11/14/18 Doug McVay

Dean Becker joins COL host Doug McVay who shares audio with Jules Netherland with Drug Policy Alliiance speaking about medication assisted treatment before a committee of the National Academy of Sciences, Engineering, and Medicine; and we hear from Ann Fordham with the International Drug Policy Consortium speaking about the state of international drug control before the Commission on Narcotic Drugs on November 8

Program: 
Century of Lies
Date: 
Wednesday, November 14, 2018
Guest: 
Jules Netherland
Organization: 
Drug Policy Alliance
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TRANSCRIPT

CENTURY OF LIES

NOVEMBER 14, 2018

DEAN BECKER: The failure of drug war is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization, the end of prohibition. Let us investigate the Century Of Lies.

DOUG MCVAY: Hello, welcome to Century of Lies. I'm your host Doug McVay, editor of DrugWarFacts.org. And this week, we come to you as a co-production of the Drug Truth Network, little sister comes home and hangs out with the executive producer of the Drug Truth Network, Dean Becker, and the flagship show Cultural Baggage.

This is a co-production of sorts, and it's the first time, and this is a great time. We had a lot of good stuff in the last, I was unfortunately off air for part of it, but got to hear Paul Armentano. Now, we're going to be moving onto some other things.

The Commission on Narcotic Drugs was holding intersessional meetings recently. They were talking about progress toward the political goals that were set back ten years ago, 2019 is their target year for these goals, and we're going to hear some of the -- something from that. We're also going to hear from a recent meeting, the National Academy of Sciences, Engineering, and Medicine held a workshop on methadone -- excuse me -- medication assisted treatment.

So, we're going to hear a portion of that, Jules Netherland from the Drug Policy Alliance is going to talk about policy and treatment effectiveness.

It's good to get people who have lived experience, and who have solid policy experience, and who have that kind of, sort of -- breaking down the silos is important, and so to have people with a mixture of stuff in their background is really great.

But first, I want to say, hey, Dean, so, good show so far.

DEAN BECKER: I hear you, Doug. Thank you for allowing me on your show this week. Yeah, folks, and I just want to explain something. It was five years ago, I, hell, I'm getting old, I gave it up for several reasons, but Doug's been producing Century of Lies for the last five years, more or less, and I just want to thank him. I want to thank his audience for continuing to listen to the Drug Truth Network stuff, and I hope you'll continue to support the work we do and, I don't know, keep rattling the cage, because them politicians are tired of hearing that rattling, I think. Anyway, back to you, Doug.

DOUG MCVAY: I'm just -- yeah, I'm just following from what Dean was just saying. This -- not quite twenty years ago, Dean started broadcasting with Cultural Baggage, and then set up his second show, both of them airing out of the Pacifica station, produced out of KPFT -- pardon my stammer -- but then also syndicated through the Pacifica Foundation Radio Network and through the site, and so there are loads of stations out there that carry Drug Truth Network programming.

It's getting these ideas out to the public. They're not the most popular, and yet they are so very important. I mean, it's the intersection of criminal justice and public health and civil rights, and throw in some individual health care, too, and economics, and education, all of these things that get affected because of drug policies.

And so, drug policy reforms, they're necessary, and they affect our lives in so many different ways. And, I'm just grateful to heaven that Dean has been able to get this kind of programming on the airwaves. These are important discussions, and unless there's somebody out there starting that conversation, it just doesn't happen.

And, yeah, I'm just -- it's a great honor to be part of this whole thing, and I just want to thank Dean for keeping the torch going for so long. It's -- yeah.

DEAN BECKER: Doug, look, you were going before I was going. You were in more the print media. It was nice to see you adapt so well to audio, to radio, as well, and, folks, it really boils down to this: there's nobody on the other side. By that I mean nobody willing to come on the show, and defend this drug war.

They fear the truth that me and Doug are bantering about. They know their side's losing, their side has lost. It's all over but the dying or something, but, you know, it's happening. But, Doug, you said you had a couple of segments you wanted to share with the folks. Which one were you thinking of doing first?

DOUG MCVAY: Yes, indeed, well, let's go with the Commission on Narcotic Drugs first, and a presentation from the Director of the International Drug Policy Consortium, that's Ann Fordham. Ann Fordham -- the IDPC does some terrific work coordinating the progressive reform oriented NGOs that are active in these United Nations processes.

