Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction | Review

Maia Szalavitz is an author and journalist focused on neuroscience, addiction and drug policy. She has written for the likes of High Times, VICE, The New York Times and The Guardian. Her newest book, Undoing Drugs, provides a comprehensive history of North American harm reduction movements, which arose as a response to the frightening AIDS epidemic of the ’80s. It details the harm reduction movement’s evolution from the late ’70s onwards. Groups like ADAPT (The Association for Drug Abuse Prevention and Treatment) and ACT UP (The AIDS Coalition to Unleash Power) and later, organisations like the DPA (Drug Policy Alliance) and the NHRC (National Harm Reduction Coalition) are explored. Undoing Drugs covers a range of topics across drug policy; the devastation of AIDS, the fight for supervised injection facilities, overdose prevention via Naloxone, compassionate changes to addiction and pain treatment and the emergence of national drug reform organisations.

The book is a tribute to ‘The Goddess of Harm Reduction’, Edith Springer, who is credited with introducing the harm reduction concept to America, thanks to a meeting with Allan Parry. Parry ran a successful harm reduction programme with Doctor John Marks in Liverpool, England. At one time, they were legally prescribing unadulterated, safe doses of heroin and cocaine to drug users. They also ran a needle exchange programme where they’d provide sterile needles in exchange for used ones, which they would safely dispose of. Clean needle programmes weren’t something that had been successfully organised yet in the States. Initially, they focused on educating injecting drug users on how to clean needles out with bleach and water, before re-using or sharing them. The book credits an exhaustive list of players in the harm reduction movement, from those mentioned above, to people like Yolanda Serrano, Jon Parker, Michelle Alexander, Dan Bigg, Stephanie Comer and Dave Purchase. All made valuable contributions to harm reduction in different periods, but tragically, not all of the groundbreaking and inspiring figures in this movement would survive to now, due to overdoses or illnesses.

Szalavitz experienced a major shock in 1990, when she first learned of the link between shared needles and HIV. She describes the ‘utter hell’ of waiting on HIV test results for two long weeks, before receiving the welcomed news that she hadn’t contracted it. It was at this point in her life that she decided that educating people about harm reduction and helping to introduce public harm reduction measures was precisely what she would devote herself to doing. Like Doctor Carl Hart, Szalavitz examines the racist origins of the war on drugs. She tells that even alcohol prohibition in the US had racist reasoning behind it: ‘..many white Protestants felt their power was threatened by rising numbers of immigrants from Germany, Ireland, and Italy, as well as Eastern European Jews. Prohibition was seen as a way to take back control.‘ She touches on the precedent set by The Harrison Narcotics Tax Act of 1914 and explains how in 1930, Harry Anslinger, as the first Commissioner of the Federal Bureau of Narcotics, fought for a strict federal ban on cannabis on the premise that weed ‘would seduce white women and lead to widespread insanity among previously pure white youth‘.

He ignored 29 of the 30 Doctors he interviewed about cannabis, who said that it wasn’t harmful enough to ban. This reckless anti-drug attitude would continue later, most notably with Presidents Nixon and Reagan. Szalavitz outlines the public mindset, from the ’60s onwards, as follows: ‘..illegal drugs had been firmly linked in the American mind with poor, Black, and brown criminals — and the stereotype of the “addict” as a lazy, devious, and violent sociopath mapped perfectly on to the racist stereotypes many whites held about those groups. With a compliant media, it was easy to blame violence and poverty on drugs — and not the socioeconomic circumstances that actually do lead people to problematic relationships with substances. It was also easy to spike fear that the evil drugs used by poor Black and brown people would soon be coming for innocent white babes.‘ Elsewhere, she quotes a lawyer, who said the following about crack cocaine in a New York Times op-ed in 1986: ‘If we blame crime on crack, our politicians are off the hook. Forgotten are the failed schools, the malign welfare programs, the desolate neighborhoods, the wasted years.

It’s apparent from these descriptions of the anti-drugs rhetoric of US authorities that the narrative on drugs has long been manipulated by those in power, to avoid taking responsibility for the neglect of various social issues and as a means of scapegoating ethnic minorities, particularly African Americans. The narratives of traditional and dominant twelve-step recovery programmes are challenged, such as those found at Narcotics Anonymous and Alcoholics Anonymous, where their only measure of success for an addict is total abstinence from intoxicating substances. Addiction is viewed as a ‘progressive disease’, such that if someone changed from buying crack every weekend to smoking a joint once or twice in a month, that person would be labelled ‘still using’ and ‘not in recovery’. This is because ‘progression of the disease’ is seen as inevitable, meaning that in their view, such an instance of seemingly controlled cannabis use ‘will ultimately spiral back to chaotic crack addiction’.

