“Of course addiction leads to crime…We have made it illegal”

Rev. Alexander E. Sharp Drug Education, Faith Perspectives

Every generation has its icons. When it comes to drug policy the Rev. Howard Moody belongs at the top of our list.  As pastor of Judson Memorial Church in New York’s Greenwich Village from 1957 through 1992, he opposed the War on Drugs even before Richard Nixon declared it.   When most in society responded to drug addicts—then called “junkies”—as modern-day lepers, Rev. Moody embraced them.  He founded the first drug treatment clinic in Greenwich Village. He called out a society that to this day condemns as criminals those who use drugs.   We know—above all else—that criminalizing drug use is immoral.  As we work to end the War on Drugs, lost long ago (although its bureaucratic generals in Washington D.C. do not recognize this), we can  learn and be guided by insights Howard Moody gave us. The following texts are excerpted from sermons, from a book, and from articles published in the journal Christianity and Crisis. “It is important that we finally recognize that cures and prescriptions for ending drug use by the intimidation of harsh legal penalties are much more dangerous than the drug itself.” [CAC, Nov. 24, 1969] “Attempts to control social behavior by legal fiat, as in the case of our attitude toward heroin addicts, leads to certain immorality.  We judge that the addict’s ‘sickness’ or ‘personality weakness’ is morally or legally wrong and then we deny the patient relief by making his medicine illegal and its acquisition a felony punishable by imprisonment.”  [CAC, Nov. 15, 1971] “It is evidence of our pharisaical self-righteousness that we, a people who manufacture, pre-package and sell escapism as a salvation, at the same time label a portion of our population… as dangerous, criminal types, ‘dope fiends’ and ‘insanely sick’ people.”  [Voice] “The problem is not drugs as pharmacological agents, it is people—not only people who take certain drugs, but people who are prejudiced about those who use certain drugs and people in authority who pass laws against certain drugs.”  [CAC, Nov. 15, 1971] “Of course addiction leads to crime because we have made it illegal to carry or use the drug.  I wonder if the diabetic who was deprived of insulin and had to acquire the next shot illegally would seem any less a criminal type in the extent to which he might go in acquiring it.   “The trouble with most of our policy in the past 15 to 20 years is that it has not recognized that control, prevention, and treatment cannot be dealt with separately…Every attempt to isolate a human problem from the social milieu that produces it and nurtures it is doomed to failure.   “For this reason those of us who stand on the other side of the law from the addict and the drug user should take a serious look at ourselves and the society out of which illegal drug addiction has grown.  It might prove a helpful exercise in humility to confess the collective immorality of a society that spawns these social ‘miscreants.’ “For a culture that legally spends millions on betting, booze, and beauty, it seems incongruous (if not morally reprehensible) to condemn to everlasting shame and dehumanization the bewildered and frightened ones who choose to get lost in the netherworld of a heroin high.” [CAC, June 14, 1965] “Drug use is natural and universal, found in all times, all places, and in many societies.  So it is a little ridiculous to treat drugs as the ‘Enemy,’ whether it’s the church treating drug use as a ‘sin’ or the state treating it as a crime.”  [Sermon] “The Church has been and will be, consciously or unconsciously, unwitting accomplices in ‘scares’ and ‘wars against drugs’ because drug hysteria always indicts individual behavior and morality rather than the endemic social and structural issues that are at the heart of a form of social disintegration in this country.” ([CAC, Nov. 15, 1971] “I think church people, and perhaps many people, love the ‘just say no’ campaign; but that was the concoction of an administration that had just said ‘no’ to every program aimed at creating alternatives for kids in the ghettos.  Unfortunately these kids can’t say no to poverty. They were born and bred in it.  They can’t say no to not working.  There aren’t any jobs.” [CAC, Nov. 15, 1971] “The greatest beneficiaries of the outlawing of the drug trade are organized and unorganized drug traffickers.  More than half of all organized crime revenues come from the illegal drug business.” [CAC, Feb. 19, 1990] “Interdiction is supposed to reduce street sales by raising the price of drugs through increasing the cost of smuggling the drugs.  But a recent Rand Corporation study showed that ‘smuggling cost’ accounts for one percent of the street price. That will scarcely affect sales.  Interdiction accomplishes almost nothing.” [CAC, Feb. 19, 1990] “Why is it that the more money and personnel we put into interdiction, the more drugs we have on the streets?  Decades and billions of dollars later, we are worse off than ever.” [CAC, Feb. 19, 1990] “The $10 billion a year spent on interdiction hasn’t done much to stop the flow of drugs.  But we have managed to clog our prisons with drug offenders and bring to a stand-still the criminal justice system in our large metropolitan areas.“ [CAC, Feb. 19, 1990)] “The attempt to prevent, regulate and control drug-taking is always greeted with protest and evasion…During Prohibition, people still got drunk, became alcoholics, and menaced the highways—but some things were worse.  Contaminated ‘rotgut’ whiskey caused blindness, paralysis and death.“ [Fentanyl is today’s version of a prohibition-induced drug. —Ed.]   “If Congressman Rangel knew history better, he would not add to the hysteria by taking up the sword in the drug war against a spurious enemy, for he will be impaled on his own sword and the people of the black and Hispanic ghetto will be the victims.“ [U.S. Rep. Charles Rangel served five primarily African American districts in New York City from 1971 to 2017.  He supported the War on Drugs in the 1980s—Ed.]  [Sermon] “What is the role of the churches in this troubled area?  First, to educate themselves about the facts and fictions of addiction… perhaps the most important and immediate task is to help create a new climate of public opinion whereby our laws may be liberalized so as to deal realistically and humanely with the victims of addiction.“ [CAC, June 14, 1965] “Unless we are willing to evaluate the options, including various legalization policies, we will likely enlarge the catastrophic consequences of our present policies.”  [CAC, Feb. 19, 1990] SOURCES: Christianity and Crisis. Vol. 25, 1965-66; Vol. 29, 1969; Vol. 31, 1971; Vol. 50, 1990-91. [CAC] History as Antidote to Drug Hysteria. Sermon. March 1990. [Sermon] Moody, Howard. A Voice in the Village. New York: Howard Moody, 2009. [Voice] I wish to thank Abigail Hastings, long-time friend and parishioner of Rev. Moody, for compiling this material. Rev. Alexander E. Sharp, Executive Director

