with addiction and get them off the streets.

Indigenous people are over-represented in overdose deaths in Vancouver's opioid crisis. The First Nations Health Authority estimates that 193 First Nations men and women died of overdoses in B.C. in 2018, a 21 per cent increase from 2017.

But by forging a unique connection with fellow Haisla members, Harry is helping people struggling with addiction get into treatment — and in some cases, reconnect with their families.

Harry hopes his three-year-old model can be an example to other First Nations whose members are now living in the Downtown Eastside. In January, that hope became a reality. The Nisga'a Ts'amiks Society, a non-profit that delivers programs and services to urban Nisga'a Nation citizens in Metro Vancouver and Vancouver Island, hired its own outreach worker to work with Harry.

"I lived in the absolute hell of addiction and I took my family along for that ride," Harry said. "Now I feel free and I want everybody that I work with who struggles in alcohol and drugs to feel the way I feel today."

'I found my purpose'

Harry, 51, was born in the Haisla First Nation in Kitimat, B.C. Haisla means "Dwellers downriver" when translated into English.

He excelled in soccer and basketball in his teens in Kitimat, but was also living with violence in his home, he says.

He started drinking alcohol in his late teens. But when he tried cocaine at age 19, his addiction quickly accelerated from weekly to daily.

Harry's addiction reflected a national trend. According to the Royal College of Physicians and Surgeons in Canada, more than 25 per cent of Indigenous people have substance abuse problems.

Once, after a three-day drug binge in Vancouver, he returned home and saw his children when he walked in the door. Their expressions haunted him into sobriety.

"They had such hurt looks in their eyes," Harry said. "I vowed I would never do anything to bring on those hurt eyes and heartbreaks anymore."

Harry got treatment, then started attending Alcoholics Anonymous and Narcotics Anonymous meetings.

But he still felt for people on the Downtown Eastside, and often brought coffee there.

When he bumped into a young relative in 2017 who was deep into addiction, the pair connected and Harry encouraged him to get treatment.

One day the man reached out, asking Harry to drive him home to Kitimat. Harry drove 18 hours to get him into a treatment centre.

The young man's father was a Haisla First Nation council member, who believed Harry might be able to help others like his son.

Six months later, the council asked Harry to become their nation's first urban outreach worker, and to find their own people struggling with addiction on the Downtown Eastside and get them off the street.

"My first month into recovery, an elder told me the creator kept you here for reason and you have to find out what that reason is," Harry said. "I found my purpose with this offer."

'You're not alone'

Edwin Pfho left Kitimat in 1997 after being told to leave by his then-girlfriend's relatives. He says it was because he wasn't there for his infant daughter.

Despondent, the Haisla First Nation member travelled to the Downtown Eastside. To cope with his pain, he drank alcohol, cooking wine, hand sanitizer and even hair spray.

"I'm lucky to be here and not six-feet south after putting those things in my body," he said.

Pfho, 52, often slept wherever he passed out. Some of his friends never woke up after similar binges. After bouts in the hospital, Pfho sought treatment but later relapsed.

He was passed out on the street when he met Harry.

"He picked me up off the street and said 'My name is James Harry. I'm from the Haisla First Nation, and I want you to know that you're not alone,'" Pfho said. "It felt good to know that somebody out there did care about me. I didn't think no one cared about me."

Pfho got treatment again, but was resolute about sobriety this time. He's been sober since, and this July will celebrate his third year of sobriety. He's now employed, working for Mission Possible, a non-profit in Vancouver's Downtown Eastside providing work opportunities for people experiencing homelessness and poverty.

"If I wasn't for James I'd probably still be out there in my addiction or six feet under," Pfho said.

He visited Kitimat in December but never got to meet his now-adult daughter. He's reticent about why, but said, "One day, I hope."

Trauma is a common denominator among the Haisla people Harry works with.

According to Harry, most are "runners" fleeing trauma. Many spent their childhoods in care like Pfho, who was adopted out at age five.

"Ninety-nine per cent of the people down there have been impacted by residential school or Sixties Scoop," Harry said. "It got passed down at home. People fled, don't want to go back and end up here. Some of them lose their lives here."

The opioid crisis adds urgency to Harry's work.

Two Haisla members Harry tried helping died of fentanyl overdoses. The deaths made him question himself: am I doing enough? Could I have done anything differently?

"It was devastating. But a friend told me that I can't be there 24 hours. I can only do the best that I can."

Hoping against hope

Harry is racing against time to help a 20-something Haisla who is deep into addiction, living on the streets and has been hospitalized multiple times.

"I can't tell you his story. That's for him to tell, but I can say he lived a horrible life," Harry said.

He last spoke to the young man, who was living in an alley, in December. "I told him that he's not alone, and that he deserves to go on and live a good life," Harry said.

Harry helped arrange for him to go to a detox facility, but the young man didn't show up. Harry hasn't seen him since. "He's just out there now," he said.

Back on Hastings Street, Harry peers back up the block before walking back. He'll continue scanning the streets and alleys for the young man, reaching out to him and hoping.

Hope is all that is left for some.

But Harry and Pfho know that even in this desolate place, hope can take on a life of its own.

 
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GHB deaths could be prevented*

NDARC and UNSW Media | 21 Feb 2020

NDARC have released a report finding most GHB related deaths in Australia could have been prevented through simple harm reduction knowledge.

GHB has gained popularity as an illicit recreational drug. A total of 74 GHB (Gamma hydroxybutyrate)-related deaths identified between 2000-2019 have been examined in a new report by the National Drug and Alcohol Research Centre (NDARC) at UNSW Sydney.

The report calls for better awareness of GHB overdose as simple measures can avoid loss of life.

Professor Shane Darke from NDARC said; “Many of the deaths involving inhaling vomit (aspiration) could possibly have been avoided by placing the person in a recovery position.”

Vomiting and aspiration are common with GHB overdose. The maintenance of adequate respiration, clearing the airway, and calling an ambulance are crucial.”

The report highlights that 82 per cent of GHB-related deaths occurred in a home environment, with only three cases associated with consumption of the drug in a club.

To focus solely on preventing harm at clubs, raves, or festivals would be to overlook where death is most likely to occur,” Professor Darke said.

The mean age of the GHB-related deaths was 31.5 years old and more than 70 per cent per cent of cases were male.

More than 20 per cent of deaths were aged over 40, and ages ranged into the sixties,” Professor Darke said.

Just over half were employed or a student, which differs from other drug related deaths like opioids or methamphetamine.”

The predominant circumstance of death was accidental drug overdose (80 per cent).

Other deaths were due to trauma (12 per cent) with motor vehicle accidents being the most frequent, and suicide (8 per cent).”

Mixing GHB with other drugs

Almost all cases involved the presence of other drugs (more than 90 per cent). The most common were methamphetamine, MDMA, and alcohol.

Where present, the average alcohol concentration was more than twice the legal limit for driving in Australia,” Professor Darke said.

Mixing GHB with any other drug is incredibly dangerous and increases the risk of harms such as respiratory depression.”

The median GHB blood concentration was high at 230mg/L but went up to six times higher at 1350mg/L.

The report calls for better messaging for people who use GHB.

People need to realise that this is a dangerous drug with a serious risk of death. The idea that this is some type of safe party drug is completely wrong,” Professor Darke said.

If you see anyone with key signs of overdose like vomiting, shallow breathing, loud snoring, or have passed out, put them on their side, clear their airway and call triple zero immediately.”

*From the article here:

 
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Opioid vending machine opens in Vancouver

by William Turvill | The Guardian | 17 Feb 2020

MySafe scheme for addicts aims to help reduce overdose deaths in Canadian city.

A vending machine for powerful opioids has opened in Canada as part of a project to help fight the Canadian city’s overdose crisis.

The MySafe project, which resembles a cash machine, gives addicts access to a prescribed amount of medical quality hydromorphone, a drug about twice as powerful as heroin.

Dr Mark Tyndall, a professor of epidemiology at the University of British Columbia, came up with the project as part of an attempt to reduce the number of overdose deaths in the city, which reached 395 last year.

“I think ethically we need to offer people a safer source,” he said. “So basically the idea is that instead of buying unknown fentanyl from an alley, we can get people pharmaceutical-grade drugs.”

Don Durban, a social worker from Vancouver, is one of 14 opioid addicts using the MySafe vending machine. After being prescribed opioid-based painkillers in the early 2000s, the father of two developed an addiction and now feels unable to cope without a daily dose of hydromorphone.

