11/24/17 Carrie Stefanson

Carrie Stefanson of Vancouver Health re safe consumption of drugs/(14:13)Andy Watson of B.C. Coroner Services/(23:34)Neill Franklin Dir of LEAP/(41:15)Paul Armentano Dep Dir of NORML/(50:13)Sam Chapman Dir of Safer Spaces in Portland

Cultural Baggage Radio Show
Friday, November 24, 2017
Carrie Stefanson
Vancouver Coastal Health



NOVEMBER 24, 2017


DEAN BECKER: Broadcasting on the Drug Truth Network, this is Cultural Baggage.

DR. G. ALAN ROBISON: It's not only inhumane, it is really fundamentally un-American.

CROWD: No more! Drug war! No More! Drug War! No More! Drug War!

DEAN BECKER: My name is Dean Becker. I don't condone or encourage the use of any drugs, legal or illegal. I report the unvarnished truth about the pharmaceutical, banking, prison, and judicial nightmare that feeds on eternal drug war.

Hi friends, this is Dean Becker, thank you for being with us on this edition of Cultural Baggage. Man, do we have a show lined up for you today. First, we're going to Canada.

CARRIE STEFANSON: Hi Dean, I'm Carrie Stefanson, I'm the public affairs leader for Vancouver Coastal Health, which is one of five health authorities in Vancouver, British Columbia. We're -- we are kind of at the epicenter of the overdose crisis, because we have the Downtown East Side in our area, where we have a huge problem with illicit drug use, including fentanyl, heroin, cocaine, various types of substances.

So, as a health authority, we are contracted by government. We operate as a nonprofit to provide health services to our jurisdiction, and those services include primary care at our hospitals, acute care, and community based care, harm reduction, prevention, treatment when it comes to the overdose crisis. We also provide residential care for our citizens, and we serve more than three million clients every year.

DEAN BECKER: Wow. Well, that's quite an undertaking there. Now, Carrie, you know, there are those here in the US that say Canada, you know, you have to wait in line to get a doctor, you might die while you're waiting, but, that's just not the case. You guys have a very thorough health system up there, do you not?

CARRIE STEFANSON: We have a very robust healthcare system in Vancouver. We are at the leading edge of technology and innovation. In my job, I do a lot of the proactive media, so I'm meeting with doctors, hearing about the new things they're doing, and when you compare us to the US, yes, our systems are very different, but in the work I've done, I've certainly seen a lot of firsts that have happened here, and care to American residents as well who really have got the top notch care here that might not even be available anywhere else in North America, and they were fortunate enough to end up here by circumstance.

DEAN BECKER: Yes, ma'am. Now, getting back to the Insite facility there, where drug users come in, safely, by that I mean without the threat of police interference, can come in, can make use of the very clean, sterile facilities, they can do their drugs, and there's a medical -- trained medical staff there on site, in case there is an overdose. And, well, let's talk about the number of visitors, the number of potential overdoses. What happens there at Insite?

CARRIE STEFANSON: Well, you're correct in your summary of Insite, Dean, I mean, it is a place where people can come in and use drugs safely. Insite, which is North America's first legal supervised injection site, was opened in 2003, and it really was born out of the need to stem the tide of HIV cases. We were seeing a growing number of HIV and hepatitis C cases, and that was because of the sharing of needles.

So, among injection drug users, sharing needles was one of the primary ways that blood borne diseases can be transmitted. So people at Insite are less likely to share needles on the street for a variety of reasons. Many injection drug users seek help from other people when they're injecting, and this sometimes involves sharing needles. When they come in to Insite, they have a way of injecting safely themselves. They're less likely to require help from others. They are less likely to share needles.

They have access to sterile injecting equipment, and other harm reduction supplies, like condoms, so providing this to clients provides safer practices, and reduces the risk of disease transmission, but it also reduces the likelihood of overdose. And since 2003, I can tell you that 3.6 million clients have injected illicit substances under supervision at Insite, and no one has died there.

DEAN BECKER: Now that's admirable, it's amazing. It's wonderful. And I guess what I'm wondering, you know, outside of Vancouver, there are other cities now that are setting up tents, if you will, trying to set up a temporary means for people to do safe injections. It's being replicated across the country, is it not?

CARRIE STEFANSON: Yeah, I mean, in British Columbia, we have both supervised consumption sites, used to be called supervised injection sites, it's just new names now, it's the same thing. So we have supervised consumption sites and overdose prevention sites, and when you refer to tents being set up, that would be an overdose prevention site.

So overdose prevention sites are really temporary measures in response to a public health emergency that was declared in our province in April of 2016, so they have supervision for injection but they wouldn't have the full gamut of healthcare services that you would get at a supervised consumption site, like Insite, which would have broader goals and generally more comprehensive services, including prevention of HIV and hep C transmission as we discussed, but also, you know, nurses there can treat injection related wounds and infections, they can provide instruction on safer practices that, you know, can lead to more serious and costly healthcare problems.