The Church of Safe Injection Saves Lives

Rev. Alexander E. Sharp Drug Education, Faith Perspectives, Harm Reduction

There is a new church on the horizon.  It usually operates out of the back ends of cars, often after dark and late into the night.  So far it exists in six locations in Maine as well as in six other states. It is called the Church of Safe Injection.   Its founder is a 26-year old drug recovery coach named Jesse Harvey.  He preaches the Gospel of Harm Reduction: we should use all possible measures to protect drug users from the harm of their drug use. Measures include clean needle exchanges, and, in the case of potential overdose deaths, a life-saving substance called naloxone.   “All too often, people who use drugs are offered only two choices, ‘Get sober or die.’” Harvey wrote recently in the Portland Herald.  “Jesus would have rejected this shameful and lethal binary….’Let all that you do be done in love,’ states 1 Corinthians 16:14. Too often when ‘religious’ people attack us on Facebook, their hate shines through and they betray this passage.  They betray Jesus.” Last October Harvey started loading up the trunk of his 2017 Honda with sterile needles, naloxone, rubber tourniquets, alcohol swabs, and other materials to avoid infection.  Every week, usually in the evening, he drives to a site in Lewiston where drug users congregate. He makes these supplies available to all who need them. For many, these gatherings seem almost like a mass.  Harvey himself has no doubt he is doing what Jesus would have done: “If syringes had been around in Jesus’ day, He would have supported safe injection, and he would have made sure the people he hung out with had access to sterile supplies.” While many states have now authorized needle exchanges, 15 do not, and services that do exist are often sparse.  Maine, which spans over 35,385 square miles, offers only six, mostly in the southern part of the state. Only four make naloxone available. Harvey is certified as a minister by the Universal Life church, which ordains individuals to perform weddings, baptisms, funerals, and start congregations. He carries a card that identifies him as a “disciple & acolyte.” The Church of Safe Injection has only three rules for members:  they must welcome people of all faiths, including atheists; serve all marginalized people; and, of course, commit to supporting harm reduction. For the most part, the individuals have gathered outdoors. But there have been some house meetings along readings, including scripture. The location within a physical structure will bring Harvey closer to what has been his goal from the beginning:  a safe injection site where individuals can administer their own drugs under supervised care to insure safe and clear conditions. Such sites exist in at least 60 cities spread across Western Europe, Canada, and Australia. They are illegal in the United States, but strong support exists in Boston, New York, Philadelphia, San Francisco, and Seattle.   Harvey’s strategy at this point is: first, to incorporate the church as a not-for-profit; and, then, to apply for a religious exemption from federal law.  He is looking to a 2006 Supreme Court decision that permitted a small sect to continue import a mind-altering drug – ayahuasca – for use in religious services. At the end of the day, what Jesse Harvey is doing is an act of civil disobedience. He is breaking the law.  He distributes more than the limit of 10 needles at a time permitted in Maine. He also has never obtained certification to operate a needle exchange facility.    He sees no alternative. “Overwhelmingly, the churches I’ve reached out to are not interested in helping people who use drugs…Politicians, law enforcement, and health care haven’t taken the lead here, so our church is,” he writes. “Join the Church of Safe Injection and save lives.”   “We do not encourage drug use. However, it is our sincere religious belief that people who use drugs do not deserve to die, not when there is a proven, cost-efficient, feasible, compassionate solution that can be so easily implemented.” Who among us can disagree? Rev. Alexander E. Sharp, Executive Director

