03/11/20 Thomas Farley

This week on Century of Lies: the Philadelphia City Council is considering a bill that could prevent a local nonprofit from setting up a supervised consumption facility. We hear from Philly Health Commissioner Dr. Thomas Farley and harm reduction advocates Brooke Feldman, Devin Reaves, and Bill Kinkley. Plus, new research shows that alcohol deaths are on the rise in the US.

Program: 
Century of Lies
Date: 
Wednesday, March 11, 2020
Guest: 
Thomas Farley
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CENTURY OF LIES

MARCH 11, 2020

DEAN BECKER: The failure of the Drug War is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization and 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 www.drugwarfacts.org.

Public health advocates and leaders in the city of Philadelphia have been working for a long time to get approval to set up a supervised consumption site in that city. Safe House, a harm reduction nonprofit had successfully beaten back attempts by the U.S Department of Justice to stop them from moving forward. Everything was looking good, Safe House announced it was moving forward and that they had a location, and that is when things changed. Opponents pulled out all the stops promoting ‘not in my backyard’ protests, fear mongering, propagandizing. City council members responded with a bill to prevent any supervised consumption facility from opening unless it could get the approval of ninety percent of the people and businesses within a one-mile radius of the proposed location –ninety percent, nine-zero – of people and businesses located within a one-mile radius, which is one-mile in any direction from the proposed site. Ninety percent, one-mile radius. I am curious, are there any substance use treatment facilities that are within a mile of where you live? Any half way houses? How about mental health facilities? Are there any bars within a mile of where you live? Any coffee shops? What about independent bookstores – feminist bookstores? A black owned bookstore, a lefty bookstore? Would any of those be able to exist if they needed to get ninety percent of the people and businesses within a one-mile radius to say that they support their existence? Do you think we’d have legal marijuana or medical marijuana, or any kind of drug policy reform if it had to get ninety percent approval before it could happen?

By the time the Philadelphia City Council Committee Hearing ended, the bill had been amended to require only eighty percent approval – that’s eight-zero. All right, I will get off the high horse. Let’s get on with the show. Let’s hear some audio from that hearing. The hearing was on March 9th, and the first speaker is going to be Dr. Thomas Farley, Health Commissioner for Philadelphia.

DR. THOMAS FARLEY: Good morning, Chairperson Bass and Members of the Public Health and Human Services Committee. I am Dr. Thomas Farley, Health Commissioner for Philadelphia. Bill Number 200189 would establish actions that must be taken before what it calls a Supervised Injection Site may operate. We oppose this Bill because it creates what appear to be insurmountable obstacles to the operation of overdose prevention facilities in Philadelphia. You have my written testimony and in the interest of time I am going to skip through this somewhat.

Philadelphia has the highest overdose death rate of any big city in the nation by far. Our overdose fatality rate is three times that of the number two city, which is Chicago, and five times that of New York City. The City’s strategy to address this crisis contains many elements including the overprescribing of pharmaceutical opioids, working to make Medication Assisted Treatment more widely available, and making the antidote naloxone more widely available and promoting its use. While naloxone is being used by many people around Philadelphia and has undoubtedly saved many lives, too often people inject without a bystander nearby who is carrying naloxone and has the skills to administer it. As a result, people overdose fatally at home, in public bathrooms, and on the street. In 2018 the City announced its interest in having one or more overdose prevention sites operate in Philadelphia as one piece of its overall strategy. These sites are locations where people who are addicted but not in treatment can inject under medical supervision so that they don’t die of a drug overdose and that serve as entry points to drug treatment. This decision was taken after a review of the scientific evidence, deliberations by the Mayors task force to combat the opioid epidemic, and site visits by city leaders to similar facilities in Canada. This review led to three main conclusions. First, overdose prevention sites save lives and that is the conclusion not only by the experts of the task force, but also medical experts at both the American Medical Association and the Pennsylvania Medical Society. Second, overdose prevention sites can serve successfully as gateways to drug treatment. Third, overdose prevention sites actually improve conditions in the surrounding neighborhoods. Specifically, the site in Vancouver was shown to reduce injection related litter such as used syringes and the number of people injecting on the street by about half. That makes sense because the sites take injection activity that is now often in public and bring it inside, and out of view. There is no evidence that these sites cause an increase in neighborhood crime, which is why the Vancouver Police Department is among the strongest supporters of the sites there. Since then the City has worked with partners to address necessary issues prior to opening one or more overdose prevention sites in Philadelphia. Recently a federal judge clarified that operation of an overdose prevention site is legal. We now face the tough issue of where facilities like this should be located. We fully appreciate the interest of neighborhoods to engage in decisions about the siting of such facilities. That engagement did not take place in south Philadelphia but it is now clear that it should have. However, Bill Number 200189 places insurmountable obstacles to this siting, specifically the Bill would not allow the operation of a supervised injection site without the approval of ninety percent of the residents, businesses, and institutions within a one-mile radius of the facility. The Bill does not say how these opinions will be measured; among other problems, there is no explanation of how residents, businesses, or institutions would make their opinions known. Who would gather their opinions, or how to weigh the opinion of a resident versus an institution, assuming that an institution can have a single opinion?

