Fighting for Space: A Story of Perseverance

grygielny Guest Pieces, Opinion

A Review By Dr. Mary Nelson

We are in the midst of an opioid crisis. In 2016 there were an estimated 64,000 fatal drug overdoses across the US. Our response has been inadequate and unsuccessful, but the work of activists in Vancouver provides paths for action. Travis Lupick tells the stories of those who paved that path, interspersed with insights into the effort to replicate that model in the US, in his book Fighting for Space. In 2016, I was able to visit the pioneering Vancouver treatment program, Insite, and to meet the people involved. I can attest to the power of a more humane and life-giving approach.  

Lupick offers a moving introduction to harm reduction and describes how it can be a model for the US. “Our government and police have waged war on people that use drugs,” says Lupick, resulting in bloated prisons and rising death rates. He depicts the effort to find a better way in Vancouver over the period 1990-2014 through the eyes of service providers who came to understand that criminalization and abstinence don’t work for many struggling with addiction, and that new approaches need to be tried.

One of these health workers was a nurse, Liz Evans, who left a hospital job focused on the immediate medical needs of addicts to manage a last-resort housing complex, the Portland Hotel.  Under Evans’ leadership, the Portland accepted drug addicts and mentally ill people as they were, asking, “How can we help?” The result was a hectic but caring “community” of residents.  Other staff brought their own strengths and perspectives to this work. Mark Townsend identified creative ways to convince politicians to increase funding for alternative approaches to drug treatment. Organizer Ann Livingston, committed to engaging addicts themselves in shaping and advocating for their own solutions, facilitated their involvement in designing a more effective and humane response to addiction.    

Frustrated by the indifference of politicians, and society more broadly, to the HIV/AIDS crisis  and escalating deaths in Vancouver’s downtown, an organization of drug users took shape, the Vancouver Area Network of Drug Users, or VANDU.  They began with a demonstration in a major downtown park, where activists and addicts bore 1,000 crosses inscribed with the names of victims of drug overdose, and a large sign reading, “KILLING FIELDS.”  A year later the network organized an international conference in the same park, with speakers from Europe who ran safe drug injection sites and other humane efforts sharing their experience, expertise, and validation.  Their testimony opened the eyes of some government and medical officials and created the opportunity to push for harm reduction approaches in Vancouver.

Lupick describes harm reduction as “strategies all about keeping people alive and as healthy as possible until they can arrive at a place in life where treatment or abstinence works for them.”   Drug users who lived in the Portland Hotel could shoot up in their rooms, and staff became equipped to deal with overdoses.  But many users were still on the streets and in dark alleys, and too many were dying.  Several times temporary injection sites popped up only to be kicked out by landlords.

Slowly, HIV/AIDS activists, enlightened health care practitioners, police, and politicians frustrated by the failing status quo came together around a four-pronged approach to addiction:  prevention, treatment, enforcement, and harm reduction.  

Finally in 2003 a single drug injection site was approved as a 3-year pilot to test the harm-reduction approach. It provided a safe space where people who bought their drugs outside were welcomed, provided with water and sterile equipment, and supervised by a medical professional in case of overdose.  A second room provided post-injection “cooling spaces,” and a friendly community coffee pot humanized the place.  Statistics showed a significant reduction in deaths from overdose and HIV/AIDS. This safe haven also opened the door for connections to other forms of health assistance and care. Research on Insite  validated anecdotal findings of significantly reduced deaths from overdose, people moving into more stable living situations, and healthier action.  These findings have been documented and published in countless journals.

Insite and its housing components (Portland Hotel, etc) are still operating today, but expansion has been glacial. Lupick recounts how opposition from downtown business associations and, city officials have threatened the pilot model.  VANDU and its allies continued to organize for decriminalization of drug possession, harm reduction efforts, and legal drug injection sites.  Aided by lawyers, a court case went to the Supreme Court, which rendered a narrow decision that applied only to the existing drug injection site. The struggle continues, but there is hope, and lives are being saved in the process.

What can we learn from the Vancouver experience?  It takes the selfless commitment and compassion of pioneers like Liz Evans. It takes creative efforts to raise awareness and destigmatize drug use in the minds of politicians and voters.  It takes outreach to allies, including HIV/AIDS advocates, public health advocates, communities of faith, families of drug users, and politicians.  It takes involving drug users in organizing and action, both for better results and to empower them to take charge of their lives. It takes persistence and resilience for the long journey with small successes along the way.  

