Fentanyl test strips allow for a safer supply and safer use, which minimizes the harmful effects of fentanyl rather than simply ignoring or condemning it.
Dear Friends and Colleagues, Blessings to all of you who are observing Holy Week and Passover this week. It’s been exciting to jump in with Rev. Sharp and help to identify new opportunities for the CNDP community to make a difference. Faith leaders are a critical voice when it comes to ending the War on Drugs. For too long, our society has reduced substance use and substance use disorders to moral failings and responded with punishment and incarceration. We are in desperate need of a compassionate public health approach to drug use. First, thanks to all of you who took action to support the Marijuana Opportunity and Reinvestment and Expungement (MORE) Act. The bill has passed the House! As you might know, the Senate will be the big challenge for this legislation. But, this historic House vote continues to demonstrate that the tide is turning against cannabis prohibition. Second, we have another action opportunity for you. CNDP has partnered with Faith in Harm Reduction to launch a faith-leaders sign-on letter to support the opening of Overdose Prevention Centers (OPCs) — oftentimes referred to as supervised consumption sites. 120 OPCs operate in countries across the globe. They are an evidence-based harm-reduction strategy that saves lives, improves health, and reduces the spread of disease. OPCs allow people who use drugs to do so in a medically supervised environment and provide critical services like drug testing and sanitary equipment. No one has ever died from an overdose in an OPC. They’ve been studied intensively and shown not to increase drug use or crime in the communities where they operate. Tragically, they are still considered illegal under federal law. New York City opened the United State’s first official OPC back in December in a direct challenge to these unjust restrictions. Now, Attorney General Merrick Garland will make a determination as to whether or not the federal government will move to close these centers or allow them to operate. Will you make sure that AG Garland hears from faith leaders who support this important work? Add your name and voice today. Sincerely, Timothy McMahan King
As this unremittingly grim, even dark year, draws to a close, I offer one ray of light in the area of drug policy. For the first time, the United States now has overdose prevention sites up and running. 59 opioid overdoses, most potentially fatal, have been reversed in the first month of operation. This major breakthrough took place in New York City on November 30. In two locations—Washington Heights and East Harlem–individuals struggling with substance use now can inject drugs under medical supervision, rather than doing so alone, often in dirty alleyways and public bathrooms. These sites, soon to be linked in a new organization called OnPoint NYC, offer a variety of other medical services. Drug treatment is available but not required. Individuals can also test their drugs for the highly lethal drug fentanyl and other contaminants, thus protecting themselves from a major cause of overdose deaths. Our nation experienced over 100,000 overdose deaths in 2020, with over 2,000 in New York City alone. The United States has been waiting for too long – far too long – for overdose prevention sites. Over 120 in exist in 10 countries including France, Germany, Norway, Spain, Canada, and Australia. They save lives, result in safer communities, and enjoy the support of law enforcement. Two years ago, it appeared that such a site would open in Philadelphia. The mayor, city council, and law enforcement officials were supportive. But the Trump administration’s regional U.S. District Attorney blocked the opening under the so-called crack house law, which bans operating, owning, or renting a location to facilitate the use of illegal drugs. The Supreme Court has declined to hear an appeal. In New York City, Mayor Bill De Blasio began supporting overdose prevention sites in 2018 and has been joined by the district attorneys for Manhattan, the Bronx, Queens, and Harlem. Mayor-elect Eric Adams has also expressed support. President Biden recently became the first U.S. president to endorse harm reduction and has proposed over $30 million in federal funding. The U.S. Justice Department has not yet commented on whether it will intervene. City officials have urged Attorney General Merrick Garland not to prosecute operators of sites where local officials have approved them. These sites are not a new issue for Clergy for New Drug Policy. In 2016, we organized a clergy visit to Insite in Vancouver, at that time only such site in North America. We have supported efforts to open sites in other locations. While New York City’s is the first, we were delighted to hear that the Rhode Island state legislature has authorized two pilot programs. The concept also is being intensely debated in cities across the country, including San Francisco, Denver, and Boston. Why is this step in the United States such a significant breakthrough? The saved lives are surely important. 600 New Yorkers died of opioid overdose in the first three months of 2021. This number might have been cut by at least 30% had the two new sites been operating. More fundamentally, the sites are important because they are the purest expression of harm reduction, in which the focus is on reducing harm to those struggling with substance use rather than insisting on abstinence as the only moral approach. Measures such as: testing for contaminants such as fentanyl; sterile syringes; the availability of Naloxone, a drug that almost instantly can reverse the effects of an opioid overdose; and medication for opioid use disorder such as methadone, buprenorphine and other drugs. These measures are increasingly accepted, but they will not help individuals who are dead. In their first month, the New York City sites have received strong community support. Their director, Sam Rivera, notes, “We are partnering with the NY Police Department,” as he told a New York City radio audience recently. “They are here at our sites to support us and make sure there are no disruptions to what we are offering. They