Szalavitz also covers the Housing Works organisation, which was founded to combat homelessness and addiction through the provision of free housing. The organisation was based on the ‘Housing First’ premise that it’s ‘highly unlikely that someone living in an unstable setting or entirely without shelter will be able to quit alcohol or other drugs while still on the street.‘ Along with the likes of Stand Up Harlem, they were shown to have tremendous success in reducing chronic homelessness and by extension, addiction rates. They stood in stark contrast with housing provision programmes that demanded the near-impossible from drug users – that they be entirely ‘clean of drugs’ before granting them accommodation. Root causes for many people who end up in damaging life scenarios are mentioned by the author, where she states: ‘Virtually everyone who ends up homeless, addicted, mentally ill, and HIV positive has a long history of childhood trauma, typically compounded by the experience of racism and the extreme distress and social rejection that comes with living on the street or being incarcerated.

Although Undoing Drugs is often heartbreakingly tragic, it is a vitally important book that highlights the success of applied harm reduction and the contrasting failure of continued ignorance and stonewalling. It considers the countless people who take drugs who are routinely stigmatised, marginalised, and de-humanised due to conservative, hardline drug policies. The key message throughout is an urgent need for the powers that be to adopt a more humane and effective approach for drug policy. Emphasis is placed on the importance of protecting human lives above all else. Maia Szalavitz‘ book is full of data that proves the success of initiatives which treat drug users with respect and dignity, helping them to stabilise themselves and restructure their lives enough to feel ready to quit the drugs that they were disrupting their lives with in the first place. Perhaps by now, world leaders should be sitting up and listening keenly to the likes of Ms. Szalavitz, instead of ‘being tough on drugs’.

* The Green Lens would like to thank Hachette Books for providing us with a review copy of this book.

Laura | 15.06.2021

Laura suffers with chronic depression, anxiety, insomnia and back pain, which she was prescribed Valium for ten years ago. She says she hasn’t ‘popped’ a Valium since a few years ago, when she lived in Canada and had access to medical cannabis.

Twitter / Instagram: @ucancallmelola

Can you please outline your relationship with alcohol in the past and why it was that you decided to stop?

I used to think of my relationship with alcohol as pretty typical, but now I can see it was more sinister than that. It started with the ‘normal’ teenage experience of being around fourteen years old and scheming ways to get cans of cider or a naggin of vodka in a park on the weekends, but it grew into something somewhat crippling socially. I felt as though I needed it to be social, genuinely like it was some sort of armour to put on before going out or some magic drink that made me care less about things and pretend to be ‘grand’. Now, with the benefit of age and objectivity, I can see that I was self-medicating my well-established mental health issues in the only way I knew how – the same way generations before us did, which has been culturally normalised for us. I was definitely abusing it. I was regularly drinking alone in the evenings while at home watching TV. A bottle of wine after work at (the age of) nineteen was about standard. Even before then, I used to secretly take a few shots of rum or vodka before going out to my friends as a teen. Not that I told anyone. It was a problem. I stopped drinking at about 26, four years ago.

You once compared the damage alcohol can do to how harmless cannabis is in comparison. You said: “No one smokes themselves into requiring their stomach pumped at Beaumont (hospital) on a Saturday. No one smokes a joint and starts a fight at a party. But “social drinkers” clog up A&E when bars and pubs are open as normal.” Why do you think this cognitive dissonance persists in Ireland about alcohol?

I think that we have been passing down broken ideas and unrealistic rules between our generations. Our cultural and social norms are super influential, of course, but we model ourselves on what has been modelled to us at home first and we internalise our caregivers’ behaviours before we even know we’re doing this. I believe that our previous generations lived in eras of shame and mortification over any (social acknowledgements of) mental health problems, illnesses, addictions and disorders. These generations also lived in times of suppression of information and emotional control under a corrupt church and a conservative government, intent on parroting the 1USA’s War on Drugs propaganda. In short, they lived in the dark and are now terrified of this new information and distrustful of it all. It’s come as a total shock in comparison to the information of the world that they grew up with. All they know is ‘booze is okay and everyone does it’ and no one calls it a drug, so its damaging effects are ignored. 

I’m extremely hopeful that this is a statement on Ireland’s dissolving cognitive dissonance, however. I don’t believe that we face the same set of challenges that they faced. Our access to fast, good information is not something that was available to previous generations. We watched 9/11 on our TV screens as it happened; a different country, a news event in real time. When my father was the age I was in 2001, his house in Castleknock burned down…and that made the newspapers, the next day. Kids can Google for their own information now, but forty years ago, you might need to go to the local library and hope they had an encyclopedia that would answer your kids’ question… either that or guess, and likely pass along faulty advice or answers. We have so much more information that I don’t believe we can continue to hold such contradicting beliefs about a person’s right to drink, smoke, consume substances or the right to alter one’s consciousness.

You said that cannabis was a “huge help with chronic depression & anxiety” and that it has helped your back pain more effectively than your long term Valium prescription. It has also helped you to combat issues with food & insomnia. What beneficial effects do you get from weed?

For me, weed functions as a muscle relaxant for my back pain, an anti-anxiety support and to help with the symptoms of panic attacks if or when they occur, to help me to eat when my nausea is in flare up, to help me sleep when my insomnia is active. All of these effects are instrumental to my being able to cope with and heal my mental health issues and deal with past traumas. It’s such a huge help and it doesn’t have the side effects that I was getting from my antidepressants or Valium prescriptions. 

