10/09/19 Liz Evans

A federal judge has rejected the Justice Department's attempt to stop Philadelphia nonprofit Safehouse from setting up a supervised consumption facility. On this week's Century we hear from Liz Evans, one of the founders of North America's first supervised consumption site, Insite, in Vancouver, BC. Plus, an update on the vaping crisis.

Program: 
Century of Lies
Date: 
Wednesday, October 9, 2019
Guest: 
Liz Evans
Organization: 
Drug War Facts
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TRANSCRIPT

CENTURY OF LIES

OCTOBER 09, 2019

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 and welcome to Century of Lies. I am your host, Doug McVay, Editor of DrugWarFacts.org.

On today’s show we are going to talk about harm reduction and supervised consumption sites. On October 2nd, a federal judge ruled that the federal Crack House Law does not apply to supervised consumption sites clearing the way for Safe House, a Philadelphia nonprofit to start opening a legally sanctioned, supervised consumption site. It would be the first in the United States. Activists around the country are celebrating that victory and are moving forward with plans for their own areas. We will be talking about that and hearing about that in a bit, but first loyal listeners will know that I have been talking quite a bit about the vape crisis over the last few weeks. There is a lot of misinformation that is going out, especially via social media about what’s happening.

The bottom line is that the Centers for Disease Control and state health agencies do not yet know what is causing these vaping illnesses – these vaping related lung injuries. They do not yet know why people are getting sick and dying. Anyone who is telling you that they know the cause or that it is this thing or another is blowing smoke. The reality is that we don’t yet know what is going on. There is some misinformation out there and I think the best way to counter it is just to give you some of the facts. For instance, this is a portion from a news conference on September 26th, Oregon’s State Health Officer, Dr. Dean Sidelinger, MD, MSEd, FAAP. This is Dean Sidelinger’s response to a question from a reporter.

MALE VOICE: Speaking of those products, let’s say there were cannabis products – were these products that were licensed to be sold in the state of Oregon or are these for lack of a better term, black market?

DR. SIDELINGER: For the products that were used by the people in Oregon were all from licensed retailers. That is not the case in all of the cases across the nation where there has been a mix of products that come from licensed retailers as well as unlicensed retailers but in Oregon all of the folks who have been reported to have this injury have reported having licensed cannabis products.

DOUG MCVAY: That was Dr. Dean Sidelinger, MD, Oregon’s State Health Officer. To repeat – patients in the state of Oregon with vape related lung injury including the two who died appear to have gotten their vape carts from legal, regulated dispensaries. They were not coming off the illicit market. We do know that there are problems with illicit market out there but we do not know that this is entirely what the source of these problems are. In fact, in the state of Oregon it seems that these folks got them through the regulated market. So there is more going on than we know about. Now I have been trolled on Twitter a bit from some of the people from the vape industry. They have been claiming that they are regulated by the FDA, they have to jump through so many hoops. The problem is that they haven’t actually done that. These premarket tobacco product authorizations have not actually been filed. Most of the industry is actually operating in some respects illegally and the FDA has been letting them get away with it. You don’t have to take my word for it – straight from the horse’s mouth – acting FDA Commissioner Ned Sharpless. He testified before the Subcommittee on Oversight and Investigations and the Committee on Energy and Commerce on Wednesday, September 25th. The hearing was entitled “Sounding the Alarm – The Public Health Threats of E-Cigarettes”. We are going to hear now an exchange between Ned Sharpless, acting Commissioner of FDA and Representative Diana DeGette who is the Chair of the Subcommittee on Oversight and Investigations.

REP. DEGETTE: Now, Dr. Sharpless, the 2009 Tobacco Control Act gave the FDA the authority to put e-cigarettes under its regulatory authority which the FDA did in the 2016 Deeming Rules, is that right?

DR. SHARPLESS: That’s correct.

REP. DEGETTE: And in 2017 the Administration extended the compliance deadline by four years for companies to submit materials to the FDA for review of the public health risks of e-cigarette products, is that right?

DR. SHARPLESS: That’s correct.

REP. DEGETTE: Is it accurate to say that e-cigarette products are only on the market because the FDA has exercised its enforcement discretion to allow them to remain on the market and not because the products have been reviewed by the FDA?

DR. SHARPLESS: All Enz products currently on the market are illegal. They have not been reviewed by the FDA specifically.

