DPA Podcast Episode 47: Maia Szalavitz Considers Harm Reduction’s Past and Future
The harm reduction movement began as a reaction against drug war policies that criminalize, punish, and hurt people – and a need to save lives. As a public health approach that aims to reduce the harms related to drug use and minimize risk, it offers a fresh and compassionate alternative to the war on drugs. In her new book, New York Times bestselling author Maia Szalavitz chronicles the fascinating and impactful history of this movement. DPA's Sheila Vakharia sat down with Maia to talk about her research, her book's timeliness, and where the movement can go from here, including the decriminalization and legal regulation of drugs.
You can keep up with Maia’s work at her website, maiasz.com. Her new book, Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, is available wherever books are sold.
Transcript
Intro (0:02)
Welcome to Drugs and Stuff, a podcast from the Drug Policy Alliance.
Gabriella Miyares (0:09)
Hello again, and welcome to Drugs and Stuff. I'm your host, Gabriella Miyares. If you're familiar with our work at the Drug Policy Alliance, you're probably familiar with the term harm reduction. In a nutshell, harm reduction is a public health approach that aims to reduce the harms related to drug use and minimize risk. It's an approach that offers a fresh and compassionate alternative to the war on drugs. Today, we're very excited to welcome New York Times bestselling author Maia Szalavitz, who has just released a new book about the history of the harm reduction movement. DPA's own Sheila Vakharia sat down with Maia to talk about her research, her book's timeliness, and where the movement can go from here. Let's listen in.
Sheila Vakharia (0:59)
Hello, everyone, and thanks so much for joining us for this episode of Drugs and Stuff. My name is Sheila Vakharia, and I'm the Deputy Director of the Department of Research and Academic Engagement here at the Drug Policy Alliance. It is my pleasure to interview Maia Szalavitz today about her latest book: Undoing Drugs, The Untold Story of Harm Reduction and the Future of Addiction. Maia Szalavitz is a neuroscience journalist and bestselling author who has been writing about addiction drug policy and neuroscience for over 30 years. Her work has been published in renowned outlets, including the New York Times, The Guardian, Time, The Atlantic, Scientific American, and others. Her last book, Unbroken Brain, was a New York Times bestseller, and we wish her similar success with her latest. We are thrilled to have you with us today. Welcome, Maia, and thanks for joining us.
Maia Szalavitz (1:44)
Thank you so much for having me.
Sheila Vakharia (1:46)
Before we get started, I wanted to ask you a little bit about what made you decide to write this book at this particular moment? And what inspired you to move forward with this huge undertaking, basically documenting the whole history of a movement?
Maia Szalavitz (2:00)
Well, somebody had to do it. And for many years, people said they were going to do it, and nobody did. And now I realize why. [laughter] But, I just felt like it had to be done before long, because you know, people aren't with us forever.
Sheila Vakharia (2:16)
Yeah.
Maia Szalavitz (2:17)
And so it was also kind of -- my very first book, the one that I was trying to publish when I was working for Charlie Rose in the 1990s, at that time, I sold a book, it was going to be a, an, as I phrased it then, "the addict's perspective on drug policy." And it was sort of part memoir, part policy. So the memoir part went into Unbroken Brain. And the policy part has mostly gone into Undoing Drugs. It's interesting, because of course, when that book got killed back then, I thought, I'm gonna never have a career, my life is gonna suck forever, this is gonna be horrible. But so it's nice to be able to reuse some of the stuff that originated in reporting I was doing at that time, and it makes it very fresh, because I have the stuff right from the 90s. Right from when I went to Liverpool, right from, you know, when the movement was really just starting out. And so I basically decided to do it, because nobody else was doing it, and it needed to be done.
Sheila Vakharia (3:16)
Mm hmm. And I think this actually transitions really well into the next question that I came up with, because I did appreciate how you wove your own personal journey and harm reduction throughout this book, including your own drug use and recovery. Can you talk a little bit about, for those who haven't read the book and are going to be reading it soon, how you became a harm reductionist yourself and how your own evolution could potentially be a model for others, who are still trying to wrap their heads around alternatives to abstinence and traditional ways of viewing drug use. And also, you know, "undoing drugs," as you call it.
Maia Szalavitz (3:46)
Yes, yes. So um, I became a harm reductionist before it was even named. Somebody taught me to protect myself from HIV by using bleach to clean needles. And she, I only learned her name when I was reporting this book. But I, at the time, did not know that IV drug users were at risk. Even though half of all the IV drug users in New York at that time, were already HIV positive. And the guy I was about to inject with actually was HIV positive. So, um, so I really believe she saved my life. And I was also furious, because when she told me that I was at risk, I realized that people had deliberately left me ignorant. That, in fact, politicians actually wanted to stop people from handing out bleach or teaching people about bleach because that would "send the wrong message about drugs." So I was sort of in harm reduction, again, before the name, before I was in recovery, that sort of traditional version of recovery.
Sheila Vakharia (4:56)
Sure.
Maia Szalavitz (4:56)
And then when I got into that traditional form of recovery, I experienced the clash between the abstinence-only experience and the harm reduction folks. And so my journey to understanding why harm reduction was the better way came in part through my own personal clash with being told all of this stuff in rehab about "this is the one true way. And this is the only way you can get better. And this is the truth, capital T about addiction," and then realizing that the science totally didn't support that. You know, at that time, the only people who were online were like, deadheads, academics, computer scientists -- weird, quirky people in many ways, none of whom were fans of the drug war. And so when the internet began, began to blossom, there was already this like, anti-drug war culture that was blooming there. And one of the things that was amazing to me was that, like, when you could actually access that academic research. And you could actually talk to some of the people who did the studies, and they would tell you that you were wrong, and you had better have a good argument, if you thought you were going to convince them otherwise. And so then I would end up being convinced usually, often after a fight, because, you know, I deeply believe this, I was told that my recovery depended on these ideas, like the first drink gets you drunk, or the first drug gets you high, or whatever you want to rephrase that expression as, you know, or, you know, and if you touch it once, like you're doomed, you're a zombie. And you know, this is not true. And actually believing that, if you do relapse, makes your relapse much more dangerous. Because you think, "Oh, I just had a little bit, but I've blown it. I don't have 12 years anymore, or whatever it was that I had -- so I may as well."
Sheila Vakharia (6:50)
Yeah!
Maia Szalavitz (6:51)
You know, and so there's a whole lot of research on that. It's called the abstinence violation effect, technically, but the "fuck it" effect works just as well, if we're allowed to say that. But you know, and it really it is a real thing. And so anyway, but so I would actually argue with some of the people who invented these concepts, or worked with the researchers who studied them. And I got tired of getting beaten down. So I joined the correct side.
Sheila Vakharia (7:18)
Sure, sure. One thing that I think your book tried to do was to highlight how intersectional our movement was, from the very beginning, in terms of race, class, gender, drug use status and sexual orientation. Even though many people may only recognize the names of white cis-het men who gained national prominence, you write about how harm reduction, like other movements, is and was a microcosm of society at large. So we weren't immune to a lot of the kind of dynamics of white supremacy, sexism, homophobia, which can impact, you know, who gets elevated, and whose voices are heard. Can you, for a second, tell us about some of the few unsung heroes that you deliberately chose to uplift in the book, who may be unfamiliar to some of our listeners?
