04/20/22 Sheila Vakharia

Century of Lies
Sheila Vakharia
Drug Policy Alliance

This week on Century we discuss adolescent overdose deaths, harm reduction, and recovery with Joseph Friedman, an addictions researcher and MD/PhD student at the Center for Social Medicine at UCLA, and Dr. Sheila Vakharia, Deputy Director of the Department of Research and Academic Engagement for the Drug Policy Alliance.

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07/01/20 Sheila P Vakharia

Century of Lies
Sheila Vakharia
Drug War Facts

"Stimulants and Harm Reduction webinar. This week we hear portions of “Tweaking our Harm Reduction: A stimulants Webinar.” Participants included:
Dr. Sheila P Vakharia, Deputy Director of the Department of Research and Academic Engagement for the Drug Policy Alliance; Christine Rodriguez, a consultant in drug user health and harm reduction who recently founded Higher Ground Harm Reduction, which is focused at the intersection of harm reduction and climate change/systems disruption; Mindy Vincent, a Licensed Clinical Social Worker specializing in mental health and addiction treatment and the founder and Executive Director of the Utah Harm Reduction Coalition; and Brandie Wilson, the moderator, who is the Executive Director of the Chicago Recovery Alliance."

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JULY 1, 2020


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'm your host, Doug McVay.

On June 29th, the Chicago Recovery Alliance hosted a webinar entitled "Tweaking Our Harm Reduction: A Stimulants Webinar."

Well, first we're going to hear an introduction and opening presentation from one of the participants. Christine Rodriguez. She's a consultant in drug user health and harm reduction who recently founded Higher Ground Harm Reduction, which is focused at the intersection of harm reduction and climate change and systems disruption. Before this, she developed a harm reduction-focused statewide capacity building initiative in Maryland.

CHRISTINE RODRIGUEZ: My name's Christine, some of my more recent stimulant related work, this year founded a small project to work on the intersection of harm reduction and climate emergency, and other sort of systems disruption. And two months after that COVID-19 hit the United States, which I completely did not anticipate before maybe, you know, January

But as part of that, I did some work on a toolkit related to COVID for harm reductionists. As a part of that, there's a piece that is specific to stimulant use. I'm going to pop the link to that in the chat box for you. And I just wanted to talk through some of these points, um, as sort of the structure of our conversation. Um, so a lot of the things that are included here, this is by no means exhaustive. If you see tips and tricks that are missing, I would love to hear from folks, I know there's extensive experience in our community.

Uh, so as a non exhaustive guide here, I'm speaking to some harm reduction considerations, particularly in the time of COVID. Um, the first thing that we wanted to raise is something that Sheila ended on talking about, right, are these drug shortages and bad cuts there that we're seeing across the country.

COVID-19, I think we weren't sure how to anticipate if and how the drug market would be disrupted, and because of all the different sort of routes and our country being so big, we've seen that, that has impacted the country in varying ways, right? So, whereas before COVID hit, we certainly saw as Monte put in the chat box, um, you know, fentanyl in the methamphetamine, particularly on the west coast, um, you know, creating a risk of opioid overdose among folks that are just not expecting to experience that are not necessarily thinking that they need Narcan for themselves.

We're also seeing the drug market disrupted different ways across the country. Anecdotally in Iowa, methamphetamine is, is essentially nonexistent anymore. Um, folks can't find it and the price of crack has skyrocketed in response. Um, we also heard in North Carolina that the fentanyl that's being sold is essentially white powder and to folks who are not, um, uh, opioid experienced, uh, looks a lot like the cocaine, right. And so really needing to expand like Sheila was talking about our conceptions of, um, how people use drugs, how stimulant use is related to opioid use, um, what overdose prevention education looks like and for whom we're giving that education.

So these are things that we really want to be talking to our participants about. They're our best source of information, our fastest source of information on how the supplies are getting disrupted, um, what might be happening out there and, um, respond accordingly.

You know, it's, it's hard when you're, um, when you're poor, when you're marginalized, the idea of stocking up on your preferred drug. Um, and if that's, um, a privilege that you have, it'd be great if you can, um, plan for those sorts of disruptions by stocking up, of course, starting low, going slow classic advice. Um, particularly when we're not sure what things are being cut with in the kind of disruption that is so widespread, that COVID is caused it's pretty unprecedented in our time, um, which leads us to overdose, right?

And over amping, um, Sheila raised this drug checking for fentanyl is going to be really important in this time and checking our stimulants, right. Or there was some great work done by harm reductionists out on the West coast. You can check basically anything for fentanyl, fentanyl test strips. Um, and I know Brandie has a lot of experience around drug checking.

And they've also found that when you're doing this with methamphetamine in particular, that the residue that you use, you're going to want to dilute it more than you would with another drug, maybe like a little half a cup instead of the couple teaspoons that you would use. Otherwise it tends to pop a false positive. And of course, if it pops a false positive, you know, there are worse outcomes.

Maybe you're a little safer with your drug than you otherwise would be because you think fentanyl is present, but it turns out fentanyl wasn't can always do more. You can't put less in your body once it's in there. Right. Um, so drug checking for fentanyl, we got a really great tip around checking your drugs for actual stimulants. So the same company that sells fentanyl test strips sells cocaine, test strips, um, and a number of others.

So if you want to check to see if your cocaine is actually cocaine, then that it's really handy tool. Um, we were told, um, by, um, a lovely man Patrick out in Salt Lake City with One Voice Recovery, um, about the, the utility of being able to test your meth with bleach, right, to make sure that if you want meth, that it is meth and you can put a tiny little shard in, in your bleach household bleach. Um, and it should start spinning around and going off like fireworks. Right.

Um, all of these strategies, I know Mindy can share a lot more about from a programmatic angle, um, we're to want to keep Naloxone handy. Right? Always, um, we just never know who we're with. What's in our drugs, what's in other folks, drugs. I just, we can't beat that drum, I think, hard enough.

Naloxone is all over my house, it's in my purse. Um, I have buttons that let people know that Naloxone is in my purse. Um, so anything we can do to stay prepared, particularly if our peers use drugs, if we use drugs ourselves, um, to prevent that overdose. Um, so over amping, um, a little more complicated, there's not the miracle drug Naloxone for over amping. We wish we had for almost everything in our, um, in our health system.

But we're gonna really want to remember, like some of the basics around staying healthy, keeping our immune system healthy, like staying hydrated, making sure we're eating food, doing our best to get some sleep, um, you know, breathing exercises, sometimes exercising. Um, if you have access to a shower sometimes getting that warm or that cool shower, whatever feels best, um, and really just, um, engaging and sort of, you know, this, uh, a lot of the ideas that we talk about around mindfulness and, um, and centering and those sorts of things.

And while it may be hard to think about in the moment, um, that's some of the planning that can go into, um, your setting, right. Drug set and setting before you use, if there are any things that you can put in place just in case, um, you do end up over amping or someone that you're with does, um, we put a little note in here around hygiene and cleanliness that's because of COVID, right?

So just another reminder to folks, to like wash your hands as much as, um, well possible or you see fit, right. Um, ideally you're washing your hands for at least 20 seconds before you're preparing your own drugs. Um, if you can't prepare your own drugs, um, you know, ideally the person who is washing their hands before and after, especially before, um, you know, especially in this time of just, um, incredible numbers of overdose, it's complicated, giving the advice to social distance, to physical distance from each other, while we know that drug use is, um, not just social, but sometimes by necessity you're with other folks. Right?

And if it's a concern that one of you has been covered exposed, if there's any way to at least stay maybe six feet apart, if you have masks that you can wear, um, these things can be incredibly important.

DOUG McVAY: That was Christine Rodriguez. She's a consultant in drug, user health and harm reduction who recently founded higher ground harm reduction. She was speaking recently in a webinar entitled "Tweaking Our Harm Reduction: A Stimulants Webinar" that was hosted by the Chicago recovery Alliance.

You're listening to Century of Lies. I'm your host, Doug McVay.

