Thrilled to be here at the @MethadoneLib conference!

Great turnout in the room and I’m sure we have plenty folks logged in remotely representing so many diverse groups and regions!

We all share a commitment to #FreeMethadone!

We are listening to an infuriating clip from @National_usu ‘s podcast Naturally Noncompliant to hear from people about their experiences and why we need to #FreeMethadone.

Follow and tune in podcasts.apple.com/us/podcast/nat…

People often ask, "What about treatment?" "Why aren't they in treatment?" when talking people with addictions or other mental health diagnoses.

We talk about treatment as some magical black box- people walk in sick and then walk out "better," improved, stabilized, asymptomatic. But the reality is that treatment is slow and time-consuming.

Change does not happen overnight; it may not look how you expect.

The first days, weeks can be challenging. You settle in. You meet the counselors- some are great, some are terrible. You may not speak right away

New CDC report on OD trends in US 2016 to 2021 🧵

- The US fentanyl-involved OD death rate is 21.6 per 100,000, a rate that more than TRIPLED in just 5 yrs
- Methamphetamine-involved OD death rate more than quadrupled,
- Cocaine rate more than doubled

🔗cdc.gov/nchs/data/vsrr… - Meanwhile the rate of heroin-involved OD remained relatively stable during the 5 year period,
- Oxycodone-involved OD rate decreased by 20+%

**At this point, any talk of the overdose crisis without acknowledging prevalent stimulant use misses the mark

Watching @CNN and @andersoncooper talking about the overdose crisis. They are talking about two tragic cases of young people who died of overdose with their grieving family members.

Both overdoses were with counterfeit pills. (1/?) In first story, the young person thought it was a Percocet. When he was overdosing, a friend was deterred from calling 911 for fear of law enforcement.

In second story, the young man ODd while talking to his girlfriend on the phone but she didn’t know signs of him overdosing.

Many people do not realize the difference between these terms and that they actually mean different things:

Decriminalization =/= Legalization =/= Regulation

These are three different things.

And only 1 of them ensures a known, tested, and monitored drug supply for all users. 1) Decriminalization simply means that possession is no longer a criminal offense.

You cannot get arrested, booked, finger printed.

No potential jail time.

Nothing on your record when you get a background check.

You may owe a fine. You may be diverted to a case worker.

Learning from Dr. Joseph D'Orazio that xylazine is being detected in over 90% of tested heroin and fentanyl samples in Philadelphia.

Screenshot below shows that it's also prevalent in overdose victims - xylazine + fentanyl positive in 100% of those who died in 2020. Also, Philadelphia seeing a notable trend of decreased benzodiazepine-involved overdose deaths while xylazine-involved overdose deaths are rising.

This is a HUGE loss for all of us today.

The false claim that we are "protecting our youth" rings hollow. Vaping among teens is down from peaks.

Instead, countless adult smokers will continue to smoke or return to smoking, and die.

https://twitter.com/NPR/status/1539985248821338112

Youth vaping rates are falling as we tighten restrictions on product sales already.

💥Nearly 90% of 8th graders did not vape last year;
💥Nearly 80% of 10th graders did not vape last year;
💥Nearly 70% of 12th graders did not vape last year.

Source: monitoringthefuture.org/data/21data/Va…

Tuned in to @HarmReduction's office hours, "Responding to Xylazine in the Drug Supply".

Starting with Rafael Torruella of Intercambios speaking on his qualitative research with PWUD in Puerto Rico who have been dealing with xylazine in the drug supply for years. It has been readily available on the island for nearly two decades. It was discussed in his dissertation interviews years ago and you can read more about his past research has been published substanceabusepolicy.biomedcentral.com/articles/10.11…

@maysoonzayid I totally hear you. And I'm happy to tweet about it and have tweeted about before.

So- giving out pipes and syringes, as well as these other items, are a form of harm reduction. It's a way to engage people who currently use drugs into support and services. @maysoonzayid Though the federal government has not paid for a lot of these items in the past, many of us live in communities where state and local governments do. Or grants/foundations have paid for their distribution.

While illegal in some states, this practice is getting decriminalized

Hey harm reduction friends and drug policy nerds, let's share our #DrugPolicyResolutions for 2022 by using this hashtag!

I'll go first-

I will not affirm the "hard" vs "soft," "plant" vs "powder," and "legal" vs "illegal" drug binaries in my activism in 2022. I will not call the current crisis an "opioid" crisis, since it is actually driven by:

- a toxic drug supply;
- overdose deaths;
- polysubstance use;
- prohibition;
- systemic racism, classism, and ableism.

#DrugPolicyResolutions

People do drug for reasons that are adaptive, functional, and reasonable.

Nicotine is an amazing drug for so many reasons.

Too bad the most accessible form is combustible and carcinogenic.

Stigma, not science is why e-cigarettes are unavailable for those most vulnerable.

https://twitter.com/hyuumanatees/status/1459981386522243078

We often talk about the ‘success’ of our public health measures to reduce cigarette smoking- taxes, smoking bans, stigma, etc.