Maia Szalavitz (8:02)
I mean, Yolanda Serrano is the first one that comes to mind. And she was absolutely pivotal in harm reduction in New York. She, working with Edith Springer, did the first bleach outreach to you know, teach people in shooting galleries, how to protect themselves. And they went out every night to these really intense places where, you know, the police decided "we're not going there!" And they went out and, and taught people and saved lives. And they also, Yolanda in particular, one of the cofounders of the organization that that they were working for, had some kind of connection to Rikers. So they were able to go in there. And they would bring a doctor and Yolanda and Edith would sit there. And the doc -- the, the person would say their symptoms, and if it was the symptom that could get them out, they would say, yes. If it was not the symptom, they would say no. And, you know, they got a lot of people released. Obviously, everyone with HIV should have been released anyway. So I don't believe this was, you know, underhanded, I believe it was great. Um, and, you know, so they, they did that when, you know, Rikers had this horrifying AIDS ward, that was just a humanitarian nightmare. And, you know, that part of the history I didn't even know. So Yolanda is one, Keith Cylar is another major figure. He's a co-founder of Housing Works. And Housing Works, from what I can tell, either is the first group to do Housing First, or was simultaneous with the other first Housing First organizations. And Housing First is basically bringing harm reduction into housing, and saying like, Okay, um, you know, the thing that is doing the most harm to people who don't have shelter is being homeless. So, let's start there. And let's not, you know, say, Oh, you must, you know, quit drugs to deserve to be in a house. And so Keith and his partner, Charles King, did a lot to bring harm reduction into the housing area. And, and Keith, personally, as an active user, helped transform a lot of people's policies around employment related to active drug use, because he was so vital to the organization, and was such an amazing speaker, and, you know, just convincing presence, that it was worth it if occasionally he couldn't show up.
Sheila Vakharia (10:39)
Right.
Maia Szalavitz (10:39)
And, you know, just thinking about it like any other disability, you know, like, sometimes if you're in pain, you're not gonna be able to go give that speech. And that's okay, we'll have somebody to fill in for you at that point. And when you can, we're there for you. I mean, I think it's just such an amazing thing, once you stop seeing it as like, Oh, we must punish this person, because they're using drugs in that way they will, I don't know, hit bottom or something?
Sheila Vakharia (11:04)
Mm hmm. I really appreciated how much your book highlighted the courage of our original harm reduction leaders who actively broke the law to do the work because of the urgency to act and to do something while institutions were failing them. And, you know, we need to acknowledge that even today, this is a reality. We've got dozens and dozens of underground syringe service programs operating, overdose prevention centers, at least one that we've been seeing published research out of, happening underground, while people are saying we're not going to wait for policymakers. But on the other hand, you know, we're also watching as our interventions became public health-ified and professionalized, you know, when we think about, for instance, naloxone and syringe access in certain red states, for instance. So, you know, in your opinion, what do you think is lost when the history of a movement, particularly in this underground and subversive history, kind of gets whitewashed or decontextualized?
Maia Szalavitz (11:58)
I mean, you know, Monique Tula said a great thing about this, that I quoted in there, she's like, you want your movement to go mainstream, because then you're having an impact. But you also feel like that same kind of feeling that you feel when like, the band you love gets big. And that's like that's, that's me saying that.
Sheila Vakharia (12:16)
I'd be there first!
Maia Szalavitz (12:17)
No, exactly, oh no, they're not cool anymore! Um, but it's like, it is a struggle, and you do lose things. And the thing that you have to be sure not to lose is the authentic connection between people and the genuine centering of people who use drugs in the community where you are, because if you just like, relegate them to like unpaid peer positions, or you know, or very low paid, or, you know, if you don't actually work to center active users in your work, then you will lose that spirit. And it's difficult, you know, and, and people don't have unlimited budgets and stuff like that. But I think I don't know, it's going to be very interesting to see what will happen now that all this opioid money's about to start flowing.
Sheila Vakharia (13:05)
Sure thing.
Maia Szalavitz (13:06)
And I'm scared, like, that some of it will lose that indie kind of spirit. And that fundamental compassion, that is really just one human to another, um, because it can get commodified. But, you know, we still know many good caring people within the health profession. So I think that, you know, a lot of that can be preserved.
Sheila Vakharia (13:33)
Yeah, I mean, it makes me think about Cabell County, West Virginia, which, you know, West Virginia is one of those states where syringe service programs are embedded within public health departments. And in Cabell County, the Public Health Department said, We need proof of residence for you to get your syringes here, and we're still going to do one to one exchanges. And you know, that is, I think, one of those examples and a cautionary tale for us in thinking about how to not lose the spirit of harm reduction, right, and remembering that it's about meeting people where they're at, lower thresholds. And, and yeah, understanding that these are folks who are failed by other systems, let's not create another barrier for them.
Maia Szalavitz (14:14)
Right. Right. And I mean, at the same time, you have to meet West Virginia where it's at, unfortunately.
Sheila Vakharia (14:19)
Exactly, exactly. And I think that these are kind of the the new tensions that are going to continue to emerge, and we're going to have to navigate.
Maia Szalavitz (14:26)
Yeah, absolutely. Yeah.
Sheila Vakharia (14:28)
So um, you know, since this book actually ended up being finalized and released in the midst of the COVID-19 pandemic, you had to find ways, obviously, to tie together the, you know, the current moment in what you were talking about, but it wasn't -- it didn't seem too hard for you, because in some ways you were also trying to use the HIV and overdose crises, that harm reduction emerged to address, to draw a bridge between what we're experiencing now with COVID. And so, you know, what do you think is some of the potential of what harm reduction has to offer in this moment?
Maia Szalavitz (15:00)
Sure. So, I mean, it was amazing to me and quite gratifying to see you, even in the early days of the pandemic, people starting to use the term harm reduction in relationship to measures to prevent the spread of COVID. And sometimes it was annoying because it got credited to gay men rather than drug users, although some of the drug users were gay men too.
Sheila Vakharia (15:23)
Sure.
Maia Szalavitz (15:24)
But it was just like, I really felt like that was another one of those moments where harm reduction was really coming into the mainstream, and in terms of what it has to give, basically, any risky behavior that human beings engage in, is going to be difficult to eradicate. And so instead, you have to work on reducing harm. And so human beings need to socialize, it's like a fundamental part of our biology.
Sheila Vakharia (15:50)
Yeah.
Maia Szalavitz (15:51)
And we deny that at our peril. So to think that you're going to basically have people isolate for a couple years, is going to cause as much problems as COVID would do. So what you have to do is things like masks, and things like meeting outdoors. And you have to know the enemy, the virus, like, what it -- how it actually is transmitted, so that you know, we don't do, you know, hygiene theater of like spraying everything, when it's really airborne. Yes, we should still wash our hands. But mostly your risk is from talking to people close up, not from touching the door.
Sheila Vakharia (16:31)
Right.