There are lots of us around Europe and around the world, and we starting to have some real impact. Change at the international level, it's true what Paul Armentano said earlier on the show, it's slow, if it ever happens, it's incremental and that's being kind and generous.

DEAN BECKER: Yeah.

DOUG MCVAY: On the other hand, in these nations, things do happen, and it's, you know, ideas, they do have impact, and when we see something happening in one country, that encourages folks here, and, you know, I mean, Uruguay legalized marijuana a few years ago when we were talking about legalizing in Colorado and Washington, and, you know, I believe truly that that had an impact.

All of these things, policies don't happen in a vacuum. Anyway, let's get on with Ann Fordham, she's the executive director of the International Drug Policy Consortium, she was addressing the Commission on Narcotic Drugs on November Eighth, specifically talking to them about the progress that the world has made towards its goals that they're supposed to review next year.

ANN FORDHAM: Firstly, as a civil society representative, I would like to thank you, Madame Chair, and the CND Secretariat for your continued commitment to the meaningful engagement of civil society in this forum.

The practice of civil society engagement at the CND is increasingly held up as a good practice example, and the great strides that have been made on that front in the last ten years is strongly welcomed, and appreciated.

The role of civil society, part of the role, indeed, is to bring the realities on the ground to bear in these important discussions. In formulating social and public policy, it is fundamental to consider the impact on the lives of people and communities, on public health, and on human right, both at the core values of the United Nations.

Thank you in particular, all of you, for your collective support to the civil society task force, of which I am a member. We have continued our work after the UNGASS to engage global civil society from all regions of the world in the lead-up to 2019.

We have just closed the global online consultation to seek new inputs from civil society on their views on the last decade of drug policies and ideas for the future. The results of that consultation will be presented here in Vienna, on the Fifth of December, and we invite you all to attend.

My intervention today however is on behalf of the International Drug Policy Consortium, IDPC. We are a global network of a 105 civil society organizations from over sixty countries. The majority of our members are working at the national level, and include networks of people who use drugs, representatives of farming communities, and other affected populations.

We come together to promote open and objective debate in drug policy making and call for evidence based policies that are effective at reducing drug related harm, that are based also in the broader priorities of the United Nations: human rights, development, peace, and security.

In Resolution 60/1, member states agreed to take stock of the implementation of the commitments made to jointly address and counter the world drug problem. As a contribution towards this critical discussion of taking stock, and in the absence of a comprehensive formal review process, IDPC has produced a civil society shadow report that reviews progress towards the overarching goals from the 2009 Political Declaration and Plan of Action.

In addition, the report also seeks to evaluate whether, and how, the implementation of the Political Declaration has contributed to the broader priorities of the UN, of protecting human rights, advancing peace and security, and promoting development. 

And finally, our report offers recommendations for new goals and metrics for the next decade of drug control, focusing on the UNGASS implementation and the achievement of the sustainable development goals.

In terms of the methodology used, in addition to looking at the progress on the targets from Operational Paragraph 36, we selected 33 actionable and measurable actions out of the 234 actions in the Plan of Action.

We looked at the best available data between March 2009 and July 2018. The data are largely taken from UNODC and supported by other UN data from WHO, OHCHR, UNAIDS, UNDP, and others, as well as academic and civil society research. Our report is supported by 685 references.

There is a great deal of data in the report and I invite you to read it. We have hard copies here with us today. It's available at the document center but also available online as well.

For now, I'll briefly just share some of the headlines, with specific references to the targets from Operational Paragraph 36, and this is just a really brief snapshot, and also Angela Me presented some of these data today, and as I said, we took a lot of this from the World Drug Reports.

On Target One, which seeks to reduce or eliminate the cultivation of certain plants, data from the UNODC shows us that over over the last decade, there has been an increase in opium and coca cultivation, which are now at record levels.

On Target Two, which seeks to reduce both illicit demand as well as health and social risks, we note, as stated this morning, an average increase by thirty-one percent in the global demand for all drugs.

With respect to reducing health and social risks, we have not seen a reduction in HIV, hepatitis C, or TB prevalence amongst people who use drugs. Overall infection rates have remained stable, but in some regions are still increasing.

There's a worrying increase in drug related deaths, with WHO reporting some 450,000 deaths in 2015. Around one third to one half of these are fatal but mostly preventable overdoses, and the rest of them complications related to HIV, hepatitis C, or TB infection, which are also to some extent preventable and treatable.