Unlike most addicts, Durban, 66, does not have to break the law by sourcing his fix through drug dealers. Instead he is prescribed Dilaudid – the brand name for hydromorphone – and, for the past couple of weeks, has been able to collect his pills from a vending machine near his home in Eastside, a rundown neighbourhood with a large homeless community.

“This is a godsend,” he told the Guardian during one of his visits to the machine. After verifying his identity with a biometric fingerprint scan, the machine dispensed Durban with three pills for each of his four daily visits, in line with his prescription.

“It means I don’t have to go and buy iffy dope,” he said. “I have a clean supply. I don’t have to deal with other people so much. You’re treated like an adult, not some kind of demonic dope fiend. We’re just people with mental health issues.”

Vancouver already has several schemes in place to accommodate for its large community of drug addicts. A pioneer of so-called harm reduction techniques, Vancouver was the first North American city to introduce a supervised injection site – where users can administer drugs in front of medical professionals – in 2003, and there are now several in the area. There are also programmes allowing users to access prescribed Dilaudid or pharmaceutical heroin.

Tyndall believes his scheme, which he hopes to roll out in other cities, will help addicts by giving them more autonomy – allowing them to pick up supplies at their convenience without having to visit pharmacies at specific times.

However, the MySafe project and Vancouver’s other harm-reduction techniques are not universally popular.

Dr Mark Ujjainwalla, an addictions doctor who runs Recovery Ottawa in eastern Canada, says users of illegal drugs need treatment for their conditions rather than easier access to substances. He argues such schemes are in effect ushering users towards death, rather than treating curable conditions.

“If you were a patient addicted to fentanyl [and you came to me], I would say: ‘OK, I will put you in a treatment centre for one to three months, get you off the fentanyl, get you stable, get your life back together and then you’ll be fine.’ Why would I want to give you free heroin and tell you to go to a trailer and inject?"

“I’ve got people here who have changed their lives. They were in jail, prostituting, and they came to my clinic, we put them on methadone, they got their lives back, they’re working again. Isn’t that a better story?”


Ujjainwalla also fears drugs distributed from machines such as MySafe could end up on the black market.

Dr Ricky Bluthenthal, a professor of preventive medicine at the University of Southern California, disagrees. “It’s always better for someone to use licitly produced, safe medication rather than illicitly produced or illicitly distributed substance, which often have contaminants and other things that are unhealthy for people,” he said.

Durban also believes the machine will help him back to good health. “My long-term aim is to get off of these drugs,” he said. “What I’ll do is try to get down to a minimal dose and then if it starts acting up again, I’ll see Mark and ask him to bring it up again.”

 
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Regulate supply or deaths will continue

by Travis Lupick | Vancouver Straight | Apr 16 2019

The theme for the 2019 National Day of Action on the Overdose Crisis was "safe supply," a call for the government to offer clean alternatives to street drugs that often contain fentanyl.

Hundreds of people marched through downtown Vancouver. Five years into an overdose crisis that’s killed thousands in B.C., protesters called for Canada to regulate drugs. They want the federal government to take the country’s illicit-narcotics supply away from organized crime and offer pharmaceutical alternatives to unknown substances purchased on the street.

“There are thousands dying in this country because of unsafe drugs,” said Louise Cameron of Moms Stop the Harm, a group of parents who have lost children to the overdose epidemic.

“Until we have a modality of care in place where there is access to treatment for people who want it, and no barriers to that, we need to keep people alive. To keep people alive, we need a safe drug supply. No one can recover from death.”

Cameron spoke to the Straight outside North America’s first sanctioned supervised-injection facility, Insite, as a crowd gathered there as part of Canada’s National Day of Action on the Overdose Crisis.

More than 4,000 people in Canada died after taking drugs last year. The gathering at Insite was one of more than 20 events held across the country as a call for governments to do more to reduce overdose deaths.



The theme for the Vancouver march was “safe supply.” Just before the demonstration got underway, Dr. Mark Tyndall, lead researcher for the province’s Opioid Overdose Response Team, told the Straight that B.C. has likely made as much progress as it can with traditional harm-reduction programs such as supervised injection. "If we’re going to begin to reduce overdose deaths, B.C. will have to expand access to clean drugs that are regulated by the government," he argued.

“We’ve come to a point where this regulated supply is the only intervention that makes sense,” Tyndall said. “As long as people are buying their drugs in alleys and not knowing what they’re getting, people are going to continue to overdose.”

North America's first sanctioned supervised-injection facility, Insite, served as the gathering place for Vancouver's 2019 National Day of Action on the Overdose Crisis.

In Vancouver, pharmaceutical alternatives to street drugs are available on a limited basis. The Downtown Eastside’s Crosstown Clinic provides roughly 100 patients with diacetylmorphine, the medical term for heroin. And PHS Community Services Society (PHS) and Pier Health Resource Centre together provide an additional 200 people with hydromorphone, a common prescription painkiller that’s similar to heroin. Today’s Vancouver rally was a call to expand access and establish similar programs throughout B.C. and across Canada.

Karen Ward, a drug-policy advisor for the city of Vancouver, also argued that Canada’s overdose crisis will continue as long as criminal gangs control the country’s supply of illicit drugs.

“When we’ve gone this far down the road, I think that safe supply is really the only option we have left,” Ward told the Straight.

There were 1,510 fatal overdoses in B.C. in 2018, according to the B.C. Coroners Service. That compares to 991 deaths in 2016 and 368 in 2014. The synthetic-opioid fentanyl was associated with 87 percent of 2018 deaths, up from 15 percent five years earlier. But Ward argued it is not fentanyl that's at the core of Canada's crisis.

“It is not fentanyl, per se. It is contamination,” she explained. “Picking on fentanyl or this drug or that drug is missing the issue, really. It’s uncertainty. It is not knowing what’s in a substance - that is the problem.”



Many people who the Straight spoke with during the demonstration expressed frustration with the need for the day’s event, and noted they’ve attended many protests like it before.

"We’ve been talking about this for years,” said Dean Wilson, former president of the Vancouver Area Network of Drug Users (VANDU). “For the last four years, we’ve been dying in numbers like we were dying of HIV in the 1990s. The solution is really simple: prescribe….We want heroin, we want fentanyl if people want it, we want morphine, we want codeine if people want that. Prescribe it.”

Wilson suggested that so many people dying every year for so many years now serves as clear evidence that those who are in positions of power simply do not care about the lives of people who use drugs.

“They actually love it,” he said. “They don’t have to do anything and we die off in huge numbers. I just don’t believe in government anymore. They all lie. And they’re all full of shit.”

Harsh words, but it’s unlikely there was anyone within earshot who might take offence. The only politicians the Straight spotted attending the demonstration were Vancouver city councilor Jean Swanson and Vancouver East MP Jenny Kwan.

From Insite, the march proceeded along East Hastings Street and then up Granville Street, to the north steps of the Vancouver Art Gallery. There, the event’s MC, Tina Shaw, asked for people to set any judgments they might hold aside and follow the scientific evidence that shows that regulating drugs will save lives.

“Safe supply equals life,” she said. “Plain and simple. Whether you agree with drug use or not, the point is that people are dying and these lives matter. They have meaning. And safe supply means that people live.”

 
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Member of Washington's Snohomish County Syringe Exchange preparing for an outreach effort.

Large majority of Washington state's heroin users want to reduce use

by University of Washington | Medical Xpress | 10 April 2020

A new survey of people who inject illicit drugs in the state of Washington yields positive and important findings for policy makers as the world struggles to deal with the COVID-19 pandemic, said authors of the survey by the University of Washington and Public Health-Seattle & King County.

Most people—82%—who inject heroin and roughly half of methamphetamine users are interested in reducing or stopping their use and are open to a broad array of services to help them manage their substance use, according to the 2019 Syringe Exchange Health Survey led by UW's Alcohol & Drug Abuse Institute and Public Health-Seattle & King County.

The latest results of the survey, which has been conducted every two years since 2015, also show that possession of naloxone—a drug that rapidly reverses opioid overdose—has increased substantially. Researchers found that nearly 80% of respondents in King County and outside the county who use opioids possessed a naloxone kit in 2019, compared to 2015 when only 47% in King County and 24% outside the county possessed naloxone.

"These surveys provide important insights into the complex lives of people who use drugs in our state and can be used to inform our health care, public health, social service, public policy and criminal legal system responses, particularly during and after the COVID-19 pandemic," said study co-author Caleb Banta-Green, principal research scientist at the institute.