But more importantly, they provide linkages and referrals to addiction treatment and primary care, as well as overdose response, so they are really the -- places like Insite are really a full range of healthcare services that are provided there, and I've been at Insite a number of times, and I can tell you that, you know, there are times when, the nurses there have told me, that someone will come in and they'll say, they'll detect that they're not feeling well and they'll take them into the back room, where they have an exam room, and they'll find something far more serious, you know, hemorrhages and things like that, that are life threatening, where they're able to detect that and send a patient to the hospital, and they can get the care they receive.

So it's not just they're coming in for the sole purpose of injecting. Insite's also a point of contact between the users and the healthcare community. And that's a really important part of it, because making those connections can get people connected to services down the road that could, you know, change their path in life.

DEAN BECKER: You know, last week I carried a segment about a woman who had lost her son to a heroin overdose, and she felt compelled to help with those temporary, the tent facilities, if you will, because she recognized that, you know, too many kids were dying, especially with this fentanyl, which is going around now, which is winding up in a lot of drugs being circulated. Do you have an analysis of how many drugs now have that fentanyl contained therein?

CARRIE STEFANSON: Yeah, we're seeing a lot of fentanyl in drugs, we're seeing fentanyl in heroin, we're seeing fentanyl in cocaine. I'm just looking, at the top of my fingertips here, I think the first nine months of 2017, the number of heroin samples that tested positive for fentanyl across Canada, so that wouldn't just be in our health authority, was 60 percent. So sixty percent of the heroin contained fentanyl, and four years earlier, in 2012, we figure that about one percent of the samples we had contained fentanyl.

So that's a massive jump, and we're even seeing higher numbers than that here. Fentanyl is in a lot of the drugs that we see, the most common drugs that we test for fentanyl are cocaine, methamphetamine, those types of drugs, and of course heroin, and, you know, people don't know what they're getting when they get drugs off the street, they don't know how toxic they're going to be, and in most cases, they do contain fentanyl.

DEAN BECKER: That echoes so much. I close this program, Cultural Baggage, with the thought each week that because of prohibition you don't know what's in that bag, please be careful, and that's -- it's just such a massive influx of fentanyl, and it's potentially so much more deadly than the street heroin, which was, you know, not a hundred percent, it was kind of a known quality back when, but it never was this strong until recent years. Your thought there please, Carrie.

CARRIE STEFANSON: Yeah, I mean, British Columbia declared a health emergency in April of 2016, and that was due to the rising numbers of illicit drug overdose deaths, and the rise can be attributed to the presence of fentanyl and its other analogs: carfentanyl, these highly potent opioids in the drug supply.

So, it is fentanyl that's contributing to the unprecedented number of deaths not only in Vancouver but throughout British Columbia, and in the US as well. And when we've had a look at our stats from 2012, you know, certainly we have -- nearly a thousand people died in our province last year of overdoses, and that number will likely be higher this year. If we go back to 2012 and we look at today, if we take fentanyl out of that equation, the overdose numbers, or rate, really haven't changed, so what has changed is fentanyl. So fentanyl is in there, and it's killing people.

When we started using naloxone to reverse overdoses, which is a highly effective substance to reduce overdoses, you know, we were giving people one ampule of naloxone, and now, sometimes it takes three or even four to reverse an overdose. So people are becoming more tolerant, but the drugs are also becoming stronger.

DEAN BECKER: Now, I'm not asking you to make a, you know, political statement, but here in the US, we have cities, Portland, Seattle, San Francisco, Ithaca, New York, and even my city of Houston, Texas, where there's rumblings and mumblings about the need for a safe injection site within those cities. I'm not asking you to recommend it, but there are cities in Canada which have been averse to, you know, following in Vancouver's footsteps, but what's your thought there? Is it making a difference, is it a worthwhile endeavor, these safe injection sites?

CARRIE STEFANSON: Well, I think, Dean, the numbers really do speak for themselves. People are dying every day of drug overdoses in British Columbia, where we live, in our city. It's a huge problem. We're losing mothers and fathers and sons and daughters, and if we look at what we're doing, so, you know, yes, we need to do more, we always need to do more, all of us need to do more.

If we look at our supervised consumption sites, which we now have three, and we look at our overdose prevention sites, which I believe we have five now, despite 3.6 million people using Insite, our primary site since 2003, not one person has died there. But, there have been 6,400 overdose interventions there, so 6,400 people who've gone to Insite and injected drugs have overdosed, but they've been caught by the nurses and the staff there, and they've been saved.

So, those people are going to use drugs anyway. They, potentially, would have died if they had not been supervised. So that's over six thousand people right at Insite. I would say it's worth it. One life is worth it, but sixty four hundred lives? I think those numbers do speak for themselves.

DEAN BECKER: Well, once again, we've been speaking with Carrie Stefanson. She's with Vancouver Coastal Health up there in British Columbia. Carrie, is there a website, maybe some closing thoughts you'd like to share?

CARRIE STEFANSON: Sure. Dean, yes, if people are interested in about finding out about Insite, or about our supervised consumption services, supervised injection services if you want to call it that, and our overdose prevention sites, they can certainly go to our website at VCH.ca.