The Dangerous War on Syringe Exchange Programs

Tom Houseman Drug Education, Harm Reduction, Uncategorized

In a 1996 episode of the tv show Spin City, Deputy Mayor Mike Flaherty (Michael J. Fox) is discussing a proposed syringe exchange program with city hall’s Head of Minority Affairs, Carter Heywood (Michael Boatman). Flaherty would rather the city stick with its old plan of handing out AIDS prevention pamphlets, because “it’s almost impossible to inject narcotics with a pamphlet.” The scene is played for laughs, but there is an underlying truth.  The US government has historically avoided harm reduction policies in favor of strategies that are less controversial, but also woefully ineffective. Syringe exchange programs have existed in the United States since the 1980s. They were created by community activists, without government support, as a response to the AIDS crisis. Since HIV is transmitted through blood, distributing clean needles reduced the risk that somebody could become infected with HIV after sharing a needle previously used by an HIV-positive person. Indeed, countless studies have shown that access to clean needles drastically reduces infection rates of not just HIV, but infections such as Hepatitis as well. In addition, those who repeatedly reuse needles risk a variety of infections. By providing drug users with clean, sterilized needles, syringe exchange programs are one of the most effective forms of harm reduction. As the opioid epidemic leads to increased rates of heroin use, syringe exchange programs are more important than ever. Unfortunately, draconian laws at the federal level and in many states make it extremely difficult for syringe exchange programs to help the people who need them most. U.S. Code Title 21 Section 863, also known as the “drug paraphernalia statute,” bans the distribution of drug paraphernalia. The Department of Justice defines drug paraphernalia as “any equipment that is used to produce, conceal, and consume illicit drugs,” a category broad enough that they mention “miniature spoons” as potential paraphernalia. Many states have similar laws, also vague enough that syringes are not always necessarily included. Even when syringe exchange programs are exempt, funding them publicly is an additional hurdle. Until 2016, it was illegal to use any federal funds to support syringe exchange programs. Even now, while funding these programs with federal money is legal, the money cannot be specifically used to purchase needles, a piece of legal tightrope-walking meant to deflect criticism that the government is “soft on drugs.” There are 15 states in which it is illegal to run a syringe exchange program, a diagonal stripe across the country from Idaho to Florida. In these states, which make up the bulk of the Midwest and the Southeast, drug paraphernalia laws forbid individuals from selling or distributing syringes if they have reason to believe that they will be used for illegal drug use. But even in states where syringe exchange programs are legal, hurdles created by state and local governments, as well as local law enforcement, make it unnecessarily difficult for harm reduction organizations to ensure that drug users have access to clean syringes. Illinois is one of the few states in the Midwest that allows syringe exchanges, but the onerous restrictions placed on these programs make the work far more difficult than it should be. Organizations like The Chicago Recovery Alliance must obtain a “research exemption” in order to distribute syringes, a barrier that makes it harder for them to reach the people who need them most.   And there is, in fact, no need for more research on the efficacy of syringe exchange programs. Mountains of evidence show that such programs are cost effective for cities and states and that access to clean syringes lowers rates of HIV infection without leading to increased rates of drug use. Effective syringe exchange programs save lives and make communities safer. This has not stopped towns from shutting down needle exchange programs, or preventing them from opening, based on unfounded fears. Last year the mayor of Charleston, West Virginia forced a local syringe exchange program to shut down, claiming that too many used syringes were being found unreturned. This was a baseless claim; 9 out of every 10 needles distributed were returned to the program. Earlier this month, Scientific American dug into why so few syringe exchange programs exist in Virginia, one of the states hit hardest by the opioid crisis. One of the issues, they found, is that “the law [requires] any local community to obtain formal written consent from local law enforcement officers for programs to operate,” and “continues to criminalize possession of even sterile syringes” for the program’s customers. As a result, only three of the seventy-five eligible counties in Virginia have a syringe exchange program. The opioid epidemic is worsening by the year; more people are going to be using heroin, often without the resources they need to stay safe. Harm reduction is about helping people stay safe while offering them whatever support and assistance they need. No program does that more effectively than syringe exchange programs, yet too many states are stuck in a War on Drugs mindset that punishes and stigmatizes drug use. That approach has failed, and harm reduction is one of the new strategies that must be embraced. In the fictional world of Spin City, Deputy Mayor Flaherty shoots down the idea of a needle exchange program. “We are in a war against drugs, in case you haven’t noticed,” he tells Haywood. “That’s the same war we’ve been fighting the last forty years?” Haywood asks sarcastically. “How we doing?” More than twenty years after this scene was first shown on television, it seems that too many politicians have the same answer to that question as Michael J. Fox’s character did at the time: “Any day now.” Tom Houseman, Policy Director