You know ever since college, I've been a social justice progressive. My interests and understandings have evolved and expanded, I appreciate nuance more, but those progressive values haven't changed really. Though, that was always focused on systems and on other people, my own behavior, I didn't really give it much thought wasn't that long ago that I started to understand that I do have issues that need to be dealt with, okay, heck there's no need to sugar coat it. I was a jerk, I am a jerk. Now I'm trying to be better, but it took me a long time to even start looking critically at myself.

And when I finally did, I didn't like what I saw. And that was back in 2012, 2013, like a year or two before I started hosting this show. I hope I've made some progress. Not real sure about that. And I'm not the one who gets to judge it. I do know that it's a continuing process. It's not some course that has a certificate. At the end. I got involved in drug policy reform as a marijuana legalized you're back in the 1980s, our movement reeked of toxic masculinity back then. And it still does.

We've gotten a little bit better, but my gosh, we have a long way to go. So here's the thing. I was a high profile drug policy reformer for a long time, I was big in the eighties. I was part of that toxic environment. I contributed to it. I am sorry. Of course apologies aren't enough. I have a lot of work left to do. Actions, not words.

I'm not a movement leader anymore, but I do have some degree of notoriety. I have a social media presence and I have a platform I want to do better, be better, and to be a good ally, and to do that I need to listen and to learn. It's a process. It's a journey and friends, however long you've been listening to century of lies with me as host. You've been on that journey along with me. In fact, we're still on that journey. So buckle up listener and let's get this show back on the road.

And by the show, of course, I mean, Century of Lies, a production of the Drug Truth Network for the Pacifica Foundation Radio Network on the web at I'm your host, Doug McVay editor of

We're going back to that recent webinar entitled "Tweaking Our Harm Reduction: A Stimulants Webinar." The participants included Dr. Sheila Vakharia, deputy director of the Department of Research and Academic Engagement for the Drug Policy Alliance; Christine Rodriguez, a consultant in drug, user health and harm reduction who recently founded Higher Ground Harm Reduction; Mindy Vincent, a licensed clinical social worker, specializing in mental health and addiction treatment, who's also the founder and executive director of the Utah Harm Reduction Coalition; and Brandie Wilson, the moderator, who's the executive director of the Chicago Recovery Alliance.

And we're also going to stay with the topic of toxic masculinity. It's a problem in society. No group is really immune, not the marijuana legalization movement nor the drug policy reform movement, nor the harm reduction movement. There was a Q and A at the end of the webinar, the question and the discussion were sparked by some recent news within the harm reduction community. You'll get the gist of it. I'm not taking time out of the show to go over the details cause you don't need them to follow along. You can find out all that on Twitter, go to my feed. I'm @DougMcVay. So here's that Q and A.

BRANDIE WILSON: I think Kiefer has a really important question, a comment, a conversation starter about, um, he would love to hear more about ways programs, which haven't historically served, sex workers, including stimulant using sex workers can step up in this movement - moment, moment of reckoning around sexual violence, exploitation, abandonment of sex workers by the majority of the harm reduction movement.

I have a whole lot of anger wrapped up in that currently. Um, the silence is goddamn deafening, um, and I currently am not engaged in sex work, but as someone that has had a pretty substantial history with it, I can not figure out how to compartmentalize what is not being said and what is not being done by cis male leaders in our movement.

Why are we the ones speaking where women, the ones, why are sex workers, the ones, why aren't programs, leaders, and why aren't, why don't we have to come up with the framework? Why do we have to say, if you don't call yourselves out, we're calling you out. Like, I mean, that, wasn't the rant that he asked for. Um, but it is so indicative of like the lack of value women trans and sex workers have in this goddamn movement. And if you are allies and you say you are allies, where are you? Where have you been it's days? And there have been lists for years. And these are your friends too, where are you? Why are we here by our goddamn selves? Um, anyway, uh, so

CHRISTINE RODRIGUEZ: Right. Yeah. That's right. Yeah,

BRANDIE WILSON: Someone else should probably ...

CHRISTINE RODRIGUEZ: I mean, I would, I would say that like some of it needs to start with acknowledging that there are far more sex workers in our movement than are out. Um, and far more people with sex work experience then feel comfortable sharing because of this because of knowing how vulnerable that makes you, um, to harassment and abuse and assault.

And I, you know, I think seriously, a responsibility to people engaged in sex work, um, which includes, you know, education, you know, not just, I feel like it's the same way that, um, you know, we reach out to people who sell, which are not necessarily different from people who use, but, um, we've reached out to people who sell to engage in harm reduction. Um, we have to talk about how to be a good client. Um, we have to talk about what it means to be, um, a responsible client, um, of sex workers to be a responsible man in particular, um, to women broadly.

And these things shouldn't be acceptable behavior to come into a drop in center, um, to come into a harm reduction space. There, there should be some, um, some codes of some kind of conduct, um, because it's, it's unacceptable and it's heartbreaking. And it, um, and it's been going on for so long. And I don't, I don't see it stopping. I just see a sort of baited breath hoping that it passes, um, and hoping that it stops with Devin Reaves and that it doesn't spread to others and that others are not impacted. And hopefully this will just blow over, um, the silence, uh, Brandie, um, I've, I am beyond disappointed.

BRANDIE WILSON: The other thing for me about the silence is historically a lot of these folks on these lists are white men in power. So y'all are letting a black man who is a young leader, take all the heat. Um, accountability looks like you stepping up and having faith in the community to let you grow and to apologize for potential harms. You've done. Like that's why we're here. Um, and so, maybe also consider your whiteness in all of your goddamn silence.

MINDY VINCENT: Well, here in Utah, we're so far away from everyone, I feel like, but, um, you know, I didn't know about like things that were happening elsewhere until it started coming up. And I do know though, as a female period in the world, like, I know what it's like to, you know, always, like, and I dare to use the word always, be inappropriately touched, hit on, harassed all the time.

I felt for me, like, one thing I that I have to do, like, I dismiss that behavior all the time because I'm just so used to it. I'm so used to it that I'm just like pfft, you know, cause it's just not, we're saying something every single time it happens. Right. And you know, so me as a female, I am willing to say something more often and continue to do that until I say it every single time that it's inappropriate, you know, so that people don't ever, so the men don't ever get the idea that they get to treat any of us, however they want any ever, ever, you know.

And it's funny, when I was teaching at the University of Utah, I was actually, I quit the University of Utah over this because I said that as a female in arenas of leadership in public administration, that I always have less credibility than any man.

And, uh, someone found that offensive and I don't care, um, because they have, I guarantee there's no man, including Devin Reaves, who's ever been in a meeting, embedded dressed as babe or sweetheart. I promise no one ever cut him off when he was talking over and over and over again, you know, and said, listen, babe, you know, I know you think what you're doing is this and this and that.

CHRISTINE RODRIGUEZ: Hey thanks kiddo.

MINDY VINCENT: Right. And it's like, Oh, and that's just infuriating in itself. You know? So I know I'm willing to step up and say more often and take up that space that like we've been told all of our lives to not take up because we're too much for too loud or too this, for to that. Right. And then as someone who, who runs a harm reduction organization, we do, I am a substance abuse treatment provider, like, I'm a substance abuse provider.

And that is where we serve people who are using drugs in that entire spectrum and everywhere it intersects. And that includes with our sex workers. And we hope to get the swap chapters started here. And when all this happened, I mean, most people on her probably know who Damon Harris is, Damon Harris. He's, he's been with me since day two and he's more of a feminist than I could ever be.

So I'm incredibly blessed to have this ally man at my organization. And as a friend who fights with me on all fronts, but he's so good at listening. And he's so good at leading and listening and saying, come on, let's go talk to the people we need to talk to and ask what they need for support. How do we stand be the best allies that we can be, you know?