The BC Coroner's Service in British Columbia tracks all deaths, so that would be all overdose deaths, and they have quite an extensive amount of information on their website about the toxicity of illegal substances and how much fentanyl is in the drug supply, and the whole response from a provincial level, so if health authorities or, you know, administrators, or politicians, are interested in gathering information, certainly the BC government and the BC Coroner's Service has a lot of that information out there.

ANDY WATSON: My name's Andy Watson. I'm the manager of strategic communications and the spokesperson for the BC Coroner's Service. And the BC Coroner's Service, like a state run body, we're a provincially run body in Canada, and we investigate all deaths that are sudden or unexpected in the province of British Columbia.

And the goal that we have in investigating those deaths is to try and gather facts to determine, you know, why somebody died, in what circumstances, and hopefully to be able to make recommendations or pull data together to help prevent future deaths.

So it's a very important role, because we look for trends, and then we try and help policy makers to make determinations of what needs to be done next to help reverse trends. And, it's a job that we take very seriously.

DEAN BECKER: Well, it's a very serious job, yes sir. Thank you, Andy. Now, I, you're well aware of this ongoing opioid crisis. It's hitting America very hard, it's hitting Canada very hard. I think it's worldwide in its expanse. And, can you talk about recent trends, which drugs are causing the most problems there for you guys?

ANDY WATSON: Yeah, you know, I think the biggest thing that we're seeing in our data, which we've really started to capture since the start of 2016 in detail, but we've been looking at it, you know, for over a decade now. We're starting to see fentanyl detected in the majority of the deaths that we investigate.

You know, I mean, again, I don't want to sound alarmist or anything like that, but about four in every five deaths have fentanyl detected in the post-mortem testing that we're doing. And what that clearly shows us is that fentanyl is in our drug supply, and that we have a contaminated drug supply that's really a high risk at right now for any, any people who use substances.

And so the challenge is, if you're an individual who uses substances, there's, it's a really high risk right now. Anytime you use a substance, and there's no way of knowing securely what supplies are safe and which ones aren't, because even, you know, people who think they're using a safe supply, we're seeing them in our statistics, unfortunately.

DEAN BECKER: Yes, sir. Do you have a tally, a number of deaths, or comparison of those death totals?

ANDY WATSON: What I can tell you is that year over year we've seen almost a hundred and fifty percent increase in the number of deaths with fentanyl detected. And, you know, through the first eight months of 2017, we saw 823 cases of illicit drug overdose deaths with fentanyl detected. In the same time period in 2016 we only saw 328 cases. So that accounts again for about four in every five illicit drug overdose deaths, that fentanyl has been detected.

In addition to that, starting in June of this year, we started testing for carfentanyl, and we've seen that detected in about 24 cases thus far, and of course, we're still doing testing in other cases that are open for investigation, so that number may rise. But that's for June, July, and August, 24 suspected cases. And I believe that the number's moved into the 30s, based on what I understand from the data up and to the end of September.

DEAN BECKER: Wow. Wow. And that's the 10,000 times more deadly than morphine, if I remember right.

ANDY WATSON: That's correct. And I, you know, it's used, from what I understand, it's been used as a tranquilizer for large animals. So, when you think about the power and the potency of that, you know, it's just, it's a scary thought to consider just how lethal the drug supply is right now, when you have things like carfentanyl, which is even stronger than fentanyl, and fentanyl is killing people at an alarming rate, so, the challenge is, is really, how do we keep this out of the supply?

And, you know, we're working with providing our data to law enforcement and to policymakers, and the health and mental health sector, and, you know, we continue to try and do that, to try and help reverse this trend, but, like you said earlier, this is something that's pervasive across North America. It's hitting different regions with different challenges. But the numbers are clear, that this is a crisis and we need to continue to work collaboratively and find some innovative ways of dealing with this, to try and help people and prevent future deaths.

DEAN BECKER: Yes, sir. And I'm not asking you to, you know, create policy here, but, I'm a former law enforcement officer, I work with a group called Law Enforcement Against Prohibition, and, you know, we've studied this for well over a decade now, trying to come up with that means, whereby we can curtail these deaths, and the only one that we've come up with is to legalize heroin, make it available to adults at a reasonable price. I'm not asking you to create policy, but, what do you guys recommend to your government? What are you discerning, what are you relaying to your authorities?

ANDY WATSON: You know, really, our role in this crisis is to try and provide timely and accurate data, so that we can make evidence based decisions. And certainly we've heard advocates from within the province recommend legalization, or some more access to, to substances, so that they know the supply that they're getting them from, if it's regulated, it's safe.

We've heard from our federal government, though, that right now, they're not looking at the legalization of any substances aside from marijuana. You're probably aware that cannabis is looking -- is going to be legal in Canada, beginning midway through next year. So, coming back to where we play a role in this, we try and provide the data to help people influence decisions and make decisions that will help save lives.

And so, again, I wouldn't want to make any policy recommendations, because that's not our role here. But certainly, we have heard, we've heard the advocacy efforts that are going on in the province, and certainly there's people here in British Columbia that think that's the way to go. But we've heard from the federal government right now that that's not something that's on the table.

