09/04/19 Mike Discepola

Century of Lies
Mike Discepola

This week on Century of Lies, a discussion about harm reduction for people who use stimulants featuring Mike Discepola, San Francisco Aids Foundation; Issac Jackson, Urban Survivor’s Union; Shilo Hassan Jama, The People’s Harm Reduction Alliance; Daniel Raymond, Harm Reduction Coalition; and Mindy Vincent, Utah Harm Reduction Coalition.

Audio file




DEAN BECKER: The failure of the 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 McVEY: Hello and welcome to Century of Lies, I’m your host, Doug McVey, Editor of drugwarfacts.org. Well this week we’re going to talk about two of my favorite things; harm reduction and stimulants. I’ve been talking for quite a while about the fact that stimulants are once again on the rise in the United States, that use rates are going up, that availability is going up and that we’re seeing more stimulants out there in the world and then unfortunately the most recent set of data regarding overdose deaths bears that out, so we’re gonna go back a couple of years to a Drug Policy Alliance conference and listen to a portion of a panel, it’s called, “Moving Out of the Shadows: Harm Reduction for Stimulant Users”, the moderator is Lindsay LaSalle, she’s Senior Staff attorney, Drug Policy Alliance’s California office. The people we will hear are Mike Discepola, Director, Substance Health Services for the San Francisco AIDS Foundation in San Francisco, California, Liz Evans, Executive Director of the New York Harm Reduction Educators in New York, New York, Issac Jackson, Chapter President, The Urban Survivors Union in San Francisco, California, Shilo Hassan Jama, Executive Director of The People’s Harm Reduction Alliance in Seattle, Washington, Magali Lerman from Reframe Health and Justice in Washington, D.C., Daniel Raymond, the Policy Director at Harm Reduction Coalition in New York, and Mindy Vincent, Executive Director of the Utah Harm Reduction Coalition in Salt Lake City, Utah. There’s a lot of content, let’s get to it.

LINDSEY LASALLLE: Why don’t we just start digging right in, obviously one of the risks of stimulant use like opioid use is the transmission of infectious diseases; HIV, HEP C, and one the primary interventions is of course, syringe access but the question is syringe access is generally tailored to meet the needs of people who use opioids so how can we more specifically engage with the stimulant using population in our syringe access programs, and Mindy, I’ll turn first to you.

MINDY VINCENT: Thank you. Oh, this one’s much louder. Hello. So, in Utah we’ve had a significant methamphetamine problem for going on like two decades and we also have a very significant opiate issue there as well and a lot of our methamphetamine users—I mean we have people who use cocaine, but not very many so you’ll hear me talk about methamphetamines. So one of the things—I mean there’s so many layers of how we have to best serve them, one of them being our exchange model. The population I work with—our methamphetamine uses inject significantly more times per day than our opiate users often and so being about to fight for a needs based program when we’re handing out syringes is incredibly important for us. Methamphetamine users where I live—again I only have the context of my people, so where I live and the people I serve—we have a lot of chaotic injection behavior, there’s something going on right now with people doing what’s called “Dick Rockets”, and they’re injecting in their penis and so we’re having to do a lot of interventions around that and just trying to get people to maybe not do that and maybe not do that and maybe Booty Bump is instead or something, so we have a lot of the “party and play” scene in our area, too, in the rural areas where people don’t necessarily come out of any kind of closet whatsoever so trying to reach those people is difficult. We have to use a lot of peer driven stuff to reach a lot of our methamphetamine users because so many of them are in rural areas because we have a lot of oil fields and steel mills and stuff in our rural areas and so those people work very long days especially on the oil fields—the work like 10 days on and 7 days off and things like that so that’s where a lot of our methamphetamine use is and so it’s hard for us to reach those folks because they don’t access services as often as our opiate users do. Our opiate users have overdoses or abscesses more often than our methamphetamine users do so for many reasons they access services more so it’s harder for us to find our stimulant users and they’re also more paranoid about talking to us because where I live, law enforcement is our greatest barrier and people are afraid to access services because of that so we have to find somebody who’s in the community and then we can start reaching people from there and it has to be the person who originally reaches out to these stimulant uses has to have been a stimulant user themselves that these people can verify or they’re not even going to talk to us. So lucky for me I spent 17 years building my reputation so people talk to me. We also have significant barriers serving all of our drug users because we don’t have access to services. Utah did not do Medicaid expansion. We have great treatment services if you’re within Salt Lake City, but Utah is also a very abstinence-based state. Everybody in Utah wants you to get sober and if you don’t get sober it’s because you just don’t want it bad enough and that’s what people will tell you all day long so if we’re anywhere outside of Salt Lake City getting people into any kind of detox services-treatment services is super difficult and that’s one of our greatest barriers, being able to serve these folks. Other thoughts on how we can tailor syringe exchange to meet the needs of stimulant users.