As people of faith, we know all are created in the image of God, including drug users.  God calls us to work for justice for all God’s people.  God gives us infinite hope that sustains us in the struggle for a more humane and life-giving approach to drug addiction.

Mary Nelson was the founding President and CEO of Bethel New Life, a faith-based development corporation on Chicago’s West Side.  Over 45 years in that community and 27 years in that role, she brought a perspective of faith and hope to a community many considered beyond redemption. Nelson holds a doctorate from Union Graduate School and has taught asset-based community development to pastors and community leaders. In April 2016, she visited Insite as part of a pastoral delegation organized by Clergy for a New Drug Policy.

Progress in Preventing Drug Deaths: A Philadelphia Story

Tom Houseman Legalization

 By Tom Houseman

You might be surprised to learn that the most dangerous aspects of heroin use have little to do with the drug itself. Heroin injection’s dangers are largely driven by the risk of overdose (especially if the user is unsure of the potency of the particular dose being taken) and the use of dirty needles leading to infections, HIV, and Hepatitis C. Harm reduction is a strategy to reduce those risks, ensuring that substance use disorder is not a death sentence, and that someone who uses drugs gets the support they need to receive the treatment that is right for them. It is easy to shame and condemn a drug addict, but if we want to help them live, instead of just letting them die, we need to do more.

Providing a facility in which people can safely inject under supervision of a medical professional would drastically reduce these risks and save lives, but currently no such facility exists in the United States. You can read about North America’s first safe injection site, Insite, in our review of the book Fighting for Space. Insite staff have overdosed thousands of drug overdoses, and not a single death has occurred. In addition, when heroin users have access to a safe injection facility, rates of HIV and Hepatitis C go down, as do the number of publicly discarded needles.

Such a facility would have an enormously positive impact in the United States, yet those who think that these facilities incentivize drug use (they don’t) have ensured that none exist. As a result, those who inject drugs are forced to reuse needles, inject with dirty water, and rush their injection to avoid being caught and arrested. Instead of trying to help those with substance use disorders, too many are only looking for a way to ignore drug users or punish them.

Sheetz, a chain of convenience stores in and around Pennsylvania, recently announced that, in an attempt to drive away drug users, they will be replacing all of the lights in their bathrooms with blue bulbs. Because veins are more difficult to locate under blue light, the injection process is harder and more dangerous. While it makes sense that a business would not want illegal activity to take place on its premises, this decision shows how desperately safe injection sites are needed in areas with high rates of heroin use. Overdose deaths in Pennsylvania increased by 37 percent in 2016 to a rate of nearly thirteen deaths per day. In addition, 1,170 people were diagnosed with HIV in Pennsylvania in 2015, and rates of Hepatitis C infections increased by 233 percent.

Fortunately, progress is finally being made. On January 23rd, city officials in Philadelphia announced their support for the creation of a safe injection site within the city, the first step in what will likely be a long and legally complicated process. With one of the most liberal District Attorneys in the country, and a police commissioner who was once “adamantly against” such a site but who allowed the evidence to sway him, Philadelphia could be the one of the first cities in the country to open a safe injection site. San Francisco has plans to open a facility in July, while plans are also being discussed in Denver, Seattle, Baltimore, and New York City.

One would hope that the religious communities in Philadelphia would support such an act of compassion and charity, seeing it as a way to support members of their community who are struggling with substance abuse. Yet one week after the safe injection site proposal received the approval of city officials, an opinion piece by Gina Christian for the website Catholic Philly rejected the notion of such charity, calling it “a new low” for the city’s efforts to help addicts, and writing that “God would appear to disagree” with harm reduction measures. Armed with inaccurate data and a quote from Catechism of the Catholic Church 2291 on the grave sin of drug use, Ms. Christian says that the real solution to the plight of heroin addicts is to “put the needle down now – forever.”