DEAN BECKER: Now, one other question I wanted to ask you about, and I've talked to several, you know, reformers and a toxicologist, and they were talking about, one of the main complications, one of the main factors in creating a death from use of these opioids, is to combine it with alcohol. Do you find that in your analysis to be true?

ANDY WATSON: We have seen -- we've seen alcohol detected as one of the main substances that being detected in our post mortem testing, and that may be in isolation or it may be mixed with other drugs. We are doing some expanded analysis right now with our, just some additional data we're collecting for any fentanyl detected or illicit drug detected deaths from the start of 2016 and on, and so one of the questions that we're hoping that will answer is to what degree are we seeing mixed toxicity.

Certainly the initial data we have suggests that about three of every ten cases have some level of alcohol detected in them. That's any of these illicit drug deaths that we're investigating. So, there the evidence would suggest that that is a factor, and we hope to have some more specifics on that in months to come.

DEAN BECKER: Well, real good. Friends, we've been speaking with Mister Andy Watson. He's the manager of strategic communications at the BC Coroner's office. Andy, is there a website where folks could learn more about what you guys are finding, some closing thoughts?

ANDY WATSON: Yeah. I think, you know, the easiest way to find our data is to google BC Coroner's Service, and look for our statistical reports. And every month, we try and provide updated data to show what the trends are, you know, things like the fact that we are averaging about three illicit drug overdose deaths per day for the last month that we were sampling from, and that was September of 2017.

And really, we are seeing, you know, the death rates per hundred thousand people, they've spiked dramatically, from about six deaths per 100,000 people in 2012, to over 30 now in 2017. So we really encourage, if you want to see some more data, it is available online, and we try and provide monthly updates so that we can see what the latest trends are with this information.

DEAN BECKER: Andy, I thank you sir. Good stuff. I'm sure my audience will appreciate it.

ANDY WATSON: And I want to thank you, too, for, you know, raising awareness for this important issue. It's by having discussions like this that we can, we can educate each other and help inform society, and again, we don't want to have more statistics. We want to see people going home to their families at the end of the day, and obviously we've all been impacted by this crisis in one way or another, so thanks for your interest.

DEAN BECKER: It's time to play Name That Drug By Its Side Effects! Empty pockets, theft, lying, withdrawal, nose bleeds, fits of rage, depression, uncontrollable itching and sniffing, prostitution, jail time, heroin use, loss of friends, loss of life. TimeÔÇÖs up! The answer, from Purdue Pharma: oxycodone.

Well, today we've had the chance to hear a lot about what's going on up in Canada, about the changes that are taking place and the changes that need to be made up there. We have a very similar situation down here in America. We've got the same opioid crisis going on, we've got politicians pushing, pulling on marijuana, medical marijuana.

But one thing that is constant is that my band of brothers in Law Enforcement Action Partnership, are not slowing down, are continuing to discuss this situation with politicians and preachers and anybody who will listen. Now, I have with me the executive director, my friend, Mister Neill Franklin. Hello, Neill.

NEILL FRANKLIN: Hey, Dean. Thanks for having me back on the show, I appreciate it, appreciate you very much.

DEAN BECKER: Well, thank you, sir. I, you know, I can't help but think of all the thousands of people that are now dying from this stupid fentanyl and carfentanyl, and how we just think continuing to do the same thing will fix it. Your response to that, sir.

NEILL FRANKLIN: Well, you're absolutely right, Dean, and it's, I think, well, I know that we in this organization, in this wonderful organization, LEAP, and many of our partner organizations, we absolutely get it. We understand it, that fentanyl, carfentanyl, wouldn't even be in the picture if it weren't for the drug prohibition laws. Okeh?

Because when you turn this industry of selling drugs over to criminals, the cartels, your neighborhood gangs and crews, you cannot regulate it. You cannot control what products enter the market, you cannot control the potency of those products. You cannot control who sells these products, where they sell these products, and who it kills.

You cannot control that under policies of prohibition. That's why I know, we know, that this situation that we're currently in would not exist if it weren't for the policies of prohibition.

DEAN BECKER: You've sure got that right, my friend. Now, as the director of LEAP, you travel the US, heck, you travel the world. You just returned from Brazil, is that right?

NEILL FRANKLIN: I did, I did. As we've been saying, Dean, for a very long time, this is a global issue. These policies of prohibition, we actually export it from the United States to other countries around the globe, and obviously -- and, well, one of those countries is Brazil, obviously.


NEILL FRANKLIN: We started the exporting of these policies through the United Nations back in the twentieth century, led by Harry Anslinger, and then we ended up with the treaty on narcotic drugs, and through financial pressure, economic pressure, we forced these policies down the throats of other countries, and that's why we were in Brazil.

We talk about how fentanyl and carfentanyl, it's killing thousands of US citizens. Let me tell you something, Dean, in addition to the drugs killing citizens in the country of Brazil, every year, because of the prohibition related gang violence, they're losing 60,000 people, in addition to the problems, you know, dealing with the quality of the drugs that are circulating through their streets, and in many of the favelas.

And in addition to those 60,000 people, the police in fighting this war in these neighborhoods in Brazil, the police are killing six thousand citizens.