During the COVID-19 crisis, syringe exchanges continue to operate across Washington State, although programs have had to substantially modify how they deliver services, including distributing pre-packaged supplies, moving outdoors and providing mobile and delivery services.

Public Health-Seattle & King County is also offering screening and COVID-19 testing at the Robert Clewis Center, Downtown Public Health, Monday through Friday from 1 to 4 p.m. (one of the sites participating in the survey). At other syringe-services program locations, providers are asking COVID-19 screening questions and providing information about testing locations and other resources, public health officials said.

"People who inject drugs, and also smoke them, are at high risk for contracting and having serious consequences of COVID-19 and already use emergency health care resources at high rates," said Banta-Green.

Consequently, access to syringe services—which distribute clean syringes and help to reduce the risk of contracting or transmitting infectious diseases—during this crisis can help alleviate pressure for emergency medical care while also helping this at-risk population get treatment to reduce or stop their drug use.

"This report confirms that the majority of persons who inject drugs are interested in reducing or stopping their drug use and improving their health," said Dr. Jeff Duchin, Health Officer at Public Health-Seattle & King County. "The syringe exchange provides an important entry point and ongoing resources to help connect people to treatment when they are ready."

For instance, programs such as Public Health-Seattle & King County's Buprenorphine Pathways provides access to treatment co-located with needle exchange. The program lowers barriers to treatment safely and successfully.

Another important finding in the survey, Banta-Green pointed out, is that 68% of participants who have been diagnosed with hepatitis C remain untreated and were interested in treatment for that disease, which is good news since hepatitis C can be cured with a three-month course of medication.

"We are honored to work with our syringe-services partners across Washington state to better understand how we can best serve people who use drugs," said Banta-Green. "It's so important to understand that people are very interested in getting help, and that syringe exchanges provide an incredible array of life-saving services. They also provide ongoing personal relationships with members of our communities who are often in personal crisis and poor health."

 
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Alcohol and drug alternatives: An interview with Professor David Nutt

by Wesley Thoricatha | psychedelic Times | 29 April 2020

Professor David Nutt is one of the world’s leading experts on drugs, and one of the most lauded and controversial voices in the UK on the comparative drug harms. Professor Nutt was brought to popular attention in the late 2000’s when he was sacked from his position on the UK government’s Advisory Council on the Misuse of Drugs for being an outspoken critic of politically motivated rather than fact-based drug policy decisions. Professor Nutt is best known for his articles showing that horseback riding is more dangerous than ecstasy, and that when comparing drug harms, alcohol is the most harm-causing drug on the planet, while psilocybin mushrooms are the least. We spoke with Professor Nutt to learn more about his important work bringing sanity and sense into a world where drug policy is decided by political motivations, misled stigmas, and corporate interests.

Thank you so much for speaking with us, Professor Nutt. Can you give us a little bit of your background and what led up to the controversy you faced in the UK?

I’m a psychopharmacologist and a psychiatrist that’s interested in drugs. I study drugs, I give drugs to human beings and study what happens to their brain, and became quite an expert over the years, particularly on drugs of so-called “abuse.” I used to run the alcohol research ward at NIH in Washington DC for a couple of years, and eventually I became Britain’s leading expert on drugs that were both abused and illegal.

About 1992 or 1993 we had some deaths from ecstasy, and I was asked to join the government working group to reduce those deaths. When I started working on that, I realized that the deaths were largely preventable—they weren’t to do with ecstasy, they were to do with the fact that people were getting too hot, not having cold drinks and chillout rooms, etc. I was part of a policy group that brought in health harm reduction policies such as encouraging venues to have chillout rooms and insisting, as we do today, that every single place that sells drinks has to have free water, because many of the clubs were not even giving people water—they were even turning the taps off in the bathrooms.

As I was getting into this kind of work, I was realizing that drug laws didn’t seem to bear a lot of relationship to the harms of drugs, and that the harms were often not to do with the drugs but to do with the laws. I was appointed to head up the government’s scientific panel on drug harms and did that for a few years, and during that time the British government did something really stupid against our recommendations and banned magic mushrooms. They actually broke the law doing that. They contravened the Misuse of Drugs Act, which says they should consult with the expert panels, and they didn’t do that. It became clear at that point that all that they wanted was for us to ratify the decisions they made—they didn’t really care if we agreed with their decision. Every time we brought the report in making recommendations, they would almost always ignore it, and it got to a point where I just got irritated by it all and started telling the truth and pointing out they were making political rather than science-based decisions.

When you spoke out it was such a powerful statement from someone in your position. There was, I daresay, even some cheekiness in how you pointed out that horseback riding was more dangerous than ecstasy.

They refused to let us review the harms of ecstasy; they actually refused. I’m a clinician, and I saw patients. While we were doing that review, I saw this woman, a patient of mine, who suffered frontal lobe damage from falling off her horse. I started getting interested in the harms of horse riding, not least because my two daughters ride horses. I discovered how harmful horse riding was, but I also discovered a number of people addicted to horse riding—they were riding even though they’d been damaged from it. So I wrote this thought piece called “Equasy” on equine addiction syndrome just to make people think about the comparative harms of other activities. Banning drugs because they are harmful is all very well, presuming there should be some threshold of harm. People found my article absolutely brilliant or were very, very angry about it. I got insulting letters from horse riders and such, and the government hated it because it confronted them with reality that they were making arbitrary laws.

And that was the beginning of my end—it was a direct challenge to their policy decisions. They set out to sack me, and it was eventually when I said that alcohol was more dangerous than LSD—and that was it, I had to go then.

And of course, alcohol clearly is more dangerous when looking at data, despite the fact that it isn’t stigmatised and LSD is.

Unquestionably! Yet in the States today, most scientists still won’t say that, because NIDA doesn’t like it. If you stand up to the big funding bodies in America you won’t get funding. Luckily, our funding bodies up till now (it might change after Brexit) are independent of the government; they have their autonomy. But I think we’re going to go down the American route at some point.

But anyway—I said it, I got sacked, and that was a big mistake on their part because the sacking created enormous interest. Up to that point, there was little interest in comparative drug harms, and nobody had ever heard of me. But when they read what I was sacked for, they said “Hang on a sec, what he says makes sense. Why are you sacking someone for telling the truth?”

Absolutely, it’s brought so much awareness to this. Would you say politicians in general are too cowardly to speak the truth, and they’re making politically motivated decisions rather than health or evidence-based ones?


Oh, almost every single one of the drug laws has been brought in for political gain. I mean truly, the drug laws are 95% politics and 5% health.

And the real losers are the people who are getting hurt or incarcerated as a result of these laws.

Yes, and it’s not just the people who’ve been locked up or whose lives are ruined with criminal records for using drugs, it’s also everyone who has been denied access to medicines such as psilocybin or LSD or cannabis or ecstasy.

Thankfully the tide seems to be turning, at least here in the States. What’s your take on the more recent developments—ketamine and cannabis being more legalized, psilocybin being decriminalized in certain areas, MDMA being declared a breakthrough medication, and so on? Hopefully in the way that the US set the archaic global drug laws, it can help to reverse that same tide by adopting new and better drug laws, setting an example for others to follow.

I do hope so, and of course it does: Colorado, Washington State, California—they’ve not collapsed into anarchy because cannabis is legalized [laughs]. The opening up of the medical cannabis market could have been so much better if federal funds were allowed to researchers, but there’s still this barrier against using federal funds because it’s illegal federally. There’s this unwritten rule that you can’t find anything good with these drugs that we’ve stigmatized so much in the past.

What’s your opinion on the decriminalization vs. legalization and regulation routes?

I’m very much in favor of something between the two. Decriminalization is definitely a useful step on the way. I like a regulated market, like the Uruguay approach rather than the Colorado approach. I think actively commercializing drugs is going to tend to increase the risks of people overusing, or people who shouldn’t be using. My charity Drug Science has done a little bit of research on this, looking at the benefits of different policy options. Certainly for alcohol and cannabis we’ve come to the conclusion that a state-regulated market, selling through licensed premises like pharmacies, would be the best way forward.

That sounds like a very solid approach. I was reading about your work with Alcarelle, a less harmful version of alcohol. Any updates on that?

It’s been frustrating. I identify compounds which we know for various reasons would do the business of being an alternative to alcohol, and almost certainly being a lot less harmful. It’s proved impossible to purchase them or access them, I think because the companies that have them think it is just too radical—they don’t want to be associated with something seen as so left field, and maybe they don’t want to get into battle with the drinks industry.