REP. DEGETTE: Okay. In fact your testimony says, “No Enz product in the United States is on the market legally”. Right?

DR. SHARPLESS: Right.

REP. DEGETTE: Okay. So you also agree with the CDC that e-cigarette products are not safe, is that right?

DR. SHARPLESS: E-cigarette products are not safe. They are not without harm.

REP. DEGETTE: Okay. So here is my concern, both FDA and CDC says e-cigarettes are not safe. We are seeing an explosion of young people using the products and now we are seeing serious illnesses around the country – but FDA still allows these products to stay on the market even though they haven’t undergone a full market review. I think time is of the essence. When does the FDA intend to use its regulatory authority to assess the health impact of these products?

DR. SHARPLESS: I agree with you. I think time is of the essence. I think the context of the history is perhaps important. In 2017 when that light regulatory touch was taken the data at that time showed that youth use for those products was leveling off or going down and therefore I think the FDA being a science driven organization opted for that policy at the time. Then what happened, as you described, is this epidemic of youth use.

REP. DEGETTE: Right.

DR. SHARPLESS: And now we have accelerated our timeline, we have stepped up enforcement, we have stepped up education, and I can tell you we are on this problem –

REP. DEGETTE: So what is your timeline?

DR. SHARPLESS: --the next major development will be the finalizing of this Compliance Guidance which will have the effect of removing nontobacco flavors from the market and we expect that to be weeks.

REP. DEGETTE: Okay, and then what are you going to do after that?

DR. SHARPLESS: Typically when a Guidance is finalized it has 30 days to go in to effect or some period along those lines and then we apply an enforcement strategy which –

REP. DEGETTE: Is the flavor strategy the only thing the FDA intends to do?

DR. SHARPLESS: I can’t speak to the Guidance and process but it is certainly the major target of that effort.

REP. DEGETTE: Why is that? Do you think that is going to solve the youth vaping epidemic?

DR. SHARPLESS: No. We do not believe that any single policy or process will solve the vaping epidemic. It is a combination of enforcements, education, and multiple policy things that we are doing.

REP. DEGETTE: And are you continuing to review these products to see if they are inherently safe or unsafe?

DR. SHARPLESS: All Enz products will have to submit an application to the FDA by May 2020.

REP. DEGETTE: Okay.

DR. SHARPLESS: So very soon everything should be coming in, but flavors would be removed from the market sooner than that because of our concerns about the youth epidemic of use.

REP. DEGETTE: Okay. Just one last question. How far is the FDA prepared to go to protect the health and wellbeing of young people if it determines that these are unsafe?

DR. SHARPLESS: The FDA is a science driven organization. If the data supports more aggressive measures than we will take those measures.

REP. DEGETTE: How far?

DR. SHARPLESS: We could ban all flavors for example.

REP. DEGETTE: Thank you.

DOUG MCVAY: That was Acting FDA Commissioner Ned Sharpless, MD., testifying before the Subcommittee on Oversight and Investigations and the Committee on Energy and Commerce on Wednesday, September 25th. He was being questioned by the Subcommittee Chair, Representative Diana DeGette. Again, to emphasize what Dr. Sharpless just said, the reality is – none of these nicotine vape companies are technically operating legally because none of them have actually filed their Premarket Tobacco Product Authorization’s. We don’t know what is in those products. The companies are able to hide their ingredients. Sometimes they call them a proprietary mix – trade secret. RJ Reynolds has a product that they use for flavoring, they call that product simply Butter Starter Distillate. Sounds innocent until you check what the FDA says Butter Starter Distillate is and then you find out it is largely Diacetyl. Diacetyl has been implicated in lung injuries, especially with workers in microwave popcorn plants because although it is a food additive that is relatively safe when you put it in to food and then consume it normally. When you heat it to the boiling point and then inhale the hot gases that result, Diacetyl can be dangerous and Diacetyl is going in to tobacco products. Is it going in to the vape products? Maybe, but a lot of them are withholding their ingredient lists.