DEAN BECKER: Well, lord have mercy. Look, we've got this, this crazy -- Duterte in the Philippines, who has --

NEILL FRANKLIN: In the Philippines.

DEAN BECKER: Who has vowed to kill thousands. He said, I might have to kill three million of my citizens to rid our nation of these drugs. And he wears that as a badge of honor, and our current resident of the White House shakes his hand, considers him to be a good buddy, and congratulates him on his efforts. Your response to that, Neill.

NEILL FRANKLIN: So, here's someone who has not a clue as to what this whole drug use situation is about. He has not a clue, he has no idea what's going on mental health wise, he has no idea why people use in the first place. You know, as long as there is one living and breathing, breathing body in the Philippines, there will be drugs in the Philippines.

I, you know, it's -- this is what happens when you allow ignorance to venture into the halls and the chambers and the board rooms of those who lead countries, including our country. We -- we have a responsibility as citizens to educate the people that we elect and place into these positions of extreme power, because if we don't, this is the type of policy setting we get.

So, you know, that's what we do, in LEAP. That's what we will continue to do, as long as this issue exists, and not only that, you know, I, like most people, am really concerned about our kids, Dean, and these policies are the worst possible policies for our kids, no matter what country you're in, as these kids are constantly being recruited by these gangs and the cartels into selling these drugs, they eventually start using, because of the childhood trauma that they see and experience. And then they're dealing with mental health, unresolved mental health issues that foster their addictions.

DEAN BECKER: I do not understand why politicians don't stand forth and proclaim the need to stop funding terrorist cartels and gangs, to basically eliminate overdose deaths, because that's what ending this prohibition would do. Your response, Neill.

NEILL FRANKLIN: Well, I think there are two main reasons here, Dean. Obviously, if there is the ignorance, then -- which is real, you know, I spoke to that, you know, the ignorance of our poiticians as it relates to these policies, to drug use, to people who have problematic drug use, and so on, so we'll continue with that.

The second is that it has now become a big moneymaker. These policies of drug prohibition, the war on drugs, has become a huge moneymaker for corporate America. Whether we're talking about private prisons, whether we're talking about drug testing companies, whether we're talking about the drug, pharmaceutical companies. You know, they don't want to see marijuana legalized in this country or anywhere around the globe, because then their profits suffer.

You know, at every turn, there are so many people, corporations making money off of the status quo. Just like the war on terror. So, we talk about the criminal -- the prison industrial complex, which, you know, is just like the war industrial complex, you know. Whenever there's conflict, people are making tons of money, and the war on drugs is all about conflict.

Dean, no one wants to give up power. No one wants to give up any money. Even our government organizations, such as the DEA, where this huge dynasty is being created. Prior, when, in the infancy of the DEA, the late '60s going to the early '70s and Richard Nixon, then it took on, the Bureau of Narcotics took on the form of the DEA. It was managed by $26 million, was what was needed to run that organization.

Now it ballooned into this dynasty of the past 40 to 50 years, to where it is $2.6 billion every year to run it. It's a huge dynasty. No one running these organizations, or in charge of these organizations, you know, in Congress, wants to lose that power, that they have. No one wants to lose the money that they're making, which, you know, is interchangeable at times with power.

So, that's one of the things that we're also fighting. And Dean, I want to thank a couple of people for bringing us down into Brazil to talk about these issues, and to work on resolving these issues in a country like Brazil. And the first one is Hannah Hetzer. She's with the Drug Policy Alliance. And the other lady is a very, very impressive young lady by the name of Clea Nohia. She is from the SSRC, which is the Social Science Research Council out of New York, and they're just doing great work in countries down through Central America [sic], mainly Brazil, and I just wanted to thank them for making that possible.

We still have a lot of work to do down there. We're going to continue to go down there. And, you know, and Dean, thank you for the work that you're doing over the airways, because, yes, your show reaches policymakers, and it reaches thousands upon thousands of citizens across this country. That's what we need, we need these moments of education for folks. At least, you know, to tickle their desire to learn more, so that they can go to places like our website and others and learn more about these issues and hopefully help us do the things that are needed to resolve them.

DEAN BECKER: Well, you know, elsewhere in this show, I talked to a lady who speaks for Vancouver Health about the Insite safe injection site. I talked to the coroner's office up there in Vancouver, as well. I'm hoping to get additional interviews with others in that regard, maybe those trying to make it happen in Portland and elsewhere.

But the point I'm trying to do here, it kind of coincides with what you're talking about there, Neill. I'm trying to work with the James A. Baker III Institute here to educate the local politicians, and by that I mean Houston and Texas, to the need for a safe injection site in our fair city, to save hundreds of people from dying needlessly each year from these contaminated drugs.

And I'm certain if we can get some traction, you and other good folks from LEAP will help us to make that happen, and I just want to get your thought in that push. I mean, Ithaca, New York, Seattle, San Francisco, many cities are considering this. It's a worthwhile endeavor, is it not?

NEILL FRANKLIN: Oh, it very well is. We have been pushing this ever since the first four states moved with marijuana legalization. You know, Colorado, Washington state, Oregon, Alaska, when they legalized adult use of cannabis, we were already saying, okeh, now what's next? What do we need to do, what can we start, what do we need to start educating people on? And we selected supervised injection facilities, safe consumption spaces, like in Vancouver.