And I think that's what everybody needs to do. We all need to, you know, just like with the Black Lives Matter Movement, you know, as a white person, I get to ask, well, how do I get to be the very most ally in the world? You know, how do I get to help? Because that's what I need to do because that's the privilege that I have. Now I’ll start going off. Sorry.

SHEILA VAKHARIA, PHD: And I think one of the things that we have to that I'm constantly reminded of is that we're more of a microcosm as a movement of the larger societal problems than we'd like to admit. And I think that there is this kind of exceptionalism that comes when you're part of a movement that has an issue or a cluster of issues or certain areas that you feel like are the, you know, the, the factors that brought you together, but that, that made you so, so aware that marginalization was a thing and that, that marginalized identity brings you all together.

And I think that in us being a microcosm of the larger world, a lot of the men in our space forget that women have always been aware and queer folks and folks with a variety of, of, of kind of nexus areas of marginalization and intersections is that we have always been aware that we don't live single issue lives.

So I think the unidimensionality of drug user identity for a lot of men is their spoiled identity or is their marginalized identity. And, you know, they've, they've done a lot of development and work around that as an issue for where their rights have been violated and where they need to move forward.

Those of us who've come in already aware that we did not live single issue lives, brought all of those with us and our spaces weren't ready for that because, um, because we have people who still, for some, for many privileged folks who live on these different, nexuses like, um, you know, that was the one issue that they did the most work in development around.

Yet, there were a variety of other issues and, you know, cause we are a transphobic movement. We are a heterosexist movement. We are, you know, there, there are so many other ways that, um, that we've become very like that. There are a lot of people in power who are still very unidimensional analysis of our issues.

I think this all brings that to light because, um, the other thing is too, and like this kind of goes into like kind of a larger critique. I think, of, of drug use, like, recovery kind of framings as well, is that, you know, those of us who don't even who pushed back against the 12 steps, I mean this idea of a rock bottom is very clear. And for a lot of folks, the rock bottom that was in their narrative was engaging in sex work or trading sex or selling sex.

And for a lot of people that narrative has spilled over into how they look at people who, who sell sex or trade sex, um, in our movement as seeing them as some people who it's a function of their survival, right? Like, you know, where do we, where do we add nuance to acknowledge that there are people in our spaces who engage in survival sex work and who, who do not identify with that as being a salient identity, you know, sex workers being a salient identity, but there are folks in our movement for whom being a sex worker is an identity.

And it has nothing to do with hitting rock bottom. It has to do with bodily autonomy, a choice that of a career or a way to make money that is flexible to their parenting responsibilities, to their disabilities, to their ability, to, to engage in meaningful work, to support themselves and their loved ones.

I think that we also have to kind of tie that in there somewhere and I still haven't fleshed out what that's about, but I do think there is this idea that that selling or trading sex has been framed as like a rock bottom indicator that we also just don't have space in our broader narrative to see sex work as work.

CHRISTINE RODRIGUEZ: It makes really clear to me that we need to develop some kind of internal accountability, healing, justice processes. Um, because we, like, in addition to all of that, Sheila, are also a movement of folks who are particularly averse to calling the police. And so when we are not, um, socialized to call authority, we're kind of, you know, quite the opposite. Um, then what what's available for us in place of formal authority, when we need some reckoning to occur, when we need someone to be held accountable for harm.

And those structures haven't been built up in parallel with our sort of the police mentality. Um, and I don't think police are the answer. Um, but something, something community-based needs to exist. And men have to be a part of that. That can't be just us, you know, talking to ourselves about it. Um, they have to buy into it and participate and hold each other accountable.

MINDY VINCENT: And it can't just be “I'm sorry.” Now, you know what I mean? Like the #MeToo movement started a couple years ago. So at very least, a couple years ago, people should've known that behavior was appropriate.

You can't take back damage that you've done to somebody. This is what I tell my kids all the time. Like you have to pay attention forward because going back and saying, I'm sorry, sometimes it's just not going to be good enough. You know? And you can't come back and say, I'm sorry, the, you know, I sexually assaulted you or I'm sorry that I harassed you and belittled you and treated you that way. And I'm taking accountability. That's that isn't enough

I guess if you didn't know that that behavior was inappropriate, you should have paid attention two years ago while you were posting all over Facebook and sharing all these things where it's about everybody else's defects, you know, because it's not okay to harm people in such a way. Like we all make mistakes and I don't think human beings should have the famous mistakes for the rest of their lives. Right?

However, there's mistakes. And then there's like a f***** up person, right? People don't get to just come forward and say, I'm taking accountability will ever be cheers and says, okay, good for you because you want some of the damage you've done. Can't be healed in the first place. Cause I'm sorry. It doesn't cut it.

CHRISTINE RODRIGUEZ: Yeah, it absolutely has to be centered survivor centered, right. Because accountability is whatever a survivor says. Accountability can be for a given offense. And I just, miss me with you all join book clubs and read about masculinity and that's accountability. That's, that's just not, if a survivor says it's not, um, that might be some good prevention for folks, learning is incredibly important and evolving is important and I believe it happens. Um, but, but we need to be able to define accountability for ourselves, for other folks.

DOUG McVAY: That was from a panel entitled, "Tweaking Our Harm Reduction: A Stimulants Webinar" that was hosted recently by the Chicago Recovery Alliance. Participants included Dr. Sheila Vakharia, Christine Rodriguez, Mindy Vincent, and Brandie Wilson.

You've been listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web of You can follow me on Twitter, I'm @Doug McVay and of course also @drugpolicyfacts.

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 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.

07/24/19 Joao Goulao

Cultural Baggage Radio Show
Sheila Vakharia

Dr Joao Goulao, Portugal's Drug Czar Part 2, Sheila Vakharia of DPA re overdose death rates & memorials for Paul Krassner & Mark Kleiman

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JULY 24, 2019


DEAN BECKER: Hi folks, this is Dean Becker, the Reverend Most High. This is Cultural Baggage. We're going to start off with a bit of sadness today. Paul Krassner, one of the founding members of the Yippies, has passed away. He was a guest on Cultural Baggage in November of 2014 [sic: 2004].

PAUL KRASSNER: People magazine called me the father of the underground press, and I immediately demanded a paternity test. But, in 1958 I started a magazine called the Realist, which was a satirical magazine, and I didn’t know it was countercultural because there was no such word yet.

But -- but, you know, it was -- I felt like a Martian and I knew that if I was the only one, there was no hope. And -- and so, the magazine began to attract a lot of Martians.

DEAN BECKER: I hear you.

PAUL KRASSNER: And so then I got involved in what you might call participatory journalism. So, when I interviewed Ram Dass -- who was then Richard Alpert -- and Timothy Leary, I ended up taking 300 acid trips.

So, I never made a distinction between observation and participation. And I also never labeled an article as investigative journalism or satire, because the line more and more, as you know, has blurred into nothingness.

DEAN BECKER: Another note of sadness for our show's beginning: The passing of attorney Mark Kleiman [sic: Mark Kleiman was a professor of public policy and received his PhD in public policy from the Kennedy School of Government], a reformer who rattled every cage on both sides every opportunity he had.

MARK KLEIMAN: Well, there's the big issue about stoned driving. I think there's less to that issue than meets the eye. It looks like if you're just using cannabis, the additional risk of driving is not huge. It's not small, people should not get stoned and drive. But it's certainly less than the risk of using your cell phone while you're driving, even if you're using a hands free cell phone.

So I think we've got to regard that as a traffic problem and not as a drunk driving problem. That's the -- that view is not the currently dominant view. Everybody wants a stoned driving law that looks just like a drunk driving law.

In general, there's a tendency to say, well, look, we already have a legal intoxicant, it's called alcohol. Why don't we just apply those same policies to cannabis? And my answer to that is, because the policies toward alcohol are really bad, and that's just not a set of mistakes we want to repeat. Cannabis is not as dangerous a drug on most dimensions as alcohol.

