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.

Drug Use for Grown-Ups: Chasing Liberty in the Land of Fear | Review

Doctor Carl Hart is a Professor of Psychology, specialising in Neuroscience at Columbia University in New York. He is well-known for his research on drug abuse and addiction, which has been his passion for over 25 years. He opens his latest book, 1Drug Use for Grown-Ups, with the lines:

“I am an unapologetic drug user. I take drugs as part of my pursuit of happiness, and they work. I am a happier and a better person because of them.”

As a means of better educating drug users and thereby facilitating their health and happiness, he suggests that people focus on four areas – Dose, Route of Administration, Set [individual user characteristics], and Setting [environment in which drug use occurs]. These four areas can greatly influence the user’s experience – whether it will veer more towards a beneficial or a negative one.

Early in the book, he highlights the complete failure the war on drugs has been by quoting the United States drug control budget of approximately $35 billion a year in taxpayer money; in 1981, the amount stood at $1.5 billion. This is a gargantuan budget increase, but traditionally-popular illegal drugs are as commonplace now, if not more so, than they were back then. Dr. Hart believes that one unstated aim of the drug war is to prop up the budgets of law enforcement and prison authorities, along with drug treatment centres and urine drug testers. Those in law enforcement receive the bulk of drug-war money according to the Professor, and more drug arrests mean more overtime, bigger budgets and stronger job security for those in law enforcement, while more prisoners keep prison authorities content. It’s worth noting that the U.S. has got the biggest prison population on the planet, at an astonishing 22.12 million inmates. This system includes 3130 private prisons. It’s clear from the statistics that prison authorities are among those who benefit enormously from the war on drugs.

The Professor believes the term Harm Reduction is dated and should be gotten rid of, or replaced with a more nuanced term, because: “The language we use shapes how we think and behave”. Elaborating on this, he says: “We need to cut the bullshit and stop pretending drugs inevitably – and only – lead to undesired outcomes”. He doesn’t believe there should be a specific term for harm reduction, mentioning other existing phrases which could be used, such as: “common sense, prevention, education, and the like”. Dr. Hart emphatically states that “Drug abuse and addiction are a minority of the many effects produced by drugs…” Of his years spent researching drug use, he says: “More and more, I came to realise that drug-abuse scientists, especially government-funded ones, focus almost exclusively on the detrimental effects of drugs…” He says that addiction “represents a minority of drug effects, but it receives almost all the attention, certainly the media attention”, before asking: “Have you ever read a newspaper article or seen a film about heroin that didn’t focus on addiction?”

Other universally-accepted lifestyle choices involving calculated risk are listed, including flying and driving – two potentially dangerous activities, which statistically involve few injuries or deaths when engaged in correctly. The information that’s typically found about heroin is compared with a driving analogy: “Imagine if you were interested in learning more about cars or driving and could only find information about car crashes or information about how to repair a car after a crash”. Regarding the small fraction of users who suffer with addiction, he says there are a substantial proportion of addictions involving “co-occurring psychiatric disorders – such as excessive anxiety, depression, and schizophrenia – and socioeconomic factors – such as resource-deprived communities and under-employment”. The Professor stresses that there are no inherently “evil”, wholly-negative drugs, despite what we are told growing up. Regarding the age-old gateway drug myth about cannabis, he states that it “grossly overstates the evidence by confusing correlation with causation…the vast majority of pot smokers never go on to use so-called harder drugs.”

He discusses the alarmism of typical cannabis-focused headlines which often blame it for psychosis. The studies such claims are based on generally make bogus interpretations of their data. This is because weed-centred studies often highlight when volunteers have marked if they have ever experienced certain psychotic symptoms (something many people do at some point in their lives) on a questionnaire. Such studies then decide that those volunteers qualify for psychotic disorders, when in reality, determining if someone suffers with a psychotic disorder requires rigorous consulting with psychologists and psychiatrists. It is not simply a box-ticking exercise. Of similar note, the inaccurate reporting of the results of toxicology reports by authorities and the media is looked at. These results generally involve many complex factors and according to Dr. Hart, “one of the most important limitations of many recent analyses and reports on drug overdose deaths is that the co-occurrence of alcohol is ignored completely”. 

Brain imaging data is another area the Professor breaks down into basics – structural scans look at the size of brain structures, without telling you how they’re functioning. Functional scans provide brain activity information (i.e. specific neurotransmitter activity), but not brain structure information. According to Dr. Hart, these scans only capture a moment in time. This means it’s nearly impossible to determine if drug use caused any difference to the brain, or if that difference was there before the scan occurred. Multiple scans are needed at different times to gain a true understanding of whether drugs have affected the brain or not, so the result of what is a highly nuanced procedure often ends up becoming an alarmist ‘finding’ about brain deterioration. The ignoring of tobacco and alcohol’s effects on the brain are also common oversights. Toxicology reports and brain scans, so often misinterpreted and misrepresented by prohibitionists and the media, often make the aforementioned mistake of confusing correlation with causation.