Now take whatever position you want to take on bans. Bans are a stupid idea. Prohibition never works. If we don’t have full disclosure of what is going in to these products. Isn’t that the purpose of regulation? We need to have drug safety testing at festivals. We should have it in city streets and in supervised consumption facilities which we will talk about in a moment. We should have it there and the reason is that you need to know what is in that product. You need to know what is in that drug you are taking. People are selling these products legally and yet we don’t know what is in them. That is wrong. Regulation is supposed to mean enhanced product safety. It is supposed to mean testing. It is supposed to mean that we know what the ingredients are and yet we are allowing the tobacco and vape industry to get away with – well I won’t say murder because that would be jumping to judgement. What they are getting away with is lying to consumers. They are lying to you and me and that has got to stop.

You are listening to Century of Lies, I am your host Doug McVay. We have been talking about vaping and harm reduction and now we are going to talk about harm reduction and supervised consumption sites.

On October 2nd, a federal judge ruled that the federal Crack House Law does not apply to supervised consumption sites. The U.S. Department of Justice and the U.S. Attorney’s office in Philadelphia had sued to stop a nonprofit called Safe House from setting up a supervised consumption site there in Philadelphia. Fortunately with this judge’s ruling, Safe House will be able to push forward. Around the country activists are also moving forward with supervised consumption facilities. A lot of people have been waiting on this decision and so this ruling by the judge that the feds were wrong is really, really encouraging and heartening to people around the country. Today we are going to hear a little bit more about harm reduction and about supervised consumption sites. Liz Evans is the Executive Director of Syringe Exchange Programs for the Washington Heights Corner Project and the New York Harm Reduction Educators. Liz is also one of the founders of Insite, which is North America’s first sanctioned safe injection site located up in Vancouver, BC. Back in 2015, she was honored by the Drug Policy Alliance at their International Reform Conference in Crystal City. We are going to hear Liz’ address to the Drug Policy Reform Conference.

LIZ EVANS: I am just going to first thank you for having me here. It is a really big honor to be around such incredible people and to be part of this struggle. I feel like everyone has already said everything there is to know about the War on Drugs, but I am going to share a little bit of my perspective on the human rights and how really the War on Drugs has created the condition to make it absolutely impossible for drug users to have their human rights acknowledged and also how that has resulted in a situation where there is pretty much no public outcry about that fact. I know you all know that and many of you are working tirelessly to create the kind of structural changes that we need to change things while others of you who are here have had your rights stripped so you know how fundamental this experience is because you are walking it every day in your lives.

From my perspective this war against drug users has raged on so long that the values of it have become almost like – that they have seeped in to our societal DNA and they afflict people around the world in every corner of the world every day and yet the values that we have adopted make us blind to seeing it.

For the last 25 years I have been working with people who use drugs and some people have described my in the past as a harm reduction activist but my feelings about this term are very mixed That is because I think that the violations that have taken place against people who use drugs can’t really be remedied just by simple things like giving people clean needles. While I know that is part of the solution the human rights abuses extend far beyond these sorts of interventions. Whether it is gun violence the (UNINTELLIGIBLE) of Brazil or torture in the name of treatment in Cambodia, or mass incarceration in the U.S., I just really resent a monumental waste of resources being channeled in to barbaric policies that only serve to oppress human beings. But what personally upsets me the most is that I have known so many – and do know so many beautiful, kind, funny people who use drugs who in their lifetime feel characterized by an unutterable shame. They feel personally responsible for what is ultimately arbitrary and random but an attack on people. In Bogota two days ago I was asked by a T.V. reporter why we should even help people who use drugs because they are delinquent, unproductive members of society.

Like the refugees from Syria, we are blaming the victims the war has spat out – a war people are running from every day. Refugees of our drug war also seem to be threatening somehow by their very existence. We are afraid of them, we other them, we treat them with contempt and we push them aside. For many people simply using public spaces like a park bench is a problem. You get hassled by a police officer or a security guard or even arrested. Community centers put on extra security guards to keep people who use drugs out. They can’t walk in to banks. They get refused service in restaurants. They get threatened by neighborhood vigilante groups and they are often just randomly beaten up. None of this is grounded on anything real except for the brutalizing conditions that we have created and forced people to live in. Where there is a palpable fear of people who use drugs and it permeates everywhere.