This attitude, in addition to showing a complete misunderstanding of how challenging it can be to struggle with addiction, seems to have little in common with a Christ figure who “comforts us in all our affliction, so that we may be able to comfort those who are in any affliction, with the comfort with which we ourselves are comforted” (2 Corinthians 1:3-4). Harm reduction techniques, including safe injection sites, are a way to meet addicts at the place in their addiction where they are, rather than forcing them to adhere to unrealistically strict rules before we offer them help. Instead of seeing addiction as “a deal with the devil,” as Miss Christian does, doesn’t it make more sense to see it as a disease, and to offer those stricken with it any help that we can?

Testimony before the Illinois Senate Hearing on Cannabis Regulation and Taxation: Molly Lotz

grygielny Decriminalization, Drug Education, IL

January 22, 2018

Good morning esteemed members of the Illinois General Assembly

My name is Molly Lotz.  I am a School Social Worker and Counselor from Colorado.  When Colorado legalized recreational marijuana consumption and sales I was working in an alternative school in a mountain town.  Still working at the same school, two years later, and after early sales of recreational marijuana, my students started to come to me and ask for straightforward information on how marijuana use might affect the developing brain.  They had been exposed to a DARE type of program during their early education and now, just 6 years later, legalized recreational marijuana was my students’ reality.  They had parents who were using recreationally, they had grandparents who were using marijuana medicinally and I realized that in Colorado at least, we couldn’t teach marijuana to our youth in the same way as other substances.  We had to tease out marijuana education and not lump it with heroin and methamphetamine.  My students needed, and were, in fact, asking for accurate, fact-based, not fear-based, information on how marijuana might affect them and their developing bodies and brains.  I took a look and found not a single post-legalization, marijuana-specific curriculum available to help me support my students navigate this new reality.  

So I teamed up with a fellow educator and we decided to create what our students were asking for:  A comprehensive marijuana-specific, curriculum that informs and empowers youth using up-to-date research and information on how marijuana use affects them.  What we knew is that youth needed the facts about how marijuana affects them and understand the difference between adult use and youth use as well as recreational use and medicinal use.  We  created a program that promotes delaying first use and/or abstinence during adolescence by supporting youth’s self-efficacy and to inform them using honest and accurate information.  Recognizing the detrimental educational impacts of a marijuana policy violation, we also created a program that allows administrators to keep kids with a marijuana policy infraction in schools and at the same time still addressing the policy violation in an effective way thus disruption the school to suspension to drip out to prison pipeline.

This approach has been shown to increase youths’ perception of risk around youth marijuana use while at the same time not vilifying the adults in their life who may use medicinally or recreationally.  Youth need to be made aware of increasing marijuana potencies and concentrates as well as how early marijuana use can impact brain and cognitive development and functioning.  Youth need to know that a marijuana policy violation in their school or community can lead to long term consequences like impacting educational opportunities such as FAFSA eligibility and a possible school suspension or expulsion.  If we don’t give our youth this information to accompany recreational marijuana campaigns or commercial rollout, we are doing them a great disservice.  Additionally, if we doing acknowledge and educate youth on how their classmates may be using marijuana medicinally we are going backwards and not evolving with the changing landscape.  We have to help educators find the balance between educating youth about the risks of adolescent recreational use and providing a safe and compassionate environment for medicinal needs.  Old drug education programs do not do this.

One of the top issues on voter’s minds is youth marijuana access and education.  Colorado legalized before proper marijuana educational programs were in place and is not paying catch up.  Illinois can prevent this.  Several Colorado schools and youth serving organizations have already adopted this progressive approach to youth marijuana education.  I would ask that as you develop recreational marijuana policies and appropriations that you consider implementing a progressive youth marijuana educational campaign so you can go to your constituents and feel confident that there is an effective solution to addressing the concerns around youth access and education.

Thank you for the opportunity to speak with you today.

Molly Lotz, LCSW
Co-founder of Marijuana Education Initiative
School Social Worker

Testimony before the IL Senate on Marijuana Legalization: Leslie Mendoza Temple, MD, ABOIM

grygielny Decriminalization, Drug Education, IL

January 22, 2018

Good morning, Senator Steans, Representative Davis and esteemed members of the General Assembly.