CHAIRPERSON BASS: Commissioner, do you want to summarize or wrap up?

DR. THOMAS FARLEY: Let me just say this, as Health Commissioner it is my job to prevent unnecessary deaths in Philadelphia. Overdose prevention sites are one means of doing that and taking that tool away from us would mean that people whose lives could be saved will continue to die unnecessarily of drug overdoses at home, on the street, and in public bathrooms. Thank you for the opportunity to testify.

CHAIRPERSON BASS: Thank you, Commissioner. We will now recognize Councilman David Oh.

COUNCILMAN OH: Good morning, Commissioner.

DR. THOMAS FARLEY: Good morning, Councilmember.

COUNCILMAN OH: I appreciate your testimony. We are looking at process and you have testified in opposition of ninety percent of the community favoring the placement of a safe injection site. Do you have a percentage that you prefer?

DR. THOMAS FARLEY: I don’t think I can express the percentage because we have the larger problem of how those opinions would be measured, and whether it would be by vote, or survey. Who would conduct the vote, and who would conduct the survey? How do you weigh an institution versus an individual? I think if there is some process for measuring these opinions we would need to look at that and see what is feasible.

COUNCILMAN OH: What is your recommendation?

DR. THOMAS FARLEY: I would welcome any process where there are people who have strong views on each of these and there are strong views on either side. Any process where people engage and has a serious exchange of views and an effort to reach a common ground, processes beyond that is not my expertise. I am a doctor and Health Commissioner, but I think such a process like that would be a good thing.

COUNCILMAN OH: We do have those processes as well as zoning processes and bid processes. My understanding due to the fact that I am not a district councilperson is that in order to get a bid business improvement district approved, if thirty-three percent of the residents oppose it, it cannot move forward. So we have processes provided that we have a process, which the City will administrate. We pass the bill and the City administrates it. What percentage of the population do you think should approve of the placement of a safe injection site in to their neighborhood in order for this process to move forward?

DR. THOMAS FARLEY: My understanding of the bid process is that a third of the neighbors have to affirmatively communicate to whomever is receiving these opinions that they are opposed to it; not that a survey is done of everyone and a third has to be opposed to it. It is essentially opt out or opt in, which is different from just one-third of the opinions. As far as what the process ought to be and what the threshold ought to be is not my expertise so I cannot answer that question. I would simply say that the current bill is an insurmountable threshold and if you feel that there is some more appropriate process we would be happy to look at and get back to you with our opinions.

COUNCILMAN OH: Were you quoted in an article which referenced the study in Kensington that stated that ninety percent of the residents approved of placing a safe injections site in their neighborhood?

DR. THOMAS FARLEY: There was a survey done in Kensington, I was not part of the study. The results showed a large majority support for it.

COUNCILMAN OH: Ninety percent.

DR. THOMAS FARLEY: I don’t remember it being that high but it was a large majority of support. There were concerns about the methods by which people were surveyed. Basically there were people out in the neighborhood assessing opinions from people that walked by, and while that sample may not be totally representative it was published in a peer reviewed journal so that people can at least see those methods and use that as estimate. I think it’s a positive thing that high percentage of the people who were surveyed supported that and I think that is useful information.

DOUG MCVAY: That was Dr. Thomas Farley, Health Commissioner for the City of Philadelphia. He was testifying at a City Council Committee Hearing on March 9th, he was there opposing a bill before the council that would effectively ban supervised consumption facilities by creating onerous and outrageous obstacles to their implementation. You are listening to Century of Lies, I am your host, Doug McVay. Let’s hear more testimony from that hearing. This panel features Devon Reaves, Brook Feldman, and Bill Kinkley.

