03/27/19 Abraham Gutman

Century of Lies
Abraham Gutman

This week on Century we talk about about overdose, harm reduction, pain policies, and opioids with Abraham Gutman, opinion writer at the Philadelphia Inquirer.

Audio file



MARCH 27, 2019

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

DOUG MCVAY: Hello, and welcome to Century of Lies. I'm your host Doug McVay, editor of DrugWarFacts.org.

Well folks, I promised you last time that I was going to bring you more from the Commission on Narcotic Drugs' sixty-second annual session, and we will get back to that next week.

Thing is, that there were some things in the news I wanted to talk about, and I got the opportunity to talk to somebody I've wanted to have as a guest for some time now. Abraham Gutman is an opinion writer for the Philadelphia Inquirer, so, I think you'll like the show.

On the phone with me now is Abraham Gutman. He is an opinion writer at the Philadelphia Inquirer.

You're the reason I noticed recently that Senator Karen [sic: Kristin] Gillibrand, the New York Democrat, had introduced some legislation that would have put some severe limits on opioid availability, would have put some limits on prescribing ability rather.

There are some serious problems with that legislation. You're not -- it appears you're not the only one who's been pointing this out to Senator Gillibrand, but, as I say, I heard it from you first, so, tell me what's going on? What is Senator Gillibrand trying to do?

ABRAHAM GUTMAN: So first of all, thank you for having me. A few days ago, Senator Kristin Gillibrand that tweeted that to address the opioid epidemic, we must work to address the root causes of abuse.

So the idea is that she's leaning into a narrative of the crisis that says the reason that so many people are now living with addiction is because so many people were prescribed opioids and then they took it, they got hooked, and that was how this started.

So if you want to end the addiction, what you need to do is to end the reason people are starting the addiction, which is the availability of opioids prescribed by physicians. Which seems like a logical narrative, and we see a lot of people on both sides of the aisle taking the narrative to heart.

We see a wave of books that are telling that exact narrative: I broke my ankle, I went to a doctor, they gave me percocet, they gave me oxycontin, and now I have addiction. But, when we look at the data, when we unearth the real effects of opioids on people, we see that the statistics look a little bit different, that the vast majority of people who get opioids don't get addicted.

Some 92 percent of chronic pain patients don't have a problem with opioid addiction, even though they take it almost every day.

So this notion that the problem here is a drug that is, you know, so addictive that people are taking it, it's such a big concern, it's problematic, and in reality, while there was a reckless prescription that was driven by a for-profit entity, Purdue Pharma, that spread false information about risks and about prescription stewardship, and how to be a good prescriber, it is not the case that the heart of the issue is that by being exposed to opioids, we created a crisis, we created addiction.

So, the first fault of the bill is that it doesn't address the actual cause, because it comes out of a narrative that is not the narrative of why this crisis is happening right now.

So that's the one side of things. But then when we look at it practically, what will happen if, you know, a lot of bills are misguided, a lot of bills don't hit the mark a hundred percent, but a lot of them are also harmless, so, you know, why get upset?

What the bill suggests, and I will say that I haven't read the actual text of the bill, and I don't believe that anyone outside of her and her co-sponsors office and the committee office in the Senate, because the text is not available online.

But what we learn from the press releases on the bill, from Senator Gillibrand's office, is that it's legislation that will limit prescription of opioids for acute pain to seven days. And the way the Senator frames it is, you know, if you have your tooth pulled, you don't need more than seven days of opioids.

And here we have a big issue with what is the definition of acute pain. So, the way that Senator Gillibrand is using acute is as something that is mild, as something that is small, as something that is not that big.

But in reality, acute pain is only defined by duration. So usually the literature defines acute pain as less than three to six months. So all acute means is that it will pass.

So now let's imagine someone that has major spinal surgery after a major car accident. That's acute pain. Are we comfortable with saying seven day prescription limit? Is that the amount of painkillers that person could get? I am not.