Now we’re making and manufacturing our own compounds. We’ve got our own chemists, we’ve nailed the pharmacology and are making new compounds that we can patent. So I’m hoping to have some patents finalized in 6-8 weeks and then hopefully get actual investors. Then we get to the stage of ramping up the production and doing all the safety testing, and hopefully in a few years having something on the market.

It strikes me as so insane that it’s considered radical to offer a less harmful version of the most harmful, widely abused substance on the planet.

Obviously I couldn’t disagree with you [laughs]! What’s fascinating is how. Let me share some of my observations with you. Have you followed the vaping story?

Yes, actually I have.

Maybe it’ll go the same route as the vaping story. Maybe we’ll start finding people in America who start saying “We don’t know what it does, it hasn’t been around for 100 years, it could be toxic…” and start lying about it, the same way they lied about vaping in order to destroy it. The irrationality of decision making about drugs is so perverse and so prevalent and it’s been around for so long, that you can see that investors might think, “Can we be sure the US government won’t ban it?” I can’t be sure. It would be a stupid thing to do, but you’ve seen Massachusetts ban vaping with flavors but not ban vaping with nicotene, so there is an absurdity to the decision making about drugs.

Indeed. As someone who personally quit smoking with vaping, I was really concerned with the stories of people getting sick and dying from vaping. When I started doing research, 9 out of 10 news sources referred to “vaping” in general as the cause, rather than referring to the true culprit, a very specific unregulated bad batch of underground THC cartridges. It was so disingenuous.

It was deliberate. It was a deliberate ploy, and I think the CDC was behind it. There is this paranoid belief that vaping is a gateway to cigarette smoking, which actually the evidence suggests it isn’t. Because once you vape, why would you want to smoke cigarettes, they’re so horrible in comparison. This is alcohol prohibition rising again 100 years later: let’s ban anything that people might enjoy! You can’t ban cigarettes, but let’s ban vaping because it’s still little companies.

You’ve got to remember that in America, the anti-smoking brigade is an army of scientists who make a living being anti-tobacco. Their whole philosophy is “anti.” So when vaping comes along, they are anti. If you’re a hammer, everything looks like a nail. If you’re anti-tobacco, then anything you breathe in with nicotine gets the same treatment regardless of comparative risks.

So who knows what’s going to happen? Maybe the anti-alcohol people will take against me. I can tell you, I had a very, very interesting debate last year with a friend of mine who runs the Scottish Health on Alcohol Initiative. He is against Alcarelle. He says he doesn’t believe in harm reduction for alcohol; he believes in people stopping drinking. He believes in harm reduction for heroin [laughs] and even harm reduction for cocaine, but not alcohol, so why not? He says what we’re doing is just giving people a recreational drug, not a safer alternative to alcohol. Even intelligent, articulate people just can’t get their head around this concept, because they haven’t really thought about it before.

 
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Harm Reduction Works: An exciting new alternative to Narcotics Anonymous

by Travis Lupick | Filter | 19 May 2020

The pandemic is taking a toll on people’s mental health, and there’s likely no group more affected than people who struggle with their drug use.

“People are so isolated right now and longing for connection,” Jess Tilley, co-director of the Urban Survivors Union, a national group of drug users, told Filter. “And then when you add being a drug user on top of that, or being a frontline worker or working in harm reduction, it’s worse. We’re sort-of the outcasts of society to begin with, so it’s so hard to find our community.”

A recent CNN report on an increase in overdose deaths across the Appalachian region coinciding with the spread of coronavirus used the phrase “pandemic’s-worth of triggers.” It’s a combination of anxiety, loneliness, stress, boredom and—for anyone who has lost someone to the virus or the burden it’s placed on the healthcare system—of loss and of trauma as well. Whatever one’s trigger might be for resuming use or using with greater risks, it feels like COVID-19 has brought it.

On top of it all, social distancing orders shut down mutual-support groups’ in-person meetings exactly when many people in recovery from addiction needed them more than ever.

Narcotics Anonymous (NA) meetings were relatively quick to move online, as were those of Smart Recovery and similarly large organizations. But the vast majority of such groups are based in the 12 Steps, only support abstinence, or come with other one-size-fits-all philosophies with which many people take issue. If COVID-19 has you using drugs in an unhealthy way, and if you’re not thrilled at the idea of surrendering yourself to a higher power or don’t want to quit completely, where can you turn for support?

“I used to utilize 12-step groups and I really missed that that community. And yet, philosophically, I’m feeling a little bit differently now.”

Meghan Hetfield, who works in family planning and peer recovery in Catskill, New York, told Filter that she found the answer just before the virus swept across North America.

“I used to utilize 12-step support groups at different times in my personal recovery and I really missed that human connection and that community that I had when I was attending those meetings,” she began. “I’ve really missed that aspect of my life. And yet, philosophically, I’m feeling a little bit differently now than the 12 Steps.”

Listening to the drug policy podcast Narcotica one night, Hetfield heard Tilley describe a new model of support group. With her nonprofit, HRH413, Tilley recounted experimenting with a model not dissimilar from NA. But instead of placing abstinence at the center of everything, it roots itself in harm reduction.

This sounded very interesting to Hetfield. Shortly after, she made the two-hour drive east to Tilley’s homebase of Northampton, Massachusetts, and attended one of HRH413’s meetings to see what Harm Reduction Works (HRW), as it had been named by this time, was all about.

Hetfield described finding what she didn’t know she had been looking for. “I wanted to provide the same space for people here,” she said. “It’s a way to build community around harm reduction in a way that I don’t think has been possible before. It is self-replicating and allows people to be in this space, whatever that looks like for them. Just come as you are.”

“I think this model is going to be really attractive to a lot of people right now who are struggling for a sense of belonging that doesn’t have a million rules,”
Hetfield added.

How the meetings work

So what is this model?

As the founder of the New England Drug Users Union and a high-profile name in America’s harm reduction movement, Jess Tilley is HRW’s de facto spokesperson, and her personal experiences helped inform its creation from the ground up. But the group is the brainchild of her HRH413 cofounder, Albie Park. In a telephone interview, Park conceded that for a support group that was originally conceptualized as an alternative to NA and the 12 Steps, HRW actually has quite a bit in common with them.

“HRW meetings are scripted,” Park began. They begin with a reading and end with a reading, and in the middle is a topic of the day and time for people to share. So the skeletal structure will feel familiar to the millions who have attended NA or AA. But from there, Park continued, HRW departs from NA in ways that some 12-steppers will disapprove of and others will find refreshing.

While most NA groups forbid “crosstalk,” HRW meetings place feedback and discussion at the centre of their meetings. Anyone sharing does however have the option to ask that the group only listen, Park noted. In addition, HRW lacks NA’s sponsorship structure and the pitfalls that can come with the sort of power that sponsorship gives one NA member over another.

"Setting it apart from the vast majority of recovery-support groups, HRW has no requirement for abstinence."

HRW also declines to track participants’ “clean time.” There are no keychains for days abstinent and therefore none of the shame or stigma that abstinence-only groups can inflict on members who slip. What’s more, while many NA groups reject medication-assisted treatments (MAT) such as methadone or buprenorphine, or even view the availability of the overdose-reversal drug naloxone as enabling, HRW fully welcomes people on MAT and HRW meetings often distribute Narcan and syringes right in the same rooms where participants discuss aspirations for abstinence.

Finally, the most notable aspect of HRW, setting it apart from the vast majority of recovery-support groups, is that HRW has no requirement for abstinence. Attendees can express a desire for abstinence or share that they’re actually not interested in abstinence at all. Maybe they want to transition from injecting drugs to smoking them, or stop sharing needles and instead begin visiting a syringe exchange. Perhaps they are considering giving methadone a try. Or maybe a participant is simply looking for a shoulder to lean on.

“What 12-step has, is it is a redemption-story machine with that classic story arc,” Park said. “This [HRW] is just your life. There’s no demarcation point [around abstinence]. It’s not that clean. HRW makes room for things to be a little bit messy. It makes room for people to figure shit out….It was conceived for the person who is saying, ‘I don’t know what’s going on, I don’t know what’s happening, but I know I have to do something.’”