SHILO HASSAN JAMA: I think this is really important – Paul Harkin and Mark Hensley, in the 90’s started to develop these services that-programs that are up here have implemented and the fact that we are still talking about how to work with stimulant users as a larger conversation is really disgraceful for the Harm Reduction community and it’s about time that we wake up and realize that we didn’t invent (BEEP). Drug users are the ones that had to implement these services for themselves and then they had to finally convince Harm Reduction places to listen and so we’ve only been doing—really focus on smoking stimulant use for the last probably 7-8 years and the fact that Paul and Mark developed this stuff before I even knew their names and I started developing some of this stuff and they said, “yeah, yeah—we did that in the 90s.” Like get with it kid, right and I think it’s really important that we understand that we gotta get over this (BEEP). Focused services on opiates do not work with services for stimulant use and we need specific services for them and every single program that serves anyone who uses stimulants should have these written in they’re not rocket science. It’s getting some sort of liquids or food to do your metabolisms, it’s having pipes so people can regulate their use better. It’s actually showing them a level of respect not calling them ‘Tweakers’, and not doing discriminatory language. This isn’t rocket science.


MIKE DISCOPOLA: I’d also add I have programs that coordinate closely with our syringe access services with the AIDS Foundation and having specific services at the syringe access sites for meth users—for stimulant users. So having Harm Reduction groups right there that are super low threshold—like we have a book club that has some narrative based –lets read a short paragraph and then kind of talk about how that relates to our life or we have just kind of a “come on in, have some food”. A lot of our service around stimulant use and that kind of low threshold have a really high hospitality focus so food, refreshments, socks, syringes and really rely highly on, as Charlie was saying, bringing in networks of users. Users bringing in their buddies. So I think—and the other side of the syringe access searchers say is really training our syringe access staff to really be able to endure the energy that comes in when speed users are coming to the site and what some of the behaviors that speed users may have that may be really scary, you know kind of the mental health 101, understanding psychosis. Not necessarily wanting to fix it, but just being ok being with it. People who are psychotic are generally not dangerous people so we have to be willing to be with people where they are and to acknowledge that what I find—even in the lounge that we have with our syringe access site is that the stimulant users and the opiate users – they do ok together. They work it out. We have our kind of quiet side where people are kind of chilling and we have people emptying out their bags and doing their spinning over here and I think we have to get more comfortable as providers dealing with that and being around people who are activated on the level that some our speed users can be.

ISSAC JACKSON: Hello. Working with crack smokers over the years has been quite an education for myself and people in my group and one of the things that’s amazing is the stigma that crack smokers face and the misunderstanding even within public health and Harm Reduction communities, for instance, there’s a stereotype that crack smokers are mostly black men and ever since we started, we started doing data on who – you know collecting data on who comes, ethnicity and gender, who comes together – kits and stuff and then it turns out that more black men are about half the number of people that come, but the other half is black women, white men, white women – all kinds of people. So I think San Francisco from our site black men are not the majority and so that means that any programs that you’re gonna create for this population, you have to really – you can’t assume anything. You have to go out and collect data – make sure they are reaching everybody.

LINDSAY LASALLE: Daniel, I’ll give you the last word and then we’ll move on.

DANIEL RAYMOND: Thanks. I think, to respond to Shilo, a different way of looking at it, which is not to invalidate his way of looking at things is that I think in the history of syringe exchange programs in the United States, syringe exchange has sort of default been optimized not so they’re specifically for opioid users but historically for programs operating in predominately larger urban areas and that they have overlapped with progressive states so if you have a population that’s using a drug that tends to be younger or more rural or heavier representation of LGBTQ populations. The syringe exchange programs as they evolved in the political context of the epidemic in the United States for the most part did not evolve in spaces where those were the main people that you’re trying to reach but we’ve naturalized and normalized—okay so this is what a syringe exchange looks like.