So, the issue here is that, while a lot of people, including the Senator, recognize that for chronic pain patients, prescription limits and, you know, guidelines that limit the availability of opioids, have created a rising suicide among chronic pain patients. A lot of people feel like here it's okeh because what we're talking about is acute pain, and not chronic pain, when in fact, acute pain says nothing about how mild or severe the pain actually is.

DOUG MCVAY: The news reports are saying that she's now said that she's open to improving the idea, that she's heard concerns. She's also, oh, I should also mention, she's announced that, Senator Gillibrand has announced that she's running for the Democratic nomination for president.

How seriously should we take the, I mean, she says she's heard our concerns. Should we, do you think we're okeh now, or is that, I mean -- what does that mean?

ABRAHAM GUTMAN: Well, I can only tell you how I read that. First of all, let me say that I applaud Senator Gillibrand for looking into the issue in the first place. We see a lot of senators, including people running for president, ignoring the fact that 70,000 people died last year, and the year before -- and 64,000 the year before, of overdose, many of whom of an opioid overdose, although not all.

So I do applaud her for having interest in the topic, and we need more people, high profile people that use platforms such as presidential campaigns to talk about this issue. So that's a good thing.

When Senator -- I don't know her, and I believe her. If she says that she's listening, I believe, and that means that this is our time not to step back away from the critique, but to lean into it, because she says that she's listening. So let's have her get something to hear. Right?

So, I think that this bill cannot be corrected or amended to be a good bill, and the reason is that a prescription limit is not how medicine should work.

If you are concerned that doctors aren't practicing prescription stewardship that is responsible and they don't know how to prescribe opioids, require training, education, get those doctors to a place that -- people in America know that when they go to a doctor, they get good care. The solution is not to legislate how doctors behave.

And I don't understand how doctors are not deeply offended by this bill, because what basically this is saying is, you're all misbehaving, I don't trust you, I'm going to impose a limit, because I don't think you're capable of change.

I'm not saying that all doctors are perfect, I can tell you that a lot of places have played around with, you know, what is the minimum order, what is the standard order if you just, you know, what is the default order in the computer in the hospital's reference system. All of those nudges are good. Let's help doctors prescribe better, let's help doctors reduce prescription when it's unnecessary.

But saying that we're going to legislate medicine, and to that level of interaction between physician and patient? So when a doctor said, you need eight days, then a bill says Congress says no you can't? That is very problematic, to me, and so, I don't think this bill can be improved. I think it is unnecessary, and I think it oversteps the boundaries of a healthy relationship between physician and patient.

DOUG MCVAY: Kind of radical, letting doctors handle questions and decisions about healthcare. I don't know. But, well, it's just one -- I mean, I've been following this war on pain patients for the last, oh my god, it's been twenty years, and I mean we just keep seeing, you know, let's put more restrictions on, put more restrictions on, yes, but now, if people really ....

I don't know. And then it gets to the other, I mean, root causes. Root causes? There are thousands of those opiate overdoses, of those that are suicides, many more than we want to admit are actually suicides, I mean, what root cause are you addressing if all you're doing is taking away the tool that the person uses to kill themselves? I mean, that's not a root cause, that's .....

ABRAHAM GUTMAN: And, about that, I think that that gets to a really important point, that we did see a major reduction, and some of this is positive, in opioid prescriptions in the past, you know, two decades, or decade, and I believe there was a twenty percent decrease between 2006 and 2017. That's a big -- that's a big decrease. So one in five prescriptions was't written.

At the same time, we see that overdose deaths are more than doubled from opioid overdose deaths. So, if you have major back surgery and you can't get a percocet, or a painkiller that will help with your pain, an opioid is not always the right medication for you, but it is sometimes. If you live in Philly, you know, buying heroin is really easy.

And, that's dangerous. That is what we want to avoid. When someone takes a percocet, we know what they're taking, we know how much they're taking, and we know to follow that. When someone takes -- uses heroin from the street, is it heroin, is it fentanyl, is it carfentanyl? How strong was it? How much was that, what white powder was it? You know? A lot, a little? We don't know.