Through the second half of 2019, HRW was slowly beginning to gain traction outside of Tilley and Park’s hometown of Northampton, attracting chatter at drug policy conferences and clicks online. Then came COVID-19. It was more important than ever for people to feel support. And quite suddenly, in just the last two months, HRW rapidly grew online to seven virtual meetings held weekly on Zoom hosted out of five cities around the United States. (Anyone interested in checking out a HRW meeting on Zoom can find a list maintained on the group’s Facebook page. Additional information is also available at hrh413.org.)

Park said that he’s been pleasantly surprised. “If COVID had not happened, I probably would not have made the choice to go online,” he explained. “Then we started [online] and the meetings have been really, really well received.”

“I feel like I can finally talk about what my recovery really looks like.”

It was actually Hetfield who hosted the very first HRW online gathering. She said one of the most encouraging things she’s observed in their Zoom meetings is true honesty.

“Often people feel really good about not using heroin in five years but guess what, ‘I had a couple of beers over the weekend and I’m okay.’ It feels really good to say that out loud,” she recounted. Hetfield noted that HRW’s lack of an abstinence requirement means people can return to use without feeling like they’ve disappointed the group. That extra space can help people in recovery stop at a beer or two, whereas if they were NA, they might feel like a small slip with a glass of wine is a good reason to pick up an eightball, Hetfield explained.

“I feel like I can finally talk about what my recovery really looks like,” Hetfield said she’s heard participants say. “Somebody’s recovery or change process should be honoured and celebrated even if that doesn’t include abstinence,” she added.

Evaluation under way

It’s still early days for HRW and there so far exists no sort of data on how this harm reduction model might assist people with recovery or otherwise improve health outcomes. But a small team of addiction researchers has been commissioned by the nonprofit Rize to evaluate groups incorporating harm reduction into recovery, and one of the organizations they’re looking at is HRH413 and HRW.

Jennifer Carroll, a medical anthropologist, is a member of that team. She emphasized she could not comment on a program under review, but spoke generally about a need for alternatives to 12-step and abstinence-only models.

"If someone is coming from a situation of being abused, the last thing in the world they need is a recovery platform that requires them to acknowledge their powerlessness.”

“The biggest problem with 12-step isn’t actually 12-step, it is that so many people believe that it is the end-all-be-all of personal change or wellbeing,”
Carroll, an assistant professor at Elon University in North Carolina, told Filter. “If there is someone who is interested in 12-step, they absolutely deserve and need to have access to that tool….The challenge comes when people are shuffled into 12-step programs when that is an inappropriate form of care.”

"For example, if someone is coming into a support group from a situation of being abused,"
Carroll said, “the last thing in the world they need is a recovery platform that requires them to acknowledge their powerlessness.”

The evidence of NA’s effectiveness in maintaining abstinence is indeed mixed, as the spirited debate around a recent high-profile New York Times article illustrates. Especially when assessing abstinence outcomes with different substances, 12-step groups do not work for everyone, the literature suggests.

Carroll added that there’s an obvious appetite for new models and philosophies for recovery. “My inbox blows up a lot with people who want a neutral source of advice — ‘This is happening with my nephew,’ or ‘This is going on with my husband,’ or ‘Do you have any thoughts or do you know anyone in this area?’ — Carroll recounts. “And frequently, those requests are for any suggestion I can make about support groups or mutual-aid groups that are not 12-step oriented.”

Especially in the context of COVID-19 and continued requirements for people to remain in their homes, Tilley said there is one thing that HRW has borrowed from NA that inspires people to “keep coming back.”

“Those of us who were part of 12-step and who left, for whatever reason, whether it be the program, the people, or if we just felt we outgrew it or we started using again, the biggest thing that we miss is the community,” she said. “We miss the camaraderie. And that is HRW.”

 
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Beyond stigma: How researchers may trigger drug users

Filter | 15 Jun 2020

Harm reductionists have long called on journalists, politicians and treatment providers to adopt non-stigmatizing language when speaking about people who use drugs. Despite such efforts to reduce drug users’ feelings of shame and stigma, they can still be harmed by language from other sources.

Some crystal methamphetamine users report that their cravings can be triggered by the communication strategies of researchers and service providers, found—among other things—a June 11 Harm Reduction Journal study examining the attitudes of anti-retroviral therapy (ART) patients towards smartphone-based research.

Researchers can survey future participants (quite literally) wherever they’re at through smartphone-based questionnaires on drug use and ART adherence. But this presents the challenge of adapting their language and framing to fit the demeanor and disposition of a participant with whom they are not physically present.

The Harm Reduction Journal study participants were concerned that receiving messages from a hypothetical app asking directly about their meth use could detract from their recovery. “I’m more inclined to think that askin’ that question may cause some people who might be tryin’ to stop to relapse,” one participant told researchers.

People addicted to methamphetamine, like other drugs, are vulnerable to “cue-induced” cravings. These include paraphernalia, like bubble pipes used to smoke it, as well as verbal and visual cues. These can “cause significant impacts,” wrote Iranian researchers in 2010, on how people manage their use.

Throughout harm reduction history, people who use drugs have innovated approaches to positively impact their own lives. The HRJ participants were no different, providing a number of suggestions for future researchers to better conduct smartphone-based studies around drug use.

One meth user recommended reframing how drug use questions are asked. Instead of asking a future study participant if they had used drugs in a given time period, the researchers could instead inquire about abstinent days, the person suggested. “Have a check mark where you can mark how many days you been clean. Thirteen, fourteen. Have you missed—if you’re not clean, just X or somethin’… use a more positive term.”

Another suggested that future questions refer to drug use through non-representational images. “Have two faces. A good or a bad. Then just have those faces determine whether—meaning, did you use, or did you not use? … What color are you today? Then just pick—if you use that day, you just pick a certain color.”

Language can greatly influence drug users’ wellbeing. Service providers with “poor patient insight into triggers of drug use,” the study authors write, “can contribute to a framework that is inadequate for providing timely intervention to patients.”

Interestingly, one 2019 study showed that people in recovery who use language considered to be stigmatizing, like “addict,” do not have more negative outcomes as a result—underlining the difference between language that is used to self-identify and language used by others about impacted people. “Language may have only a marginal impact on individuals in recovery,” wrote its four authors, “although professionals and the general public should continue to avoid using stigmatizing labels.”

Service providers and researchers are duly encouraged to abide by the language guides, like those published by the National Institute of Drug Abuse (ironically) and Changing the Narrative. Their lexicon could benefit from avoiding dogmatic vocabularies if they truly wish to meet people who use drugs where they’re at.

 
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MDMA and LSD drug testing kits that could save your life

Danielle Simone Brand | Double Blind | 10 April 2020

Everything you should know about 'the best MDMA and LSD test kits on the market.'

Drug testing, sometimes called drug checking, is an essential harm reduction tactic to ensure that a substance is truly what you think it is, and not adulterated by potentially toxic chemicals that could cause an unpleasant or fatal reaction.

The best thing about drug checking is that you don’t need a whole chemistry lab to do it! In fact, you can test your drugs in the privacy of your own home with a drug checking kit such as for MDMA or LSD. Indeed, drug checking is easy, requiring only a few reagents (liquid testers) to ascertain whether your substance is pure, or contains
other elements.


Alexander Shulgin

MDMA

MDMA first surfaced as a psychotherapeutic aid in the 1970s. Though analogs of the drug had been synthesized earlier, most sources credit chemist Alexander Shulgin for discovering the formula, along with psychotherapist Leo Zeff for helping bring its psychotherapeutic properties to light. Because of MDMA’s particular euphoric and empathic influence on the user, it showed promise in therapeutic settings for healing trauma and promoting personal and spiritual growth. In the 1970s and 1980s, early adopters caught word of the molecule’s recreational uses, and by 1985 MDMA was listed in the U.S. as a Schedule I drug.

Effects of MDMA

MDMA causes your serotonin neurons in the brain to release larger amounts of serotonin. It also causes the release of dopamine neurotransmitters, as well as oxytocin and prolactin hormones. This effect can lead to feelings of euphoria, greater willingness to communicate, decreased fear, increased connection to others, and feelings of love or empathy.

MDMA moreover decreases activity in the amygdala, which is where memories are stored. This effect, coupled with those listed above, is why MDMA has been so useful in treating PTSD, which the nonprofit MAPS is currently investigating. In fact, MDMA for PTSD has been placed on the FDA fast track to become an approved medication in psychedelic-assisted psychotherapy early this decade. MAPS is currently in the third and final phase of FDA-approved research.