The start of my career was as a nurse in a psychiatric emergency room in a very large hospital where I was young, idealistic, and naive as a nurse. I found I became very uncomfortable in this environment as I watched how certain patients would just annoy the staff. They do things that are irritating to the staff and the staff would respond with sarcasm or rudeness and sometimes even anger which then created a series of reactions. The patient would slam a door or say something threatening followed by being jumped on by an orderly, injected with heavy tranquilizers and then the series of behavioral therapies. People being deprived of a towel, slippers, toothpaste, or locked in a Quiet Room. Drug users typically were denied pain medication, they were accused of pill seeking and by almost care provider in the city we felt justified kicking drug users out of healthcare. This was seen as appropriate. They didn’t deserve help because they weren’t “treatment ready”.

We created these circumstances in which we dehumanized people from the very beginning. First, we robbed them of their rights. Second, we didn’t provide them with any respect or dignity. Third, we blamed and punished them. So for the patients that came in to the hospital with the most complex problems we did almost nothing. In fact, we did the least. Can’t medicate out poverty. Can’t medicate homelessness. We don’t have medicines that heal social exclusion or end racism and medication doesn’t replace the inhumanity of the war on people who use drugs.

I couldn’t really articulate at that point why I felt so depressed and angry but I left the hospital and I went to work in the community directly with people in an area in our community disparagingly known as Skid Row where I started running a hotel housing project. Idealistically I thought I could help people here and we housed people that just didn’t fit but it was in this environment that I was forced to see my own human limitations when I was confronted by very complex and intense human suffering and it was here that I had to embrace my own human frailty and pain because it was being mirrored back to me in everybody I met.

While obviously people are not defined by their labels, 90% of the people that we housed were injection drug users and lots were involved in the sex trade. About 50% had HIV and everybody had a criminal record. Malnourished and suffering from third world diseases I ran around trying to do stuff but instead I just watched people dying.

I found Freddy, who was hanging out of his bed having aspirated on his vomit and Joyce who died of an overdose when she working in the sex trade at another hotel and Barb who was Alexandria’s grandmother – - I found her alone in a rocking chair with the needle still in her arm.

Each day I would walk to work feeling nauseous wondering what it was I was going to find understanding I couldn’t do much, but at the very least I could provide space. Space for people who were abandoned, people who were alone, people who I was watching suffer but at least we could be with them together. What was happening in our building was a microcosm of what was taking place across our community. With about 15,000 low income residents, 6,000 were roughly injection drug users and we had a very open public drug scene. We had very aggressive policing and by 1998 the infection rate to HIV had reached what was known as saturation point.

Across our province in that same year we had one drug related death every single day. Our neighborhood was called “four blocks of hell” by the media. Over an eight year period over 60 women went reported missing. Women mostly aboriginal, mostly drug users, and mostly working in the sex trade. Angela I knew well. When I filed the Missing Person’s Report, I was told by police that she had probably gone on holiday to Florida. Instead we discovered that a serial killer had been driving women out of our community on to his farm for almost a decade and he slaughtered them and threw them away with his pigs. Angela’s DNA was found on the farm. In this brutalizing context we struggled with what we could do but creating space was actually radical and controversial, because we made a commitment to house people regardless. We created a non-eviction policy because we said our goal was just to create space where we didn’t allow people to keep on renting. Here we talked openly about drug use rather than trying to hide it. We handed out needles, we trained staff to do CPR, we used Narcan, and we equipped ourselves with Ambu bags and airways. Just creating this space was controversial and challenging because it went against all of the dominant values and beliefs people had about addiction. We were told that people on crack were crazy, out of control, prone to violence, incapable of reason – that we should be careful not to house people on crack and we have many and this was never our experience. We were criticized by doctors who called our approach dangerous. They said we were doing something grossly irresponsible, we should force them to leave the neighborhood – not let them live in our project. We were making them more likely to use drugs; we had to move them in to an abstinent environment.

Counter to this our community was a place where people felt accepted. While we were bereft of institutional supports or care it was a community of misfits who were able to find friendships and when we were able to provide this space of acceptance, their will being improved. Over the years we opened many other such spaces – places like a community bank, a dental clinic, hundreds of housing units, a drop-in center with a crack pipe dispensing machine, alcohol maintenance programs, an emergency shelter with a crack inhalation room, a woman-specific low barrier treatment program, art gallery, grocery store, and a soccer team. (MUSIC FROM 22.10.6 to 22.36.4) and we were able to open Insite.