On Target Three, which seeks to reduce the availability of psychotropic substances, including synthetic drugs, there has been a huge increase in the number of new psychoactive substances on the market.

In addition, the available data shows increasing production and expanding markets for methamphetamine, and the record levels of the illicit use of prescription drugs in some parts of the world.

On Target Four, which seeks to eliminate and reduce the diversion and trafficking of precursors, despite the best efforts of member states, the INCB reports an increase in the use and number of precursors.

On Target Five, to eliminate or reduce money laundering, again, despite tighter controls, estimates are that less than one percent of all money being laundered is currently being seized.

In parallel, we looked at the impact of drug policies on the fulfillment of human rights, and in particular the right to health. Globally, only one in one hundred people who use drugs live in countries -- who inject drugs, I should say, live in countries with adequate coverage to both needle and syringe programs and opioid agonist therapy.

While for evidence based treatment, there is reportedly little increase in the availability of drug dependence treatment between 2010 and 2016, and coverage remains low for many key treatment interventions, such as detoxification, opiate substitution treatment, peer support groups, cognitive behavioral therapy, to name just a few.

We've discussed this already today, also in terms of access to controlled medicines, around 75 percent of people remain without access to adequate pain relief, and this is primarily in the global south. The WHO has estimated that 92 percent of the world's morphine is consumed by only 17 percent of the world's population.

In terms of other human rights impact, we see continued use of the death penalty for drug offenses, and a very troubling increase in the number of extrajudicial killings in the name of drug control.

With respect to human rights associated with incarceration and disproportionate punishment, according to UN data, one in five prisoners worldwide is incarcerated for a drug offense, the overwhelming majority of whom are incarcerated for drug possession -- a possession offense alone.

In certain regions, the proportion is even greater for women, who are the fastest growing prison population in many parts of the world.

Finally, in terms of advancing development, there has often been too great a focus on eradication measures at the expense of a broader development focus that takes into account the particular issues faced by communities in both rural and urban contexts.

In formulating the next phase of drug policy, we call on member states to honestly consider the progress, or lack thereof, that has been made towards the overarching goal in the 2009 Political Declaration to significantly reduce or eliminate the illicit drug market, as well as the progress made towards the implementation of the UNGASS outcome document.

As our shadow report states, it is difficult to credibly claim progress given the reality of a robust and growing illicit drug market, coupled with both -- a rise in both drug related harms as well as devastating policy harms.

Ten years ago, the previous UNODC executive director, Mister Costa, referred to the unintended negative consequences of drug control as part of that previous ten year review. That paper is as unfortunately relevant today as it was ten years ago.

In addition to offering up our shadow report as a key contribution to this important phase of taking stock, the IDPC network has come together and elaborated four key asks for the 2019 process.

Firstly, the international community should consider adopting more meaningful goals and targets in line with the 2030 Agenda for Sustainable Development, the UNGASS outcome document, and international human rights commitments, and move away from targets that are focused solely on eliminating the illicit drug market.

Secondly, member states should meaningfully reflect on the impact of drug control on the UN goals of promoting health, human rights, development, peace, and security, and adopt strategies that actively contribute to advancing the 2030 Agenda, especially for those most marginalized and vulnerable.

Global drug policy debates -- sorry. Thirdly, global drug policy debates going forward should reflect the realities of drug policies on the ground, both positive and negative, and discuss constructively the resulting tensions with the UN drug control treaties and human rights concerns associated with drug control efforts.

Finally, beyond 2019, member states should end punitive drug control approaches and put people and communities first. This includes promoting and facilitating the participation of civil society and affected communities in all aspects of the design, implementation, evaluation, and monitoring of drug policies.

Thank you very much for your consideration, and your continued commitment to civil society.

DOUG MCVAY: That again was Ann Fordham, the International Drug Policy Consortium, addressing the Commission on Narcotic Drugs. That was on November Eighth. Those meetings go on in Vienna, Austria, at the UN International Centre, and they don't -- they don't maintain an archive.

I mean, there's a video, which is live, webcast live, but there's no archive of these proceedings. Whatever happens at the CND is what they say happened at the CND. A few years ago, the International Drug Policy Consortium was working through civil society in trying to get a voice from NGOs inside these proceedings, and one of the things that they worked on was a project to track what actually happens there, and to make it known publicly.

