Guest Blog by Kim Brown, President, QC Harm Reduction On May 25th, 2011 my world came to a crashing halt. My thirty-three-year-old son Andy died from an accidental heroin overdose. We knew he was in trouble, we knew he injected drugs, and most of all, we knew we were at risk of losing him…and then we did. I was a single mom working as a nurse, and I adored my kids. Now one was gone. The damage done to a family when a child and sibling dies is staggering, especially when the death is caused by a drug overdose. The shame and stigma directed your way after losing a child to an overdose is quite debilitating. In any event, there were no neighbors with casseroles or offers to help and very few condolences. I was introduced to harm reduction when I sought support for my grief online. I discovered GRASP, Grief Recovery After A Substance Passing, and found other mothers to whom I could talk. GRASP literally saved my life. While pouring out my heart to these mothers I’d met, I was struck by their absolute certainty that our children’s deaths could have been prevented. Had we been able to access harm reduction tools, including naloxone, clean needles, and safe spaces for them, maybe our kids would still be here. With this knowledge, I began to turn my grief into advocacy. We founded QC Harm Reduction, our 501(c)3, non-profit organization in 2015, but had been seeking allies to support naloxone training and distribution since 2012. Iowa did not have a naloxone access bill, so we began to advocate for one at our state capitol. Finally, in 2016, after four grueling years, our law was passed. As we attempted to build support for training and distribution in our community, we continued to get pushback from many stakeholders. Stigma, shame, and a focus on abstinence were sadly still the rule of the day. My dear friend, a former Catholic Worker, Michael Gayman, introduced me to some folks in the faith community who operate The Center, Love in Action (LINK). They listened as I explained how a simple harm reduction tool, such as naloxone, could save the lives of people who use drugs. Our mission was well received, and they invited QC Harm Reduction to be a partner organization. As a result, we have been able to reach those directly impacted by drug use at The Center, in Davenport, Iowa, and through our street outreach. We have partnered with the homeless shelters in our community and have expanded our street outreach and services. QC Harm Reduction, in addition to distributing naloxone, now provides HIV and Hepatitis C testing, all free of charge. Unfortunately, Iowa has yet approved needle exchanges. We are working to change this. We also distribute food, clothing, backpacks, and other items necessary for survival, including, importantly, love and acceptance to those who are often discarded and forgotten. I am deeply grateful to The Center and their faith community for the love and support they’ve shown me, QCHR, and those individuals we are helping to serve. We are trying to get people to connect the dots. People on the streets are put in jail for low-level drug offenses, and they are often parents. This is disrupting the lives of children and families, and the human costs are too great. The Center and QCHR believe strongly that harm reduction is a human right and that everyone is entitled to safety and compassion. Love is love. Every life is worth saving.
I live in Illinois. My state has received a B- in its approach to the War on Drugs and how it aligns with a “health not punishment” response to drug use. This grade tells me that we have some important changes we can and must make. We must move to taxing and regulating marijuana, legalizing low level recreational use. I am pleased that we have decriminalized marijuana so that low level possession is treated as a civil offense, like a traffic ticket. However, marijuana arrests continue, especially in poor neighborhoods of color. The illicit drug market encourages gang activity and violence. Prohibition of marijuana breeds a War on Drugs mentality. Police continue to be seen as a hostile presence just over marijuana. We must seek to do more than reform civil asset forfeiture. We must abolish it. With the ACLU taking the lead, Illinois has reversed a laughable part of a bad law. When police seize property allegedly related to a drug crime, the burden of proving guilt now rests with the government rather than the accused. But our grade is still a D+. The standard of proof is too low: “preponderance of evidence,” rather than “beyond a reasonable doubt.” The government does not even have to establish that a crime has been committed. Police retain and fund their budgets with the proceeds they seize. Conflict of interest continues almost unabated. I am heartened that we are finding ways to ways to save lives, ease suffering, and help people restore their lives through harm reduction policies. We no longer insist upon the “abstinence only” demand that has dominated this country’s approach to drug use and recovery. But I do not understand why we do not provide Medicaid coverage for access to methadone. This could permit many people struggling with a heroin abuse disorder to work and remain with their families while receiving treatment. Fortunately, we do not have private prisons in Illinois, nor do we send prisoners to private prisons out-of-state. Thus, we do not support an industry that lobbies for laws that wants as many people in prison as possible. But even after those convicted of drug felonies have paid their debt to society and been released from prison, they are denied access to key benefits, including nutrition assistance. If we can change this, our grade will be an A rather than a B+. Our state map does not yet track some important things we are working in Illinois. Sentencing reform is critical. We are hoping for a bill that would reclassify most low-level drug offenses as misdemeanors rather than felonies. We are about to become one of the first states to pass legislation that provides a roadmap for police departments to divert drug abusers to treatment rather than jail or prison. And we may well be the first state to make it possible for our medical marijuana program to help those suffering from opioid abuse. We are making progress in Illinois. This new map shows me where we should concentrate our efforts. What does the map tell you about what you can do in your state? Reverend Alexander Sharp