(MALE VOICE): Drug use patterns, why they are here, why they need to use the site and we told them what the site could offer and we make sure that they know that the site is for them; it is for their healthcare. It is an important social contact for people and it is an important place of respite. So after we have had that conversation if they decide to sign up, we will sign them up quickly and we’ll give them a code name that they can use so they can use the site anonymously. After that, people can go in to the Wait Room where they wait to get in to the Injection Room (IR) and there is staff there to chat with them – find out how they are doing and make sure that they feel comfortable at the site. They will go in to the IR where they will be given a booth and shown the array of clean equipment that we have which is broader than most needle exchanges can offer. We will show them things like where the sinks are so they can wash their hands with soap and water before they use. It is incredibly important, small things like that. They can talk to a nurse while they inject. They can learn safer injection techniques. They can see the nurse after they are done for some wound treatment if it is necessary then they can go and grab a cup of coffee or juice afterward and chill out and we can talk about some of the broader issues. We can talk about what it is like living in downtown east side. If this person is homeless we can talk about housing. If this person needs methadone we can get them in touch with that. If the person wants to talk about detox we can tell them about Insite upstairs. It is a great site for people to go to where we can just look at them, treat them as human beings, treat them with respect, and ask what their needs are.

LIZ EVANS: These spaces together created what we sometimes think about as a state within a state. This was essential to be able to legitimate the lives of the people that we were surrounded by. In a community where almost everybody felt a profound sense of self-hatred and a deep sense of shame, having this approach replaced punishment with kindness and coercion just simply with space.

One day my friend Bud, who was on those previous slides – he was doing a writing group at our hotel and he came to me with tears in his eyes and he said, “I have had enough”. Whether it was the murdered missing women, the daily funerals, or the generalized horror of watching so much suffering, our paths and frustrations converged. We realized that talking about these things was no longer good enough. Action was required, we had to do something and this was the beginning. We blocked traffic, we burned reports, we built banners, we disrupted meetings, and we found many flashpoints for activism – lots of them. Whether it was police abuses in the media where they wrote weekly salacious columns against drug users or when our mayor put a moratorium on funding for drug use programs, or when there were not enough needles being distributed and HIV was still raging

We decided to focus on opening an injection site as our goal and the journey to keep this site open and to keep it open required unbelievable tenacity and an enormous commitment right up until the end. In spite of hundreds of opposing forces in the form of politicians, community business leaders, scathing media articles, and a federal government that we had to fight all the way to the Supreme Court. Insite opened 14 years ago and it remains the only legally sanctioned demilitarized zone on this continent.

It redefines the concept of inclusion for drug users because it tells drug users that above everything else it is your life that matters. When I walked in to that run down hotel 25 years ago, I had no idea what I was getting in to but just opening that space and fighting back was all we could do. Our community has always been a place of resistance and the battle continues. However, there are some key shifts that we can celebrate that have taken place as a result of this approach. We now have hundreds of housing units – some of them are new. We have innovative and creative healthcare services that have specifically been designed to create space for drug users. Police don’t arrest people for possession in our neighborhood instead they direct them to Insite and they give them access to what is now a pretty big array of housing and supports because they know what people need is access to care and support.

HIV transmission in our community have been virtually eliminated and the life expectancy of people in our community has increased by ten years. All of this is a drop in the bucket, however, in the fact of how much work we obviously have left because we have to move human rights forward everywhere for people who use drugs and this shift has to happen by us.

DOUG MCVAY: That was Liz Evans, Executive Director of Syringe Exchange Programs for the Washington Heights Corner Project and New York Harm Reduction Educators. Liz was also one of the founders of Insite, North America’s first sanctioned safe injection site. She was speaking at the Drug Policy Alliance’s Reform Conference about supervised injection sites and harm reduction. The Drug Policy Alliance has its International Reform Conference the beginning of November. It is in St. Louis, Missouri this year. You can get information at the Drug Policy Alliance website: www.drugpolicy.org, or go to the conference site at: www.reformconference.org.

For now that is it. I want to thank you for joining us. You have been listening to Century of Lies. We are a production of the Drug Truth Network for the Pacifica Foundation Radio Network. On the web at: www.drugtruth.net. I have been your host, Doug McVay, Editor of www.drugwarfacts.org.

Drug Truth Network has a Facebook page – please give it a like. You can follow me on Twitter, I am @dougmcvay, and of course also @drugpolicyfacts. We will be back in a week with 30 more minutes of news and information about drug policy reform and the failed War on Drugs.

This is Doug McVay saying so long.