Dopesick Offers Harsh Truths and a Path Forward

grygielny Drug Education

For nearly forty years a perfect storm has been building to create an opioid epidemic. Economic instability has plunged huge portions of the country into poverty with no escape in sight. An evolution in the way doctors considered patient pain–egged on by profit-hungry pharmaceutical companies–has flooded the country with opioids. Those in power turned a blind eye to the increased risk of addiction, and those who spoke out were ignored. Journalist Beth Macy has become the great chronicler of Mid-American turmoil through her books Factory Man and Truevine. In Dopesick: Dealers, Doctors, and the Drug Company that Addicted America, released last month, she turns her gaze to the opioid epidemic. The stories she uncovers are shocking and horrifying, but the most surprising thing she finds amidst those whose lives have been ruined by opioids is hope. It can be easy to think of the opioid epidemic or the War on Drugs theoretically. Many people do not personally know anyone who uses heroin or who is incarcerated for selling drugs. They might not have ever spent time in former mining towns or rustbelt cities devastated by economic depression, high unemployment, and skyrocketing rates of opioid overdose deaths. In recent years, books such as In the Realm of Hungry Ghosts and Dreamland have offered readers a ground-level perspective. Their stories help us understand how addiction can consume and destroy lives, and how many government policies in the name of the War on Drugs only make things worse. Dopesick is the latest addition to that pantheon, explaining the rise of opioids in America and why it has been so difficult to break their hold. What makes Macy’s exploration of the opioid epidemic so effective is its comprehensiveness. She begins by digging into the origins of the epidemic, shining a harsh light on the tactics of pharmaceutical companies like Purdue Pharma in promoting OxyContin. Bribing doctors and lying about data, Purdue relentlessly pushed the prescription of opioid painkillers, making hundreds of millions of dollars in the process. Ultimately, Purdue was sued for blatantly untrue claims that the opioid painkillers they marketed were non-addictive. After failed attempts to bully the plaintiffs and get the lawsuits thrown out, Purdue was eventually forced to pay over $600 million in fines. It amounted to a drop in the bucket for the wildly profitable company, and Macy pulls no punches in painting it as a hollow victory. The damage was already done. Next, Macy looks at the War on Drugs, following a group of law enforcement officers tracking high-profile traffickers in Virginia and Maryland. Men like ATF Agent Bill Metcalf embody the worst instincts of law enforcement, attempting to stamp out opioid addiction through aggressive policing. Even with good intentions, the police officers and federal agents who think that we can arrest our way out of the opioid epidemic are only making things worse. Their tactics play out like a bad TV procedural, dehumanizing both addicts and dealers, all of whom are victims of a broken system. By shining a light on how law enforcement views and treats those caught up in drugs, Macy makes it clear why the War on Drugs has been such a fiasco. If Macy is far more concerned with harsh truths than easy answers, it is because there are far more of the former than the latter. But in following a group of those struggling with opioid use disorders, and those who love them, she helps us understand why some are successful and others aren’t. It almost never has to do with the individual, and far more often is about the opportunities and support provided to them. Medication-assisted treatment typically involves treating addiction with an opioid substitute such as methadone or buprenorphine. It is by far the most effective form of treatment for opioid use disorder, yet it is heavily stigmatized. Many rehabilitation programs refuse to accept those on MAT, demanding complete abstinence from drugs. There is a reason Macy chose to title her book Dopesick: those forced to endure the brutal symptoms of opioid withdrawal are driven to relapse, while medication provides much-needed stability, increasing the likelihood of recovery. Fortunately, MAT is becoming more common. Doctors and public health advocates are learning to treat people where they are, rather than enforcing unrealistic standards of behavior. Dopesick does not offer a happy ending, though. There are still too many people dying because they cannot get the help they need. What it provides, instead, is a path forward. There are alternatives to opioids, to opioid addiction, and to overdose deaths. The strategies are not easy or simple, requiring coordination between multiple levels of government and the public, as well as a complete reframing of the causes of and solutions to addiction. There are going to be more stories like those told in Dopesick. Maybe someday soon, those stories will end in triumph. Tom Houseman