This is how we do syringe exchange in the Bronx or Chicago or in Boston and that doesn’t necessarily translate to doing it in Utah. So some of this is about not so much about difference between the drugs but differences between the geographies and the demographics of who’s using these drugs, you know and then all these other points pertain. If you want to reach youth—young people don’t want to hang out with older drug users I general so having use-specific services, use-specific outreach, use-specific staff and volunteers is how you connect. Same with stimulants. If you find that most the people that you’re reaching are opioid users then there might be some exceptions, but in a lot of places people don’t necessarily want to mix because everybody observes some degree of stigma from their drug of choice. Do they also want to take on stigma from every other drug that’s out there that’s associated with who’s hanging out in that dropping center. I’ll stop there.

LINDSAY LASALLE: Thank you. I want to turn now to mitigating the risks of the mode of administration and so at Shilo – I want to turn to you to talk about the ways that you were able to help some folk’s transition from injecting to smoking?

SHILO HASSAN JAMA: So we did a smaller survey and asked if we provided pipes would you use them and would you likely inject or smoke more and this is again, I will talk about how not every drug user’s the same as someone who’s historically been an opiate drug user. When they said yes, we would change our behavior, I would’ve said, yeah, I doubt if people are gonna go from injecting to smoking and I was completely and utterly wrong and this is why I listened to my participants and I don’t listen to my opinions. They started smoking more instead of injecting and then the first thing they would say is hey, we can make our doctors’ appointments, we can do all of these things and I think that a lot of it is – it’s the same thing that Dr. Hart says, if you don’t use enough it’s not very fun. If you use too much it’s very scary and then there’s that middle point but if all of us use meth we would all have our different middle point that would be what’s our comfort level and so providing those things – one, drops your rate of all of the blood-born infections and two, lots of people would come to our program and say, hey, I need syringes because I don’t have access to a pipe. So now they are using riskier behavior in order to administer the drug because we didn’t think of pipes and I think also talking about as we talk about safe consumption rooms—I am just gonna throw this out—we need to include smokers on the ground floor. If we do not include smokers on the ground floor we are telling smokers they have to inject in order to be safe and have a safe space and so I think it’s really – this is really important as we develop those programs that smokers be included on the ground floors.

LINDSAY LASALLE: And Issac, I wonder if you would like to talk about the crack pipe distribution at the Urban Survivor’s Union in San Francisco kind of did from the ground up and what some of your results were from that and how you engage folks in that process?

ISSAC JACKSON: Well one thing that we did from the very beginning is we designed or ordered our own pipes to specification in terms of being a mixture of Pyrex and glass so that they don’t break as easily and they also don’t heat up as fast, which allows us to enter in conversation with people because they ask us when they come up what it’s made of and it’s like any drug has its fan base experts and so you get into long conversations about Pyrex vs glass, blah, blah, blah. What’s important to that? Well you develop rapport with your community that you’re working with and you also develop – you learn things from people and you know, arguments about Brillo, arguments about everything. It’s really interesting because you know it proves that drug use is more than just a chemical reaction in your brain is a social process and so this allow us to enter in to the social process of people that are using. Most of the people that come to our site probably – I won’t say most, but a lot of them are homeless and we are in to the community where we’ve been working. We have our own pipes, probably one of the better one in the city. Anyway, that’s kind of how we started with engagement the sort of funny things that people like to talk about and expanding on that.

DOUG McVEY: You are listening to Century of Lies, I am your host, Doug McVey, and today we are listening to a forum on harm reduction for stimulant users. It was presented at the Drug Policy Alliance conference in 2017 that took place in Atlanta, Georgia. This year’s Drug Policy Alliance Reform conference will take place in St. Louis, Missouri, it’s in November this year. You can find more information by going to reformconference.org, or go to the Drug Policy Alliance website at drugpolicy.org. It’s always a terrific conference. Wish I could make it this year, unfortunately, circumstances don’t allow me a lot of travel right now. That will change soon, but for now I am stuck here in Portland. Well, there are worse places to be.