DEVON REAVES: Thank you, Councilwoman, for taking my testimony. My name is Devon Reaves, this is my sixth time testifying before elected officials. I am a person in recovery, I used drugs in Philadelphia for over a decade and I overdosed and died on August 20th, 2007. I was revived at the hospital at the University of Pennsylvania and I came back to Philadelphia. Several years later after sustaining my recovery in south Florida I received my Master’s degree in Social Work with a focus in Social Policy and Practice. I have worked with people who want to continue (UNINTELLIGIBLE) recovery for over a decade. I have been quoted in newspapers all over the country and millions of people have seen or heard my story through my work with the CDC, and the recent profile in Men’s Health, and I am the Executive Director of the Pennsylvania Harm Reduction Coalition, I have served on the Mayor’s Task Force alongside Councilman Oh. Really what I want to say in these two minute testimony time is that my father and grandfather were both victims of the war on drugs. My parents were in the military so I have no home city; I moved eight times before I was 18, but I am humble enough to call Philadelphia and the extended community around Philadelphia my home for the majority of my life and it is my chosen home. I know that the war on drugs has been inequitably pushed upon people of color and my father felt that which is why he was not in my life from the time I was two and a half until I was grown. I know that what happened then was wrong and often times when I hear other leaders of color talk about this issue it almost seems like they are saying that this happened to us and we should continue that behavior. When Mr. Jones spoke about reparations, I and all of my colleagues clapped because we also believe in reparations but we do not believe in leaving anybody behind. Harm reduction is an intervention that means that we are going to have an intervention around any risky behavior and that could be jumping out of an airplane, or driving in a car. Sometimes it is the provision of sterile syringes and for a very small group of people, it is providing them a safe place for them to use drugs so we can help them stay alive another day and begin and sustain their journey to recovery. I know this Bill is about the process and I can tell you as somebody that tried to open a recovery residence in Councilwoman Bass’s district and tried to follow the process it was almost impossible to help people inside of the community of German Town because of that pushback and I just want and have always wanted to help people and see them get better. This is why I think supervised consumption sites will do.

CHAIRPERSON BASS: Thank you for your testimony.

MALE VOICE: Hi, my name is Bill Kinkley. I am a person in long term recovery from an Opioid Use Disorder. In my prior life I was a registered nurse and a paramedic for about 15 years or so. The reason that I am in recovery today is because I had access to harm reduction services, and sterile syringes which is why I don’t have HIV and Hepatitis C. I had a wife that did not believe that enabling was a real thing and chose to love me so we essentially had a safe injection site in my home because I overdosed multiple times in my home but because we had access to naloxone, she was able to revive me and today I am a father of three beautiful children, a good husband, and someone who serves my community but I also work every day with drug users in the community and that community asks every day when it is going to happen because they don’t want to die. I just went to a funeral a month ago and gave the eulogy at a friend’s funeral who was in treatment, left treatment early, and refused to go back to treatment because he couldn’t smoke in the treatment center in Philadelphia and he died alone on the street because he didn’t have access to a place where he could be revived. I am obviously in support of a supervised consumption site but I also hear voices on the opposition and I hear their concerns. I think their concerns are very valid a lot of times and they are concerns that need to be addressed. I am a big advocate of listening to the others but what I find problematic about this Bill is that I think that effectively shuts out any conversation. We have talked a lot, especially the opposition about needing a democratic process and we need the community involved. I think this Bill is very un-American because it sort of takes away the opportunity for conversation. To close, I am a supporter but I do believe that the community needs to be engaged and a part of this conversation. I also think that happened last week was a big failure. I think we all need to do better in terms of listening to the other side and working together to find a solution so that we can stop going to funerals of friends every week.

CHAIRPERSON BASS: Thank you for your testimony.