But no policies are neutral-we see racial disparities in smoking rates, also by class, ability, and education status.

Smoking still stratifies us.

🚨The DEA is soliciting public comments on their production quotas for Schedule 1 and 2 drugs and they are due in 2 days - at 11:59pm Tuesday Nov 16th.🚨

Some of these quotas are GREAT! Some aren't.

Join us at @DrugPolicyOrg and submit your comments today!!

A thread 🧵(1/n) Why should you submit comments? Because the DEA decides annually how much of these Schedule 1 and 2 drugs should be produced every year for:
🩺 medical purposes,
🔬 scientific purposes,
🔍 research purposes, and
🏭 industrial purposes.

(2/n)

The Biden Administration declared this week to be #OverdoseAwarenessWeek.

And they did something absolutely unforgivable that will cost people their lives and freedom: They proposed extending the class-wide scheduling of fentanyls.

A thread 🧵
whitehouse.gov/ondcp/briefing… 1) Currently, fentanyl is a scheduled substance. Some analogues with proven high potency have been scheduled as Schedule 1.

Class-wide scheduling means that EVERY FENTANYL ANALOGUE EVER SEIZED IN THE FUTURE will be treated as a Schedule 1 drug with harsh penalties. Huge problem.

1) There is a growing body of qualitative research with people who use opioids unpacking the many reasons that some have begun to use methamphetamine.

Here's a great new study that highlights how functional many find its use. tandfonline.com/doi/full/10.10… 2) Although the sample size is small, based in Dayton OH, their findings are aligned with several other recent studies highlighting similar motivations for use.

Here's a part of their descriptive table showing how many used it to manage opioid withdrawal and for other reasons:

Some Drug War Facts:

✅Illicit drug use occurs in every zip code but drug arrests don't.
✅A drug arrest record (even without a conviction or incarceration) can mess up your life.
✅The drug war has made social workers, doctors, teachers, etc. into frontline enforcers like cops. ✅Drug use disorders are the only health condition where being actively 'symptomatic' makes you a 'criminal' too.
✅The drug war and criminalization makes recovery harder to achieve.
✅The drug war incentivizes unsafe drug use and behaviors to avoid law enforcement detection.

🧵A THREAD 🧵
1) I've been doing harm reduction work for 15 years and I've learned a few lessons about how to talk about it with people who aren't quite there yet.

I presented on this a few years ago and I'm going to share my slides and talking points here with you today - 2) First of all, it's important for US to reframe.

Rather than seeing non-harm reductionists as RESISTANT, I think it's more helpful to see them as RELUCTANT.

This helps us to approach conversations with more compassion and patience (altho not always easy!)

One of my final points at the #StigmaSummit was the need for us to include people who CURRENTLY use drugs in
➡️developing programmatic policies to address stigma and barriers,
➡️evaluating them, and
➡️ measuring them.

And that they need to be compensated for their time. (1/3) And that researchers must include and PAY people who CURRENTLY use drugs in research abt them & their needs:
➡️Developing questions
➡️Gathering data
➡️Analyzing/interpreting data
➡️Writing and presenting on findings

#StigmaSummit drugpolicy.org/sites/default/…

Congratulations to advocates in Vermont, who successfully decriminalized the possession of small amounts of buprenorphine without a prescription!

Here's a thread on why this is great news and how it will save lives during the overdose crisis (1/x)

vtdigger.org/2021/06/03/ver… Q: What is buprenorphine?

Buprenorphine (AKA Suboxone), is a lifesaving medication for Opioid Use Disorder. It helps people get off street opioids.

Check out my thread about how it reduces mortality

https://twitter.com/MyHarmReduction/status/1400830281116962818

🧵🧵🧵
NEW STUDY:

The rate of all-cause mortality for people on Opioid Agonist Treatment (buprenorphine or methadone) was 53% LOWER than the rate when people were not on these medications. (1/x)

jamanetwork.com/journals/jamap… “This association was consistent regardless of patient sex, age, geographic location, HIV status, and hepatitis C virus status and whether drugs were taken through injection."

AND

“Associations were not different for methadone vs buprenorphine” (2/x)

🧵🧵🧵

The drug war and criminalization are the unmeasured confounding variables that impact ALL other variables and outcomes in drug and drug policy research.

We don't even know the full extent of how they impact everything we THINK we know about drugs.

FULL STOP.
(1/x) Some examples:

➡️Any study about the supposed effects of an illicit drug on emotional, mental, physical health and well-being of users.

As long as the participants used the unmonitored and unregulated illicit supply, you never really know what you're measuring. (2/x)

On May 6th, the class-wide scheduling of fentanyl analogues expires. We should let it.

Hear me and @grantwilder3 explain why this policy is old fashioned drug hysteria + racism that will only increase criminalization and overdose.

fb.watch/4UDbnv6Lbs/ This is a bit of a tricky issue to explain, but basically - the DEA wants to preemptively schedule every fentanyl analogue in existence and that will ever exist as a Schedule 1 drug with 'high abuse potential and no medical use.' BUT THIS IS A TERRIBLE IDEA...