The Great Reefer Barriers: Why We Don’t Know More

grygielny Drug Education, Marijuana Legalization, Medical Marijuana

Politics should not dominate science.  When researchers propose studies about the medicinal value of a drug or substance, research funding  should be determined neither by the whims of politicians nor bureaucratic self-interest. Yet, when it comes to medical cannabis research, politicians and federal officials have an iron grip that have serious consequences on the lives of millions of Americans. The passage of the Controlled Substances Act in 1970 is one of the most important events in the history of the War on Drugs. Fueled by anti-drug rhetoric, the Controlled Substances Act established the Drug Scheduling System. This system,  based more in already debunked drug myths, has determined the legality of various substances for medicinal and research purposes for decades. The most egregious category placement in the scheduling system is undoubtedly cannabis. Congress categorized cannabis as a Schedule 1 drug, deeming it to have a high potential for abuse and no accepted medical use. Incredibly, this placement meant that marijuana was considered as dangerous as heroin, and more dangerous than cocaine and meth. This scheduling placement has suffocated progress on cannabis research for decades. The regulatory hurdles that must be overcome are currently so complex and burdensome that they would be funny were the ramifications of such regulations not so serious. Reading through a recent report from The National Academies of Sciences, Engineering, and Medicine on the barriers to cannabis research are both dizzying and infuriating. Proposals for research involving cannabis must be submitted to the Drug Enforcement Adminstration, the National Institute of Drug Abuse, and any relevant state agencies. Some of these agencies brazenly display their biases in the types of research they approve. In 2015, more than eighty percent of cannabinoid research funded by the NIDA was on the harmful effects of marijuana, rather than any potential medicinal effects.   Who could expect that the Drug Enforcement Administration would support research on cannabis as medicine?  Yet its approval is required. The DEA in 2016 stated its intent to permit marijuana to be available from approved registries.  But it has yet to approve a single application. The only acceptable source for marijuana used in research is the University of Mississippi. Many researchers have pointed out that the samples provided are not nearly as potent as the product sold legally in many states, hampering the effectiveness of research. That researchers in California cannot use marijuana legally grown and sold in California is absurd. As a result, research that could save and improve lives is difficult to perform. The first ever trial of the effect of medical marijuana on Post-Traumatic Stress Disorder in Military Veterans was only approved after seven years. Then, after another twenty months, the NIDA-approved cannabis was finally delivered, and was found to be contaminated with mold. Many medical researchers have been vocal about burdensome regulations. Sachin Patel, who studies cannabis at Vanderbilt University, has spoken publicly about the medical community’s desperate need for “well-controlled unbiased large scale research studies into the efficacy of cannabis for treating disease states.” Researchers also point out the absurdity of the claim that cannabis has a high potential for abuse and no accepted medical value. “In the biomedical research community,” Eckard College’s Gregory Geredemann has said, “it is universally understood that cannabis is a very safe, well-tolerated medicine.” Despite these regulations, and the anti-marijuana bias of the NIDA, research continues to prove that the medical value of cannabis is vast, and that access to it will reduce pain and save lives. Studies have shown that smoking cannabis can help reduce chronic pain in HIV-positive patients, symptoms of multiple sclerosis, and the development of Alzheimer’s. Earlier this year, two studies provided evidence that access to medical marijuana can help stem the rise of the opioid epidemic, potentially saving thousands of lives. More and more states are legalizing marijuana for both medical and recreational purposes, acknowledging that the potential for abuse is low and that there is undoubtedly medical value to the drug. Yet over the last decade attempts to downgrade cannabis from its Schedule 1 placement have been stymied by the federal government. In 2011, DEA Administrator Michele Leonhart rejected a petition to reclassify marijuana on the basis that the “risks of marijuana use have not been shown to be outweighed by specific benefits in well-controlled clinical trials.” The irony of this statement is, of course, that well-controlled clinical trials are almost impossible to run unless marijuana is reclassified. In 2016, the federal government was given another opportunity to reclassify the drug, and again chose to maintain the status quo. Statements in favor of reclassifying marijuana have come from The American Medical Association and the American College of Physicians. Earlier this year, a report from the Senate Appropriations Committee on barriers to marijuana research stated that “At a time when we need as much information as possible about these drugs, we should be lowering regulatory and other barriers to conducting this research.” Given the aggressive anti-drug stance of both President Trump and Attorney General Sessions, it is unlikely that such barriers will be lifted any time soon. For now, researchers must continue navigating highly burdensome  regulations in order to study cannabis, including storing cannabis in a safe or a vault. It seems that knowledge about the medical benefits of cannabis is also being kept in a vault, one that lawmakers who cling to debunked claims about the dangers of marijuana refuse to open. Tom Houseman