When you first started using cannabis, did you wean yourself off Valium or stop all together? 

Well, I didn’t use the Valium often enough to require weaning off it. There’s a genetic history of addiction in my family and so I was too scared to take the prescription regularly enough to become in any way reliant on it. Instead, I self medicated by drinking most nights to help me with pain, sleep and to dissociate from it all. Of course, I couldn’t see at the time that instead of avoiding a substance abuse situation like I thought I was doing, I was just doubling up the speed of my alcohol abuse. So when I received my first batch of medical cannabis, it was like opening up the cover of a new book. I don’t feel like I’ve lost or given up anything. I felt like I upgraded the efficiency of my medication. Same with the drink. All of a sudden, I had absolutely no desire for it any more. Now all I miss is the variety of flavours alcohol comes in. I’m pretty sick of Coke or Club Orange as my only beverage options most places, but that is honestly the biggest personal drawback for me in the change over.

Have you experienced any side effects since switching from Diazepam to cannabis?

Other than the above mentioned, before smoking any weed I was suffering in a number of ways. When I began smoking, first it was for my back pain, but soon I noticed a sizeable shift in my mental and emotional strength and ability to look internally at things clearly where I had never been able to before. I was suddenly becoming more aware of myself, my traumas, my triggers and it calmed my chaotic, anxiety-ridden thoughts so that I was finally able to admit to myself that I was unwell, had been unwell for quite a while and desperately needed the help of a mental health practitioner to get back to a healthy place. It sounds hokey and woo woo, but it facilitated the mental and emotional processing I needed to see clearly and care about myself enough to get help. Diazepam made me spaced out, guilty and ashamed, drained and headache-y for two days after use, and unable to drive or operate heavy machinery. I guess the heavy machinery thing is the only unchanged side effect.

Would you recommend those similar to you to make the switch, or do you feel it’s a personal decision to make? 

I think that it’s definitely a personal decision regardless, and that someone should be as informed and comfortable as possible. I do think it should be an option for everyone to try, but that everyone’s reactions are a little different and based solely on the individual. Cannabis won’t work perfectly for everyone, just like every antidepressant won’t work for everyone or why some people can’t drink certain drinks without getting aggressive or blacking out. Our individual body chemistry obviously plays a huge part. I do think that a natural option is a good one to have on the list of options that should be available for adults to explore and for mental health professionals with the correct information and experience to recommend. The best thing anyone can do is be as informed as possible.

How were your experiences with cannabis in Canada and how did they compare with using cannabis in Ireland?

Night and day. There is no comparison. Trying to buy some dried flower buds in a little sandwich bag shouldn’t feel like an arms deal with the ‘Ra, but unfortunately it does. We like to order CBD products from 2Little Collins dispensary instead, and also have some friends who grow their own plants and will send some love our way when they have spare.

When did you first become interested in cannabis?

Just before moving to Canada. They had recently legalised, so I wanted to be informed before arriving there and not be completely ignorant of the situation.

Do you know a lot of people who use cannabis?

More than I could count for you. It’s not uncommon, just semi unspoken.

What are your thoughts on Irish prohibition laws surrounding cannabis and other drugs?

Completely and utterly embarrassing and very transparently put in place to ‘look the part’ and follow suit with other very vocal nations, but comprised of very little fact and backed by zero research. They have created a thriving black market selling dangerous product and profiting criminals. 

When do you see the Irish government reforming our cannabis laws?

Do you see those who are in power at the moment making these reforms?

I’m torn. My hopeful, optimistic side sees legalisation and regulation of weed in the next three to seven years, if our leaders are smart enough to look to the 3Canadian model and the amount of revenue that was created there from nothing. It would also make some farmers unions happy as they have been lobbying for similar rights to grow hemp and related products and it would create a brand new industry full of jobs and additional international trade. My more cynical and pessimistic side agrees with the hot take from 4Blindboy, where he says that the Irish government will likely wait and wait until the USA legalises on a federal level, starts looking internationally and comes sniffing around our tax-light shores for a place to set up shop. Either way, it will be the money that sways them. That’s the only language they speak.

If you had an audience with Frank Feighan, Stephen Donnelly and co, what would be your message to them?

Catch up or move aside. We’re done with leaders who lead us nowhere. Be part of the solution to the problem or be left behind, but you won’t be able to hold up progress forever.

References

1 We highly recommend that you read Doctor Carl Hart’s book on this topic, reviewed here –

https://greenlensblog.com/2021/05/13/drug-use-for-grown-ups-review/

2 Check out the Little Collins CBD site at this link – https://littlecollinscbd.com/

3 To learn more about cannabis in Canada, check out my interview with Farrell Miller of

 NORML Canada here – https://greenlensblog.com/2020/12/09/farrell-miller-toronto-canada-21-11-2020/

4 Watch this recent Newstalk interview with Blindboy about cannabis in Ireland –

https://youtu.be/gXtJqwSLkiQ