ask us for paperwork so they can refer people to us who they see are using drugs.” “The sites really speak for themselves,” commented staff member Kailin See. “They’re not just for people who use drugs, they are also for the communities where they’re located. The community asked for less public injection, fewer improperly discarded syringes on streets and playgrounds, less overdose death, less crime in their neighborhoods.” The sites received high praise from an emergency department nurse: “In many cases, departments are overrun and the staff is exhausted. I’ve personally tried to resuscitate patients who — even though emergency services got to them and gave them Narcan – died because it was too late, and we’ve lost those patients. Anything we can do to decrease the burden on emergency services is really important.” One New Yorker recalled, “I was a resident of Washington Heights [and] used some of the safe needle exchange services probably 10 years ago. Only because of programs you’re talking about was I able to get clean, stay clean, reintegrate into society, hold a solid job. I hear people saying things like ‘Not in my backyard.’ But you’re right, you are where there is the most need.” As we close the door on a most difficult and troubling year, may I extend my best wishes for a healthier and happier New Year in 2022. Sincerely, Rev. Alexander E. Sharp, Executive Director, Clergy for a New Drug Policy
As we witness the agony of our withdrawal from Afghanistan, most of us think that after 20 years there at least we are ending America’s longest war. But conventional wisdom would be wrong. The United States is still fighting a War on Drugs which Richard Nixon officially declared on June 17, 1971, over fifty years ago. Both wars have been fueled by false assumptions. When the concepts that are used to justify a war prove misguided, it is reasonable to believe that our leaders, supported by the public, will change course. This is what has caused us to leave Afghanistan. The same thing can happen with the War on Drugs. The false premises that have propped up the War on Drugs for over 50 years are clear. The first misguided assumption is that the best way to keep individuals from using, and too often abusing, drugs is to punish them. Prohibition, which criminalizes drug use, does not work. As President Carter famously observed, it is a cure worse than the disease. If punishment were a meaningful deterrent, we would have won the Drug War long ago. The American public understands this. 68% of the U.S. public supports the legalization of cannabis. Adult recreational use is now legal in 19 states and D.C.; medical marijuana in 36. Slightly more than one-half support the decriminalization of low-level use of all drugs. The second false assumption is that drug use, rather than the harm caused by drugs, should be the object of our concern and the metric by which we should define success. Our policy metric when it comes to drugs should be “harm,” not “abstinence.” Tragically, it took the AIDS crisis beginning in the early 1980s even to conceive of this approach, so obvious when you think about it. As AIDS spread, it became clear that individuals using drugs were being infected by sharing contaminated needles, and that such infections could be minimized by making clean syringes available. Like decriminalization, harm reduction enjoys growing public support. Clean needles are now available in 300 exchanges across the country, and the federal ban on such services has been lifted. Naloxone, an antidote which can quickly bring an individual back from drug overdose, is legal in 49 states and available over the counter; there are over 120 overdose prevention sites throughout the world, where individuals can safely test their drugs and use them under medical supervision. We will have such a site in the United States very soon. Specifying the false premises of the War on Drugs helps us to understand what an end to that war would look like. We also now have proposed federal legislation that would get us there. On June 15, 50 years after Nixon declared his War on Drugs, representatives Bonnie Watson Coleman (D-NJ) and Cori Bush (D-MO), working with the advocacy group Drug Policy Alliance, introduced the Drug Policy Reform Act (DPRA). This bill would decriminalize low-level possession of all drugs, treating such offenses like a traffic violation. It would shift drug regulatory authority from the Department of Justice to Health and Human Services “to emphasize that substance use is a health issue and not a criminal issue.” If passed, it would drive a stake through the heart of the War on Drugs. How close are we to its passing? All the suffering notwithstanding, it was obviously easier to withdraw from Afghanistan than it will be to end the War on Drugs. The former was possible through Executive Action. Congressional approval is much harder. This is especially the case since the War on Drugs has entrenched support among stakeholders in the current system such as prosecutorial offices and prisons, sweetened with federal funds, at virtually all levels of government. Further, lawmakers who support drug policy reform can be labeled by opponents as “soft on crime.” For these and other reasons, developing a national constituency for the Drug Reform Policy Act will require the same kind of state-by-state trench warfare that has brought us to the cusp of national marijuana legalization. Oregon took the first step in February 2021 when it decriminalized low-level possession of all drugs in combination with access to 10 treatment centers across the state. Executive leadership could make a big difference. Perhaps this is not so far-fetched. As a presidential candidate in 2020, Pete Buttigieg stated that he would “eliminate incarceration for drug possession, reduce sentences for other drug offenses and apply these reductions retroactively, and legalize marijuana and expunge past convictions.” These would be important first steps. It has taken over 50 years for policies to emerge that respond to the potential dangers of drug abuse and addiction with healing and compassion rather than false assumptions about punishment and incarceration. It is time now to bring to an end what is, in fact, America’s longest war.