So the risk of overdose, the risk of -- by the way, wound, skin wounds, abscesses, obviously HIV and hepatitis C, all increase when you transition from this regulated medical care world into an illicit and criminalized market, when we don't have enough services to support it and reduce harm in it.

DOUG MCVAY: This is my interview with Abraham Gutman from the Philadelphia Inquirer. We will be back with that in just a moment. This is Century of Lies. I'm your host Doug McVay.

You've got limited time and I want to get to a couple of other things while I've got you on the phone, because, as I said, you're an opinion writer at the Philadelphia Inquirer, and Philadelphia has been in the news quite a lot, for very good things for once.

Your city is one of a growing number around the country where people are setting about trying to set up a supervised consumption site, safe injection site, overdose prevention site, in Seattle they were calling them community health engagement locations, I don't care what the euphemism is, these things work. SIFs, supervised consumption sites, they work.

Your city has come about as far as anybody, possibly further. You've got your, the people at City Hall seem to be in favor, you've got the Department of Justice scared, because they've actually filed a lawsuit to try and stop you. But, so tell me about what's happening in Philly, tell the listeners about what's happening in Philly because this is just so exciting.

ABRAHAM GUTMAN: Yes. So, Philadelphia has the highest overdose death rate of any large city in America. It's very -- a very discouraging sign. The epidemic, or the crisis, takes two forms. One is it's, you know, among a population that is also homeless, that is visible, that we see, you know, public injection, and that becomes an issue for neighborhoods and a nuisance, and people are scared. That has public safety implications.

At the same time, we have 75 percent of people who die at home alone, so we have these hidden overdoses, oftentimes in their own, you know, own home, and if there was someone with naloxone, an opioid reversal medication, then the death would have been avoided.

So, the idea of a safe consumption space, or site, or again, as you said, there are many, many names that advocates and researchers call this, is to understand that the treatment of opioid overdose, of that moment, not of the addiction as a whole, just that moment, is rather simple.

There's a medication, it's called naloxone, or Narcan, and by using it with CPR skills, a lot of people who have died from opioid overdose don't need to die. But what that requires is not using alone.

The problem is that in a world with a war on drugs, using alone makes sense, because you don't want the cops to see you, because you don't want maybe your family to know, your employer to know, and you don't want, if you're in a, you know, vacant house, you want to use really fast because you don't want anyone to maybe, you know, attack you, rob you, what have you, things that could happen, you know, in some places that are pretty scary for the people in addiction.

So you're more likely to use faster, more likely to use in an unsafe way, and are more likely to not notice how much you're using. And you're more likely to practice unsafe injection practices, which also cause, you know, skin problems, again, wounds, and all -- and heart infections, all what have you.

All of those things are not related to opioids. So, heroin doesn't cause a wound in your arm. Heroin isn't the culprit in heart infections. What is, is, you know, the speedy injection. What is, is the unclean water that you use with -- in the process, or the unclean surface of your skin when you inject.

So, what if we have a room, and that's all it is, people, you know, go really far beyond with their fears, but what if we just have a room where people can come in a well-lit environment with, by the way, with a syringe biohazard trash can, so you can also dispose of the syringe after you use it.

And you can use drugs in a place that, if something happens to you, someone can respond, in a place where you have wipes, with alcohol, for your skin, you have clean running water, you have a mirror, so you can, you know, inject safely and, you know, be responsible with yourself and your own body.

And, maybe you have fentanyl testing strips that you can check to know how much to use, because if it's fentanyl you'll maybe use less, or slower, than if it's heroin.

So, all of these wrap around services that, when in a criminalized market, we don't know what is the substance and you need to use in fast and dangerous ways, a safe injection sites prevents. Most importantly, there would be someone on site that had naloxone so if you do overdose, you can be revived.

This is not a very complicated concept. Right? But for some reason, there's a lot of debate, mainly among law enforcement and politicians, and not so much among academics, on whether or not this is -- will it work.