DEAN BECKER: Mark Kleiman was 68 years old. Paul Krassner, 87. A bit later we'll hear from Sheila Vakharia of the Drug Policy Alliance about overdose death rates. But first up, this is a continuation of the discussion I started last week, my interview with the General Directorate of Intervention on Addictive Behaviors and Dependency. I'm speaking about in esssence the drug czar of Portugal, Doctor Joao Gouloa.

JOAO GOULAO, MD: Nowadays, with our experience, we have 17 years of experience to show, okeh, our data on this, I insist, it's not solved, we still have problems, we have new challenges every day, and new things, and new responses to offer, but, the overall evaluation of our system is positive. I think there's --

DEAN BECKER: Oh, I agree. I heartily agree.

JOAO GOULAO, MD: I still do not have the time enough for Uruguayan experience, from your experience in the States, or in several states, and I'm not -- we are not facing the desperate situation here, so we can take --

DEAN BECKER: Take a little time.

JOAO GOULAO, MD: Take our time. Okeh?

DEAN BECKER: I, and again, I want to agree with you. There was a situation, I think it was two summers ago, a very hot day, 95 degrees, hundred degrees, and these youngsters, you know, probably 16 to 20, or 25, passed out in the park because they had smoked this synthetic marijuana. Their temperatures rose to 104, 105 degrees, they had ambulances hauling to the hospital quick as they could. We do have to be careful moving forward, I agree with you.

JOAO GOULAO, MD: I should think so, I think. I have a lot of sympathy for some movements that are struggling for human rights of drug users and all that, but that's not exactly the same to say okeh, no problems about using drugs.

DEAN BECKER: Oh yeah. I'm with you, sir. I touched on this earlier, and you're becoming aware of it, the taxi drivers are becoming aware of it, each person I mention this to, that in the US, you know, we arrest 1.6, 1.7 million for minor possession of drugs each year, crowding our jails.

We demonize them, and then we make them jump through so many hoops to prove they're worthy individuals again. Many times, they can't get credit, housing, a job, any respect, and you guys don't -- you may put people behind bars for a short time, but once they get out, you don't hold it against them forever, like we tend to do in the United States.

JOAO GOULAO, MD: No. No, we try to keep them in contact with our structures, having a professional as a reference, that can help them to deal with the difficulties in everyday life. Okeh? We have, for instance, the problem, when someone comes to one of our treatment facilities, he is evaluated by the treatment team, and immediately at the same time, same week, is evaluated by the reintegration team.


JOAO GOULAO, MD: And, along with the treatment plan, there's a reintegration plan. What are the needs of this guy? Housing? Meeting his family again? Reconnecting to, finding a job, professional training or something?


JOAO GOULAO, MD: Does he have -- ever studied, or is a complete -- sometimes it's not reintegration, it's integration for the first time, people -- okeh? So, we try to build a plan, and be with them, trying to find the adequate responses.

For instance, the positive discrimination problem that we have, it ended during the financial crisis, was the problem with vida emprego, life employment.


JOAO GOULAO, MD: Which was a problem based on microcompanies. Okeh? And we had our social workers knocking the doors of those companies, and convincing people, convincing the employers, okeh, I want to bring you a new worker to work with you. We have nothing to spend with him, you just -- you are going just to spend your time teaching him how to do a job.

DEAN BECKER: Give him a chance.

JOAO GOULAO, MD: Give him a chance. You are going to have tax benefits during his time with you, and we will pay the minimum wage. That's set for six months. Okeh?

By the end of it, you only have to be aware that there are some difficulties that you are going to notice on him. Difficulties in dealing with time. Okeh? Which is a very difficult dimension. Yeah? But please evaluate his work by the end of the week, and now -- and not by the end of the day. Okeh?

Because probably he's going to come half an hour late, and to try to leave two hours before time, but the next day he will stay until night, and, well, by the end of the week you evaluate.

And by the end of the six months, we will take off the wheels of the bicycle --


JOAO GOULAO, MD: -- the small wheels, and you decide, you keep him or not. And then, you just offer him an employment, normal work. Okeh? I just bring him in order that you know each other.

DEAN BECKER: So much cheaper than throwing him in a cage.

JOAO GOULAO, MD: We found jobs for thousands of new employees. Okeh?


JOAO GOULAO, MD: We have problems nowadays with this program, because during the financial crisis, those small companies, those small enterprises, closed in the hundreds, so, most, they went to bankrupt. So, some of those new employees have lost their jobs, and their new lives ruined.

This is to tell you that not everything is perfect in our system.


JOAO GOULAO, MD: Because we could not anticipate that it was going to happen.


JOAO GOULAO, MD: And, it poses a problem of sustainability to the responses that you -- that we built. But anyway, I think it was a good experience, anyway.

DEAN BECKER: Well, yeah, and with many positive results, right? Yes sir. You know, I feel privileged that I got to speak with you at dinner the other night, we had lunch together yesterday. I'd like to think that we -- we understand each other, that we respect each other's positions quite a bit.

And, I mentioned to you that it was, I don't know, 8 or ten years ago, I worked real hard, then current drug czar in the US, John Walters, was coming, and I contacted his office, I learned about it, I tried to set up an appointment, I wanted to do an interview with him.

I captured the audio from his presentation, and when it was over I walked up, and, Mister Walters, I'm Dean Becker, I've been trying to contact you. He finished packing his briefcase, four guards gathered around him, and escorted him out of the building.

And as he was leaving, I said, Mister Walters, will you at least take my card and one of his guards stepped out, reached his hand inside his coat, and said he doesn't want to talk to you. And that was the only response I've ever gotten through 16 years of trying to interview US drug czars, and other high echelon officials. They hide from me. Your response to that, please.

JOAO GOULAO, MD: Then, my response is, sorry if I am not very modest, but I think my response is my attitude towards you, and towards the group, and the way that yesterday I faced some critics from Portuguese drug users and former. Of course, we are aware that things must be -- could be better. Okeh? But I don't fear to discuss it publicly with them, and we learn something from each other, from that discussion.

So, I do not -- I do not avoid any kind of contact.

DEAN BECKER: I interrupt briefly to remind you that we are speaking with Doctor Joao Goulao, in essence the drug czar of Portugal.

JOAO GOULAO, MD: A couple of months ago, I was in Macao, China, presenting our drugs policies to representatives of countries like the Philippines, Singapore, Indonesia, and they were completely astonished about what I was saying.


JOAO GOULAO, MD: And they seemed to be very critical in their faces, but by the end of my presentation, they came to me asking for more questions, and could you explain it better how it went, something new, and I believe that our responsibility is also to leave a seed on those minds that have completely different ways to address this problem.

DEAN BECKER: I commend you for having done so. We in the US seem to be regressing. Our attorney general and especially our president is talking about maybe it's time to start killing drug sellers, as much like Duterte in the Philippines, much like in Singapore and in China as well. Your response there, please.

JOAO GOULAO, MD: My response. Well, I think this is not the way, and we have -- we only can give our example, and our results. And that's my response.

DEAN BECKER: Got a couple of questions left for you. One is, I mentioned yesterday, Harry Anslinger convinced everybody that prohibition was the way to go in the United States and then he convinced the United Nations, and the globe said okeh, we'll do it, but, there are provisions within your agreements with the UN that you could forego, or you can opt out of, and with a six month warning, I think it is.

Your thought there, sir, is there -- is there a means or need to redirect the UN's focus to -- more in line with your policy?

JOAO GOULAO, MD: I believe that things are changing, even at the United Nations. Okeh? Once again, the current Secretary-General of the United Nations is António Guterres, who was the prime minister of Portugal when we decriminalized drug use. And his mindset on this subject is important, I believe.

But I also believe that there are some movements inside United Nations bodies, UNODC but mostly on IDPC -- INCB, sorry, International Narcotics Control Board, who are the guardians of the treaties.

Last year in New York, at the UNGASS -- let me tell. When we first approved our decriminalization law, United Nations bodies were very critical about it. We had some visitors coming to Portugal, and they were very, you know, those Portuguese, they did so -- in 2009, for the first time, the UNODC report started to say, even if the Portuguese decided to decriminalize, the results seem to be positive. Yeah?