On the physical side, MDMA may cause loss of appetite, shivering, feelings of restlessness, or even feelings of warmth. It’s important to note that MDMA should not be taken on a regular basis, as for some, there is a comedown, which entails the time it takes for your brain to replenish its serotonin.

How long does MDMA last?

The total duration of MDMA is about three to six hours, with an initial onset of 20 to 90 minutes.

What does MDMA look like?

MDMA often comes as a white or light brown crystalline powder, contained in a clear capsule. Sometimes it may come as light brown rocks. In other cases, especially if you’re taking ecstasy (which may contain other components beyond MDMA), it comes as a pressed pill, which may be a variety of colors and feature a design.

Why you should test your MDMA

According to Emanuel Sferios, founder of DanceSafe, MDMA prohibition has created 'the most adulterated market in history.' Over the last few decades, hundreds of drugs have been sold as ecstasy or molly that contain little to no MDMA. Of the numerous counterfeit drugs DanceSafe has tested, dangerous cathinones (a.k.a. “bath salts”) and meth surface frequently. While these MDMA counterfeits may yield psychoactive effects, they won’t likely feel as pleasurable or expected as those of MDMA. And, in the wrong doses, they could also be fatal.

Sferios was first introduced to MDMA as an informal therapy that helped him process difficult experiences from childhood. About a decade later, a friend brought MDMA back to his attention as a party drug—a use that resonated with Sferios, given its ability to boost energy, euphoria, and social connection. “I was blown away when I went to my first rave in Oakland—by how beautiful the culture was,” he tells DoubleBlind, citing the diverse demographics and peaceful vibe he found. By that time, MDMA had become the most sought-after rave drug and prohibition was well underway; the substance that Sferios had known to be both fun and therapeutic was being widely publicized as dangerous.

“No one is saying that MDMA use carries no risk,” Sferios says. Consumers of an unadulterated version of the drug can suffer adverse effects, and even die, if they take too large of a dose, or drink too much or too little water during the roll. But the risks grow when those who believe they’ve taken MDMA have actually taken meth, PMA, cathinones, or something else entirely. To be ultra-clear: It’s counterfeiting—which results from prohibition, and an unsupervised black market—that poses the biggest risk; in the right doses, and with a thoughtful set and setting, taking MDMA is a fun, transcendent, and even therapeutic experience for many people.

The MDMA-associated deaths in the 90s and the subsequent media villainization of the drug prompted Sferios to found DanceSafe in 1998. The organization’s mission is to educate consumers of club drugs and to encourage and facilitate testing for risky counterfeits. Altogether, DanceSafe’s four staff members and hundreds of volunteers practice a philosophy known as harm-reduction that’s gained traction in Europe but has yet to receive widespread credit in the U.S. The idea behind harm reduction is simple: to reduce the negative consequences associated with drug use.



MDMA test kit

Of the two testing methods used by DanceSafe, one employs infrared spectroscopy, which can yield detailed information about a molecule. But testing by means of spectroscopy involves funding and staff hours to utilize the machine at festivals.

The other method is much more cost effective and can be done at home by anyone. DanceSafe offers testing kits for MDMA, LSD, and a number of other compounds, both online and at festivals. The point of the MDMA and LSD testing kits is to tell you whether the primary ingredient is what you intended to consume.

Testing is critical, says Sferios, because you can’t reliably identify MDMA or LSD by look, smell, or taste.

MDMA testing at a glance

- Common MDMA counterfeits: PMA and PMMA (two compounds producing similar effects to MDMA but with more toxicity), cathinones (aka “bath salts”), and methamphetamine

- Risks of consuming counterfeits include: hypertension, elevated temperature, difficulty breathing, and death

- Most counterfeits don’t contain any MDMA

- Roughly 80-90 percent of what’s sold today as MDMA is authentic; as recently as 2015, that figure was closer to 30 percent

- Fentanyl, the dangerous synthetic opioid, hasn’t cropped up on the MDMA market yet, though some observers think it could soon

- DanceSafe MDMA kits contain one free fentanyl test strip; additional fentanyl strips can be purchased separately*

- MDMA test kits include three reagents, or liquids that turn color in the presence of particular chemicals: Marquis, Simons, and Froehde

- Used together, these reagents can reliably determine whether MDMA is the main ingredient in a pill—though they can’t indicate absolute purity

- Follow all steps in the kit. Read the testing kit instructions in advance, and be sure you’re sober when you test.



Albert Hofmann

LSD

LSD is a 'classic' psychedelic that was initially synthesized in 1938 by chemist Albert Hofmann, who was working for the Swiss company Sandoz Pharmaceuticals. Hofmann had intended for it to be used as a respiratory and circulatory stimulant, without having realized its psychoactive properties. It took him another six years to rediscover and appreciate its psychedelic qualities: First he accidentally ingested a little bit of LSD on April 16, 1943, and three days later intentionally tried it on April 19 and wrote a bicycle home, high on LSD. This day is now celebrated as the holiday Bicycle Day.

Effects of LSD

LSD binds to several 5-Hydroxytryptamine (5-HT) receptors in the brain, which causes an excess of serotonin in the synaptic cleft between neurons. LSD can alter perception, mood, and cognitive processes by acting on the serotonergic system. It also acts on the dopaminergic system, which affects processes like learning, reward systems, and motivation. The increased levels of dopamine and serotonin can make LSD feel energetic and provide an extroverted experience.

LSD can enhance the imagination and senses, stimulate thoughts, cause feelings of euphoria, universal connection, or on the flip side anxiety or paranoia, and can produce hallucinations. As a classic psychedelic, LSD in high enough doses may cause temporary ego dissolution that can result in mystical experiences and a sense of transcendence.

Prior to it being outlawed by the Nixon administration under the Controlled Substances Act, LSD was used as a powerful tool in psychotherapy. Today, researchers are returning to LSD as a tool for addiction treatment, as well as for anxiety, depression, or other conditions.

How long does LSD last?

The effects of LSD can last anywhere from eight to 12 hours, or in some cases even longer.

What does LSD look like?

Most often, LSD comes in the form of a liquid, or as a tab (upon which that liquid has been dispersed with a dropper), torn from a piece of perforated paper. In other cases, LSD may appear in the form of tablets, capsules, or gelatin squares.



Testing LSD

The LSD market looks a little different from MDMA. Until recently, LSD counterfeits weren’t considered especially risky. But the influx of a class of drugs known as NBOMes about ten years ago changed that. Variants of NBOMe, which stands for N-benzyl methoxy, simultaneously thicken the blood and constrict vessels, potentially causing heart attacks, renal failure, or stroke. Fentanyl and analogs like carfentanyl also appear as counterfeits or adulterants in the LSD market today.

While Sferios notes that in recent years, the illicit markets have, to some degree, cleaned themselves up (with certain distributors now refusing to sell fentanyl or fentanyl analogs for instance), a staggering array of new, illicit compounds and research chemicals hit the market every year. Besides prohibition and growing demand, factors contributing to the illicit market today include the rise of the dark web and the cover of anonymity provided by cryptocurrencies.

When it comes to the intentions of illicit manufacturers and dealers, Rachel Clark, who works in communications and development with DanceSafe, gives these folks the benefit of the doubt. “The purpose [of selling counterfeit drugs] is not to kill people,” she tells DoubleBlind. "Instead, some manufacturers and dealers are likely unaware of the ins and outs of new molecules or research chemicals which, in some cases, mimic the effects of the better-known drugs, but carry more risks. Some may not even know the origins of what they’re selling.”

Testing LSD at a glance

- The last decade has seen a proliferation of drugs sold on blotter paper resembling LSD, but with high levels of toxicity

- NBOMes mimic the effects of LSD but carry significantly more risk; the analog known as 25i NBOMe is highly toxic

- Between 2013 and 2016, roughly one person a month died after ingesting an NBOMe sold as LSD; fortunately, the rate has since slowed

- Carfentanyl, an extremely potent fentanyl analogue, is—like LSD—active at the microgram level. Because it’s sometimes sold on blotter paper, confusion between the two drugs can arise.*

- The DO series of drugs, including DOB and DOC, are psychedelics, sometimes sold as LSD, that typically have longer lasting effects and are not well-documented for safety

- LSD test kits are simpler than those for MDMA: Ehrlich’s reagent turns purple in the presence of LSD or closely related drugs. According to Sferios, “If it turns purple it’s pretty much going to be LSD, or a prodrug of LSD like 1P-LSD or ALD-52.”