Maia Szalavitz (16:31)
And so understanding which activities are high risk and which activities are low risk, again, like, parallel to like safer sex or safer injecting, allows you to make better choices about risk. And I think one of the things that the CDC did not learn from the HIV experience and from harm reduction is that you need to have clear, honest communication about risk. And you can't assume that people are too dumb to make decisions in the face of varying risk.
Sheila Vakharia (17:03)
Yeah, absolutely. So as you wrap up the book, in the final chapter, you speak a bit about how harm reduction has gone through cycles, where we see ourselves moving a few steps forward with policy wins, some greater acceptance of our interventions, federal funding, but then also that at any given time, we've had, you know, steps back as well, you know, challenges around opening overdose prevention centers, ongoing challenges with nimbyism, shutting down our programs. You know, in what ways do you think the Biden administration has shown that they've evolved from his days as a drug warrior in the Senate? And in what ways do you think the Biden administration has shown more of the same regarding drugs and drug policy?
Maia Szalavitz (17:40)
Right. Well, they're the first to ever explicitly say that they support harm reduction as a main goal of policy. So that's clearly a big win. They're not freeing, you know, people. They are ridiculous on marijuana and ridiculous on decriminalization in general, because I would still like, I have, I maybe should put money on this. But I would like somebody to give me a coherent argument for criminalization. That is not "it sends a message." Because it doesn't do anything good. Putting people in jail increases their risk of dying. It increases HIV risk, suicide risk, overdose risk, it's not treatment, it takes away money for treatment, because you're spending money on arresting people and locking them up. If drug arrests are such a great way to, you know, prevent addiction or prevent drug use, how come there's no correlation between the amount of drug arres-- drug arrests, and the addiction rates or the rates of use of various things? It's just ridiculous. So I mean, I certainly believe you can make an argument that Philip Morris fentanyl is a bad idea. But what we tend to do is have these extreme strawmen like that. And say like, Well, obviously, we must keep criminalization, otherwise, we will have you know, Purdue Pharma times 10. Well, how about actually regulating things, like genuinely regulating them, and working in context to reduce harm? For example, the kratom thing?
Sheila Vakharia (19:15)
Yeah.
Maia Szalavitz (19:15)
Um, like, clearly less harmful than most prescription opioids, and then certainly all illegal opioids just because you don't know what's in them. So why would you ban it in the midst of a crisis when people are using it to get themselves off of these more dangerous things? But we don't have this overall harm reduction view. And like, I think there's a trap when you see Oh, harm reduction is needle exchange or harm reduction is naloxone or something like that? No, it's a policy that says you have to reduce harm first. And that means you have to do it in context. You know, another horrible example, which Biden seems to be continuing, is just this relentless drive to lower opioid prescribing. We've cut opioid prescribing by 60% since 2011, and our overdose rate has doubled.
Sheila Vakharia (20:07)
Right.
Maia Szalavitz (20:07)
Why do people think that cutting prescribing without treating either pain or addiction is going to do anything but drive a black market and probably lead some people to suicide? Like, why would we think that cutting off opioids is going to, you know, treat pain or addiction, it's completely irrational. And yet the people who supported this policy blithely went into it, and convinced everybody that this is the way to go, because of course, "supply side works best." You know, it just, it's horrifying to me and I, I'm, I'm really angry with some of those people, because they use the, you know, the lawsuits to like create this narrative about opioid addiction. That isn't true. No, most people don't get addicted to opioids, when they take them surgically. 70% of the adult population has taken opioids and 0.5% has an active prescription opioid addiction. So this is a ridiculous thing. It couldn't happen every time. And it certainly can't happen 25% of the time, otherwise, we would have many, many more millions of people with opioid addiction than we actually have. So, um, so that's silly. And the other thing that that is really, sort of driven by this lawsuit agenda is this idea that most of the people who got addicted were pain patients.
Sheila Vakharia (21:25)
Right.
Maia Szalavitz (21:26)
No, 80% of the people who became addicted were getting their drugs from friends or family members, or somebody's medicine cabinet or any source other than a doctor. That's 80%, the vast majority of the people who have problems with these drugs aren't taking them for medical reasons. So let's be honest about this. Purdue is bad and over marketing is bad. But what happened was people got into somebody else's medicine cabinet, not the evil doctor turned them into a "scummy addict."
Sheila Vakharia (21:56)
Air quotes!
Maia Szalavitz (22:00)
Believe me, I don't want to like be quoted as that. So yes, air quotes there. Definitely. Um, so yeah, I mean, but it's just like, you know, this, this whole idea that the drugs are the problem, and not seeing it from the perspective of the people who use drugs, who see drugs as part of the solution. You're not going to solve the problem by taking away someone's solution. So let's be honest about what we're doing. If we just want to take away medical opioids in the hopes of preventing future kids from getting exposed, which really is not going to work all that well, given that most people who end up using -- misusing prescription opioids are already using cocaine and methamphetamine, which we haven't controlled. You know, it's just, and what's sad about it is that we have this humane alternative within harm reduction, with decriminalization, with treating people like they are seeking something. And like they, you know, they're seeking to feel okay.
Sheila Vakharia (23:03)
They have needs that need to be met.
Maia Szalavitz (23:05)
Exactly. And you know, maybe they're poor, maybe they're jobless, maybe, you know, they're rich, and their life feels meaningless. Because we're exploiting people all the time -- I don't know, but like, whatever the problem is, it is one. Because people who are doing well and don't have childhood trauma, mental illness, or some kind of despair, do not suddenly experience euphoria from a drug and say, Okay, I'm going to give up my wife, my kid, my cat, especially the cat.
Sheila Vakharia (23:34)
So as we wrap up, I just wanted to wrap up with one last question. And I think this piggybacks pretty nicely off of what we were just talking about, you know, you speak about long term goals. Right. So decriminalization as being a step along the way, you allude to problems with how Purdue was regulated as being another issue. Can you talk a little bit about what you recommend in your last chapter around the Controlled Substances Act and your belief in the, in the potential of the role of the FDA in really helping us move forward with solutions?
Maia Szalavitz (24:03)
Yes, well, um, this has to require the FDA to have much more funding and much more freedom from industry. But if they had that, they could have a role in choosing what substances should be readily available, um, for, I just hate the term recreational use, but I haven't come up with a better one yet. I mean, I guess non medical use, because it just like, it doesn't feel like recreation to shoot heroin. You know, because there's various things that are going you know, so many things going on under that rubric. But anyway, yes, I would like to see a sort of FDA for recreational drugs so that you could get things approved like marijuana, cannabis, like psychedelics, like, things like kratom. You know, there is no way scientifically that you can argue for legal tobacco and alcohol, and illegal marijuana, because the level of harms related to those substances is just so different, and it doesn't favor the legal drugs. I think it is definitely the case that allowing all humans to access opioids freely will cause problems. And also, completely attempting to control them will cause problems. There's a vast middle ground that needs to be explored, that needs a lot of research to understand, like, how do we deal with a substance like cocaine? How do we deal with a substance like heroin? We need to come up with creative ways to minimize harm. Like we're never going to eliminate harm. And that's like, it just breaks my heart all these overdose deaths. Michael Williams most lately, obviously. Dan Biggs still also --
Sheila Vakharia (25:54)
-- very fresh.