In 2016, at the UNGASS in New York, the president of the INCB showed a slide saying Portugal is an example of best practices within the spirit of the United Nations. Well. It's still a prohibitionist paradigm. Okeh?

But, the evolution of the mindset in the United Nations bodies has changed a lot, and I also believe that Portugal worked a little bit like a snow cleaner, opening the way for others to make the same kind of movements, and -- but I also believe that our main responsibility within the United Nations context is to call those who are left behind: Philippines, Singapore, to come into more humanistic approaches. Okeh?

So, of course we -- you may wish to go a step forward, but wait for those who are left behind, okeh, because there are many thousands of millions of people living there and suffering for those promises. And being -- having a humanistic approach, based on human rights, you can't forget those populations that live in those countries, and that have to face that kind of regime.

DEAN BECKER: Now, my last question is kind of the follow-up, yesterday, my question was kind of interrupted, and I'll try to phrase it more realistic.

Sir, you know, they, we, in the US, it's been about a hundred years of drug war, that has escalated. They used to have five year plans to fix it, but when each five year plan failed I guess they just quit doing that, realizing five years was not going to get it done.

But it's my thought, I've been to Bolivia, Mexico, I've seen the horrors that go on in those countries, the abuses, the barbarity, and I guess my question to you sir is that, you know, considering the horrible consequences that do develop from believing in this drug war, should we not reconsider some of the moral superiority that we claim exists within this drug war and nuance the situation to make it actually more moral, more realistic, more human? Your thought please, sir.

JOAO GOULAO, MD: Okeh. The issue is exactly what you said. The war on drugs is based in stigma, is based in the fact that you consider not drug addiction, not as a disease, but as a vicious, a thing, there are moral focus on it, and shifting from that social representation into the idea that we are dealing with a health condition, and I insist with the same dignity and patience, must have the same dignity that others that suffer from diabetes, hypertension, whatever.

This was thought possible, or close to, with our model, because the social perception has changed a lot. You know? Nowadays, you can -- you can, if you face -- if you are facing any kind of defeat of this related to drugs, you can discuss it in families, in schools, in workplace. You go to your boss, oh, boss, I have problems with alcohol, drugs, or whatever, I need to go for treatment for six months. Okeh, you go, I keep your post, and you return when needed.

So this is the kind of respect that you can have, if you have any kind of physical or mental disorder that imposes you to stay out of work. With addiction, nowadays it is considered with the same level of dignity. And that makes all the difference. Okeh?


JOAO GOULAO, MD: So, the moral judgment, a sin, vicious, that is the thing, and words matter. The way people refer to those conditions matters a lot. There's a report from the Global Commission that was presented in the, in Vienna last week, about the impact of, even of words, and expressions that you use in official documents, internal, the mentalities, when speaking about those issues.

DEAN BECKER: Yes sir. Doctor Goulão, I thank you so much. I do appreciate you --

JOAO GOULAO, MD: Thank you, it was a pleasure.

DEAN BECKER: -- sharing your thoughts.

JOAO GOULAO, MD: It was a pleasure to meet you, the other day, yesterday, I was very pleased.

DEAN BECKER: Well, that's it, there you have it, I also was very pleased to meet Doctor Goulao, he's a very fine, human individual, and I hope he's the first of many drug czars that I get to speak with.

It's time to play Name That Drug By Its Side Effects! Agitation, paranoia, hallucinations, face chomping, lip eating, heart devouring, brain slurping, ecstasy, suicidality, zombie-ism. Time's up! The answer, according to law enforcement, from some crazy-ass chemist somewhere: mephedrone, otherwise known as bath salts.

Okeh, we just heard from Doctor Joao Goulao that the year I interviewed him 27 people overdosed and died in Portugal, and based on their 10.3 million population, it turns out that here in America, we are more than 80 times as likely to die of an overdose.

Here to talk to us about that situation and perhaps what we could do moving forward, from the Drug Policy Alliance, is Sheila Vakharia. Hello, Sheila.


DEAN BECKER: Hi, Sheila. You've written a piece here lately talking about drug overdoses, have you not?

SHEILA VAKHARIA, PHD: I, yeah, yeah, we at DPA are paying very close attention to the numbers that have been getting released about overdose deaths.

So, CDC just recently released some data a few weeks ago indicating that perhaps overdose deaths have stabilized and maybe slightly decreased by around five percent nationally.

And, you know, a lot of people aren't sure what to make of this information. Should we take this as meaning perhaps all of our efforts have come to fruition and that maybe we've actually started to stem the tide of overdose deaths. Others are saying, you know, has there really been that big of a change? I'm still seeing people die.

And so, we at DPA want to kind of offer up an interpretation of these numbers in light of the facts that we still are losing almost 70,000 people a year to overdose deaths, even though the numbers went down slightly, and that actually these national trends kind of don't acknowledge the fact that on a state level there are still states where the overdose deaths have increased.

And so we just want to make sure that before we think of taking a victory lap, that we stop to think about the fact that lives are still being lost and that there's still much work that needs to be done.

DEAN BECKER: Thank you for that, Sheila. And, what doesn't get the recognition I think it deserves is the fact that the number of drug users from cocaine to heroin to LSD to marijuana, they all fluctuate year to year, how to say it, that the number of drug overdose deaths is going to fluctuate as well based on those trends. Would you agree with that thought, Sheila?

SHEILA VAKHARIA, PHD: Sure. And what we do know is that fentanyl has become an intractable part of our drug supply at this point. And so that regardless of fluctuations in rates of other drug use, we know that fentanyl has entered our opioid supply and in parts of the country is the largest driver of overdose deaths.

So, we need to acknowledge that this new substance that has entered our markets has actually started to drive a lot of these avoidable and preventable deaths.

DEAN BECKER: Right. And, I don't know if they're rumors or how much truth there is to it but I'm hearing that fentanyl is now being found even in upper type products like methamphetamine and even cocaine.

SHEILA VAKHARIA, PHD: We are hearing that people are reporting the sense that stimulant drugs like cocaine and methamphetamine might be getting adulterated with fentanyl, and the jury is still out about what might be driving that.

And until we get more information it's hard to say what exactly is leading to that. We can presume that perhaps some of this is due to accidental adulteration. But another thing that we should really acknowledge is the role that, you know, this overdose crisis has never really just been about one class of drug at a time.

We know that the reality for a lot of people is that they use more than one type of drug. So we know historically we've talked about this a lot, the idea of people using speedballs. And so people who might like the feeling of both injecting cocaine along with heroin, and so perhaps, you know, finding that someone's autopsy results indicate that they had cocaine and fentanyl in their system and heroin in their system, we need to acknowledge that some of that might be due to the fact that they were using them together.

DEAN BECKER: All right, Sheila, thank you for that. And, Sheila, you made a little mistake there, you said contaminated with methamphetamine. If I could get to just say 'contaminated with fentanyl,' and I'll plug that back into that slot.

SHEILA VAKHARIA, PHD: Oh, thank you so much. And so what we do see is that people might be noticing that their stimulants are contaminated with fentanyl, and again, it may be accidental.

DEAN BECKER: What you're bringing forward is counter to much of what the positives, I guess it is, the government is trying to put forward. It's not time to take that lap of triumph yet, is it?

SHEILA VAKHARIA, PHD: No, it's time to double down and to expand even more access. So, although we should applauding efforts to increase access to naloxone and that we are seeing these tremendous initiatives to get more doctors waivered to prescribe buprenorphine, which is a life saving medication for opioid use disorder.

I think while we're doing all these really amazing things, we need to think -- we need to think about still expanding beyond that and what other strategies we can be using.

There are technologies such as fentanyl test strips which can actually help users test their drugs to see what is present in them and to see if fentanyl is present, and we know that from research that people who test their drugs and find out fentanyl is present are more likely to take other precautions, or to be safer when they use or reduce their likelihood of using.