Well it works, there's 120 of those around the world and in none of them has anyone ever died, because again, if you hit an overdose quickly with Narcan, your odds of success are very, very high.

So last year, last January, in Philadelphia, representatives of the Mayor, the District Attorney, police and health commissioners came and said we're giving a green light for someone else to do this.

We're not going to give public money, and we're not going to do it ourselves, but if anyone wants to do this in our city, we'll work with them and we will support with wrap around services. The DA said we won't charge them, the police said we won't arrest them.

Then there was a lot of community uproar. What will happen, it will raise crime, it will raise drug use in these neighborhoods. The studies from all around the world suggest that that is not the case, and actually it reduces public injection, it reduces dropped syringes.

So folks in neighborhoods that now have those problems, which we can all agree no one wants their kids walking to school and seeing a person inject heroin, or playing in a playground that has syringes and dropped needles on the floor, then this is also a solution for them. Right?

Like, everybody wins. But still, we have this big, big, big discussion, and a lot of people are not in favor. A lot of councilmembers are not in favor. But in the summer, former governor, Pennsylvania Governor Ed Rendell, decided to incorporate a nonprofit called Safehouse that will open the first one in the United States, the first safe injection site, what they call overdose prevention sites.

A few months go by, and there's a lot of questions about what will happen, and then, the US Attorney for the Eastern District of Pennsylvania, a Trump nominee, or operative, sorry, has decided to file a lawsuit against Safehouse to prevent them from ever opening.

So this is where we are right now. Yesterday there was big news that they found a location, in a neighborhood called Kensington, which is considered in many ways to be the epicenter of the crisis. So that was expected.

I personally, and a lot of others, hope that there will be multiple around the city, so, you know, again, this would be good for everyone, because in a lot of neighborhoods there are dropped syringes, in a lot of neighborhoods there are people in addiction who need these services, so the more we have, the more -- the neighborhood in Kensington won't necessarily feel like, again, we're throwing these problems at them, which is definitely a feeling that exists there.

So they found a location, the lawsuit needs to go on. The argument of the DOJ is that they've suggested that it falls under the "crack house" statute, which, the statute says that any place that is intentionally operated, owned, what have you, for the purpose of using, selling, distributing, manufacturing drugs, is illegal under federal law.

It's kind of obvious that they didn't have a public health intervention in mind when the crack house statute was written originally. So. now is the question whether or not they will, the federal judiciary will see the crack house statute as covering a public health intervention.

I'm hopeful that the solution -- what will actually happen here is that maybe accidentally the US Attorney will give us the path of a judge saying no, this is legal, go for it, and essentially legalize it from the bench. But we're a few steps from there.

DOUG MCVAY: Everywhere, I mean, I've been running some stuff from the Commission on Narcotic Drugs on the show recently, and with the Commission on Narcotic Drugs, it feels like we're consistently hearing that human rights and public health, those have to stay on the back burner because what's most important is that we create a drug free world, and so once we get everybody to fall in line and just stop doing all these drugs and stop selling and stop growing and all that stuff stops, then we can worry about things like human rights and public health.

And as stupid as that sounds, for some reason there are people who go along with that, and the -- the Department of Justice for instance, at the moment. Now this is the first -- they've made this argument before, that, oh, it's a violation, we'll do something. They've spoken up a couple of times as the debate over safe injection sites has gone on in this country. We heard it up in, I think Vermont was one.

The, but the US Attorney there in eastern Pennsylvania, the one there in Philly, is actually filing suit. What's been the public reaction?

ABRAHAM GUTMAN: I think we can't be naive. A lot of people are -- a lot of people think this is a good thing, that this is just, you know, enabling addiction, that this is coddling drug users, there's a lot of, by the way, racial grievances in here, which is completely understandable.

Oh, now that white people are dying from opioids, you somehow read different interpretations into the crack house statute, which was called -- which is called colloquially the "crack house" statute because it cracked down on people using crack, which were predominantly black and brown people.