Maia Szalavitz (25:55)
Yeah, yeah, yeah. And it just like, we're losing so many wonderful, amazing people. And one of the things that I think is like, one of the great things about harm reduction is, it shows you how valuable everyone is, and what insane losses we have when we allow racism and poverty and all of these things that harm people to thrive, and then throw away so many lives that, you know, that that could be with us. You know, that said, you know, it's harm reduction. It's not harm elimination. I understand why people say all overdose is prevent-- preventable, but I also, as a harm reductionist, understand that you can't eliminate the harm always. And that is sad. And I wish we could, but that absolutist view ends up with prohibitionism or, or other things that end up distorting people's crazy complex experience.
Sheila Vakharia (26:56)
Yeah, and I think, you know, implementing harm reduction in a world with so much social and structural inequities, lack of access to health care, you know, people living below a living wage, people experiencing hunger, I mean, you think of all those social and structural vulnerabilities that also need to be addressed when thinking about the drug supply, right, or thinking about access to drugs?
Maia Szalavitz (27:21)
Well, and I think like, you know, if we actually wanted to fight addiction, we could make a huge dent by simply raising the minimum wage, and, you know, guaranteeing decent jobs and housing for people. Obviously, there is plenty of addiction that is not related to poverty, and is related to mental illness. But again, there's so much we can do about that, you know, if we tried hard to massively reduce child trauma, we could really make a dent in so much of that, you know, not that, you know, abusive parents cause mental illness, please do not take it that way. But extreme trauma in childhood is often the thing. And that could be anything from loss to natural disasters to whatever --
Sheila Vakharia (28:10)
-- being hungry.
Maia Szalavitz (28:11)
Yeah, exactly. You know, having -- being neglected, all of these things. So, all of that, you know, it's often the difference between having a predisposition to something and actually having that condition. So if you can prevent the environmental thing that translates the genetic thing into a problem, then you will have less of a problem. And I think, you know, people will do better. But yeah, it's like, um, you know, and, and I, I tried to convey in the book as well, like, there's always this tension, and it's been an act up and in harm reduction movement, and, you know, it's like, do we give a clean needle? Or do we solve racism? we obviously need to do both. But how do we how do we balance that? How do we, you know, make, make real progress, and save real lives of human beings in front of us, but not accept that this unacceptable conditions of inequality and racism that we're in are okay, not say that's, you know, I mean, not -- not fight that as well, because it's kind of, you know, otherwise, you're reducing harm, but you're not reducing as much harm as you could reduce.
Sheila Vakharia (29:24)
Yeah, and I think that, you know, one of the important changes that we've also seen in recent years is the potential of these cross coalition movements, right. So people saying, you know, drug use is my area of expertise. And I'm going to bring that to this work. But I'm going to work in coalition with racial equity groups, criminal justice reform, you know, groups, health care access groups, and I think that that's when we start to see the richer policy proposals being proposed, including things like the BREATHE Act that we at DPA helped sponsor. You know, that was us playing a role in terms of our expertise around drugs and harm reduction, but really also lending a richness to the broader work of the need to, you know, divest and, and and work away from solutions grounded in punitive responses, and, but also to propose solutions that will have the broadest impact.
Maia Szalavitz (30:15)
Well, it was just so great to see the BREATHE Act and the Movement for Black Lives embracing harm reduction, and, you know, just not buying any of this crap about, oh, we must have more police or, you know, the -- and drugs are bad. So therefore, we must, you know, lock people up. Like, to just see that change was, like, remarkable. And I tried to write about that a bit in showcasing the work of Michelle Alexander, whose New Jim Crow, like, really made the racism of the drug war, very explicit. And so, yeah, it's, I mean, I do feel like, you know, sometimes I really want to despair these days, because, you know, climate and COVID, and just everything, everything. Um, but I look at this thing that I just wrote, and I see, it was so bad in the 80s and 90s. Like, it was so much worse in terms of where, you know, you know, like the CDC was against needle exchange.
Sheila Vakharia (31:15)
And now they're talking about drug checking.
Maia Szalavitz (31:16)
Yes, exactly. So it's, you know, we have actually made progress, it's just hard to see when you're immersed in the day to day, and I hope that activists who read this will get that renewed sense of, you know, hope, because you, it's just very hard I found to, you know, when you're in the day to day, notice the progress that actually occurs.
Sheila Vakharia (31:43)
And it's nice to see where you came from, and that we are all standing on the shoulders of these giants, some of whom have been named, and some who will remain nameless, but whose mark and impact change lives, right? And change the course of history. And I think it gives us a feeling of where where we fit in, and where we can kind of pass the baton and move forward. And you know, what kind of elders we want to be moving forward. And, yeah, ways in which we may find that we are the grumpy, rigid old people who need to figure some things out and kind of aren't quite there yet. I think, you know, and I think that that was one of the biggest gifts of this book for us and for the movement was giving us a moment to reflect on where we've been, and even also where we are right now. Because you do talk so much about this current moment and current leadership, and to think about where we want to go and where we will be. So you know, thank you so much for doing that for us. And for this for this movement. And as you said, you know, you couldn't have touched or covered everything, but I think it's such a great place to leave off for other people to pick up.
Maia Szalavitz (32:48)
That's what I hoped to do. I really wanted to start a conversation, I knew I was gonna piss some people off. But that's okay. Um, you know, this is this is like, all of our history, all of our, you know, we need many voices, we need more voices, we need more analysis and more perspective. And so yeah, hopefully, this lays out sort of the key arguments and stories. Not all of them, but some of them, and allows you to then say, okay, but you need to talk about this now, you know.
Sheila Vakharia (33:22)
Or this was missing, and let's go on this trajectory and kind of tell that whole chain of events.
Maia Szalavitz (33:27)
Yeah, exactly. Well, thank you for saying that. And I do hope it will be useful.
Sheila Vakharia (33:31)
Yeah. Well, on that note, I think, you know, thank you so much for taking the time, I think this was incredibly helpful for me, as someone who just finished reading the book and who's like mulling it over and digesting and kind of thinking through what it all means. And so I hope that our listeners today, those of you who haven't picked up the book, feel encouraged to go out and seek it out. And those of you who've read the book, hopefully, you've gotten some insights from hearing a little bit about behind the scenes, and what kind of led to the development of this book. So thank you all for tuning in today. And we'll see you around.
Gabriella Miyares (34:06)
A huge thanks again to Maia Szalavitz and my colleague, Sheila, for that look into how harm reduction is such a crucial approach in so many aspects of our lives. Again, for those interested in checking out Maia's new book, Undoing Drugs, you can learn more on her website, maiasz.com. That's m-a-i-a-s-z.com. Thanks to all of our listeners, stay safe and stay well.
Outro (34:34)
Drugs and Stuff stuff is brought to you by the Drug Policy Alliance. If you'd like what you hear in the podcast, do us a favor and rate the show on iTunes, give it five stars and a nice review. Also, we'd love to hear from you. Tweet at us @drugsnstuffDPA, use the hashtag #DrugsAndStuff, check out our website drugpolicy.org to see the other work we do, sign up for our emails, and donate. Special thanks to our producer Katharine Heller and to the hard working staff of the Drug Policy Alliance for all of their work. Thanks for listening.
