Wednesday, June 30, 2010

On history repeating itself

To this day, when you google my name, what pops up after my LinkedIn and Facebook profiles (and some other creepy websites promising to give out my phone number, pet names, and blood type after paying their fee) is this snippet from the January 2001 issue of the DanceSafe newsletter.  I don't know how it is still this popular (I've had much greater accomplishments than being quoted in a newsletter since), but my quote is especially ironic in light of recent events.  This week, local news (and now also national news) are ablaze with a story of a 15 year old girl who died after overdosing at a legal-venue-rave.  The official story is that she inadvertently drank Ecstasy-laced water from a friend's bottle, but even LA water doesn't taste bad enough to make this a believable scenario.  Whatever the case, though, it breaks my heart that the same tragedies continue to happen a decade on, and we don't really know how to prevent them.  What ISN'T helping is the reaction from the people stuck dealing with the consequences: ER doctors call for an end to raves at L.A. Coliseum.  In a twisted turn of opinion, this suggestion is the exact opposite of my (then-controversial... god forbid anyone support "going commersh" back then) comment.  All that's going to do is push raves back underground, where it's a lot harder to create a safe environment (i.e., no on-site EMTs that can have young women rushed to the hospital).

Rather than going through this cycle again over the next decade or so (face it, kids will rave.  You take away their legal options, a black market will form, and it will be all the more unregulated and unsafe), I think it is time for the people running these events to take some of the responsibility.  Yes, I'm sure throwing events of this scale is hard, and I don't know the half of what goes into it, and finding ways to prevent a bunch of teenage schmucks from sneaking in drugs just isn't very high on the to-do list.  But we can't leave it up to the kids, or even their parents.  Teenagers are notoriously bad decision-makers, and parents more often than not are not only uneducated, but also clueless about their kids' activities.  Do you really think mom dropped them off looking like that?  Chances are that is not how they left the minivan.  I mean, maybe they did, but I know my parents had rules, and yet I can't tell you how many times 16-year-old me "spent the night at Keli's house" only to find myself in an abandoned downtown Detroit warehouse, inhaling asbestos and making bad choices.  So for the times parental supervision and the emotional and cognitive maturity of teenagers fail us, I think the entities responsible for event promotion, media coverage, and discussion should step up and take some initiative.  Maybe a required crash course in "avoiding potential harms of drugs" that people have to click through before being able to purchase their tickets.  Maybe on-site peer education.  Maybe blogs that focus on ways to be safe, in addition to their DJ reviews and the inevitable creepshow photo galleries of teen asses.  Maybe just less of a laissez-faire atmosphere (I don't mean policing, but when MCs have to get on the mic and tell people to stop acting like assholes, people are acting like assholes.  Make it clear from the get-go that that won't be tolerated).

Any way you cut it, what I find the most unacceptable notion of all is exemplified in news story paragraphs that start like this: "Although many partygoers consider ecstasy to be safe,...."  Why have people not picked up a more nuanced understanding of this over the past decade?  And while I applaud thought experiments about future improvements, I wonder, who is going to actually take the initiative, and what is it going to look like?

Thursday, April 8, 2010

on double standards, this time my own

One of the readings for today's class was this article on drugs and sex in prison:

Seal DW, Belcher L, Morrow K, Eldridge G, Binson D, Kacanek D, Margolis AD, McAuliffe T, Simms R; Project START Study Group. A qualitative study of substance use and sexual behavior among 18- to 29-year-old men while incarcerated in the United States. Health Education & Behavior 31(6):775-789.