We know that people also need access to life saving medications like methadone and buprenorphine while they're incarcerated because we know incarceration is a huge risk and we've been seeing very slow uptake in jails and prisons to actually bring access to these life saving medications to people who are incarcerated.

So there's still so much more that we can be doing to increase access to these types of services. And so, yes, we should acknowledge the gains and that in some places that the effectiveness of these strategies has worked out and that we've expanded access to them, but that there are parts of the country that are still lagging behind, and where we need more -- we need to do more, and we need to think about also the ways in which the criminalization of drug use altogether could be driving this crisis.

And the fact that when you turn a behavior into a criminal act, it drives people underground and can often cut them off from life serving -- life saving services because they're stigmatized and unable to access supports.

And we know that one of the biggest ways to support recovery is to help people get jobs and stable housing and having a criminal background is one of the biggest barriers to do those kinds of things.

So, we at DPA are also proposing policy solutions to look even beyond the strategies that our government wants to move forward with.

DEAN BECKER: All right, friends, there you have it, some great advice, some warnings, if you will, from Sheila Vakharia, she's a researcher with the Drug Policy Alliance. They're out there on the web at

Well, as we wrap up today all I can say is I wish that Fox or NBC had the nerve, the courage, the intellect, to report the drug war news the way we do. And once again I remind you, because of prohibition, you don't know what's in that bag. Please be careful.

09/09/18 Sheila Vakharia

Century of Lies
Sheila Vakharia

September is Recovery Month, so this week on Century of Lies we speak with Sheila Vakharia, PhD, Policy Manager of the Office of Academic Engagement at the Drug Policy Alliance, about recovery, stigma, and harm reduction.

Audio file




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'm your host Doug McVay, editor of

Well, September is Recovery Month, and so to find out about recovery, and rehabilitation, and harm reduction, and decriminalization, and stigma, I reached out to a friend, Sheila Vakharia. Sheila Vakharia, PhD, is the Policy Manager at the Office of Academic Engagement for the Drug Policy Alliance. Let's hear that interview.

Tell me about -- what is stigma about?

SHEILA VAKHARIA, PHD: Stigma is a mark that we place on people. It's not a physical mark anymore, as it was historically. It's kind of a social mark that we place on people. Sometimes it's because of something we attribute to their character, or their personhood, or their behavior, or about their ability status.

And so, stigma is often -- it has a negative connotation. It's a mark to characterize someone as having undesirable characteristics, or being immoral, or in some way outside of the norm.

And so when we talk about stigma and substance use, and people who use substances, who kind of have addiction to substances, people who are recovering from substance use disorders, we're really talking about the stigma of the fact that most drug use in this country is illegal and criminalized, and thereby a lot of people who use substances problematically or recreationally are viewed as already outside of the norm, because they're engaging in behavior that is criminalized and seen as deviant.

But, also for people who develop substance use disorders or addictions to substances, there are a lot of myths about how addiction is -- you know, how addiction develops and who gets addicted, and there is this, you know, misconception and this idea that people with issues who maybe lack willpower, or self-control, or restraint, or people who are too indulgent, develop addiction, and so again, all those characteristics being viewed as negative can serve to further stigmatize people who use substances problematically, because they're viewed as people who couldn't seem to keep it under control.

And so, when we talk about stigma and its kind of impact on recovery, we can truly see that if people who use drugs, people who have drugs problems, are stigmatized in this population, obviously, allocating resources towards treatment or developing policies which may be more conducive to facilitating people to make changes and get the support that they need, may be difficult to pass simply because they're already viewed as a population that may not be worthy of the kind of energy and resources we'd like to put into these kinds of systems.

And then when we talk about it being a barrier to people who are already in recovery, a lot of people carry internalized stigma and shame for their past behaviors, because they know that even though perhaps maybe now they're not using problematically or not using at all altogether, but they had an identity that was stigmatized and may still feel some shame and guilt about it, and may not be prone to talk about it, because they don't want it to change how people may view them, now that they've stopped or things have changed for them.

DOUG MCVAY: Stigma can be, it's -- it's a double edged sword in that respect, I guess, then, right? Because it's not only preventing people from stepping forward, and preventing people from trying to seek some kind of help, it's also preventing the broader society from providing that help. That's --


DOUG MCVAY: Oh. That's a -- because, I mean, language, of course, is one way in which that stigmatization is furthered, is sort of driven in. And, I guess, in both ways, the things that you -- when we call people names, they start thinking of themselves that way, that's, I mean, that's textbook child abuse, isn't it? How, you know, call the kid -- call your kid by horrible names and eventually they think of themselves that way?

And that's -- but it's also, what we keep hearing -- tell me about -- you say this better than I do. Tell me about language, and how that impacts.

SHEILA VAKHARIA, PHD: Right. Well, you know, language can reflect how we think about things, but language can also change how we think about things. So, for instance, you know, when we use language which makes the person's relationship with a substance, or their substance use, the most salient thing about them, you know, for instance, when we call someone an addict or a dope fiend, or a junkie, or a crackhead, what we are first doing is conveying to someone that the most salient thing that we see about them is nothing else about their identity other than the fact that they use a substance and perhaps use it problematically.

And, the other thing that happens when we use that kind of language, first of all, is that we convey a message to that person that that's all we think of them, and that's how we see them, which then can be internalized among that, you know, among that whole population and those people, into seeing also that I am nothing more than my relationship with my substance, which can affect self-esteem and self-efficacy, can affect their hopefulness that anything could change or their willingness to perhaps change, because maybe I can't change, if this is what people say I am. Maybe this is a fixed part of my identity. And maybe I can't be anything more than that.

The other thing that that kind of language does to folks who maybe don't fit that category of substance user, is that we, on the outside, start also oversimplifying our views of people. When that kind of language becomes normalized, we think it's okeh to talk to people that way, or to call them that way or to refer to them that way.

For instance, when we see a news story or a media headline that refers to people as addicts, or crackheads, or junkies, or what have you, we start to think, even maybe perhaps before we have any preconceived ideas, this can help facilitate those kinds of ideas, which then make those identities more salient to us.

So, they have the power to influence and shape the way that we think about other groups of people, and in doing so, we lose humanity. Right? We lose our ability to see the humanity of people who use drugs, people who use them problematically, and we also make it hard for them to be able to feel human, and worthy, and deserving of help.

And so, it cuts both ways, and it doesn't help anyone, when we use this kind of terminology. And so one of the biggest things that we do in the harm reduction space and other advocacy spaces is that we're really big proponents of person-first language, putting the person's humanity before their relationship with a substance, in the same way that we would put someone's humanity before any other identity that they have.

So saying, you know, a person who uses substances, or a person who uses whichever substance, because, what it also does is it takes away the labeling and the almost diagnostic element of determining, oh, because you use this substance, that you must be addicted, or me deciding preemptively, before knowing anything about you, that obviously if you're smoking crack that it must be something that you're doing all day long.

So by saying someone who uses crack, someone who uses cocaine, again, we're just simply identifying that perhaps a behavior they engage in. We're not judging the frequency or determining what that means. But, also then it opens us up to say a person who uses cocaine, but also a person who is a mother, who is a father, who is a community member, who is a neighbor, who is a co-worker.

And I think that that is really important. We need more nuance in these conversations, rather than less.

DOUG MCVAY: It -- it's difficult for me to, I've been in this for so long and yet it's still difficult for me to understand how people can not understand these things, and yet, I mean, it's like with rehabilitation and social reintegration. It's a great idea, and it's what we say we want to do when people are exiting, whether it's a treatment program or leaving incarceration, we want them to reintegrate into society, to rehabilitate, but we throw so many barriers up for them.

We make it nearly impossible, I mean, the people who do so successfully, I mean, that's a bloody miracle, because they've overcome so much of what we've done. Why is it, why do you think it is, people -- that we have such a hard time recognizing the way that we do this?