The medical marijuana program in Illinois is one of the most restrictive in the nation. It covers only a fraction of the illnesses for which cannabis is an effective treatment. Those who apply are fingerprinted—yes, fingerprinted. And the review process, even for those suffering from cancer, epilepsy, and multiple sclerosis, typically takes more than 90 days, longer than in any other state. Given these tight restrictions and an indifferent administration, it is remarkable that Illinois might become the first state to use its medical marijuana program to combat the opioid crisis. Last year, more than 68,000 Americans died from drug overdose, including 45,000 from opioid abuse. For the first time in US history, because of the opioid crisis, life expectancy has declined. Drug overdose deaths in Illinois increased by more than 70 percent between 2013-2016. There is no simple answer to the opioid crisis, but research is showing that cannabis as medicine can make a difference. Two recent studies published in the Journal of the American Medical Association (which can be found here and here) found a lower level of opioid use and fewer overdose deaths in states where medical marijuana is legal. Researchers at DePaul and Rush universities have also determined that marijuana worked faster to relieve pain than other prescription medication, and had fewer side effects. We applaud state senator Don Harmon (D-39th) for sponsoring legislation in Illinois that would translate this evidence into action. The bill—SB 336 —would expand the existing medical marijuana program to allow individuals to use medical cannabis as a substitute for prescription opioids. Patients would do so under the supervision of a physician who could “limit the length of time a patient may receive the opioid that would have been prescribed.” This makes sense. I remember one of the “poster patients” during the medical marijuana debate. He suffered from degenerative spinal disease. He carried through the halls of the Illinois statehouse a bag of prescriptions that had cost him $50,000 a year and caused horrible side effects. After years of struggle, he was near death in an Episcopal hospital when a nursing nun said to him, “You are going to die if you keep this up. I shouldn’t tell you this, but you should try medical marijuana.” He took her advice, and is now able to live a normal life. Medical marijuana helps opioid victims by reducing the pain that drove addicted individuals to overuse opioids. It also eases the agony of withdrawal as they seek to overcome their addiction. There is simply no comparison when it comes to opioids versus medical cannabis. Opioids are physically addictive, and they can kill. There have been no recorded deaths due to cannabis overdose. Senate Bill 336 will soon reach the Senate floor, and then, hopefully, will be sent for consideration to the Illinois House. We urge all Illinois residents to use the opportunity we provide here. For those in other states, we urge you to commend this bill to your legislators as a model. It will take unified action on many fronts to cope with our national opioid crisis. We believe the use of medical marijuana can be a key part of the solution. Reverend Alexander Sharp
For several decades the United States has relied on mass incarceration as a tool for criminal justice, mental health treatment, and economic stimulus. The result is a prison population that dwarfs that of any other developed country yet has shown no corresponding positive benefits in crime deterrence, mental health, or economic benefits. The prison industrial complex has wasted billions of dollars and destroyed millions of lives. Decarcerating America, a series of essays edited by Ernest Drucker, is an admirably comprehensive and insightful attempt to address this problem. Decarcerating America approaches the problem of mass incarceration from a variety of perspectives. Contributors include public health professionals, professors, policy advocates, and researchers. That more than one writer featured was a prison inmate is a testament to the book’s approach to prison reform: listening to the voices of the currently and formerly incarcerated and taking what they say seriously. The solutions proposed throughout Decarcerating America are serious and aggressive; Drucker opens the book by stating that the goal of decarceration is cutting the prison population of the United States in half. Not surprisingly, drug policy reform is discussed in depth absolutely crucial to any decarceration strategy. Gabriel Sayegh, founder of the Katal Center for Health, Equity, and Justice, argues compellingly in favor decriminalization of all drugs. The five authors of an essay on post-incarceration harm reduction lay out the evidence against strict abstinence-based rehabilitation programs, which often do more harm than good. By punishing addicted individuals for relapses that are a part of the recovery process, these mandated programs only serve to punish people, rather than help them. The authors propose a more personal, tailored approach to helping drug addicted individuals take control of their lives. Several of the writers point out that many prison reform proposals focus exclusively on non-violent offenders, especially those convicted of drug crimes. Not only would this fall well short of the goal of a 50 percent reduction, but it dehumanizes those convicted of violent crimes, who tend to have been the victims of violence themselves, and who often suffer with drug addiction and mental illness. Drastic reform in sentence length for all crimes, and a more effective parole system, are essential to real progress. In particular, parole decisions made based on risk calculation, not the seriousness of the crime committed, would be far more fair, effective, and humane. Mujahid Farid, of the Release Aging People in Prison (RAPP) campaign, points out that the recidivism rate for people over fifty when they are released from New York prisons is one eighth that of the overall rate, a fact that is not taken into account by parole boards. Releasing almost all of those prisoners would drastically reduce prison spending without risking a rise in crime. If the goal of prison is rehabilitation, prisoners must be given a voice in how they are treated and how prisons can most effectively prepare them for their next steps. Humane treatment of prisoners will make an enormous difference. Elizabeth Gaynes and Tanya Krupat, of The Osborne Association, explore the impact that prison sentences have on the children of the incarcerated. Sending people to prisons hundreds of miles from home and not allowing in-person visits from family increases recidivism rates and has serious, long-term consequences on the mental health of children unable to see their parents. Who is benefiting from this system? In the last essay of the book, author and activist Eric Lotke looks at the local economic incentives for prisons. Prisons seem to be appealing investments for small towns in rural areas, since they provide steady jobs for local citizens. However, because they do not attract other investments, and can even dissuade other companies from moving to those towns, soon the town becomes entirely reliant on the prison and is loath to let it close. Decarcerating America is a fascinating and enlightening read for anyone who believes that the prison industrial complex needs to be dismantled. And it offers hope. Multiple contributors contend that while the Trump Administration and its “law and order” approach to crime is deeply troubling, progress can still be made at the local, state, and even federal level. By instituting policies that are proven to be effective and incorporate the voices of incarcerated and formerly-incarcerated individuals, the massive American prison system, and the damage it does, could one day be a thing of the past. A Review by Tom Houseman
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. 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. 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. 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. 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. 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.