Without going into too much detail, the paper states that drugs are widely available in prison and that people absolutely do them, and it shows that those who use injection drugs do so unsafely, i.e., re-using needles without cleaning them, sharing needles, etc.  While this was all surprising for me to read, what I need to get off my chest is the reaction I found myself having to its policy implications.  Obviously if people are shooting drugs in prison, they should have clean needles made available to them - after all, that's a most reasonable course of action outside of prison.   But the idea didn't immediately sit right.  Ultimately, of course, it seemed like the way to go, but on first read, there was this sense of "Uhhh...Imma have to think about that one" that I can't quite reconcile with the values I thought I had.  I'm not proud of it, but I AM curious about it.  Where does this double standard come from, and why do I, as a harm reduction advocate, have it??  So I started coming up with reasons why availability of clean needles in prison would send a confusing message, and quickly realized that they are identical to the reasons people have for criminalizing and condemning drug use outside of prison - reasons I usually try to talk people OUT of.  For example, prisons are supposed to be sheltered, controlled environments, so admitting that contraband penetrates their walls (built with OUR money) undermines this status.  Well, isn't our country supposed to be a sheltered, controlled environment too, with tons of money going to border control?  Policy ideals and rhetoric are being shattered in both cases, so why do I forgive the real world its porous borders and cry harm reduction, but recoil from accepting drug availability in prisons as a reality to be dealt with?  Or maybe it's the sense of surprise, that I had no idea drug use was so prevalent in prisons, so I'm going to need a minute to sit with this idea.  Well, not everyone was a raver or outreach volunteer or addiction researcher and has been around drug users half their life -- many in the real world probably also have no idea about the actual extent of the problem, and need to be granted some time to come to terms with it and realize its impact.  Or maybe I'm afraid of a sense of spite or disregard on the part of prisoners for rules that they, as part of their punishment, have been required to obey.  But as citizens and productive members of society, people in the real world also have a set of rules and laws to obey -- and I don't necessarily see it as an act of subversion or spite when they break these laws by using drugs.  Or maybe it's because many of the people in prison were sent there for the very purpose of not doing drugs anymore (not that treatment is available there, but that's another story...), so supporting them in doing it anyway is a bit of a slap in the face - but then I'm just another jerk who thinks themself morally superior and wants to teach a lesson and places conditions on reaching out a helping hand.  In the real world, I despise these kinds of attitudes; when it comes to prison, I have them??  I don't know -- there isn't an answer, but it's certainly painful to find limits to one's sense of immediate empathy.

Having thought about it, I'm of course all about supplying needles (and condoms) to people in prison.  But I don't like having observed this side of me that had to give it any thought at all.  On the brighter side, I wonder what proportion of knee jerk reactions to needle exchanges and other harm reduction programs in the real world could be reversed by just giving people a minute to let it percolate and an opportunity to articulate (and potentially realize the folly of) their concerns.

Thursday, April 1, 2010

an oldie but a goodie

I'm stoked to audit a class in the Community Health Sciences Department this quarter.  It is named "Managing Drug Abuse from a Public Health Perspective."  Hello!  It started today, and already I'm energized to learn the language and logic of this approach (in more formal terms than my noodling around drug policy conferences, anyway).

Among the first reading assignments was a paper published in the journal Addiction over a decade ago, titled "Setting goals for drug policy: harm reduction or use reduction?"  The reason I like it is that it describes the philosophies, merits, and policy implications of each approach so much more articulately than I have ever managed to, and it is thought-provoking and challenging while being level-headed and just.  Its main point is that in order to be effective, drug policy needs to define attainable goals (there is a world of goals beyond use reduction), set up reliable measures by which to gauge success (use/harm reduction can be conceptualized in several ways, not all of which go hand in hand), and recognize that with different goals come different policy implications.  It also touches on some sad truths, like the idea that choice of strategy comes down to things like political feasibility (appearing "soft on drugs") and ultimate values (caring about drug-related things like health problems, poverty, crime, etc. versus viewing drug use itself as "bad").  And as far as I can tell, all of the arguments stand to this day.

The end of the paper also states some author opinions that I really liked.
"Our recommendation is that the overall objective be to minimize the harm associated with the production, distribution, consumption and control of illicit substances.  Reducing use should be seen as a principal means of attaining that end.  However, although reducing use is a principal way of reducing harm, it is neither the only way nor a foolproof way." 
"It is our belief that augmenting use reduction with explicit harm reduction goals and admitting the possibility that one might at times be willing to accept higher use if it yields substantially less harmful use, would encourage wiser policies."

It's been over a decade since.  Surely, some harm reduction programs (needle exchanges, etc.) have made great strides, but lots of work remains to be done.  Can we get to it now?

Reference: Caulkins JP, Reuter P. (1997)  Setting goals for drug policy: harm reduction or use reduction? Addiction 92(9), 1143-1150.

Tuesday, March 23, 2010

I've been a bad bad blogger.  I have completely fallen out of the habit, and as I find myself drowning in two full-time jobs (i.e., my actual job, and hustlin' for another job), even the weekly link roundup I promised myself I'd do has fallen by the wayside.  I plan to tackle the daunting task pictured on the left over the coming days (or maybe I'll just push the reset button, I haven't decided yet), but in the meantime, I want to point out this article, describing the disconnect between the wealth of research/knowledge in existence and what the media report when it comes to drugs (summarized here for the short-of-attention-span).

Drug Abuse Prevention; Why do the American media avoid discussing research findings?
Drug Abuse Coverage Leaves Out the Science.