You know, we had visited that location, Bill Fried and I went up there, we spent some time up there, interviewed some great people, doctors and clients who use the facility, and right away, we started pushing that. So going back a couple of years, a few years now, we've been pushing that, and we really think that San Francisco will probably be the first place that we actually get one up and running in the United States.

We're hoping to do some in Ithaca, New York, we're hoping -- I'm working to do one in Baltimore.

DEAN BECKER: Good. Go ahead.

NEILL FRANKLIN: So, yes, this is something that we definitely need to do, because the first thing we have to do, in my opinion, Dean, is to stop people from dying, and this is the number one way to get people off the streets, out of the bathrooms, out of the alleys, out of the hidden places, and get them in front of medical practitioners as they're using, so that their lives can be spared and we can get them into, or get them the necessary help that they believe they need, and when they believe they need it.

DEAN BECKER: That's key, what you just said there, Neill. When they think they need it, because forced treatment, through an arrest, through being caged --


DEAN BECKER: -- just, bows the neck, it doesn't facilitate progress, does it?

NEILL FRANKLIN: It does not. Here's something else that I've learned, Dean, as I've been up in Canada, that, when I've been over in Europe and experiencing, and just learning, and be willing to learn new things, mainly about addiction as I speak to so many doctors who I've had the opportunity to speak to.

Most of the people, when they are afforded the opportunity to visit a place, and use a place like Insite, most people eventually do, because of the interaction and the caring that they feel and the compassion that they feel in these centers. Most people do, eventually, seek that treatment, when they're ready. Okeh? And as you said, that's the important thing, when they're ready.

But you know something else I learned, Dean, is that some people never seek their treatment. And because there are a few people who never the treatment, which doesn't mean we need to force them into treatment, all we need to do is to provide them a safe and secure place to continue using, maintenance, where they can continue using, and have quality of life.

And that's what they're able to do at Insite, that's what they're able to do with the Swiss model, heroin assisted treatment over in Switzerland, and, you know what, that's not such a bad thing, because the person does not die, and they go on, many of them go on to hold down jobs, they go on to, they're reunited with their families, and they live productive lives, just as though -- as though someone who were, who might be on insulin for diabetes for the rest of their lives.

DEAN BECKER: Exactly right. You know, many folks don't realize that one of the founding members of Johns Hopkins University, Doctor William Halsted, was a lifelong morphine user. He was considered to be the father of modern American surgery, and I ask folks, if Doctor Halsted was your surgeon, would you want him to do his morphine or after your operation? And I, I personally would want him to do it before, but that's perhaps --


DEAN BECKER: -- that's perhaps a nebulous thought at this time, but it proves that drugs do not destroy lives. This drug war is much more severe, is it not?

NEILL FRANKLIN: Well, it is. It really is, and what determines whether or not a drug, and when I say a drug, I'm talking all the drugs, legal, currently illegal, what determines whether or not that drug is going to be a benefit to you, or a problem for you, in addition to any mental state of mind you may be in, what determines that is the environment that you, that we, create for the drug to exist.

You know, we should always be looking at creating the most -- the safest possible environment for anything, mainly these drugs, to exist. We can't wipe them from the face of the planet, we don't want to wipe them from the face of the planet, because they carry great benefit, many of them do, when the environment is right. When you're treating pain the way it should be treated, you know, when you're trying to deal with another illness, the way it should be dealt with.

You know, so drugs have a good place, but only if you establish the right environment for them to exist, and drug prohibition, that environment is the worst possible environment that we can create, turning these drugs over to the people who want to make as much money as they can in the smallest amount of time in which they can, and where they have absolutely no regard for the safety and well being of the people that they sell the drugs to, or the people that they employ to sell them, meaning our kids.

DEAN BECKER: Well, the aggravation continues, but it is getting better, slowly, incrementally, a step at a time. We've been speaking with my boss, my good friend, the director of Law Enforcement Action Partnership. I like to remember our old name, Law Enforcement Against Prohibition, because we still do that as well. But I want to thank you, my friend, Neill Franklin. Closing thoughts, sir?

NEILL FRANKLIN: You know, I would hope that people would go to our website, which is LawEnforcemenAction.org.

DEAN BECKER: All right, for today's show, we've certainly been focused on the opioid crisis, the international implications thereof, but there's perhaps a solution to at least part of these problems, and here to talk about is is the deputy director of the National Organization for the Reform of Marijuana Laws, Mister Paul Armentano. Paul, thanks for being with us.

PAUL ARMENTANO: Thank you for having me, Dean.

DEAN BECKER: Oh, Paul, I, you know, I'm looking at NORML's website, there's something that's caught my attention that the NORML group and the Students for Sensible Drug Policy are going to co-host a gubernatorial debate there in Connecticut. That's a sign of progress, is it not?

PAUL ARMENTANO: It is, most definitely is a sign of progress. It's a sign that not only are politicians evolving on the issue of marijuana policy reform, but it also shows that our movement is maturing, and we are being seen more and more as a serious political player in these sort of electoral politics.

