01/29/20 Devin Reaves
Century of Lies
On this edition of Century of Lies, we speak with Devin Reaves, MSW, executive director of the Pennsylvania Harm Reduction Coalition. Plus more from our conversation with Professor Kerwin Kaye, author of Enforcing Freedom: Drug Courts, Therapeutic Communities, and the Intimacies of the State.
CENTURY OF LIES
JANUARY 29, 2020
DEAN BECKER: The failure of the Drug War is glaringly obvious to judges, cops, wardens, prosecutors, and millions more now calling for decriminalization, legalization and the end of prohibition. Let us investigate the Century of Lies.
DOUG MCVAY: Hello and welcome to Century of Lies. I am your host, Doug McVay, Editor of www.drugwarfacts.org.
My guest today is Devin Reaves, he is the Executive Director of the Pennsylvania Harm Reduction Coalition. They do a lot of great work and it is a real honor to have him on the show today. We will hear that interview in a moment but first we will hear from Kerwin Kaye who is an Associate Professor of Sociology in American Studies as well as feminist, gender, and sexuality studies at Wesleyan University. Professor Kaye is the author of a new book published by Columbia University Press entitled, Enforcing Freedom Drug Courts, Therapeutic Communities, and the Intimacies of the State. We had the first part of my conversation with Professor Kaye on last week’s program. Now as promised, here is more.
DOUG MCVAY: Professor, in your book you write, “Drug courts and other criminal justice oriented treatment programs do not simply work to get individuals to stop using drugs, rather, they focus their attention on changing what case managers and social workers often frame as an entire “drugs lifestyle”. I suppose it doesn’t matter that they don’t really use drugs or have a drug use disorder. They have a drugs lifestyle and so that has to be fixed. Can you unpack that? It sounds really bad.
PROF. KAYE: Indeed. The case managers spoke about a drugs lifestyle at the treatment center. The managers and social workers sometimes would speak of dope fiend behaviors, but they were referring to the same thing. What they mean by drugs lifestyle has nothing to do with the type of drug use that might be on Wall Street where some people are doing a lot of cocaine or whatever else and using that as part of their work or to play after work. That is not the drugs lifestyle. The drugs lifestyle pertains to what is happening in street life including the hustling one has to do in order to survive when they are unemployed or sporadically employed due to the economy. What the counselors talk about are things like a lack of responsibility, an inability to defer gratification and things that involve responding to all challenges that might be made with angry or violent returns or individuals not obeying and having distrust of authority. That is the drugs lifestyle. These things are adaptive for life on the street and the hustling required in order to protect themselves and maintain a reputation so they can continue to take advantage of situations that might arise. They have to be very improvisational in order to get around any rules that may be there. These are the types of things that they are trying to treat using drug treatment. When I began this research one of the questions I asked is how do they know people are getting better when no one is actively doing drugs at that moment and they are all in these residential treatment centers where they are drug tested at all times for the people who are on outpatient treatment. How do they operationalize this idea of addiction? Basically it has to do with accepting orders, doing what they are told, doing a lot of boring activities such as chores or low level work, being yelled at a lot by the counselors at drug treatment and they are not allowed to yell back. They have to learn how to take these insults to their person and not respond in kind. Apparently they just need to be yelled at a lot in order to get better off of drugs according to the way the treatment is often done.
In my mind what they were doing was more or less preparing people for entry in to low wage labor where a lot of the jobs are horrendous and their bosses may be yelling at them and they have to follow these stupid, bureaucratic rules that make no sense which is basically what they are being trained to do. This is how they know people are getting better even though no one is doing drugs. When people are able to make that transition from what they needed to do to survive as a part of street life in order to survive as part of the low wage formal labor economy. A lot of the drug dealers – many of whom have a strong work ethic already – have no problem with delayed gratification or anything like that. A lot of them found benefit in these types of programs and they were able to change the language that was being used. People who are really interested in becoming part of “respectable” society and leaving the street economy behind and making that move in to what they hope will not be the lowest level of the formal economy and that they will be able to benefit and to make use of these “skills” of being yelled at and saying nothing. On the other hand, some people might have had a real problem with anger. One person I spoke with told me that the police would stop her and she would get very angry and violent with them ending up in jail. She felt like she was able to benefit from the types of instruction and conditioning that she was receiving at the treatment center. So some people are really able to make use of this and it is particularly people that are interested in leaving the street economy and joining “respectable” society doing formal labor. The people that I felt that was true of the most were either people who had just moved in to the street economy and were shocked by what they discovered which scared them and they were happy to have any route out of that street economy or people who aging out of the street economy and had been doing it for a long time with enough success but as they get older they have a harder time maintaining their position within the street economy and they were looking for a way out.
There were a couple of different groups of people who would not benefit from this kind of treatment and they are the people who were in the street economy who felt like they were doing okay and had no interest in being part of a lower tier formal economy so they would just go through the motions and do what they could and often treatment for them is an easier way to do their time than jail. Most of the people that I spoke with, with a few exceptions felt that even though the treatments centers were turning in to mini jails they were a little bit better than actual jail. So half of the people will fail and end up in jail or prison anyway, but for a longer time than if they hadn’t accepted court ordered treatment.
This focus on this “drugs” lifestyle really feels like a way of using psychiatry in order to treat, manage, and control what is a social issue that has to do with groups that have been largely excluded from our society and forms of racialized poverty that exist in our society.