My name is Leslie Mendoza Temple. I am a board-certified Family and Integrative Medicine physician in Glenview, Illinois. I also served as the former Chair of the Medical Cannabis Advisory Board for the Illinois Department of Public Health.  It is important to note for the record that I am not speaking on behalf of any institution or my employer.  I am speaking from my personal viewpoints and experience as a clinician….and as the proud mother of 3 sons, ages 7, 9 and 11 years old.  I have no financial or other beneficial relationship with the medical cannabis industry.

My Integrative Medicine practice attracts patients with complex medical conditions- primarily cancer, chronic pain, neurologic, psychiatric, and digestive conditions.  Many of my patients seek my care as the last-ditch effort, referred by their physicians, they prefer to treat their conditions as naturally as possible and find their way to me. I have written certifications for over 400 patients, with over 200 patients returning so far for their follow up appointments, providing me feedback on their medical cannabis experience. I have studied this feedback.

An independent chart review of my certified patients showed that over 80 percent of them had  experienced relief of one or more symptoms from their chronic condition.  Medical cannabis plus or minus medications have reduced or completely relieved many of my patients’ insomnia, pain, seizures, and digestive problems. I have seen my patients reduce their benzodiazepines, their sleep medications, and most importantly, reduced or eliminated the opioids.\

Considering the opioid and heroin epidemic, medical cannabis is a crucial part of the solution to this crisis and needs more eligible conditions to be added to the program.  Anytime opioids have been prescribed for chronic pain from all sources, patients should have the option to use medical cannabis instead. Medical cannabis is not a perfect drug however, with 29% of my patients experiencing confusion about what to take, how to take it, and varying strain availability from the cultivators and dispensaries.

Despite these challenges, medical cannabis is without a doubt, one of the most important tools I have discovered in my practice, alongside good nutrition, exercise, sleep regulation, acupuncture, meditation, medications, and stress reduction strategies.

As I gain more experience with patients using cannabis in a medical, therapeutic way, I have learned more about this substance, far beyond what I was ever taught during medical school or residency training. I have struggled with how to approach the question about legalizing it for adult use.  After speaking with folks on both sides of the issue, both with passionate belief and strong conviction in their viewpoints, and without investment in the industry, and with the mother’s lens.  I have come to the following conclusions which I hope are helpful to this panel and the audience.

  1. I am in favor of regulating cannabis for adult use, over age 21. I am against its prohibition given that our current system of prohibition has failed on many levels. Regulating cannabis production and sale may help increase safety of untainted supply by going through vetted cultivators; taxation can create funding to improve drug addiction and education services; legalizing it has implications that can divert funding away from the criminal system and towards education and rehabilitation.
  2. Regarding the commercialization of legal recreational cannabis, I would say there is already a very large scale, for-profit industry surrounding current usage.  It is an illegal black market industry run by addiction profiteers who manage (with crime and violence) the supply and sale of billions of dollars annually to people of all ages. They are the gateway drug towards harder substances like heroin, crack, cocaine, and LSD. We are well aware of the public health costs of that “industry’s” 80+ yrs control of the market – and none of them are funneling money into drug education.  I’d like to try a different approach now, please.
  3. My editorial:  I do not condone its use, personally, for getting high – whether one is an adult or a child. I don’t condone alcohol or cigarettes either – for anyone. But, it is not my place to govern this aspect of life for others but rather, to guide my patients towards making healthy choices.
  4. If funds towards drug education and increased resources towards drug rehabilitation are NOT included in the legislation, then I will not support this bill.  If marketing is not controlled with strict limits on advertising targeted at youth, then I will oppose the bill.  On another note, I don’t want to see a cannabis leaf emblem marketed on every billboard going down the 294, nor do I want to see a cannabis dispensary on every street corner.  In a free market economy, I am not sure how this will all shake out if this passes. So, that’s what the hearing process is all about.  It’s a chance for our voices to be heard about how this legislation should go, if legalized adult cannabis is going to be a reality.
  5. Cannabis should be kept out of the hands of children (and their pregnant mothers) whose brains are at risk for cognitive harm. I believe that strong education can help youth make better decisions about the true potential risks of underage cannabis use, which is loss of one’s highest intellectual potential while the brain is still forming, among other risks.  There’s a recent publication on the Monitoring the Future study, a survey of 1.1 million 8th-12th graders.  In the journal, Addiction, researchers made an interesting observation.  The perception of cannabis’ harmfulness increased in 8th graders in medical cannabis states while their use of cannabis decreased by 33%.   