DEAN BECKER: And, you know, I bring this up because here locally in the city of Houston, the police chief, the sheriff, the district attorney, the commissioners, everybody is calling for a change, and I think one of the things that has caught their attention is the fact that many studies, many reports, are beginning to show that the use of cannabis can diminish if not, you know, get rid of people's opioid addictions. And you've done some studies in that regard, have you not, sir?

PAUL ARMENTANO: Well, there are now roughly thirty peer reviewed studies in the literature assessing this relationship between marijuana and opioids, and what we see consistently from the literature is that in jurisdictions where patients have legal access to cannabis, their use of opioids decreases, their likelihood of abusing opioids decreases, the incidences of hospitalizations due to opioids decreases, and arguably most importantly, opioid related mortality, both from prescription opiates and from illicit drugs like heroin, fall significantly in jurisdictions where marijuana is legal.

DEAN BECKER: And, it's just one portion of the information coming forward, that it helps decrease the number of car accidents, it actually diminishes children's use in those states where it's legal, it, all of the, you know, sky is falling portended, is just not true. Right?

PAUL ARMENTANO: Well, again, we have now in some jurisdictions, like California, other states on the west coast, nearly a two decade real world experience with the legalization of marijuana for medical purposes. In other jurisdictions, we now have three, four year, five year experiences with the regulation of the adult use of marijuana. And fortunately, researchers have been diligently collecting data from these jurisdictions for the last number of years. That's why we have this wave of studies having been published over the last 18 months or so.

And again, the data is clear and consistent to anybody who wishes to study it. And again, that is the fact that we see lower levels of opioid use, abuse, and mortality in these jurisdictions where marijuana is legal. In addition, we see that those patients who are enrolled in regulated medical marijuana programs are more likely to mitigate their use of opioids or in some cases cease their use of opioids altogether when compared to matched patients, in other words, patients with similar illnesses who are not enrolled in medical marijuana programs.

DEAN BECKER: It's just astounding, you know, I think the, the impetus, the flow, has kind of reversed direction. We're leaving reefer madness, and as indicated before, if gubernatorial candidates are willing to debate with the NORML crew asking the questions, it certainly shows a change of heart, and direction, does it not?

PAUL ARMENTANO: Well, look at what we saw in this last midterm election. We saw for instance in New Jersey, a Democratic governor who ran on a platform of adult use legalization not only defeat his Republican opponent, who opposed such policies, but he is going to replace arguably the most ardent anti-marijuana governor in the country in Chris Christie, and Governor Elect Murphy in New Jersey is not backing off this stance, in fact, within hours of winning that race, he reaffirmed his pledge to enact legalization in the first hundred days of his administration.

So, we are seeing now in some cases for the first time these electoral candidates who are seeking office are running on platforms of marijuana law reform. They recognize that seeking these sort of legislative changes is not a political liability, it's a political opportunity, and I think the candidates, at least some of the candidates in this Connecticut gubernatorial race are taking this same strategy.

DEAN BECKER: Now, that's, you know, a state situation, I was talking about, you know, county and city officials here in Texas, but, at the federal level, we are gaining some traction. We aren't exactly up and running as fast as we want to go, but there is some impetus there as well, right?

PAUL ARMENTANO: Well, again, you know, the federal battle in many ways is very different. You have to deal with largely Republican leadership, you have to deal with heads of certain committees, who are really reluctant to move forward with regard to this issue, and it makes the opportunities for enacting changes at the federal level very few and far between. It also allows those opportunities to be quashed by literally just one or two members of Congress.

So while our overall support at the federal level is growing in numbers, it is hard sometimes to see that tangible support reflected in legislative change, because literally there are a handful of about half a dozen lawmakers in Congress that are literally holding back any sort of reform from taking place.

DEAN BECKER: Yeah, I've heard it said many times that if they were allowed to vote in secret, marijuana would be legalized today, but that's, that's for another day, I suppose.

PAUL ARMENTANO: Well, at this point, I think we're actually at, at, in a situation where if they were simply allowed the vote, we would win many of those battles, but the reality is, is that there are again a simply a handful of members who run certain committees. Peter Sessions from Texas, who runs the House Ways and Means Committee, for instance, has stifled the opportunity for House members to vote on any marijuana issue this year.

In the Senate, for instance, Charles Grassley, the Republican Senator from Iowa who heads the Judiciary Committee, has blocked any opportunity to vote on marijuana law reform in the Senate. We're literally talking about a hand -- a handful of politicians who have the ability to squash the will of the majority in Congress.

DEAN BECKER: Dang it. Okeh. Well, some powerful words from Mister Paul Armentano. He's the deputy director of the National Organization for Reform of Marijuana Laws. They're out there on the web at NORML.org. Check out their website, get involved, do your part. Help end this reefer madness.

SAM CHAPMAN: My name is Sam Chapman, and I'm a co-founder of a new group based out of Portland, Oregon, called Safer Spaces Portland. We are a coalition of Portland residents, parents, business owners, health professionals, and current and former users advocating for a safe consumption space here in Portland.