FEMALE VOICE: My name is Brooke Feldman, and I am a person in recovery. I am a social worker and I manage two outpatient addiction medicine clinics; one in Port Richmond bordering Harogy, and the other in south Philly called Clean Slate. I am also a person who lost my mother to an overdose death when I was 12 years old in Kensington before it became this hot topic and we have seen the catastrophe we have seen today. There was lots I wanted to respond to that we heard today, but I want to stick to the process as well. I agree with Bill 100% that we need better community engagement, it has been a mess from the beginning when the City announced green lighting the sites. Community members had no idea exactly what that was because we have changed the name about ten times now. There was also a lot of misinformation, rumors and fear going around and I think that is what we hear a lot is fear about if this is going to have a negative impact on their community, is this going to lower the value of my home, and is this going to be unsafe for my children? The loudest voices often get heard in this conversation but I want to say to everyone here today that there are more of us who recognize that there are multiple perspectives that need to be heard and we need better community engagement. I also want to say that community engagement and community buy-in are not the same thing. When I think of community buy-in I think of things like I would not have the right to marry my partner or to be a stepmother to my partner’s child if community buy-in was necessary. I think of things like what Selma Jones said in that if community buy-in was important then we wouldn’t have seen the lack of progress we have seen when it comes to the injustices that black and brown people have experienced. Therefore, community buy-in is not always the measuring stick for whether something is a good idea or not. Community engagement should always be the measuring stick for how we do things here in the city. I lived in Mayfair, Councilman Henan when there was opposition to the methadone clinic on Frankford Avenue and I got the fliers delivered to my doorsteps. I was at the rally on Frankfurt and Cotman Avenue where I heard the very same rhetoric about methadone clinics that we hear at overdose prevention sites and it is the same rhetoric that Devon heard when he tried to open a recovery house; it is the same rhetoric we see when we try to open a treatment program, so some of this is across the board. What I wanted to finish with is this, we need a process where people can come together not depending on City officials to sit at 111 Market Street and come up with a community engagement plan, this is not the way to go. There are more of us in this room today who can work together to come up with a process that works best for everybody. However, ninety percent support and a six month wait time is not the way to do it. Thank you.

CHAIRPERSON BASS: Thank you for your testimony.

DOUG MCVAY: That was a panel of witnesses testifying before a committee of the Philadelphia City Council. The speakers were Brook Feldman, Bill Kinkley, and Devon Reaves. They were testifying in support of a supervised consumption facility in Philadelphia.

You are listening to Century of Lies, I am your host, Doug McVay. Now for some research news. A report in the medical journal JAMA Network Open, found that alcohol induced deaths are on the rise in the U.S. To learn more, let’s listen to a portion of this JAMA podcast featuring JAMA Network Open Editor, Dr. Fred Rivara and his colleague, Dr. Steve Finn.

DR. FRED RIVARA: --it’s a paper from NIH looking at trends in alcohol induced deaths in the United States from 2000 –2016. First of all, what is an alcohol induced death? In this paper they define it as a death, which by definition due to alcohol consumption and could be avoided if alcohol were not involved so there are things that come to mind right way such as alcoholic liver disease, alcohol induced pancreatitis, degeneration to the nervous system due to alcohol, as well as mental and behavioral disorders due to alcohol, and alcohol intoxication and poisoning. Do those make sense to you as an internist?

DR. STEVE FINN: Absolutely. Although as you are about to say, I am sure there are some things missing from that list as well.

DR. FRED RIVARA: Well why don’t you say what they are, you are the interns.

DR. STEVE FINN: Well motor vehicle accidents caused by alcohol –

DR. FRED RIVARA: Right.

DR. STEVE FINN: -- you are the traumatologist.

(LAUGHTER)

DR. FRED RIVARA: Right. (UNINTELLIGIBLE) accidental poisoning and we know that probably forty percent of motor vehicle crashes are directly alcohol involved, and about forty percent of trauma patients have alcohol onboard. Obviously this is an underestimate of the number of alcohol induced deaths. There are three things there that I think are important. 1) The absolute magnitude of these problems, 2) The time trend; 3) Racial differences. What they find is that over this period from 2000 – 2016 is that there were 425,000 alcohol induced deaths in the United States and that is a lot.

DR. STEVE FINN: It is huge. Particularly since you are not including a big portion of it, you are actually about in the same order of magnitude as opioid related deaths.

DR. FRED RIVARA: Yes, you are right. We all know that basically this is a preventable problem. It gets down to the issue of the mortality that we see today is due to preventable health problems such as smoking, obesity, and alcohol and those are probably the three biggest reasons. What they found in this in terms of looking at the causes is that about sixty percent of males and sixty nine percent of females were due to alcoholic liver disease and about thirty percent male and twenty percent females were due to acute alcohol poisoning. The important thing here are the trends and the racial differences. First of all, overall the rates went up fairly traumatically. From 2012 – 2016 those rates went up four percent per year in males and in females they went up seven percent per year. That is a pretty startling increase over the last few years. There were very large differences by race and ethnicity. If you look at males for example from the years 2010 – 2016 and non-Latino whites rate was 18.2% and Hispanics were 21.9%, American Indians and Alaskan natives is 113% per 100,000.