Dear Friends and Colleagues, If asked to name the American thinkers of the past 150 years whom I most admire, I would place the great pragmatic philosopher William James at the very top of the list. Starting as a professor of physiology at Harvard in 1873, James virtually created psychology as an academic discipline. His Varieties of Religious Experience, published in 1890, endures as a religious classic. William R. Miller, distinguished professor emeritus of psychology and psychiatry at the University of New Mexico, should be considered among James’ most worthy successors. While he may not have created an academic discipline, Miller did, along with colleague Stephen Rollnick, develop a new therapeutic technique – Motivational Interviewing (MI) – now used worldwide to treat individuals suffering from alcoholism and addiction and more broadly seeking personal change. It is easy to forget that until about 40 years ago, many people believed a confrontational “boot-camp” approach was an effective treatment for alcoholism and other addictions, The concepts of MI have helped to expose this misguided view. Miller’s experience in working with addicts also led him to explore with academic rigor the notion of sudden personal conversion. He is the first scholar since William James to do so. In his book Quantum Change, he documents what he finds to be the reality and surprising frequency of such experiences. He is now exploring the ways MI and such “change” experiences might be related. I am delighted to introduce Dr. Miller to you here, for two reasons. First, Clergy for a New Drug Policy is devoted to ending the so-called War on Drugs. The tenets of Motivational Interviewing make clear why criminalization as the primary weapon in this war, as currently fought, is a tragic response to drug possession and addiction. More broadly, these same principles offer the potential for human change regardless of the arena. Dr. Miller recently participated in a webinar broadcast by the Center of Addiction and Faith (CAF), a Minneapolis-based organization that engages clergy and churches in responding to addiction. A selection of Dr. Miller’s comments under key issues is provided below. On the origins and key tenets of Motivational Interviewing: Early in my education, I was on an internship in Milwaukee, Wisconsin working on an alcoholism unit. It was run by a psychologist who was compassionate and scientifically oriented, so I felt very at home. I knew nothing about alcoholism, really, but had been trained in Carl Rogers’ person-centered and behavioral approaches. It was the patients who taught me about alcoholism. I began reading the literature on alcoholism from the 1970s, which said, “Alcoholics are pathological liars, completely in denial, out of touch with reality, and horribly difficult and defensive.” And I said, “Gee, those aren’t the same people I was talking to.” This puzzle was the beginning of Motivational Interviewing. I realized that that picture of people being very difficult, defensive, and dishonest was a function of the way we were treating addiction at that time — in a very confrontational, authoritarian, shut-up-and-listen kind of way. The spirit behind Motivational Interviewing is partnership rather than “I’m the expert and you’re only a recipient.” It’s two people talking to each other as peers. I have expertise, but so does my client. My client knows more about him- or herself than anybody else in the world. If we’re talking about a change in that person’s behavior, I need their expertise, as well as my own. Rather than saying “I have what you need, and I’m going to give it to you,” the communication in Motivational Interviewing is more “You have what you need, and together we’re going to find it.” A central principle is that it should be the person, the client, the patient, the student, who’s making the arguments for change and not me. If I’m arguing for change and they’re arguing against change, I’m in the wrong chair. On the importance of “self-acceptance” in personal change: Here was one of Carl Rogers’ interesting discoveries: that when you experience yourself as unacceptable, it’s very, very difficult to change. It’s paralyzing. And when you experience acceptance, profound acceptance — as you are — whether from a therapist, or a friend, or your family, or God, then it becomes possible to change. Now, I don’t know why we’re wired that way, but we seem to be. On the role confrontation and punishment in response to addictions: Punishment suppresses behavior. It doesn’t teach anything new. It doesn’t say, “This is the way to go, … this is the way forward.” I began a very different approach to working with addiction accidentally and [found] very different outcomes. Human beings don’t generally take well to being told what’s wrong with them and what they should do. If you take a different, person-centered approach, you get a very different outcome. You find that you are working with a very different kind of person. When we also looked at the literature on confrontation, it is completely negative. There’s not a single clinical trial of a confrontational approach that produced a positive outcome. It was the norm at that time. We thought that that’s what those people needed. But there never was any science to the notion that if you can just make people feel bad enough, they’ll change. And nor is that my faith. On the debate over addiction as a disease or a choice: It’s an old idea that people with substance use disorders just can’t enter into a therapeutic relationship. There never was any science to that. Quite to the contrary, person-centered approaches like Motivational Interviewing have a very, very good track record. When we have this black-and-white way of thinking about things, there are only two possible outcomes, perfection or disaster. I’ve done outcome research for 40 years. Outcomes don’t look like that. They’re all over the map. It used to be alcohol dependence and alcohol abuse were different disorders. They’re not. It