Discrimination Against Drug Users
Drug Decriminalization
Drug Overdose
Drug Treatment
Harm Reduction
Audio
The harm reduction movement began as a reaction against drug war policies that criminalize, punish, and hurt people – and a need to save lives. As a public health approach that aims to reduce the harms related to drug use and minimize risk, it offers a fresh and compassionate alternative to the war on drugs. In her new book, New York Times bestselling author Maia Szalavitz chronicles the fascinating and impactful history of this movement. DPA's Sheila Vakharia sat down with Maia to talk about her research, her book's timeliness, and where the movement can go from here, including the decriminalization and legal regulation of drugs.
You can keep up with Maia’s work at her website, maiasz.com. Her new book, Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, is available wherever books are sold.
Transcript
Intro (0:02)
Welcome to Drugs and Stuff, a podcast from the Drug Policy Alliance.
Gabriella Miyares (0:09)
Hello again, and welcome to Drugs and Stuff. I'm your host, Gabriella Miyares. If you're familiar with our work at the Drug Policy Alliance, you're probably familiar with the term harm reduction. In a nutshell, harm reduction is a public health approach that aims to reduce the harms related to drug use and minimize risk. It's an approach that offers a fresh and compassionate alternative to the war on drugs. Today, we're very excited to welcome New York Times bestselling author Maia Szalavitz, who has just released a new book about the history of the harm reduction movement. DPA's own Sheila Vakharia sat down with Maia to talk about her research, her book's timeliness, and where the movement can go from here. Let's listen in.
Sheila Vakharia (0:59)
Hello, everyone, and thanks so much for joining us for this episode of Drugs and Stuff. My name is Sheila Vakharia, and I'm the Deputy Director of the Department of Research and Academic Engagement here at the Drug Policy Alliance. It is my pleasure to interview Maia Szalavitz today about her latest book: Undoing Drugs, The Untold Story of Harm Reduction and the Future of Addiction. Maia Szalavitz is a neuroscience journalist and bestselling author who has been writing about addiction drug policy and neuroscience for over 30 years. Her work has been published in renowned outlets, including the New York Times, The Guardian, Time, The Atlantic, Scientific American, and others. Her last book, Unbroken Brain, was a New York Times bestseller, and we wish her similar success with her latest. We are thrilled to have you with us today. Welcome, Maia, and thanks for joining us.
Maia Szalavitz (1:44)
Thank you so much for having me.
Sheila Vakharia (1:46)
Before we get started, I wanted to ask you a little bit about what made you decide to write this book at this particular moment? And what inspired you to move forward with this huge undertaking, basically documenting the whole history of a movement?
Maia Szalavitz (2:00)
Well, somebody had to do it. And for many years, people said they were going to do it, and nobody did. And now I realize why. [laughter] But, I just felt like it had to be done before long, because you know, people aren't with us forever.
Sheila Vakharia (2:16)
Yeah.
Maia Szalavitz (2:17)
And so it was also kind of -- my very first book, the one that I was trying to publish when I was working for Charlie Rose in the 1990s, at that time, I sold a book, it was going to be a, an, as I phrased it then, "the addict's perspective on drug policy." And it was sort of part memoir, part policy. So the memoir part went into Unbroken Brain. And the policy part has mostly gone into Undoing Drugs. It's interesting, because of course, when that book got killed back then, I thought, I'm gonna never have a career, my life is gonna suck forever, this is gonna be horrible. But so it's nice to be able to reuse some of the stuff that originated in reporting I was doing at that time, and it makes it very fresh, because I have the stuff right from the 90s. Right from when I went to Liverpool, right from, you know, when the movement was really just starting out. And so I basically decided to do it, because nobody else was doing it, and it needed to be done.
Sheila Vakharia (3:16)
Mm hmm. And I think this actually transitions really well into the next question that I came up with, because I did appreciate how you wove your own personal journey and harm reduction throughout this book, including your own drug use and recovery. Can you talk a little bit about, for those who haven't read the book and are going to be reading it soon, how you became a harm reductionist yourself and how your own evolution could potentially be a model for others, who are still trying to wrap their heads around alternatives to abstinence and traditional ways of viewing drug use. And also, you know, "undoing drugs," as you call it.
Maia Szalavitz (3:46)
Yes, yes. So um, I became a harm reductionist before it was even named. Somebody taught me to protect myself from HIV by using bleach to clean needles. And she, I only learned her name when I was reporting this book. But I, at the time, did not know that IV drug users were at risk. Even though half of all the IV drug users in New York at that time, were already HIV positive. And the guy I was about to inject with actually was HIV positive. So, um, so I really believe she saved my life. And I was also furious, because when she told me that I was at risk, I realized that people had deliberately left me ignorant. That, in fact, politicians actually wanted to stop people from handing out bleach or teaching people about bleach because that would "send the wrong message about drugs." So I was sort of in harm reduction, again, before the name, before I was in recovery, that sort of traditional version of recovery.
Sheila Vakharia (4:56)
Sure.
Maia Szalavitz (4:56)
And then when I got into that traditional form of recovery, I experienced the clash between the abstinence-only experience and the harm reduction folks. And so my journey to understanding why harm reduction was the better way came in part through my own personal clash with being told all of this stuff in rehab about "this is the one true way. And this is the only way you can get better. And this is the truth, capital T about addiction," and then realizing that the science totally didn't support that. You know, at that time, the only people who were online were like, deadheads, academics, computer scientists -- weird, quirky people in many ways, none of whom were fans of the drug war. And so when the internet began, began to blossom, there was already this like, anti-drug war culture that was blooming there. And one of the things that was amazing to me was that, like, when you could actually access that academic research. And you could actually talk to some of the people who did the studies, and they would tell you that you were wrong, and you had better have a good argument, if you thought you were going to convince them otherwise. And so then I would end up being convinced usually, often after a fight, because, you know, I deeply believe this, I was told that my recovery depended on these ideas, like the first drink gets you drunk, or the first drug gets you high, or whatever you want to rephrase that expression as, you know, or, you know, and if you touch it once, like you're doomed, you're a zombie. And you know, this is not true. And actually believing that, if you do relapse, makes your relapse much more dangerous. Because you think, "Oh, I just had a little bit, but I've blown it. I don't have 12 years anymore, or whatever it was that I had -- so I may as well."
Sheila Vakharia (6:50)
Yeah!
Maia Szalavitz (6:51)
You know, and so there's a whole lot of research on that. It's called the abstinence violation effect, technically, but the "fuck it" effect works just as well, if we're allowed to say that. But you know, and it really it is a real thing. And so anyway, but so I would actually argue with some of the people who invented these concepts, or worked with the researchers who studied them. And I got tired of getting beaten down. So I joined the correct side.
Sheila Vakharia (7:18)
Sure, sure. One thing that I think your book tried to do was to highlight how intersectional our movement was, from the very beginning, in terms of race, class, gender, drug use status and sexual orientation. Even though many people may only recognize the names of white cis-het men who gained national prominence, you write about how harm reduction, like other movements, is and was a microcosm of society at large. So we weren't immune to a lot of the kind of dynamics of white supremacy, sexism, homophobia, which can impact, you know, who gets elevated, and whose voices are heard. Can you, for a second, tell us about some of the few unsung heroes that you deliberately chose to uplift in the book, who may be unfamiliar to some of our listeners?