Dr. Hart says that complicated socio-economic issues are often reduced to being the result of “drug problems” by the powers that be. This means that more resources end up being given to law enforcement, instead of community organisations who urgently require education programmes, employment and life-saving drug services. The Professor outlines the deep-rooted, historical racism which has been such an intrinsic part of the war on drugs, stemming mostly from the U.S and spreading throughout the world thereafter. Opium developed a negative reputation because of media fear mongering in relation to the opium dens of Chinese immigrants. Dr. Hart cites an 1882 report, which said that young, respectable white people were “being induced to visit the dens, where they were ruined morally and otherwise”. The marijuana term entered common use in English because American authorities and media co-opted it from the Mexican term marihuana, to give it an association with Mexican immigrants, who traditionally used the plant and in some cases brought it to the States.

Common use of this term helped to exploit the existing hatred or distrust many Americans had for Mexicans, giving weed a negative connotation via perceived association. Media stories emerged in the ‘30s claiming that cannabis use by blacks led to violent crimes. Then there were ridiculous stories about cocaine use causing black men to become unpredictable, dangerous, and even bulletproof, in certain cases! The Professor notes that all modern reports referring to zombies and users with superhuman strength are descendents of those old media falsehoods, existing as a sensationalist, dehumanising means of justifying discrimination and brutality. During weed regulation hearings in Congress in 1937, Harry J. Anslinger is quoted as having said: “Marijuana is the most violence-causing drug in the history of mankind”. But interestingly, Dr. Hart states that there has been public data proving the safety of cannabis since it was first banned. New York City Mayor Fiorello LaGuardia commissioned a study about its use and effects and the results ran contrary to Anslinger’s hysterical statement.

Report findings from 1944 concluded that concerns about catastrophic effects from smoking weed were unfounded. It said that those “who have been smoking marijuana for a period of years showed no mental or physical deterioration which may be attributed to the drug.” Further highlighting systemic racism, Dr. Hart quotes data from The U.S. Sentencing Commission in 2017, which states that over 80% of those convicted of heroin-dealing were black and latino, despite the fact that most dealers were white. He also mentions the fact that black men make up 40% of U.S. prisoners, despite only representing 6% of the country’s population. The horrendous police killings of many African Americans, such as Philando Castile, Sandra Bland, Trayvon Martin, Laquan McDonald and Tamir Rice (who was shot at the age of twelve) are discussed in the book, as are the distortions of what occurred in subsequent reports released surrounding their deaths. These police killings and others place a glaring emphasis on the very serious issue of systemic racism in America and how the war on drugs continues to enable it.

The way the media shapes our perceptions of the effects of drugs and who is using them where, is a crucial subject area of the book. The media frenzies sensationalising the crack cocaine crisis and in more recent years opioid use in the U.S. are covered by Dr. Hart in considerable detail. The common portrayal of crack mainly being used in poor black communities, when in fact it has been used primarily by white people, will likely be a revelation to many readers of the book. The author also discusses the mythology surrounding ‘crack babies’ and writes about troubling incidents in which pregnant women who were found to have cannabis in their system then had custody over their newborn babies removed.

Drug Use for Grown-Ups is a must-read book in a time where the war on drugs is increasingly put into question across the world. I would highly recommend this book to anybody with an interest in cannabis, drug policy, health, misinformation, corruption or racism. Dr. Carl Hart expertly argues the case for every adult’s right to the pursuit of happiness, as espoused in The U.S. Constitution. He believes that safe, informed drug use should be permitted as a part of that equation. He argues this while dismantling virtually all of the arguments that are found in favour of prohibition, with an expertise developed over years of hard graft. From being a young man fully invested in the war on drugs narrative to one who sees it for what it really is – an authoritative narrative built from racism, paranoia and notions of morality, rather than one based on logic and scientific data.

* The Green Lens would like to thank Doctor Carl Hart for providing us with a review copy of this book.

References

1 Drug Use for Grown-Ups can be purchased via The Book Depository here –

https://bit.ly/3f01fMc 

2 This figure is taken from the following page, which details global prison populations –

https://www.statista.com/statistics/262961/countries-with-the-most-prisoners/

3 For more information on U.S private prisons, see this link –

https://infotracer.com/resources/us-private-prisons-facts-statistics/