They have a thing called the CND Blog, which is on the web at CNDBlog.org. The Commission on Narcotic Drugs is a UN agency, it's part of the United Nations Office on Drugs and Crime. There's no technological reason that they don't have an archive, and the idea that it's about finances is more insulting than it is laughable.

I mean, there is no other reason that they fail to maintain an archive of their proceedings, there's no other reason than the fact that they want to avoid transparency. The international drug control apparatus is opaque, and that's how they get away with doing nothing.

And meanwhile, in the United States, we talk about being unable to make these changes or this or that because of international treaties and the Single Convention. And, yet, a lot of countries are trying to move in a better direction.

We find out about this through the Commission on Narcotic Drugs, through these meetings, but, again, unless you want to stay up overnight and watch a live meeting out of Vienna, whatever happens there is what they say happens there. That's one of the reasons I do stay up overnight and record this stuff, because, you know, it's important. Light, it's a great disinfectant, you know?

DEAN BECKER: Can I jump in here a second and say this, that, am I on here or what's going on? Okeh --

DOUG MCVAY: I think you are. I hear you.

DEAN BECKER: You hear me, okeh. Yeah, what I'd like to say, I guess, is that Doug is a little younger than me, he's able to stay up more often, and certainly he drinks one hell of a lot of coffee. I'm just going to say that, because he is -- he's just a man in action, and, you know, my hat's off to him for his perseverance in grabbing this stuff, early in the morning like that.

VOICE: Okeh, let's say drug prohibition does support terrorism.

DEAN BECKER: And murder.

VOICE: And murder.

DEAN BECKER: Torture.

VOICE: And torture.

DEAN BECKER: Corruption. Bribery.

VOICE: And, whatever.

DEAN BECKER: What's your point?

VOICE: Change the law.

DEAN BECKER: I got you. Make it cheap. More available. Everywhere. Like soda, or cheesy puffs.

VOICE: Exactly.

DEAN BECKER: Cocaine at the playground. Crack stands at the laundromat. Heroin at the mini-mart. Like that?

VOICE: Face it, old man. That's what we've got now.

DEAN BECKER: Please, visit the website of Law Enforcement Against Prohibition, LEAP.cc.

DOUG MCVAY: And Dean has seen me at conferences doing coffee well into the late afternoon, into the evening. It's -- you know, I live in Portland, Oregon, and this place chose me. What can I say?

DEAN BECKER: Well, yeah. I would agree with that. Yeah, we have, you know, you and I have been to a lot of conferences together, we've interviewed, good lord, hundreds and well thousands of people at this point, and I guess, what we're looking for is that one chance to strike a blow to the logic of this drug war. Am I right?

DOUG MCVAY: Absolutely, absolutely, and that's why some of these are so important. Folks, well, our next segment, in fact it's a good segue, for instance our next segment is Jules Netherland from the Drug Policy Alliance. They were speaking at the National Academy of Sciences, Engineering, and Medicine, at a workshop that was going on regarding medication assisted treatment for opioid use disorder -- basically methadone, suboxone, and buprenorphine.

Last week, we heard Maia Szalavitz, who was brought in to speak. This week we're listening to Jules Netherland from Drug Policy Alliance, and what is -- I mean, the content is important, it's very -- it's thought provoking and it's incredibly informative. It's also worth noting that it happened.

DEAN BECKER: Well, Doug, if we're going to squeeze --

DOUG MCVAY: They can't say that "we didn't know," you know?

DEAN BECKER: If we're going to squeeze it in we've got to start.

DOUG MCVAY: Okeh.

JULES NETHERLAND: I approach this as someone whose background in public health research but mostly someone who's working in the arena of policy now, and so, I'm going to sort of take a broader, more macro view.

I want to suggest that as we think about education and training, we need to broaden our scope and help clinicians and others see addiction within a broader context, and sort of move beyond specialty training and put the issue of addiction and drug use into a much wider context.

I also want to suggest that when we're thinking about education and training, we really need to think about providers beyond clinicians, and other sectors that folks are going to intersect with and interact with, especially if we want to think about innovative policy ideas to expand access to MAT.

So, in particular, when I think about this, and think about a public health approach to expanding access to medication assisted treatment, I want to talk a little bit about the social determinants, and think about how are we providing people the supports they need to get healthy, regardless of their current drug use, whether they're on medication assisted treatment or not, and so housing, jobs, and the kinds of social support that people need.