SHEILA VAKHARIA, PHD: I, well, I think that there's two pieces here. So, first of all, recovery is much more natural and much more common than most of us even realize. However, most of those recovery stories are not going to be on the headlines, are not going to be highlighted in a film, they're not going to be the ones that we hear about in our day to day conversations.

Many people have lived their lives in which they've had periods of problematic substance use, or what they would identify as addiction, and people grow out of addiction. People change their relationships with substances. People move on to different phases of their lives. They make other choices. They choose different networks. They move away. They change.

And so much of those narratives, first of all, have never seen the light of day. For instance, Maia Szalavitz recently just wrote this fantastic piece in the New York Times, highlighting recovery stories that don't follow the traditional trajectory, that don't really have the sensationalized, sexy, shocking kind of wow factor that a lot of the stories that we've come to expect have.

And I think that that is one of the biggest shames about even how we frame substance use and recovery, is that we almost want a shocking narrative. We almost want that rags to riches story, or that huge turnaround story, when recovery is quite a normal experience for a lot of people.

And so what I say is that, you know, the people that we do sensationalize, the people who we do kind of point at and say, oh my god, look at this person, look at all they've overcome, are unfortunately the people who perhaps never had a lot of social resources or economic resources, or a lot of support around them during the point in their addiction when they decided perhaps something needed to change.

It's often those people who do need the support and extra assistance to really launch themselves, because what we do know is that social determinants play a huge role in the development of substance use disorders, and the maintenance of them beyond anything else, because when people have so many things in their lives that are lacking or that aren't being compensated for, a substance can be really, really helpful in kind of addressing those issues or at least not having to deal with them head on.

But also, it's those persistent social determinants, when you don't have access to them, that can make recovery really, really hard, because it's hard to think about stopping using my substance when it's the most adaptive thing I have in my life, especially if I'm not getting housed and I need to keep using my substance so at least I'm awake at night, and not being attacked on the street.

Or, if food is really insecure for me and my heroin habit helps suppress my appetite, perhaps there's also a functional element to my heroin use that, unless I'm being, you know, having complete access to food or good, solid access to meals, it's not going to go away.

And so, yeah, I think that there's two pieces there. Right? I think there's the social determinants that need to be addressed for a lot of people who already kind of started their addiction at a disadvantage and who need those supports to be able to pull themselves up, and then the other idea that most people do overcome, but in ways that are generally just not sexy enough to be a headline.

DOUG MCVAY: I actually worried about doing a show about recovery because, in a sense, I feel that focusing on recovery, I mean addiction, it, in a sense, I'm furthering the stigmatization because I know that most people use drugs, and that most people who use drugs do so in a non-problematic way. So, it worried me that, you know, this was, in a sense, going to, going -- that unless, I -- I feel I need to mention that, to make that clear, because other -- I'm afraid of sort of perpetuating the stigma by just starting from the, you know, substance use disorders and addiction and recovery, and ignoring the fact that well, actually, most people use drugs in a non-problematic way.

On the other hand, for people who do have an addiction, and do have these, you know, this is -- it's a real thing, I mean, you know? I overthink things.

SHEILA VAKHARIA, PHD: Yeah, yeah. I mean, I think that, when we talk about recovery, it's important to have nuance, right? So, if we're going to talk about recovery, to talk about it in a way that doesn't perpetuate any sort of mythology or idea that there's only one way to recover, I think that that's like the responsible way for most of us to talk about recovery.

So, you know, having this conversation is always a great opportunity to say that, you know, recovery should be self-defined. I mean, a lot of people in traditional treatment settings, who may be influenced by more traditional substance use kind of lingo and jargon, may have an idea of recovery as being completely abstinence oriented and substance free, particularly your substance of choice, but perhaps other substances as well.

And so, you know, one way to have this conversation in a way that doesn't mythologize recovery or hold it up beyond any other possible outcome is the idea that wellness is recovery, and that people often feel well and can be well and functional in their lives, with or without substances, and I think that that is helpful. And so, yeah, as long as you're creating a space for that conversation, too, I don't think we're upholding it above anything else, because it is a viable outcome for a lot of people and it can look different, and feel different, for different people.

DOUG MCVAY: We're listening to part of an interview I had recently with Sheila Vakharia, PhD. She's Policy Manager at the Office of Academic Engagement for the Drug Policy Alliance. We'll have more of that interview in just a moment.

You're listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at I'm your host Doug McVay, editor of

Before we go further, you know, probably it would help if we actually understood what recovery means. It's a word that we hear all the time, but, what exactly is it supposed to mean?

Back in 1994, the World Health Organization's lexicon of alcohol and other drug terms defined recovery as quote "Maintenance of abstinence from alcohol and or other drug use by any means." End quote.

Now, there's also the idea of rehabilitation. That World Health Organization lexicon defined rehabilitation as, quote, "The process by which an individual with a substance use disorder achieves an optimal state of health, psychological functioning, and social well being." End quote.

In the last few decades, the idea of recovery has evolved. An excellent article back in 2010 by David Best and colleagues, called "Recovery and Straw Men: An Analysis of the Objections Raised to the Transition to a Recovery Model in UK Addiction Services," published in the Journal of Groups in Addiction and Recovery, again back in 2010, quote:

"The target of recovery is about quality of life, rather than abstinence, although abstinence may be a long term goal for clients. However, the underlying theoretical model for much recovery work is the developmental or lifecourse model, which would suggest a significant lengthening of the time scale for the recovery process, and so the focus on change -- whether to the point of abstinence -- is a long term journey that may well take up the rest of a person's life. So abstinence orientation may well be something that either does not ever occur, or at least is not a viable goal. It is also this approach to addiction and recovery careers that means harm reduction does not have to be characterized as the antithesis of recovery." End quote.

And so with that in mind, let's get back and hear more of that interview with Doctor Sheila Vakharia.

Okeh. And I'm -- this last one is, this last one is actually difficult, but I've, it's just that I've been -- earlier today, I was playing a lot of Whack-A-Troll, trying to respond to some really, really viciously hateful kinds of comments on message boards and on Facebook.

I mean, these people -- basically, these people were saying that they thought that, you know, things like supervised injection or some harm reduction things are just enabling, and that they would just rather to see the, you know, to see your child die, because they deserved it from having used those drugs. They'd rather see them die, because, you know, otherwise we're just enabling.

Just because they're -- I mean -- the FCC wouldn't let me say what I'm thinking about people like that. How can people respond effectively to that kind of, to someone who's just, whose attitude is, oh, any, that's just enabling, we just have to toughen up law enforcement and if a few people die, well, that's just how things go. You know.

SHEILA VAKHARIA, PHD: Well, I think that the best way to do it is with compassion. So, you know, those of us in the, you know, in the treatment space talk about, you know, stages of change, and how, you know, people go through different, you know, mental and emotional processes as they decide to move towards change.

I don't know if you're familiar with the stages of change theory, the transtheoretical model?

DOUG MCVAY: Uh ... tell me --

SHEILA VAKHARIA, PHD: Have you heard of it?

DOUG MCVAY: Well, for the benefit of our listeners, well of course I've heard of that, but for the benefit of our listeners, ha ha ha.

I have no idea what you're talking about.

SHEILA VAKHARIA, PHD: So, I mean -- so, sure. So, you know, in the treatment space, we often talk about it, you know, as a way to destigmatize drug use and people who use drugs problematically, but also as a way to, you know, have more compassion and understand how people change, and we talk about this model called the transtheoretical model of change, which says that, you know, change doesn't just happen overnight, and it requires a lot of mental and emotional preparation before one is often ready to make a change.

And then even sometimes after we've made a change, you know, you may have some backsliding and you may need to recommit to the goal that you've been working towards. So I often use the kind of analogy of, like, weight loss. You know, someone doesn't just think overnight, oh, I need to lose weight. Oftentimes, they think their weight is fine, but then perhaps clothes don't start fitting, or they start noticing they look a little different in the mirror, and so they go from being pre-contemplative, meaning thinking, oh, everything's fine, there's no problem, to contemplative, thinking oh, huh, maybe I've been gaining a little weight, maybe things aren't sitting well, maybe I haven't been paying enough attention to my workout regimen or to what I've been eating.