This is the kind of thing that sets me off, because how is the public supposed to form well-rounded and thoughtful opinions when their sources of information leave out.....information??  And I genuinely wonder, where does this gap come from?  Is it that scientists don't talk to journalists in understandable enough terms?  Or any terms at all?  Or do journalists not know where to look or whom to ask?  Or is it that journalists are afraid people will criticize or dismiss their pieces if they challenge commonly held beliefs?  I suspect part of it has to do with the fact that the truth is a drag, with all its complications and nuances, while simplified statements that corroborate previously held beliefs of the target audience are more attractive (as recently demonstrated by Boehner's comments on health care reform -- although I couldn't have agreed with him less or doubted his sincerity more, his speech was infinitely more engaging than Pelosi's stumbling around details, trying to be all thorough and inclusive.)  But although engaging, I think this kind of pandering is irresponsible and lazy, and it bums me out to find so much research never making it beyond the confines of stuffy academic circles.  I'd love to hear other people's opinions on what's behind this disconnect, because apparently the only thing that gets me riled up enough to blog after 7 weeks' absence is trying to figure out what could change, and how to make that happen.

Saturday, January 30, 2010

Wednesday, January 27, 2010

more articles

also just brought to my attention, and relevant to my previous post:

article in wired magazine on someone who does dare to raise eyebrows with his research: Carl Hart: The drug data pusher.

and other good ways of putting the argument, via The MacGuffin.

Tuesday, January 26, 2010

NYT article worth a read

whoa.  i just wrote an application letter for a science and technology policy fellowship not 10 days ago, trying to articulate my stance on research, politics, and their interaction.  i focused for the most part on the idea that certain types of drug research -- particularly those that don't paint a "drugs are bad" picture -- can get buried by science policy, creating a public opinion that is skewed, even if it is based on all the latest research.  no scientist is dying to propose research that takes a million hurdles to get funded/approved, won't get published in top journals if completed, can't get press coverage, and gets them ostracized and ridiculed.  so, the research winds up stagnant, poorly explored, and unheard-of, and the only "scientific facts" the public knows are those that corroborate the more popular story.  (the most obvious example is the medical marijuana movement, but there are also some really interesting studies on LSD, psilocybin, and ecstasy for treatment of psychiatric conditions like post-traumatic stress disorder, obsessive-compulsive disorder, and distress in terminal cancer patients, that few people have heard of because they're naughty schedule 1 drugs - "no currently accepted medical use in treatment" - and who wants to be caught supporting that.)  to which i say, drugs of abuse may never be a psychiatric panacea, but can't we at least find out?  who really loses, though, are the patients that might have benefited from such research -- how can we offer them as extensive a repertoire of "evidence-based treatment options" as possible when only some of the options are cleared for evidence-collection??

in any event, what makes this a "whoa" is that as i was writing the application letter, i kept asking myself, is this argument even true?  am i setting up a straw man to knock down, when in fact science policy is much more open-minded and equitable than i give it credit for?  and then today, i came across this new york times article, laying my self-doubt to rest.

Researchers Find Study of Medical Marijuana Discouraged

it's worth a read.  it lays out and illustrates the argument nicely.

and judging from NIDA-lady's comment, not only is inequity in science policy alive and well, it's also no secret.  yeow.

but i, for one, think it's a shame that one side of an argument (any argument) should get all the publicity, while the other gets passive-aggressively silenced..... and that the receiving audience isn't the wiser for it.

EDIT 1/27/10: in fairness, i should mention that this morning i did come across this article from  the newest issue of the journal drug and alcohol dependence: Is ecstasy a drug of dependence?  (cliff's notes: the answer is "maybe, maybe not" rather than "well duh."  baby steps.)

Saturday, January 23, 2010

Thursday, January 21, 2010

on chickens, eggs, and meth

I have previously mentioned predisposing factors and brain adaptations following drug use that contribute to personality traits some may, at first pass, consider part of a "weak mind."  This paper, published a few months ago in the Journal of Neuroscience by my rockstar former office neighbor Bruce Lee (no lie -- he changed his name before he left, and to this day we can't figure out if he knew), illustrates what I'm talking about.  The title, "Striatal Dopamine D2/D3 Receptor Availability Is Reduced in Methamphetamine Dependence and Is Linked to Impulsivity," kind of says it all, but click here for more details and thoughts.

Saturday, January 16, 2010

weekend roundup

i've been extremely busy the past two weeks, and have had no time for blogs - mine or others'.....while the items on my google reader just kept piling up.  so today i turned off the phone, shut all the doors, and caught up with what's happening on the internets.  below are the articles that caught my eye.
behold, the google reader round-up extravaganza, after the jump.