I also want to suggest that part of what we need to be addressing, if we want to address stigma, is ending the criminalization of drug use entirely, and setting aside strategies that rely on punishment and coercion. I don't see how we can talk about any stigma on the one hand and continue those practices and punitive policies on the other.

I also want to suggest that part of the conversation about access to medication assisted treatment also needs to include attention to harm reduction services. If we believe that relapse is part of the course of addiction, then we need to be giving people support when they relapse and when they use, and keeping them safe and healthy, and I think we've done a terrible job at integrating treatment services with harm reduction services. Those two silos hardly ever speak to one another and are not well integrated, and that doesn't serve patients well at all.

The other thing I want to suggest as we think about education and training is that we really need to be listening to people who use drugs, whether they're current users or former users, they need to be in these rooms, they need to be part of our education and training, they need to be part of our policy development.

I will tell you as someone who's done a lot of policy development, when you don't include people directly impacted, you end up with really poor policies that have a lot of unintended consequences and are not well liked by the people that we're trying to help. So I really want to emphasize that.

Obviously, MAT is only a piece of the puzzle, and it won't succeed if we're not addressing these other social determinants in broader context that make up people's lives.

I also want to suggest one way to do that and make that shift is to start looking at outcomes other than abstinence, but to really be focusing on things like quality of life, family reunification, sort of stabilization and normalization of everyday living. Getting jobs, housing stability, that kind of thing.

And then talking a little bit about other arenas that I think we need to pay attention to in terms of education and training, and I apologize that I wasn't here for the first part of this session, but I think obviously correctional settings are a huge area where we could do a lot more to expand access to MAT, whether that's continuing MAT for those entering correctional facilities, screening and assessment for those entering who may or may not be on MAT, compassionate withdrawal for those who choose not to stay on MAT while they're incarcerated.

Offering people inductions prior to release, creating warm hand-offs to community providers upon release, and obviously there's some jurisdictions that are doing this quite well. And then, making sure that people have naloxone and harm reduction referrals upon release as well as referrals to treatment.

So, obviously, if we're going to do that, the impact on education and training is that we need to do a much better job training all the folks in that sector, from drug court personnel to correctional personnel, to probation and parole.

And then finally I want to talk a little bit about some of the innovations, service delivery model innovations, that are being floated and piloted in some jurisdictions and thought of in others, so this also has implications for workforce training.

So, one is office based methadone, delivering methadone and buprenorphine in pharmacies, induction and maintenance in emergency departments, homeless and housing programs, street based medicine and harm reduction programs. These are all areas and programs that are ripe for reaching people that are hard to reach. Telemedicine and the ECHO model for rural areas, the hub and spoke model, mobile delivery.

So there are lots of different innovations around expanding access to MAT, but that's obviously going to mean -- have implications for workforce development. That means we need to be training pharmacists, we need to be training primary care, family medicine, emergency medicine, rural providers, housing providers, homelessness service providers. Right?

It really means an incredible expansion of the kind of education and training we're doing, including frankly harm reduction providers as well.

DEAN BECKER: All right, folks, got to interrupt there, we're flat out running out of time. Doug, I wanted to give you -- we're producing this at the mothership, KPFT, this week, but this is Doug's show. We've got you about a minute left, Doug, wrap it up if you will, please.

I don't know where Doug has disappeared --

DOUG MCVAY: Sorry, hey there. Just want to say that was Jules Netherland from Drug Policy Alliance, she was speaking at a workshop on medication assisted treatment at the National Academy of Sciences, Engineering, and Medicine, and just thanks everybody for joining.

DEAN BECKER: Well, and I thank you. Doug, we'll fine tune this, hopefully maybe once a month we'll do this cross-pollination, both go live back to back for our network. I appreciate you hanging in there. We've got, well, I cut it a little short, it seemed like a good place to interrupt, but you've got about 45 seconds, you got some info you'd like to share?

DOUG MCVAY: Well, you know, just to remind folks to give our facebook pages a like, the Drug Truth Network has a facebook page of course. You can also catch these programs by podcast, the URLs are at the network home page. Follow me on Twitter, I'm @DougMcVay, and mostly just want to thank you all for joining us.

We'll be back in a week, and, yeah. This is Doug McVay saying so long. So long!

For the Drug Truth Network, this is Doug McVay asking you to examine our policy of drug prohibition: the century of lies. Drug Truth Network programs archived at the James A. Baker III Institute for Public Policy.