all lies along a continuum. Outcomes look the same way. We know that with chronic illnesses, we don’t expect people with diabetes to never taste sugar again. We don’t expect people with hypertension to abstain totally from salt in all forms. The main thing is to be moving in the right direction. What is meant by the disease model is that you are completely different, incapable of controlling what you are doing. For some people that’s helpful. Identifying with that is the way they stay sober, and that’s good. However, if you don’t remain perfect, it can be discouraging. We have a study in which we found that an endorsement of the disease model actually increases the relapse rate. People were more likely to not just use, but use catastrophically, when they believe that if one drinks one is a drunk. For some people, that’s helpful. For others, it’s not. That’s human nature and there’s not one solution, one answer for everybody. On the seemingly contradictory approaches to recovery (some evoking a “higher power,” others “personal agency”): One of the wonderful things about addiction treatment is we have a terrific menu of different science-based approaches that can help people. There isn’t one approach you should always do. One of those is the 12-step program. It’s very nicely scientifically documented. (Alcoholics Anonymous itself is harder to document, although there are a lot of studies of it.) But a 12-step facilitation treatment works on average just as well as cognitive behavior therapy or Motivational Interviewing on average. So, if one thing isn’t working, try something different. For Bill Wilson (founder of Alcoholics Anonymous), who was a banker and at the top of his game, learning powerlessness might have been the key. But if you’re working with individuals who have experienced deep trauma, they might need to focus on methods that will draw out personal agency. Feminist theology has questioned whether women in general need more powerlessness. Women for Sobriety and SMART Recovery and other kinds of approaches were developed as reasonable alternatives. Humility and ego busting and powerlessness doesn’t seem to be the path for them. On how churches and other communities can respond to addiction: First, make it a topic of conversation. So often there’s so much shame around this topic in the United States that you just don’t talk about it. You can change that norm in a church by preaching about it if you’re the pastor, by sharing stories in prayer time. Bring it out of the closet. In this country we have made it a shameful thing. Albuquerque is an interesting example. The University of New Mexico Hospital operates the largest addiction treatment program in the state. But it’s not located at the University of New Mexico Hospital. It’s in a warehouse district out by the airport. Now, why is that? It’s because we don’t want “those people” around the hospital. Except guess what? They’re already there being treated for all kinds of other things. That’s not right. We have science-based, perfectly reasonable treatment methods that are rather like what therapists are doing anyhow with other kinds of clients. And yet, we’ve somehow come to believe that this is somebody else’s work. We should mainstream it in churches, in healthcare, in psychology, in social work, in homeless services. It’s just a really common part of life and not one to be shunned. On the importance of “small interventions:” Most of the things in my career that were most important were unexpected. And I learned early that when you don’t find what you predicted, that’s when you should get interested, become curious, and follow that, believe your data and follow your data. In 1983, I was thinking of Motivational Interviewing as a kind of priming the pump or getting people ready for what would be real treatment. The unexpected thing that popped up was that after a conversation in this way, people often began changing without additional help. My training as a therapist had been “the longer you spend with me, the better you’ll get.” But I began to find that even after a relatively brief conversation, people seemed to turn a corner on what had been very longstanding destructive patterns. It didn’t make sense to me, but we kept pursuing it. That has held up over time. If you look at the stories of healing and in writings about Jesus, they’re not long interactions. They are relatively brief encounters. He almost always touches the person, which is interesting. But these things are not long-term psychotherapy sessions. Something is happening that powerfully changes the person. On the possibility of personal conversions: Some people don’t know that the author of the hymn Amazing Grace was a slaver. His last trip was not the one on which he wrote Amazing Grace. He had a couple more exchanges. And so, it doesn’t necessarily happen all at once. It’s not always like Ebenezer Scrooge, where you’re totally transformed in the moment. But sometimes people are. I wrote a book called Quantum Change. The last psychologist I could find who was interested in this was William James, for whom psychology and religion naturally fit together at the beginning of the 20th century. He was fascinated by people who are suddenly transformed and tells some of their stories in Varieties of Religious Experience. I wondered, “Is that real? Does that actually happen in real life?” Well, the stories are found in biography and autobiography. We found that it was not difficult at all to find people who had had such “turning point” experiences in their lives. They hadn’t told anybody. They often didn’t talk about it, because the experiences sometimes sound pretty crazy. I just went into the study asking, “Does this even exist? Is there such a thing as an experience that happens within a few minutes or hours that permanently changes the person, like a one-way door?” It is real and it’s common. (For more on this aspect of Dr. Miller’s work click here.) On the relation of psychology and religion: Psychology in the …