Tuesday, January 12, 2010

mouse party

short on time this week, so no rant.
but mouse party came up in conversation yesterday, reminding me of its existence, so i had to share. to nerdy minds like mine, this is endlessly entertaining. and extra commendable for being in the business of teaching children, not scaring them. so in the spirit of celebration, i present to you, mouse party!

Saturday, January 9, 2010

dummies' dilemma

i'm taking a break from my ongoing rant about just what is so infuriating about the "heroin for dummies" debate (a bunch of people got upset that their tax money went to a booklet illustrating safer injection practices for heroin), to spend some time on the subject of hypocrisy and double the context of "heroin for dummies" :)

i went to the dentist earlier this week, and while waiting for the doctor to come brutalize my molar (seriously, it took 2 shots and still hurt!), perused an issue of rachael ray's magazine, 'everyday.'  flipping through it, i came across this illustration (click image to enlarge) on how to play the holidays' "lively celebrations" right..... or should i say, BOOZING FOR DUMMIES!  DUN DUN DUN!

any other day, i would have been delighted to see this.  harm reduction at its finest.  rachael ray isn't making you go out and booze, but she's looking out for you if you do.  "eat food throughout." "order your drinks wisely." "avoid these traps."  piece of valuable knowledge.  dispelled myth.  useful tidbit to keep in mind.  you win!  you are not sleepy-eyed (rachael ray for hung the eff over?) at the thanksgiving table.  but this just so happened to occur the day after a bunch of glib news anchor types made a mockery of the same concept in relation to heroin, and the internet chimed in.  the level of hypocrisy just blows my mind -- how does harm reduction spark such controversy when we're talking about one thing, but get a jazzy full page feature when it's another??

(much) more after the jump.

dummies' dilemma

Thursday, January 7, 2010

no one is addicted AT you.

the reason i was reluctant to set up a blog for so long is that i wasn't sure i had anything new to say to the world -- what choir wants another preacher, after all.  but the "heroin for dummies" episode has shown me that maybe i'm wrong, and that maybe the ideas i take for granted aren't obvious to everyone.  so with that in mind (and awareness that you may totally already know that), here is the first in a list of things i have to say: 

1. drug addiction is a disease.

most people who got their panties all in a bunch over the injection booklet opposed its distribution on grounds like "they deserve the consequences of their habit" or "they won't read the booklets anyway."  as if by virtue of their drug addiction, people automatically got stripped of their humanity.  they are not animals, and they are not morons.  they are people, who are suffering from a disorder, and presumably would prefer to continue living.  so rather than arguing about how they got themselves into it (which ideally should be, but realistically can't always be, prevented), and holding them in contempt for their actions (which can be self-destructive and costly to others, but are perpetrated because that is the nature of the disease), a more humane approach would be to understand the disorder, admit that it's there (and recognize that wishing otherwise doesn't change that), and figure out realistic approaches for dealing with it. 

the first step in understanding addiction is recognizing it as the chronic, relapsing disorder that it is -- and not blaming those suffering from it for showing the main manifestation of the disease: compulsive disadvantageous decision-making.  click below to see what i'm talking about.

Tuesday, January 5, 2010

you're supposed to be the good ones, cnn.

"As human beings we all want to be happy and free from misery.
We have learned that the key to happiness is inner peace.
The greatest obstacles to inner peace are disturbing emotions such as
anger and attachment, fear and suspicion,
while love and compassion, a sense of universal responsibility
are the sources of peace and happiness."
Dalai Lama

yesterday, i was pointed to this video of a segment that ran on CNN earlier in the day -- an 8-minute knee-jerk, probably in response to this article ("A New York brochure advising heroin users on how to shoot up in a more healthful way cost taxpayers $32,000, officials said."), full of thoughtless commentary, smug smirks, and condescending 'tude. i found the segment and its derisive and ignorant (albeit, as some pointed out, unsurprising) message infuriating, but as the day went on and the story made the rounds
(props to dr. heimer in that last clip, btw - he's amazing), i was left just one thing: heartbroken. how are we STILL fighting this fight? and how is it that the judgmental and dismissive points of view of these smarmy-ass news anchors gain any amount of credibility?  but judging from the number of commenters that agreed with them, there are plenty of people out there that buy into it.   part of me wants to start philosophizing about the ugly side of human nature, but i think more than anything, ignorance is to blame. ignorance breeds rejection and fear, and a fearful mind cannot be compassionate. i think it's high time to change that.

in the coming posts, i hope to help reduce the harm of ignorant on-air commentary by proposing some things to keep in mind for future such stories (or maybe just intelligent debate). stay tuned.

oh hi, hello.

i'm new here.