Maia Szalavitz (8:02)
I mean, Yolanda Serrano is the first one that comes to mind. And she was absolutely pivotal in harm reduction in New York. She, working with Edith Springer, did the first bleach outreach to you know, teach people in shooting galleries, how to protect themselves. And they went out every night to these really intense places where, you know, the police decided "we're not going there!" And they went out and, and taught people and saved lives. And they also, Yolanda in particular, one of the cofounders of the organization that that they were working for, had some kind of connection to Rikers. So they were able to go in there. And they would bring a doctor and Yolanda and Edith would sit there. And the doc -- the, the person would say their symptoms, and if it was the symptom that could get them out, they would say, yes. If it was not the symptom, they would say no. And, you know, they got a lot of people released. Obviously, everyone with HIV should have been released anyway. So I don't believe this was, you know, underhanded, I believe it was great. Um, and, you know, so they, they did that when, you know, Rikers had this horrifying AIDS ward, that was just a humanitarian nightmare. And, you know, that part of the history I didn't even know. So Yolanda is one, Keith Cylar is another major figure. He's a co-founder of Housing Works. And Housing Works, from what I can tell, either is the first group to do Housing First, or was simultaneous with the other first Housing First organizations. And Housing First is basically bringing harm reduction into housing, and saying like, Okay, um, you know, the thing that is doing the most harm to people who don't have shelter is being homeless. So, let's start there. And let's not, you know, say, Oh, you must, you know, quit drugs to deserve to be in a house. And so Keith and his partner, Charles King, did a lot to bring harm reduction into the housing area. And, and Keith, personally, as an active user, helped transform a lot of people's policies around employment related to active drug use, because he was so vital to the organization, and was such an amazing speaker, and, you know, just convincing presence, that it was worth it if occasionally he couldn't show up.
Sheila Vakharia (10:39)
Right.
Maia Szalavitz (10:39)
And, you know, just thinking about it like any other disability, you know, like, sometimes if you're in pain, you're not gonna be able to go give that speech. And that's okay, we'll have somebody to fill in for you at that point. And when you can, we're there for you. I mean, I think it's just such an amazing thing, once you stop seeing it as like, Oh, we must punish this person, because they're using drugs in that way they will, I don't know, hit bottom or something?
Sheila Vakharia (11:04)
Mm hmm. I really appreciated how much your book highlighted the courage of our original harm reduction leaders who actively broke the law to do the work because of the urgency to act and to do something while institutions were failing them. And, you know, we need to acknowledge that even today, this is a reality. We've got dozens and dozens of underground syringe service programs operating, overdose prevention centers, at least one that we've been seeing published research out of, happening underground, while people are saying we're not going to wait for policymakers. But on the other hand, you know, we're also watching as our interventions became public health-ified and professionalized, you know, when we think about, for instance, naloxone and syringe access in certain red states, for instance. So, you know, in your opinion, what do you think is lost when the history of a movement, particularly in this underground and subversive history, kind of gets whitewashed or decontextualized?
Maia Szalavitz (11:58)
I mean, you know, Monique Tula said a great thing about this, that I quoted in there, she's like, you want your movement to go mainstream, because then you're having an impact. But you also feel like that same kind of feeling that you feel when like, the band you love gets big. And that's like that's, that's me saying that.
Sheila Vakharia (12:16)
I'd be there first!
Maia Szalavitz (12:17)
No, exactly, oh no, they're not cool anymore! Um, but it's like, it is a struggle, and you do lose things. And the thing that you have to be sure not to lose is the authentic connection between people and the genuine centering of people who use drugs in the community where you are, because if you just like, relegate them to like unpaid peer positions, or you know, or very low paid, or, you know, if you don't actually work to center active users in your work, then you will lose that spirit. And it's difficult, you know, and, and people don't have unlimited budgets and stuff like that. But I think I don't know, it's going to be very interesting to see what will happen now that all this opioid money's about to start flowing.
Sheila Vakharia (13:05)
Sure thing.
Maia Szalavitz (13:06)
And I'm scared, like, that some of it will lose that indie kind of spirit. And that fundamental compassion, that is really just one human to another, um, because it can get commodified. But, you know, we still know many good caring people within the health profession. So I think that, you know, a lot of that can be preserved.
Sheila Vakharia (13:33)
Yeah, I mean, it makes me think about Cabell County, West Virginia, which, you know, West Virginia is one of those states where syringe service programs are embedded within public health departments. And in Cabell County, the Public Health Department said, We need proof of residence for you to get your syringes here, and we're still going to do one to one exchanges. And you know, that is, I think, one of those examples and a cautionary tale for us in thinking about how to not lose the spirit of harm reduction, right, and remembering that it's about meeting people where they're at, lower thresholds. And, and yeah, understanding that these are folks who are failed by other systems, let's not create another barrier for them.
Maia Szalavitz (14:14)
Right. Right. And I mean, at the same time, you have to meet West Virginia where it's at, unfortunately.
Sheila Vakharia (14:19)
Exactly, exactly. And I think that these are kind of the the new tensions that are going to continue to emerge, and we're going to have to navigate.
Maia Szalavitz (14:26)
Yeah, absolutely. Yeah.
Sheila Vakharia (14:28)
So um, you know, since this book actually ended up being finalized and released in the midst of the COVID-19 pandemic, you had to find ways, obviously, to tie together the, you know, the current moment in what you were talking about, but it wasn't -- it didn't seem too hard for you, because in some ways you were also trying to use the HIV and overdose crises, that harm reduction emerged to address, to draw a bridge between what we're experiencing now with COVID. And so, you know, what do you think is some of the potential of what harm reduction has to offer in this moment?
Maia Szalavitz (15:00)
Sure. So, I mean, it was amazing to me and quite gratifying to see you, even in the early days of the pandemic, people starting to use the term harm reduction in relationship to measures to prevent the spread of COVID. And sometimes it was annoying because it got credited to gay men rather than drug users, although some of the drug users were gay men too.
Sheila Vakharia (15:23)
Sure.
Maia Szalavitz (15:24)
But it was just like, I really felt like that was another one of those moments where harm reduction was really coming into the mainstream, and in terms of what it has to give, basically, any risky behavior that human beings engage in, is going to be difficult to eradicate. And so instead, you have to work on reducing harm. And so human beings need to socialize, it's like a fundamental part of our biology.
Sheila Vakharia (15:50)
Yeah.
Maia Szalavitz (15:51)
And we deny that at our peril. So to think that you're going to basically have people isolate for a couple years, is going to cause as much problems as COVID would do. So what you have to do is things like masks, and things like meeting outdoors. And you have to know the enemy, the virus, like, what it -- how it actually is transmitted, so that you know, we don't do, you know, hygiene theater of like spraying everything, when it's really airborne. Yes, we should still wash our hands. But mostly your risk is from talking to people close up, not from touching the door.
Sheila Vakharia (16:31)
Right.