I see a huge opportunity here.  Education is an area I believe where we physicians, policymakers, schools, and the addiction healthcare community can shine in Illinois. If we take a stronger role in educating youth about the hazard of cannabis use at an early age on the brain, we could protect more kids from the potential damage they can sustain from early cannabis use.  Let’s learn from the mistakes and missed opportunities seen in early adopter recreational states – if Illinois is to legalize cannabis for adult use.


Keyes KM, et al. How does state marijuana policy affect US youth? Medical marijuana laws, marijuana use and perceived harmfulness: 1991-2014. Addiction . 2016 Dec;111(12):2187-2195.

Testimony Before Illinois General Assembly Committees on Marijuana Legalization: Rev. Alexander E. Sharp

grygielny Decriminalization, Drug Education, IL

January 22, 2018

Rev. Alexander E. Sharp

I am the Rev. Alexander Sharp, Executive Director, Clergy for a New Drug Policy.  We reach out to clergy nationally to end the War on Drugs and seek a health, not punishment response to drug policy.  Because we are based in Illinois, and I have been doing faith-based education and advocacy work for over 20 years, a substantial number of clergy and lay leaders in Illinois are aware of our work.

It might seem unusual for clergy to be advocating for marijuana legalization.  I am not advocating for marijuana use, although I don’t think it is wrong, any more than using alcohol, a far more dangerous drug, is wrong.

Many clergy support marijuana legalization because of our sense of how best to influence and even change behavior, especially of our youth.  What the failed War on Drugs has taught us over the past 45 years is that prohibition does not work.

Why?  Prohibition refuses to accept reality.   Drugs are a reality in our society.  Cigarettes, alcohol, and potentially addictive behaviors like gambling are with us.  The issue, therefore, becomes how to prevent not use but abuse.  I wish someone would make this point to U.S. Attorney General Jeff Sessions when he appears to say that all drug use is bad.

Instead of prohibition, we need to focus on preventing abuse though regulation and education.  Cigarettes are legal, but smoking has gone down by 50% in the last 25 years.  Alcohol is legal, but that we have made progress here as well.  Marijuana is illegal, and use has not gone down.  What’s wrong with this picture is that with marijuana, we have persisted in mindless prohibition.

I stress to my clergy colleagues that “legalization” is the wrong word.  We seek the “regulation” of marijuana.  That means that marijuana now obtained in the illicit market will be clearly labeled and packaged. People will know what and how much they are using.  That is far from the case with back alley and school yard purchases.

I’ve used these policy arguments with clergy across the country, and they get it. But beyond these policy wonk arguments, at the end of the day, we must educate each other, especially of our young people.  We must communicate with them in a way that makes sense to them.  They need to trust us.  I don’t see how that is possible when we equate marijuana and prohibition.

Our youth didn’t believe us when we preached “Just Say No” in the 1980’s.  When it comes to marijuana, they do not believe us now. The DARE programs where a law enforcement officer stands in front of a classroom and says “this is your brain on drugs” didn’t work when they were first tried.  These programs have adjusted since the 1980’s but they are still not effective.

I have attended many conferences where medical experts have described in elaborate detail how marijuana if heavily used can be harmful to young, still developing brains.  It can affect motivation.  I believe them. The problem is not that these facts are wrong.  Our kids should hear and take to heart every one of them.  The problem is that it is very hard to communicate them in the context of a policy – namely prohibition – rooted in abstinence.

Further, the very concept of harm reduction is impossible if abstinence is the only response to drug use.  To deny the goal of harm reduction is immoral.  The best in our faith traditions tells us that persuasion, with compassion, mercy and forgiveness; rather than punishment – in the form of jail and incarceration – are the best paths to changing hearts and minds.

All of this gives us a response to one final question that is frequently asked:  We’ve got alcohol and cigarettes, but why marijuana?  Do we really need another legal drug? My response: if really believe regulation and education are the best way to shape individual moral behavior, we should legalize marijuana even if alcohol and cigarettes had never happened.

Marijuana legalization stands on its own merits.  That why I urge your support for SB 316.