Drug testing and the law

Law enforcement and harm reduction efforts have a checkered relationship. For instance, about half of U.S. states have laws on the books criminalizing testing agents and paraphernalia. But when it comes to testing, these laws are rarely enforced. To Sferios’ knowledge, no one with DanceSafe—staff, volunteer, or festival-goer—has ever been arrested for participating in drug testing. In some cases, DanceSafe works under amnesty agreements with local law enforcement—which makes sense from a humane standpoint, considering the fact that fewer deaths and injuries occur when testing and other harm-reduction strategies are at play.

The psychedelics renaissance and drug testing

There are many reasons for the comeback of psychedelics. They’re a productivity hack in small doses and a socially-bonding tool made for dancing. They also help quench the yearning many of us have to understand the self in relation to the whole—to see past artifice and step into another way of being. Because of psychedelics’ potential therapeutic uses for PTSD in particular, Sferios theorizes that the current renaissance is a means of collective healing from 9/11—and today, in the midst of the Covid crisis, we may see even more relevance for the therapeutic uses of psychedelics.

But, as long as prohibition endures, the counterfeiting problem will remain. “The more successful the Drug War is at cracking down on real MDMA and LSD,” said Sferios, “the more motivation there’ll be for developing and selling counterfeits.”

 
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Some ways of taking psychedelics are safer than others*

by Lester Black | The Stranger | 25 Sep 2019

In the summer of 1972, someone at a dinner party in San Francisco made a terrible error. They mixed their cocaine with their LSD and accidentally served lines of powdered acid, two apiece, to seven of their friends.

A drop of acid can send someone into an eight-hour psychedelic trip. Snorting milligrams of the chemical's powdered form is unthinkable. These people had just inadvertently consumed a massive dose. Within five minutes, they were vomiting. After 10 minutes, five of the people were comatose, according to a case report in the Western Journal of Medicine. These people appeared to be on their way to sudden death.

But no one died. Within 12 hours, every single patient was conscious. After a year of follow-up exams, there were "no apparent psychologic or physical ill effects" in any of the eight individuals, according to the case report.

There's a high probability that you will come across psychedelics at least once during your higher education. Every drug has its milieu, its natural social environment. Just like meth wallows in misery and trailer parks, and cocaine mingles with mistakes and nightclubs, psychedelics (with their mind-expanding quality) fit naturally at universities where young people are regularly encouraged to challenge their usual way of thinking. So what lesson should you take from the story of the San Francisco dinner party?

To begin with, our government's classification of psychedelics as the most dangerous type of drug on earth makes no sense. Though what happened to the dinner party guests is scary, it also might be the record for most LSD ever consumed by a human. There are no known fatal human overdoses on LSD, which has led multiple scientists to determine LSD is not toxic. The theoretical lethal oral dose to humans, based on intravenously shooting mice with LSD, is somewhere around 20 milligrams, according to erowid.org, an internet hive mind for psychedelic information.

Teri Krebs, a neuroscientist at the University of Norway, has said psychedelics in their pure form are as risky as riding a bike or playing soccer.

"It is generally acknowledged that psychedelics do not elicit addiction or compulsive use and that there is little evidence for an association between psychedelic use and birth defects, chromosome damage, lasting mental illness, or toxic effects to the brain or other body organs," Krebs wrote in a letter published in the Lancet.

But the story of this dinner party also illustrates a profound irony of psychedelic drugs like acid, mushrooms, or mescaline: They may not be harming your organs like a cigarette or vodka does, but the very essence of large doses of these drugs is madness. Many of the hallmarks of a "successful" psychedelic trip—temporary paralysis, severe visual distortions, extreme confusion—seem a lot like temporary bouts of insanity.

In fact, when researchers in the early 1900s started discovering and synthesizing these drugs, they first called them psychotomimetic, which literally means mimicking psychosis. It wasn't until 1956 that the term psychedelic, or "soul revealing," was first coined.

That renaming coincided with a massive amount of research into psychedelics, with doctors administering LSD to more than 40,000 patients from 1950 to 1965 and producing convincing evidence that psychedelics could be an effective treatment for a wide range of disorders from alcoholism to depression. That research was stunted by the American prohibition of psychedelics in 1970, but research is now restarting. Johns Hopkins University announced this year that it is launching an entire center dedicated to psychedelic research.

So how do you ensure that your trip on psychedelic drugs is revealing of your soul and not corrupting of your mental stability? Here are four tips to keep in mind if you decide you want to take these fascinating drugs.

First, consider your medical history. People with a history of mental illness are at a greater risk of developing adverse effects from psychedelics (and also from pot, by the way), and many of these drugs can create harmful interactions with antidepressants and heart medications. Anyone on prescription medicines should be wary of taking these drugs without medical supervision.

Second, consider the drug's source and purity. LSD isn't toxic by itself, but an adulterated version could easily be dangerous. Psychedelics like MDMA are particularly prone to adulteration with dangerous additives like meth or even bath salts. The best way to safely consume psychedelics is by having them tested by nonprofit testing services like drugsdata.org or by buying an at-home drug testing kit.

Third, consider the dose of the drug. Microdosing, which involves taking a fraction of the dose that is required for a full psychedelic trip, is becoming increasingly popular because it offers a way to lightly experience the effects of psychedelics. Even if you want to feel the full weight of a mind-bending trip, it is probably a good idea to start slow by first microdosing and seeing how you respond.

Finally, consider where and when you are taking these drugs. The psychedelic experience, more than any other type of drug, is integrally tied to the context in which you take the substance. Psychiatrists specializing in psychedelics call this contextual information your set (or your mind-set when you take the drug) and your setting (the place and environment where you take the drug). For your first time, don't do it at a music festival where you're surrounded by crowds of people. Try doing it in a park with a few trusted friends, or a very comfy room in your house. Ideally, one of your friends will not get high and can help you if you start freaking out.

It's no accident that ancient uses of psychedelics, like the thousand-year-old indigenous use of the hallucinogenic substance ayahuasca, always occurred in tightly controlled religious settings where individuals were intentional with their mood before entering the trip, outside stimulus was limited, and there was an expert ready to guide them through the experience. Taking large doses of these drugs when you're in a hostile mood or in an unruly environment—say, Pike Place Market on a Sunday—is only asking for a bad trip.

And that "bad trip" might be the biggest danger from psychedelics. A powerful dose of psychedelic mushrooms probably won't kill you, but that doesn't make jumping out of a window or running into traffic while on mushrooms any less dangerous. (And eating the wrong kind of mushrooms can kill you, so don't go off into the woods just picking and eating anything that looks right.)

Psychedelics are powerful drugs that demand respect. Use them intentionally, and your understanding of reality, of the earth, of your connection to other human beings may be forever changed for the better. But disrespect them, and you're asking for a problem. So make sure you know what you are taking, have friends to guide you through the experience, and remember to never mix your cocaine with your LSD.

*From the article here:

 
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The rise in meth and cocaine overdoses, explained

by German Lopez | Vox

America’s drug overdose crisis could be reaching a new phase.

America’s drug overdose crisis is still largely dominated by opioid overdose deaths. But stimulants like cocaine and especially methamphetamine seem poised for a comeback.

New federal data shows national overdose deaths linked to psychostimulants like meth spiked by nearly 22 percent from 2017 to 2018. Overdose deaths linked to cocaine increased by almost 5 percent.

That isn’t the only evidence: A recent research letter published in JAMA Network Open analyzing more than 1 million drug testing results from routine health care settings found positive hits for meth were up nearly 487 percent from 2013 to 2019, and positive hits for cocaine were up nearly 21 percent.

Experts worry that the numbers for stimulants could foreshadow a larger epidemic — a potential “fourth wave” in the overdose crisis that’s killed more than 700,000 people in the US since 1999.

“Every opioid epidemic in American history has been followed by a stimulant epidemic,” Stanford drug policy expert Keith Humphreys told me.

The numbers for meth and cocaine are still dwarfed by opioids. In 2018, there were nearly 13,000 overdose deaths linked to psychostimulants with misuse potential, particularly meth, and nearly 15,000 linked to cocaine, according to the CDC data. Meanwhile, there were nearly 47,000 overdose deaths linked to opioids. Synthetic opioids excluding methadone — a category that mainly captures fentanyl — were associated with more than double the fatal overdoses linked to cocaine or meth alone.

But there are reasons to believe the crisis is broader than just opioids. A 2018 study in Science found that, while drug overdose deaths spiked in the 1990s and 2000s with the opioid epidemic, there has been “exponential growth” in overdose deaths since 1979. That suggests that America’s drug problem is getting worse in general, regardless of which drug is involved.