Maia Szalavitz (16:31)
And so understanding which activities are high risk and which activities are low risk, again, like, parallel to like safer sex or safer injecting, allows you to make better choices about risk. And I think one of the things that the CDC did not learn from the HIV experience and from harm reduction is that you need to have clear, honest communication about risk. And you can't assume that people are too dumb to make decisions in the face of varying risk.
Sheila Vakharia (17:03)
Yeah, absolutely. So as you wrap up the book, in the final chapter, you speak a bit about how harm reduction has gone through cycles, where we see ourselves moving a few steps forward with policy wins, some greater acceptance of our interventions, federal funding, but then also that at any given time, we've had, you know, steps back as well, you know, challenges around opening overdose prevention centers, ongoing challenges with nimbyism, shutting down our programs. You know, in what ways do you think the Biden administration has shown that they've evolved from his days as a drug warrior in the Senate? And in what ways do you think the Biden administration has shown more of the same regarding drugs and drug policy?
Maia Szalavitz (17:40)
Right. Well, they're the first to ever explicitly say that they support harm reduction as a main goal of policy. So that's clearly a big win. They're not freeing, you know, people. They are ridiculous on marijuana and ridiculous on decriminalization in general, because I would still like, I have, I maybe should put money on this. But I would like somebody to give me a coherent argument for criminalization. That is not "it sends a message." Because it doesn't do anything good. Putting people in jail increases their risk of dying. It increases HIV risk, suicide risk, overdose risk, it's not treatment, it takes away money for treatment, because you're spending money on arresting people and locking them up. If drug arrests are such a great way to, you know, prevent addiction or prevent drug use, how come there's no correlation between the amount of drug arres-- drug arrests, and the addiction rates or the rates of use of various things? It's just ridiculous. So I mean, I certainly believe you can make an argument that Philip Morris fentanyl is a bad idea. But what we tend to do is have these extreme strawmen like that. And say like, Well, obviously, we must keep criminalization, otherwise, we will have you know, Purdue Pharma times 10. Well, how about actually regulating things, like genuinely regulating them, and working in context to reduce harm? For example, the kratom thing?
Sheila Vakharia (19:15)
Yeah.
Maia Szalavitz (19:15)
Um, like, clearly less harmful than most prescription opioids, and then certainly all illegal opioids just because you don't know what's in them. So why would you ban it in the midst of a crisis when people are using it to get themselves off of these more dangerous things? But we don't have this overall harm reduction view. And like, I think there's a trap when you see Oh, harm reduction is needle exchange or harm reduction is naloxone or something like that? No, it's a policy that says you have to reduce harm first. And that means you have to do it in context. You know, another horrible example, which Biden seems to be continuing, is just this relentless drive to lower opioid prescribing. We've cut opioid prescribing by 60% since 2011, and our overdose rate has doubled.
Sheila Vakharia (20:07)
Right.
Maia Szalavitz (20:07)
Why do people think that cutting prescribing without treating either pain or addiction is going to do anything but drive a black market and probably lead some people to suicide? Like, why would we think that cutting off opioids is going to, you know, treat pain or addiction, it's completely irrational. And yet the people who supported this policy blithely went into it, and convinced everybody that this is the way to go, because of course, "supply side works best." You know, it just, it's horrifying to me and I, I'm, I'm really angry with some of those people, because they use the, you know, the lawsuits to like create this narrative about opioid addiction. That isn't true. No, most people don't get addicted to opioids, when they take them surgically. 70% of the adult population has taken opioids and 0.5% has an active prescription opioid addiction. So this is a ridiculous thing. It couldn't happen every time. And it certainly can't happen 25% of the time, otherwise, we would have many, many more millions of people with opioid addiction than we actually have. So, um, so that's silly. And the other thing that that is really, sort of driven by this lawsuit agenda is this idea that most of the people who got addicted were pain patients.
Sheila Vakharia (21:25)
Right.
Maia Szalavitz (21:26)
No, 80% of the people who became addicted were getting their drugs from friends or family members, or somebody's medicine cabinet or any source other than a doctor. That's 80%, the vast majority of the people who have problems with these drugs aren't taking them for medical reasons. So let's be honest about this. Purdue is bad and over marketing is bad. But what happened was people got into somebody else's medicine cabinet, not the evil doctor turned them into a "scummy addict."
Sheila Vakharia (21:56)
Air quotes!
Maia Szalavitz (22:00)
Believe me, I don't want to like be quoted as that. So yes, air quotes there. Definitely. Um, so yeah, I mean, but it's just like, you know, this, this whole idea that the drugs are the problem, and not seeing it from the perspective of the people who use drugs, who see drugs as part of the solution. You're not going to solve the problem by taking away someone's solution. So let's be honest about what we're doing. If we just want to take away medical opioids in the hopes of preventing future kids from getting exposed, which really is not going to work all that well, given that most people who end up using -- misusing prescription opioids are already using cocaine and methamphetamine, which we haven't controlled. You know, it's just, and what's sad about it is that we have this humane alternative within harm reduction, with decriminalization, with treating people like they are seeking something. And like they, you know, they're seeking to feel okay.
Sheila Vakharia (23:03)
They have needs that need to be met.
Maia Szalavitz (23:05)
Exactly. And you know, maybe they're poor, maybe they're jobless, maybe, you know, they're rich, and their life feels meaningless. Because we're exploiting people all the time -- I don't know, but like, whatever the problem is, it is one. Because people who are doing well and don't have childhood trauma, mental illness, or some kind of despair, do not suddenly experience euphoria from a drug and say, Okay, I'm going to give up my wife, my kid, my cat, especially the cat.
Sheila Vakharia (23:34)
So as we wrap up, I just wanted to wrap up with one last question. And I think this piggybacks pretty nicely off of what we were just talking about, you know, you speak about long term goals. Right. So decriminalization as being a step along the way, you allude to problems with how Purdue was regulated as being another issue. Can you talk a little bit about what you recommend in your last chapter around the Controlled Substances Act and your belief in the, in the potential of the role of the FDA in really helping us move forward with solutions?
Maia Szalavitz (24:03)
Yes, well, um, this has to require the FDA to have much more funding and much more freedom from industry. But if they had that, they could have a role in choosing what substances should be readily available, um, for, I just hate the term recreational use, but I haven't come up with a better one yet. I mean, I guess non medical use, because it just like, it doesn't feel like recreation to shoot heroin. You know, because there's various things that are going you know, so many things going on under that rubric. But anyway, yes, I would like to see a sort of FDA for recreational drugs so that you could get things approved like marijuana, cannabis, like psychedelics, like, things like kratom. You know, there is no way scientifically that you can argue for legal tobacco and alcohol, and illegal marijuana, because the level of harms related to those substances is just so different, and it doesn't favor the legal drugs. I think it is definitely the case that allowing all humans to access opioids freely will cause problems. And also, completely attempting to control them will cause problems. There's a vast middle ground that needs to be explored, that needs a lot of research to understand, like, how do we deal with a substance like cocaine? How do we deal with a substance like heroin? We need to come up with creative ways to minimize harm. Like we're never going to eliminate harm. And that's like, it just breaks my heart all these overdose deaths. Michael Williams most lately, obviously. Dan Biggs still also --
Sheila Vakharia (25:54)
-- very fresh.