So, the politics of safe injection sites, and harm reduction in the opioid crisis in general, are very complicated because of the tormented history and present of the drug war and the disparate impacts, I will say [inaudible] impact, and the purpose of it as being a means of control of people of color.

So, although not all people who are dying are white, although the fastest rate, growth rate of overdose death in Philadelphia, for example, is Latinx folks, we still hear that this is a solution that came in mind for white people.

Which in many ways is true, like, there is no doubt in my mind that because more -- the magnitude of the overdose crisis, more and more people who, you know, maybe are judges, maybe are city councilors, maybe are people who just work in administration, have more social capital, suddenly have met this personally. My friend's son, he wasn't a moral failing, he was, you know, a victim of addiction.

So the attitudes definitely also changed, at the same time, because of race and because of who's dying, but that also leads to this backlash, of, that we don't want to see it. We don't want you now, like, go, why don't you go arrest them. So it's complicated because I think the grievance makes perfect sense.

At the same time, I do think that safe consumption sites could be done in ways that are inclusive, and a classic example is moving away from safe injection, which to a lot of people signals people using heroin, white people, although that's not exclusive at all, when we can move to safe consumption and talk about smoking tents, and talk about, you know, there are safer ways to use any drug, including smoking crack.

So how do we move towards that is a really big question. So the coalition is not there yet. That said, people are dying, and we don't need to wait for the coalition to happen.

We should move forward, we could save lives and we could at the same time work to have conversations and educate about that, but we can't wait to have, you know, a big reconciliation moment between the drug warriors, the folks who are still very, very hurting from criminalization of them as black and brown bodies in this country, and folks who are dying of addiction, who are, you know, also come from all walks of life.

I can also say that the recovery community has been pushing back a lot. A lot of folks recovered through Twelve Step and abstinence only models, which worked for them, and that's amazing, but recovery is, you know, nonlinear, and each person has their journey, and there is no right and wrong way.

So, whatever recovery means to you, that should be our goal, that everybody is safe and well. So a lot of people say, you know, I recovered through Twelve Step, I recovered through abstinence only. Don't do this, I need to be at my rock bottom. By providing safe consumption spaces, you won't let them meet theirs.

But the 70,000 deaths last year show that for a lot of people, rock bottom is death. So we need to -- the coalition is not there a hundred percent yet.

DOUG MCVAY: Again, I know that you've got -- I've taken up a lot of your time so far today, and I'm grateful as heck to you. Again folks, we're speaking with Abraham Gutman, he's an opinion writer at the Philadelphia Inquirer. There's a lot happening in Philly, a lot happening around the US, and I am just really glad that, Abraham, I'm really glad that you're taking an interest in this stuff and that you're writing about it.

I've read your stuff, you do some good work. Now, we can find your writing at Philly.com, obviously, but, social media, and of course, any closing thoughts for the listener?

ABRAHAM GUTMAN: First of all, thank you for having me. I would always love to have the conversation continue. My best way to reach me is on Twitter, @AbGutman, Abraham Gutman. DMs are open, let's talk.

And my closing thought is that, this is a fight worth fighting. So, if it's a fight for pain patients, it's a fight for patients that have acute pain, and if it's a fight for the people who are currently in addiction, and need harm reduction and a safe place to be, these are all worthy fights, so I hope that as many people can join in and as this election progresses, the more people can ask questions of their candidates, representatives, from city hall to the president of the United States, and make this is an issue.

Because if 70,000 Americans died in any other way, a preventable death, I doubt this would have been the number one story of our time. But 70,000 Americans died last year, more than the entirety of the Vietnam War for the third year in a row, and we're not talking about it. So let's do everything we can to change that.

DOUG MCVAY: That was my interview with Abraham Gutman, opinion writer at the Philadelphia Inquirer.

And that’s it for this week. I want to 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 DrugTruth.net. I’m your host Doug McVay, editor of DrugWarFacts.org.

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We'll be back in a week with thirty 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.