DEAN BECKER: Now, I, earlier in the show I talked to some folks up in Vancouver, folks that, you know, deal with Insite, I talked with the coroner in Vancouver, and we have a horrible situation in Canada, in the US, this fentanyl, carfentanyl, is extrapolating the problem, is it not?

SAM CHAPMAN: It is indeed, and especially something we're very wary of here in Oregon, we -- we're constantly trying to test as much as we can at our needle exchange here in Portland, and we're not seeing the worst cases yet, but it does seem to be coming from the east coast to the west coast, and that is obviously one of many reasons as to why we are advocating for safer spaces to provide clean supplies and hopes to continue to prevent hepatitis B, C, and HIV, as well as opening the door to treatment and recovery.

These places, we envision them being able to provide health and social programs for folks who are interested in treating their addictions, and looking for help.

DEAN BECKER: Yes, Sam, now, yours is in somewhat of a start up phase, I'm aware that Ithaca, New York, Seattle, San Francisco, and now my city of Houston, are, have --


DEAN BECKER: -- getting their legs, so to speak, trying to bring the idea of the need for safe consumption facilities to these cities. Where are you at insofar as reaching the proper elected officials? Tell us about the progress made thus far.

SAM CHAPMAN: Yeah, great question. Things have been moving very rapidly, and as you've just mentioned, there is national momentum right now around this issue, and that was one of the main reasons that I made the decision to kind of really jump in and just start connecting folks. This is not a new conversation here in Portland. It's gone on for many years, and there's a lot of advocates that have been working very hard to provide a lot of harm reduction services.

The dots just hadn't been connected yet, and so about three months ago, I started convening closed door meetings with the city of Portland, the mayor Wheeler's office, and the county health department, along with our county run and funded needle exchange in Multnomah County, to talk and explore the idea of safe consumption spaces.

Those conversations have continued to develop. I had a city council member, Chloe Eudaly, comment on my Facebook page last night that she's interested, very interested, in this conversation. The mayor's office has read the studies. They are leaning towards supporting, but really, what we have in front of us right now is educating the general public, and really bringing together a coalition of people to flesh this issue out and really give it a good, thorough conversation within our community, so we can really educate folks on the current problem and how safe consumption spaces are a viable potential solution.

DEAN BECKER: Right. And you mentioned aligning with various groups of people. I'm sure that's going to include ministers and healthcare providers, politicians, law enforcement, district attorney, legislators, the whole shooting match, isn't it?

SAM CHAPMAN: Yes, absolutely. It's really important that we get community buy-in up front in this type of conversation. We're watching other localities very closely, and we've done our homework as to what has and what hasn't worked around the world.

And it's really important that although these are going to be tough conversations, and at times there may be a pushing of the pause button, if you will, to really step back and take a breath, I do think that the momentum that we have and the urgency surrounding the opioid epidemic in general reaches every corner of every type of group. And I think that we are well positioned to have productive conversations over the next couple of months.

DEAN BECKER: Right, and I think the, if you will, the opium epidemic, so to speak, is certainly helping to bring focus, helping, that's a horrible word to use, but it's bringing focus to bear on this problem.

SAM CHAPMAN: Sure. It is, absolutely, I mean, there's a case out in Denver, some of our friends out there have been doing a lot of really good work, you know. One of the council members in Denver was addicted to pain pills because he had broken his back, and got addicted. Right? I mean, these are not, you know, the stereotypical stigmatizing type of, you know, drug users that we necessarily see, you know, in the movies.

I mean, these are also everyday people, you know, not to mention that a lot of these people are also homeless. There's a big correlation between, you know, homelessness and unstable housing, I mean, directly associated with a host of unsafe injecting behaviors, from reusing needles to, you know, improper disposal. And so I think, you know, there's a lot of good work to be done here.

DEAN BECKER: There is, indeed. Once again, we've been speaking with Mister Sam Chapman, he's with Portland's Safer Spaces, which is trying to lower the instance of death and disease from drugs. Sam, we're going to have to stay in touch with one another, help coordinate this, get in touch with folks in Ithaca, San Francisco, see what we can all learn and share to bring this forward. Any closing thoughts, a website you might want to share?

SAM CHAPMAN: Sure, yeah, if anyone's interested to learn more about Safer Spaces Portland, please feel free to head over to SaferSpacesPDX.com. We're also on Facebook, and feel free to reach out to us, either on Facebook or through our website. If you'd like to get involved or if you're in another part of the country and you're already working on things, I mean, Dean's absolutely right, it's a coalition effort of advocates that are learning from each other in live time across the country, and it's important that we all work together and help each other utilize resources to get this done.

DEAN BECKER: As Sam Chapman indicated, it's going to take a hell of a lot of us doing our part to end this madness. And once again, I want to remind you, as this is so obvious within this show, because of prohibition you don't know what's in that bag. Please, be careful.

To the Drug Truth Network listeners around the world, this is Dean Becker for Cultural Baggage and the unvarnished truth. Cultural Baggage is a production of the Pacifica Radio Network, archives are permanently stored at the James A. Baker III Institute for Public Policy. And we are all still tap dancing on the edge of an abyss.