Maia Szalavitz (25:55)
Yeah, yeah, yeah. And it just like, we're losing so many wonderful, amazing people. And one of the things that I think is like, one of the great things about harm reduction is, it shows you how valuable everyone is, and what insane losses we have when we allow racism and poverty and all of these things that harm people to thrive, and then throw away so many lives that, you know, that that could be with us. You know, that said, you know, it's harm reduction. It's not harm elimination. I understand why people say all overdose is prevent-- preventable, but I also, as a harm reductionist, understand that you can't eliminate the harm always. And that is sad. And I wish we could, but that absolutist view ends up with prohibitionism or, or other things that end up distorting people's crazy complex experience.
Sheila Vakharia (26:56)
Yeah, and I think, you know, implementing harm reduction in a world with so much social and structural inequities, lack of access to health care, you know, people living below a living wage, people experiencing hunger, I mean, you think of all those social and structural vulnerabilities that also need to be addressed when thinking about the drug supply, right, or thinking about access to drugs?
Maia Szalavitz (27:21)
Well, and I think like, you know, if we actually wanted to fight addiction, we could make a huge dent by simply raising the minimum wage, and, you know, guaranteeing decent jobs and housing for people. Obviously, there is plenty of addiction that is not related to poverty, and is related to mental illness. But again, there's so much we can do about that, you know, if we tried hard to massively reduce child trauma, we could really make a dent in so much of that, you know, not that, you know, abusive parents cause mental illness, please do not take it that way. But extreme trauma in childhood is often the thing. And that could be anything from loss to natural disasters to whatever --
Sheila Vakharia (28:10)
-- being hungry.
Maia Szalavitz (28:11)
Yeah, exactly. You know, having -- being neglected, all of these things. So, all of that, you know, it's often the difference between having a predisposition to something and actually having that condition. So if you can prevent the environmental thing that translates the genetic thing into a problem, then you will have less of a problem. And I think, you know, people will do better. But yeah, it's like, um, you know, and, and I, I tried to convey in the book as well, like, there's always this tension, and it's been an act up and in harm reduction movement, and, you know, it's like, do we give a clean needle? Or do we solve racism? we obviously need to do both. But how do we how do we balance that? How do we, you know, make, make real progress, and save real lives of human beings in front of us, but not accept that this unacceptable conditions of inequality and racism that we're in are okay, not say that's, you know, I mean, not -- not fight that as well, because it's kind of, you know, otherwise, you're reducing harm, but you're not reducing as much harm as you could reduce.
Sheila Vakharia (29:24)
Yeah, and I think that, you know, one of the important changes that we've also seen in recent years is the potential of these cross coalition movements, right. So people saying, you know, drug use is my area of expertise. And I'm going to bring that to this work. But I'm going to work in coalition with racial equity groups, criminal justice reform, you know, groups, health care access groups, and I think that that's when we start to see the richer policy proposals being proposed, including things like the BREATHE Act that we at DPA helped sponsor. You know, that was us playing a role in terms of our expertise around drugs and harm reduction, but really also lending a richness to the broader work of the need to, you know, divest and, and and work away from solutions grounded in punitive responses, and, but also to propose solutions that will have the broadest impact.
Maia Szalavitz (30:15)
Well, it was just so great to see the BREATHE Act and the Movement for Black Lives embracing harm reduction, and, you know, just not buying any of this crap about, oh, we must have more police or, you know, the -- and drugs are bad. So therefore, we must, you know, lock people up. Like, to just see that change was, like, remarkable. And I tried to write about that a bit in showcasing the work of Michelle Alexander, whose New Jim Crow, like, really made the racism of the drug war, very explicit. And so, yeah, it's, I mean, I do feel like, you know, sometimes I really want to despair these days, because, you know, climate and COVID, and just everything, everything. Um, but I look at this thing that I just wrote, and I see, it was so bad in the 80s and 90s. Like, it was so much worse in terms of where, you know, you know, like the CDC was against needle exchange.
Sheila Vakharia (31:15)
And now they're talking about drug checking.
Maia Szalavitz (31:16)
Yes, exactly. So it's, you know, we have actually made progress, it's just hard to see when you're immersed in the day to day, and I hope that activists who read this will get that renewed sense of, you know, hope, because you, it's just very hard I found to, you know, when you're in the day to day, notice the progress that actually occurs.
Sheila Vakharia (31:43)
And it's nice to see where you came from, and that we are all standing on the shoulders of these giants, some of whom have been named, and some who will remain nameless, but whose mark and impact change lives, right? And change the course of history. And I think it gives us a feeling of where where we fit in, and where we can kind of pass the baton and move forward. And you know, what kind of elders we want to be moving forward. And, yeah, ways in which we may find that we are the grumpy, rigid old people who need to figure some things out and kind of aren't quite there yet. I think, you know, and I think that that was one of the biggest gifts of this book for us and for the movement was giving us a moment to reflect on where we've been, and even also where we are right now. Because you do talk so much about this current moment and current leadership, and to think about where we want to go and where we will be. So you know, thank you so much for doing that for us. And for this for this movement. And as you said, you know, you couldn't have touched or covered everything, but I think it's such a great place to leave off for other people to pick up.
Maia Szalavitz (32:48)
That's what I hoped to do. I really wanted to start a conversation, I knew I was gonna piss some people off. But that's okay. Um, you know, this is this is like, all of our history, all of our, you know, we need many voices, we need more voices, we need more analysis and more perspective. And so yeah, hopefully, this lays out sort of the key arguments and stories. Not all of them, but some of them, and allows you to then say, okay, but you need to talk about this now, you know.
Sheila Vakharia (33:22)
Or this was missing, and let's go on this trajectory and kind of tell that whole chain of events.
Maia Szalavitz (33:27)
Yeah, exactly. Well, thank you for saying that. And I do hope it will be useful.
Sheila Vakharia (33:31)
Yeah. Well, on that note, I think, you know, thank you so much for taking the time, I think this was incredibly helpful for me, as someone who just finished reading the book and who's like mulling it over and digesting and kind of thinking through what it all means. And so I hope that our listeners today, those of you who haven't picked up the book, feel encouraged to go out and seek it out. And those of you who've read the book, hopefully, you've gotten some insights from hearing a little bit about behind the scenes, and what kind of led to the development of this book. So thank you all for tuning in today. And we'll see you around.
Gabriella Miyares (34:06)
A huge thanks again to Maia Szalavitz and my colleague, Sheila, for that look into how harm reduction is such a crucial approach in so many aspects of our lives. Again, for those interested in checking out Maia's new book, Undoing Drugs, you can learn more on her website, maiasz.com. That's m-a-i-a-s-z.com. Thanks to all of our listeners, stay safe and stay well.
Outro (34:34)
Drugs and Stuff stuff is brought to you by the Drug Policy Alliance. If you'd like what you hear in the podcast, do us a favor and rate the show on iTunes, give it five stars and a nice review. Also, we'd love to hear from you. Tweet at us @drugsnstuffDPA, use the hashtag #DrugsAndStuff, check out our website drugpolicy.org to see the other work we do, sign up for our emails, and donate. Special thanks to our producer Katharine Heller and to the hard working staff of the Drug Policy Alliance for all of their work. Thanks for listening.