Harm Reduction 1
2. key principle of harm reduction
1. everyone is worthy of dignity and respect, there are stages of change, not everyone is ready for abstinence YET, treating with respect makes people more likely to get help
2. ANY step toward sobriety is GOOD!!!
SAMHSA changes to opioid treatment programs since COVID and who is against them
Since COVID, SAMHSA allowed take home, unsupervised, methadone. this resulted in fewer OD deaths of Black and Hispanic men especially
Opioid Treatment Programs themselves were against this, because it resulted in less profit
History of drug policy in the US, from Pure Food and Drugs Act to Anti-Drug Abuse Act (1988)
1906: 'The Jungle' influences the creation of the Pure Food and Drugs Act, requiring accurate labels
1912: international drug regulation conference
1914: US Harrison Act in response to international regulations (sellers pay taxes)
1919: Supreme Court rules addiction not a disease, bans physicians from prescribing narcotics
1922: possession of narcotics becomes illegal
1970: Controlled Substances Act
1988: Anti-Drug Abuse Act: harsher punishments for possession/use
What happened to DULF's Compassion Club and Liberation Front?
DULF developed CCLF as a safer supply program, but denied government waivers, so they purchased drugs off dark web and had them tested before selling to established users at a lower cost
They were shut down and arrested for possession and trafficking but judge is challenging since they were saving lives
explain arrest differences for powdered vs crack cocaine
crack cocaine is more often used by Black Americans, and they are more likely to be caught (ie street dealing instead of privately)
school zone laws add harsher punishments in more condensed urban areas
describe UK's hostel for previously unhoused men
The hostel is a form of 'wet housing', where alcohol is allowed and the residents can determine rules about alcohol. The residents independently decided that beer and wine are only allowed, and must be consumed in common space. The rules worked, and formed a community
6 risk factors for opioid OD
1. using alone
2. not knowing purity
3. contaminants (ie fentanyl)
4. using after abstinence (lower tolerance)
5. using in unfamiliar location (contextual tolerance)
6. using with CNS depressant (ie benzos)
US attempts to stop 1.production of drugs in other countries and 2. importing drugs to US
1. crop eradication: makes US politically unpopular, economically ruins poor countries
2. border patrol/interdiction of imports, domestic seizing of drugs
Trump's executive order against SAMHSA and their response
banned harm reduction (called it 'enabling'), SAMHSA listed out what they can do if they dont call it HR: wound care, sharps disposal, narcan/OD reversal training, test strips for drugs
Fair Sentencing Act 2010 and First Step Act 2018
2. Under Trump (influenced by Kim and Kanye), reduced sentences for 4000 federal prisoners incarcerated for crack (98% Black men)
managed alcohol programs in canada
these programs provide measured servings of alcohol to people with alcohol use disorder to prevent withdrawal unhoused people freezing to death after drinking; also provided place to stay, food, behavioral health etc
Overdose Prevention Center 5 typical rules
1. no one under 18
2. no one pregnant
3. cannot assist others in injecting (even staff)
4. must be local
5. no first time injectors
explain the balloon effect
temporary supply reduction will 'balloon' in other places, where there is demand there will always be supply
Dutch police response to drug users and the message it sends
-typically leave them alone as long as not violent/disruptive
-deglamorizes addiction/doesn't make it a big deal (esp to teens)
-keeps drug users from feeling detached from society/out of the criminal justice system
Most smokers of menthol cigarettes are Black (over 80%); less support available for minorities quitting smoking, potential for police brutality in implementing
four types of syringe services
1. fixed location: typically medical setting, helps in case of OD
2. pharmacy-based: more accessible, common in other countries
3. vending machines: private, available 24/7, free
4. mobile outreach: can go where need is greatest at the time, can fly under radar of police
Impact of OPCs
-reduces death and ER visits (which saves money)
-reaches people w/o medical care
-reduces public injecting/improper disposal
-leads people into treatment/sobriety
How has budget shifted from 2000 being supply v demand reduction
In 2000, 3/4 demand reduction, now more evenly split
Portugal vs Sweden policies and results
Portugal: decriminalized all possession and use, reduced deaths and new HIV cases through voluntary care
Sweden: strict prohibition, can blood/urine test suspected users (leading to highest reported drug offenders in world), has 30x OD deaths of Portugal
why doesn't research impact drug policy?
-stigma
-underfunding of research
-people see relapses (which are almost inevitable) as 'failures' of programs
opposition to syringe services and evidence against
'syringe services are enabling/lead to more use/dangerous'
research shows syringe services does not increase new use, discarded syringes, or illicit drug use in general
Describe Vancouvers safer supply programs
Vending machines with safer drugs; allows for privacy and easy access, prevents OD because no fent contamination, cheaper than OPCs because no staff is needed
Measure 110 and why it failed
Measure 110 in Oregon decriminalized possession of all drugs and attempted to establish Behavioral Health Resource Networks (BHRNs)
Failed because it was during COVID, they didn't know how to get government grants for BHRNs, and OD deaths increased 50% after 110 passed *but this was likely due to rise of fentanyl*
Alternatives to jail: Drug court, PAARI, LEAD
drug court: sentenced to treatment instead of jail
PAARI: police assisted addiction and recovery initiative: if turn in drugs to police, sent to treatment instead of arrested, lead to 33% decrease in property crime, treatment focuses on detox
LEAD: Law Enforcement Assisted Diversion, before crime is committed/arrest, connecting people to housing, treatment, job services
what are cops actually experiencing in fentanyl exposure videos and what is actual fent OD like
they're having a panic attack from being told that even being in the same room as fent will kill them (they have shortness of breath)
real OD is slowly drifting off and breathing slower until you 'fall asleep'