DR. STEVE FINN: Stunning.

DR. FRED RIVARA: Stunning amounts, and stunning differences. The rates in the ladder group of American Indians and Alaskan natives were about 3.3% per year over this entire time period. The rates in females were also quite different by race and ethnicity with non-Latino white women at a rate of 3.9% in 2000 and went up to 7.6% in 2016, so it went up by the rate of 7.8% a year among women. If you look at the rates among female American Indians and Alaskan natives, it was 58% per 100,000 compared to 7.6% per hundred thousand in non-Hispanic whites. There are startling differences here with this and the reasons for this are obviously complex and I would urge our listeners to go to The Journal. We solicited two editorials; one by a prominent Native American investigator, and one by a prominent Hispanic investigator to talk about why there are these differences here. The rates among Hispanic women went up 5.6% per year, so we are seeing a problem in both men and women and we are seeing a problem that seems to be getting worse in the last four or five years, and a problem that seems to be startlingly high particularly among Native Americans. What do you think, Steve?

DR. STEVE FINN: Well I was just astounded by the numbers and again, knowing that this probably only represents a piece of the overall societal toxicity of alcohol. It is a huge problem and I think we have been focused in our Journal on opioids for the last year. There is another chronic epidemic that is probably causing a similar burden of mortality and morbidity on society and on individuals. I think the other thing I think we now see is that mortality is going up in this country and longevity is going down, but it is the work by Angus Deaton and others showing that not only are these problems worse in certain racial groups, but it is across all racial groups as well. It was going up in whites more than Latino’s in this particular study. This combined with smoking, obesity, and opioid use is actually shortening the lives of the average American.

DR. FRED RIVARA: Right. I know there was a great article in JAMA back in December where they looked at the decrease in life expectancy in the United States really startling. We talk about diseases of despair such as suicide and opioid abuse, do you feel like alcohol is part of that?

DR. STEVE FINN: As a primary care physician we see so much substance abuse with alcohol. It is commonly a self-medication for mental health and may reflect the lack of mental health treatment in this country and the stigmas attached to it. Although what was interesting to me about this was that the biggest increases were in middle aged and later aged individuals. This is also getting down in to younger ages as well and in the age groups that you would take care of as a pediatrician. So my gut feeling is yes, that this is part of the stress of our current society and it manifests itself in many ways.

DR. FRED RIVARA: I think that this whole issue of self-medication for various mental health problems is an enormous one and I think we are seeing it a lot now, particularly in young adults using marijuana to self-medicate for their anxiety and depression and we know that it is not necessarily safe.

DR. STEVE FINN: Yeah.

DR. FRED RIVARA: Well thanks very much for listening today, and again, please go to our website: www.jamanetworkopen.com, and you can read these articles and all of our content. Take care.

DOUG MCVAY: That was a portion of a JAMA Network Open podcast with Journal Editor Dr. Fred Rivara, and his colleague, Dr. Steve Finn discussing an article published in the journal JAMA Network Open entitled, Trends in Alcohol Induced Deaths in the United States 2000 – 2016. The JAMA Journals are great resources and are highly informative. Some of their articles are open access which means that you can read them for free. Some listeners may be asking why we were talking about alcohol but long time listeners will know that one of the points I make constantly is that alcohol is a drug. The notion that it is somehow separate or distinct from other drugs is absurd, stupid, hypocritical and just flat out wrong. Destigmatizing drug use also means reminding people that the beers in your fridge and the bottles at your local liquor store are drugs. When you drink them you are using drugs. Pretty much everyone uses drugs such as aspirin, caffeine, alcohol, and tobacco. Again, the notion that there is some moral argument to justify prohibition is absurd, stupid, and hypocritical and it is just flat out wrong.

That’s it for this week. 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. You can find us on the web at: www.drugtruth.net. I am your host, Doug McVay, Editor of www.drugwarfacts.org.

The Drug Truth Network has a Facebook page, please give it a like. Drug War Facts is on Facebook as well, give its page a like and share it with friends. Remember, knowledge is power. You can follow me on Twitter: @DougMcVay, and @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. For the Drug Truth Network, this is Doug McVay saying 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 are archived at the James A. Baker, III Institute for Public Policy.