NGAIO BEALUM: --Wandered in the kitchen, “Hey, you’re just in time for lunch” (LAUGHTER), “Nice”. Who doesn’t want to have lunch? Right? Perfect. (LAUGHTER) oh you know, we’ll have our own proprietary strains, right? That’s the thing about the weed. I mean all the growers always mix and match and Dr. Davis trying to make crazy hydro (BEEP) all the time. My boy Mike called me up the other day, man. He was like, “I did it, man. I crossed a train wreck with a white widow. I call it Courtney Love. (LAUGHTER) She knows.

DOUG MCVEY: Again, you’re listening to Century of Lies, I am your host, Doug McVey. Now let’s get back to that harm reduction for stimulant users panel. Again, moderated by Lindsay LaSalle, Senior Staff Attorney from Drug Policy Alliance. The speakers are Mike Discepola with the San Francisco AIDS Foundation, Liz Evans with New York Harm Reduction Educators, Issac Jackson with the Urban Survivors Union, Shilo Hassan Jama with The People’s Harm Reduction Alliance, Maglie Lerman with Reframe Health and Justice, Daniel Raymond with the Harm Reduction Coalition, and Mindy Vincent from the Utah Harm Reduction Coalition.

LINDSAY LASALLE: I want to switch now from some of the risks associated with mode of injection to some of the risks that result from different behaviors associated with stimulant use so for instance, research shows that stimulant use is associated with infrequent condom use, with amphetamine use before sex, with trading sex for drugs or money and so there are risks associated with that type of sexual behavior and so Mike, I am wondering if you can speak to how you’ve addressed those risks through education and outreach particularly among MSM, but then more broadly for some of our panelists.

MIKE DISCEPOLA: Well kind of an interesting follow up from one of the comments for the Stonewall Project, our first funding came through the HIV Prevention section of the Department of Public Health locally in San Francisco so we’ve been closely associated with this notion of how methamphetamine is connected to the transmission of HIV right from the very inception of our programming. So you know, our programming has really been focused on HIV, Hepatitis C, STI testing and treatment and as treatment progressed – treatment as prevention and I think that when we think about sexual behavior, I think we need to be willing to have a conversation with someone about what kind of sex they want to have and what’s working about it and what’s not working about it and to do motivational interviewing around it. Everyone wants to have the best kick ass sex that they ever have had every single time but if that’s not happening for you right now and you’re using then how can we help you have that experience and not have the down sides. So those kinds of conversations is a lot of providers who are unwilling to have that conversation because service provision, especially around outpatient drug treatment has been over-focused on abstinence only care. Funding has been linked to abstinence only solutions as well so I’ll kind of go back to the sex piece again. You know this notion that it’s condoms and that’s the only option, let’s get over it people. That’s like 15 years ago almost. So if you’re talking about condoms only and that’s what you’re doing, you’re not doing what you need to do. Our services are connected to prep so we have prep navigation service at the San Francisco AIDS Foundation a high number of folks who are in our services are HIV negative or untested. We work with them until they are ready to test and if they’re not ready to test we work with them about getting engaged in our prep services so that they can get pre-exposure prophylactics and they can prevent themselves from getting HIV. Outside of for positive folks, treatment as prevention has shown effective. People who have an undetectable viral load are not transmitting HIV so for people that we are working with, we kind of do service with them to find out their knowledge base of whether or not they feel they’re undetectable and our service rates – our rates of illustrating that for our programming is showing it’s above the treatment curve that we’re seeing locally so--


MIKE DISCEPOLA: --Thank you. I talk really fast so, I’ll slow down. You know, 80-85% of our folks are reporting that they are – that they have undetectable viral loads. That means they’re not transmitting HIV. So we do focus on our folks who are out of treatment. How do we help them adhere to their HIV treatments when they’re using. What are some of the strategies, where you place your medications? Who holds your meds? Not losing your (BEEP)—how do you accomplish that, and talk about the different options – there’s condom use, there’s serosorting so having sex only with other positive guys or having a conversation with that and honestly, that happens all the time. If you look at the hookup apps, people are doing that and they’re doing it naturally all the time. So acknowledging the behaviors as Shilo was talking about for participants who are already using these harm reduction strategies and then helping them understanding what their other options are. Dealing with the anxiety that folks may have around getting on Prep. What would it mean for them, what are the side effects – all those kinds of things. Navigating the insurance portion of getting someone on to Prep can be relatively complicated in some environments. It’s less complicated with help here at Reform, but the other piece of that is also educating providers and finding providers in your communities to be willing to give Prep to drug users and to people who are meth users in particular.