Oftentimes before someone just jumps into a diet, it often takes some preparation, some planning. So, now that I've noticed that I've put on some weight, what are some strategies that I can engage in? I could think about going on a diet. I could just buy bigger clothes. I could think about working with a dietitian or a nutritionist. I could think about getting a gym membership.

And then, you know, after going through that preparation process, [inaudible], a lot of us have ambivalent feelings about our weight and our bodies, but often don't do much about them. So, you know, you get to the point where you're on the option phase, and you may decide, okeh, well I'm going to try that new workout regimen. I'm going to buy the gym membership, I'm going to start going and this is going to be my new routine.

And the action phase is kind of when you jump off and launch into this new kind of way of doing things, and living your life, and engaging with things, and you know, after a while, you may be in the maintenance phase, where it's just like it becomes a normal part of who you are.

But perhaps maybe in the first six months or so, you get busy and you stop going to the gym, and you think to yourself, well, maybe I'm doing okeh and I don't need to go back, and I slip back into my old thinking that I don't need to be doing this.

But anyway, with that weight loss metaphor, I often use that metaphor with my clients who use drugs to get them to think about, you know, like, where are you in the stages of change? Like, do you think you're used to the problem? Do you think that, you know, you need to cut down? Do you think you need to stop altogether?

But, I think that it's also really important to use that stages of change model when thinking about people who don't think the same way that we do. So perhaps, you know, someone who's saying something like, well, let those people die, they don't deserve help, they, you know, they're just a drain on society, are people who are pre-contemplative to harm reduction.

So, because they've never heard of harm reduction, because no one's ever challenged their thinking and given them a reason to kind of look at things differently, maybe they just need a little bit of help being moved.

And so instead of expecting them to be in the action phase, of being a harm reduction advocate right away, I have to think about how do I get them to the contemplation stage? I'm just kind of seeing some of the shortfalls of some of their arguments, or seeing some of the limitations of their arguments, or starting to see some of the exceptions to the things that they think are the rule.

So, in having compassion for an angry tweeter or facebook commenter who says, well, let those people die, you know, to come at them and expect them to be at the same level of understanding that someone like us is, is perhaps unreasonable and could also like shut down the conversation. Right?

And so I think an important way to get someone from pre-contemplative into contemplative is to really explore what the roots are of what those thoughts are, what those beliefs are. And oftentimes, what you hear from people who hold those stances is that either they've never met someone with an addiction and so they're basing it completely on sensationalized stories in the media and things that they've seen in the news or on TV, and so, you know, having a conversation about, you know, well, what kind of headlines do you pop up in the news versus what do people see in reality, can be a helpful way to get them to start reflecting on what they're thinking.

But then what we also see is that some people who have those extreme thoughts, actually their mom was addicted. Their brother is currently addicted. Their partner cannot stop using. And oftentimes that attitude is formed from a place of anecdotal, first hand experience, which may be really challenging and harmful and hurtful to them, that they don't really understand and so that they're reacting with a lot of anger, but often sometimes that anger is grounded in hurt and feeling of powerlessness and being like, well, I don't know what to do with myself and with my stuff and like all those other people, and they do seem to give up on those people. Do you understand what I'm saying?

DOUG MCVAY: I do. I do. I do, I wish I'd had -- I wish we'd had this conversation before I started playing Whack-A-Troll, and hopefully moving forward I'll be a little more understanding. I don't know if it will work, but I'll try. I mean, you've got to try.

SHEILA VAKHARIA, PHD: Yeah. Yeah, and so you know, like kind of coming at the, you know, those folks with -- you know, from a place of compassion in the same way that I would with a client who still wasn't sure what they wanted to do about their drug use, you know, or someone who may not see the harms of sharing syringes, or may not see that perhaps they should keep naloxone on hand, and who think that things are just fine the way that they are.

In the same way, you know, it's really important to ask questions, to find out where they're -- what their beliefs are, what are their beliefs grounded in, are there some personal experiences, are there just kind of limited information, and to really have compassion to the fact that people hold these opinions oftentimes as a way to protect themselves from feeling, you know, too strongly about, you know, feeling out of control, or they're doing it as a reaction because they haven't gotten all the information.

And so, you know, I find myself, even when I am myself in those conversations, I bristle initially, and I'm like, oh, gosh, what do I say? But then, I have to recalibrate and check myself and think to myself, they're not where I am, but, like, how can I get them there?

Until I -- and I can't get them anywhere until I understand what's informing this stance. And then, when I can understand where that stance is coming from, I can better have compassion for this person as holding this opinion because of limited information, or because they're struggling themselves, and then I can then better tailor my message in a way that they can understand.

DOUG MCVAY: What she said.

Sheila, do you have any closing comments, we're getting close to the end of the hour, do you have any closing comments for our listeners, and I want to get, you know, any websites, and your social media stuff, too, so people can follow your work.

SHEILA VAKHARIA, PHD: Yeah. Well, I mean, so, I'm on Twitter, so I can be followed at @MyHarmReduction. And I recommend checking out the Drug Policy Alliance webpage, which is, where you can get a lot of really great information about drugs, what they do in the body, different kinds of options for getting people help, and understanding, you know, what drugs do.

You can also get more information about some of the policy work that we're doing on a national level as well as in the states that we're located in. And then, you can also sign on to some of the petitions that we have circulating. Right now, we've got a great petition that you can sign onto through our main webpage, in which you can actually send a message a message to your Senator, your state senator, telling them that you support supervised consumption spaces, and that you find, that you've seen some issues with, you know, the discourse coming out of Rod Rosenstein lately, and, you know, the ways in which this administration is trying to push back against supervised consumption spaces.

So, we've got a template letter already there that you can just send, or you can go in and modify it, and it will send directly to your senators. So we've got actions like that, that happen all the time. You can sign up for our newsletter, and be up to date on what's happening in your state, and ways in which you can get involved.

DOUG MCVAY: Sheila, I thank you so much for your time, and all the great work that you're doing. I want to have you back on the show again sometime soon, we'll talk more about the criminalization side, because this is --

SHEILA VAKHARIA, PHD: Okeh. Well, thank you so much for having me, this is great.

DOUG MCVAY: That was my interview with Sheila Vakharia, PhD, Policy Manager of the Office of Academic Engagement for the Drug Policy Alliance.

NGAIO BEALUM: While marijuana's legal on the west coast, and Alaska and a lot of different places, it is still illegal in most of the country, right? So while these cats are out here making millions of dollars and everybody's got a cannabis business and we're all smoking weed in the streets, there are people in other states who are still in jail over a joint, who got fifteen years on two grams, who got arrested for a gram and a half of weed.

It's not over. We still need activists. We still need radicals. We still need to be in the streets, like, I've updated one of my new jokes about how what we need to do is just roll out from the west coast to all these others states, and just start going door to door, like Weedhova's Witnesses, and getting everybody involved.

I have some good news about weed, can I share it with you? Right? I'd like to talk to you about my faith in the cannabis hemp plant.

DOUG MCVAY: And that's all the time we have this week. Thank you for joining us. You have been listening to Century of Lies. We're a production of the Drug Truth Network for the Pacifica Foundation Radio Network, on the web at I’m your host Doug McVay, editor of

The executive producer of the Drug Truth Network is Dean Becker. Drug Truth Network programs are available via podcast, the URLs to subscribe are on the network home page at

The Drug Truth Network is on Facebook, please give its page a like. Drug War Facts is on Facebook too, give its page a like and share it with friends. Remember: Knowledge is power. Follow me on Twitter, I'm @DougMcVay and of course also @DrugPolicyFacts.

We'll be back next week with thirty more minutes of news and information about drug policy reform and the drug war. For now, for the Drug Truth Network, 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.