“My question: Why are we as a country vulnerable to all of these drugs?” Nora Volkow, director of the National Institute on Drug Abuse, told me. “What has happened that has made it possible for these drugs to take hold in a dramatic way?”

The answers to those questions could require a shift in how America approaches drugs, focusing not just on the substances making headlines but also addiction more broadly and the causes of addiction. It would mean building a comprehensive addiction treatment system that’s equipped to deal with all kinds of drugs. And it could require looking at issues that aren’t seemingly drug-related at first, like whether socioeconomic and cultural forces are driving people to use more drugs.

Drug epidemics are often cyclical

In the 1960s and ’70s, heroin was the big drug of public concern. In the 1980s, it was crack cocaine. In the 1990s and early 2000s, it was meth. Over the past decade and a half, opioid painkillers, heroin, and then fentanyl became the center of America’s drug problem.

It’s not clear if the next phase is here yet — opioids are still a huge problem — but the worry is stimulants will start to pick up if opioids plateau and fall.

“The drugs are driven by fads, a little bit of fashion,” Volkow said. “So you have eras when you have a flourishing of a particular drug and then another one takes over.”

According to experts, there are many reasons for that. One is supply. Starting with the launch of OxyContin in 1996, there was a huge proliferation of opioid painkillers, letting people try and misuse the drugs. That was followed by waves of heroin and fentanyl as traffickers tried to capitalize on the demand for opioids jump-started by painkillers. Some research shows the supply of prescription opioids was a key driver in the rise of the current overdose crisis.

There are now reports of drug cartels producing and shipping more meth than before across the US-Mexico border — a shift from the homegrown market of the 1990s and 2000s. And in general, illicit drugs have become cheaper and, in some cases, more potent over time. Federal data tracking the street price and potency of the drugs tells the story: In 1986, for example, meth was on average $575 per pure gram and on average at 52 percent purity; in 2012, it was $194 per pure gram and 91 percent purity. The price drop is similar for other drugs, though purity levels have fluctuated depending on the substance.

This makes it cheaper for someone to start using drugs. The central focus of the US war on drugs for decades has been to prevent this — by fighting drug traffickers and dealers — but it’s failed as drug cartels have consistently remained ahead of the authorities, bolstered by new technologies and globalization making it cheaper and easier to ship drugs around the world.

New demand for drugs is also a major factor for new epidemics — as people could, for example, want to supplant or enhance their opioid use with stimulants. Maybe they mix opioids with cocaine (a “speedball”) or meth (a “goofball”) because they like the mixed effects. Maybe they use stimulants after heroin or fentanyl to wake themselves up. Maybe they want to stop using opioids, whether due to the risk of overdose or some other reason, and believe stimulants are a better option.

“People get tired of it — have been there, done that, and move on,” Steven Shoptaw, a psychologist and researcher at UCLA, told me. “There is some of that with all addictions. Some people walk away from [opioid addiction], which is great. But then they walk away from it by using stimulants.”

Humphreys noted an important factor in this cycle: “Probably more Americans than ever know a drug dealer.” As millions of Americans have misused and gotten addicted to opioids, they’ve established ties with drug dealers that they didn’t have before. That makes it easier to go from heroin or fentanyl to meth or cocaine.

Underlying all of this, Volkow argued, is a sense that something deeper has gone wrong in society. She pointed to the research by Princeton economists Anne Case and Angus Deaton showing that there’s been a rise in “deaths of despair” — drug overdoses, but also alcohol-related mortality and suicides. Case and Deaton have pinned the rise on all sorts of issues, including the collapse of economic opportunities in much of the country, a growing sense of social isolation, and untreated mental health issues.

“If all of these social factors were there, and we didn’t have the supply of drugs, of course people would not be dying of overdoses,” Volkow said. “But it is the confluence of the widespread markets of drugs — that are very accessible and very potent — and the social-cultural factors that are making people despair and seek out these drugs as a way of escaping.”

One caveat to all of this: Not every place in the US is following the same drug trends. According to the Science study and provisional federal data, meth has historically been more popular in the southwest, while fentanyl has been more widespread in the northeast. Researchers have warned that could change if, for example, fentanyl reaches California in a big way. But it goes to show that what looks like a national epidemic or trendline could also be regional epidemics, with different populations and demographics, separately rising and falling.

Different drugs can merit different policy responses

There are things that can be done to combat drug epidemics in general.

One option is to attempt to reduce supply, as the drug war has generally focused on for decades. Plenty of critics are extremely skeptical of this, pointing to the fact that illegal substances have only gotten cheaper and continued flowing into the US since President Richard Nixon declared a war on drugs.

But some work by Jon Caulkins, a drug policy expert at Carnegie Mellon University, indicates that prohibition makes drugs as much as 10 times more expensive than they would be otherwise — making the drugs less accessible and less ripe for an epidemic. There’s a logic in that: If drug dealers and traffickers have to grow, ship, and sell drugs while actively evading law enforcement, and therefore can’t built up the kind of mass production seen in legal markets, that adds costs.

Another potential policy response is to address what some experts call the root causes of drug addiction — by rebuilding economic opportunities, helping people feel more connected, or addressing mental health issues. There’s some real-world evidence this could work: Iceland set up an anti-drug plan focused largely on providing kids and adolescents with after-school activities, which journalist Emma Young described as “a social movement around natural highs,” and saw drug use fall among younger populations in the subsequent years.

There are other possible prevention efforts, such as doctors more routinely screening for drug addictions or public awareness and education campaigns (although, as the surgeon general’s 2016 addiction report cautioned, some types of campaigns work better than others).

“The most impactful intervention that you can do for a medical condition is prevent it,” Volkow argued.

Broadly, the US also needs to invest much more on addiction treatment. According to the surgeon general’s report, only about one in 10 people with a substance use disorder obtain specialty care, largely because it’s inaccessible and unaffordable. More money to addiction care could help boost access, although that would have to be paired with an emphasis on more evidence-based practices.

At the same time, a one-size-fits-all approach for all drugs is going to fall short.

For one, drugs are simply different from each other. For opioids, the biggest health risk is a fatal overdose. For stimulants like cocaine and meth, overdose is still a major concern, but the bigger health risk is the long-term damage the drugs do to the brain and cardiovascular system.

From a harm-reduction standpoint, this means that simply averting overdoses can do a lot to prevent the worst health risk of opioids, even if someone continues using for years. But for stimulants, deadly harms can’t be fully reduced until levels of consumption are reduced as well. So, for example, safe consumption sites, in which trained staff supervise drug use, might have more protective benefits for opioids than stimulants. (Still, the sites can provide a lot of other services for people who use stimulants, like sterile syringes, advice on how to use as safely as possible, and a connection to addiction treatment.)

Along similar lines, treatment is, for now, more effective for opioids than it is for stimulants. For opioids, we have effective medications in buprenorphine, methadone, and naltrexone, which, according to studies, cut the mortality rate among opioid addiction patients by half or more and keep people in treatment better than non-medication approaches. In France, the expansion of buprenorphine was a major factor in a 79 percent drop in overdoses from 1995 to 1999.

There aren’t equivalent medications for stimulant addiction. In fact, the only treatment that really stands out for stimulants, according to a recent review of the research in The Lancet, is contingency management, which provides incentives, financial or otherwise, to keep people from using drugs. But this treatment is controversial — not many people want to pay people who use drugs to stop using drugs. So it’s hugely underused in addiction treatment, outside of the Veterans Affairs health care system.

So simply building up America’s addiction treatment system isn’t enough to address all of the country’s drug problems. What kinds of treatment are done and how different drugs are treated also matter. And in the case of stimulants, treatment is probably going to produce disappointing results unless treatment facilities adopt an approach many are averse to and until researchers uncover better approaches.

This is why experts and advocates have long warned about focusing too much on the drug crisis of the day. While the opioid epidemic is a problem that needs to be addressed now, it’s important to be realistic about what could come next — and taking steps to prevent not just the current kind of drug crisis but also what could follow.

“We do have a problem in the US of tending to think of one drug at a time,” Humphreys said. “During the ’90s, everyone was worried about meth, but there were plenty of people dying of alcohol, and during the ’80s, crack cocaine, even though plenty of people were dying of heroin.”

The recent rise in stimulant deaths, though, suggests that America remains unprepared.

 
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