We have a particular expertise at our program of doing that and of having those conversations. Every single treatment plan for any one that we work with includes thinking about sexual health, HIV, primary care, and drug and alcohol treatment goals. I’ll give an example; we were working with someone in our Contingency Management Program, which is a program that gives monetary compensations for urines that are free from stimulants. We have lots of people who are injecting and having a conversation with someone about how much they’re loading in their rig and be willing to have a conversation about setting up a plan, trying out something new, having a discussion afterward about how that was useful and not useful. You know, what worked about it – what didn’t work about it. Having a conversation with them about the things – that moment actually of having that conversation with someone and people are like, “you’re gonna talk with me about how much I’m loading in my rig?” We are like, yeah, we are gonna talk to you about that. We’re gonna have a conversation about that. We’re gonna have a conversation about you loading your own rig maybe, and learning how to inject yourself if you are having other people inject you – what that means and with the sex piece, how long do you go? Are you going for 5 days? Are you going for 3 days? If you want to have kick ass sex, what’s your sex like after 5 days? Having these kind of conversations and what we find is people are able to make steps in the direction of having the kind of sex that they want and reducing the harms and then realizing, wow, this creates space in my life to think about my life in a different way. I actually have the possibility meeting goals, I am actually a useful individual, I can make change in my life, I have power. Hope is that – what I always say is in our programming we hold hope for people until their able to hold hope for themselves and I think the reason for that is because so many of our systems of carers say you’ll never get better, your brain will never heal – well that’s (BEEP). (CLAPPING)


SHILO HASSAN JAMA: I also think it’s really important that we also acknowledge some of the power dynamics within the drug using culture and I’m gonna do a shout out to Jo Pucho, she had a really great idea that I feel like an idiot that I did syringe exchanges almost 15 years without doing this and people would come up and say, “Hey, I want syringes, and they want syringes, too.” They would be these couples or these partners – there’d be this clearly imbalance of power dynamics. So she came up with this plan – you speak for yourself, and you ask for what you want. No one tells you what you want, no one tells you you’ve got enough cookers, or all this stuff. You walk up as a couple and you start breaking down some of that own power dynamics and you say, ‘you can get two hundred, but he/she is going to speak for themselves.” and they’re gonna tell us exactly what they want and they are going to get exactly what they want. I think it’s important also to engage people as individuals and try to support people who are in these situations that they feel made them feel powerless, and give them back their power because I think the most intelligent, and the most thoughtful, and the most innovative outreach worker I have ever met have always been active participants.

DOUG MCVEY: You have just heard potions of panel on Harm Reduction for Stimulant Users, moderated by Lindsay LaSalle, from the Drug Policy Alliance, speakers included Mike Discepola with San Francisco AIDS Foundation, Liz Evans with the New York Harm Reduction Educators, Issac Jackson with the Urban Survivors Union, Shilo Hasajama with The People’s Harm Reduction Alliance, Magali Lerman with Reframe Health and Justice, Daniel Raymond with the Harm Reduction Coalition, and Mindy Vincent with the Utah Harm Reduction Coalition, they were speaking on a panel at the Drug Policy Alliance’s 2017 conference in Atlanta, again, Drug Policy Alliance has its next international reform conference coming up in November of this year, that’s November 2019. More information available on the web at drugpolicy.org, or go to reformconference.org, and for this week that’s 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 drugtruth.net. I’ve been your host, Doug McVey, Editor of drugwarfacts.org. We’ll be back in a week with 30 more minutes of news and information about drug policy reform and the failed war on drugs. For now, for the Drug Truth Network, this is Doug McVey saying so long.

For the Drug Truth Network, this is Doug McVey 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.