DOUG MCVAY: That was from my conversation with Professor Kerwin Kaye. He is an Associate Professor of Sociology in American Studies and Feminist, Gender, and Sexuality Studies at Wesleyan University. He is also the author of Enforcing Freedom Drug Courts, Therapeutic Communities, and the Intimacies of the State, it is an excellent book that I highly recommend.
You are listening to Century of Lies, I am your host, Doug McVay.
MALE VOICE: My name is Devin Reaves and I am the Executive Director of the Pennsylvania Harm Reduction Coalition, and we are a state wide coalition of organizations and individuals that are looking to end the war on drugs and really help people overcome their struggle.
DOUG MCVAY: Tell us about yourself. How did you get involved in harm reduction?
DEVIN REAVES: I am a person in recovery and for me that means that due to an abundance of (UNINTELLIGIBLE) resources (UNINTELLIGIBLE) and more when I was looking for help back in the summer of 2007. Through my recovery journey I went back to school and got a degree in Human Services and a masters in social work at the University of Pennsylvania and I have worked in the behavioral health industry for about ten years with most of that being in direct service. After a while I got pretty disenchanted with the way treatment is delivered and how the dogma of 12 steps, and the way things have always been was really hurting people and killing my friends so I decided to start the Pennsylvania Harm Reduction Coalition because I had already done some advocacy work with expanding access to naloxone and (UNINTELLIGIBLE) Good Samaritan policies which allows people to call 911 when their friend is overdosing and I just want to do more of that work. We got some funding and were able to pull it off and it has been an exciting two years, we just passed the two year mark.
DOUG MCVAY: That is terrific. I think it is interesting because you’ve got the lived experience background which a lot of people involved in recovery have but you also have the academic background. How do you think that the two complement each other in the work that you do?
DEVIN REAVES: I think my current position give me the opportunity to really lift up other people who are closer to the (UNINTELLIGIBLE) and are closer to the ground making sure that their voices are heard. A proud example would be the house put together a resolution to study best practices around a warm handoff in the state of Pennsylvania. When I was in the room for my first meeting I was saying that it was great that we have ER doctors, nurses, administrators, and all these (UNINTELLIGIBLE). We wanted to talk to people who are using drugs right now that are likely to engage in a warm handoff or people who have recently gone through a warm handoff program because we are the deliverers of the service, not the consumer of the services. I spent a lot of time learning from people that came from the mental health advocacy side and that was very much driven by consumers. Often times the general public sees people who use drugs and consumers of services as shady, unreliable, not experienced and we want to flip that all on its head. The academic side really gives me the ability to speak to what the research says. Intervention X has worked for 30 years in America or across the planet. My experience in this is really three-fold with my academics and having received a bachelor’s degree through my years of boots on the ground delivering direct services as well as years on the ground going to town halls, being in the community plugged in to what is happening in the state of Pennsylvania and of course the third part is that I was somebody that used drugs and lived that chaotic way for almost a decade.
DOUG MCVAY: Can you tell us a bit about the Pennsylvania Harm Reduction Coalition and some of the campaigns that you are working on.
DEVIN REAVES: Sure. We have seen across the country that the way states and communities are responding to the overdose epidemic have changed and we are really excited about that but it falls in to the very old social service dichotomy of deserving versus undeserving. In our society we see some people as very deserving of social services and we see other people as less deserving. In our country the people who are most deserving are Veteran’s as they were a blank check up to and including their own lives just to protect our country and often times it is the Veterans who don’t get the services they need. The least deserving is the old black man under the bridge panhandling asking for a nickel holding a brown paper bag with some kind of bottle in it. We tell him as a society that he needs to pick himself up by his bootstraps. So a lot of our responses to the overdose epidemic have fallen in to that same kind of (UNINTELLIGIBLE) where we say the kid from the suburbs who had a drug problem deserves to go to treatment but the people of low socioeconomic status or people who have a history with criminal justice will go to jail and maybe they will get “treatment” in jail. We focus on people who are most likely to experience an overdose and who are most marginalized by the community because if we can build a system that helps them, it will help everybody.
People who are getting out of jail experience overdose at a rate of 40 – 120 times as many as the general public so we are working at the state and local level to expand access to medications for opioid use disorder for those needing treatment as well as an increase on distribution so that people can have medication access in jails and prisons as well and that is our Serving Returning Citizens Campaign.
Our second campaign is our Treatment Overdose Prevention Campaign. People leaving treatment are also at an increased risk of overdose death (UNINTELLIGIBLE) abstinent from opioids for a long period of time add an increased risk of overdose death. A lot of that has to do with the fact that we are not giving the information out to mitigate that risk. We are not telling them that if they have been abstinent for a long period of time and they try to go back and use the same amount as before they quit using, it will likely kill them. We are not utilizing Medication Assisted Treatment like methadone and Suboxone inside of those treatment centers and so we are trying to expand information about overdose, utilization of medications to treat opioid use disorder and we are also trying to get treatment clearance to be giving naloxone to a patient and a loved one as they get ready to discharge.
Our last big campaign is our Pennsylvania Syringe Service Campaign and that is around people that are using drugs right now. If we look back to what I said earlier about the deserving and the undeserving, we give a lot of naloxone in the state of Pennsylvania to “first responders” such as cops and EMTs. We want them to have naloxone, however, the people that are most likely to have witness an overdose or reverse an overdose are the people that are using drugs. We distribute more naloxone to people that are using drugs than anybody else in the state. We want to expand syringe service programs because that is the best way to interact with people that are using drugs right now. We are working at the local and state level to expand access to syringe service programs.
DOUG MCVAY: Philadelphia is probably closer than any other city in the U.S. to establish the nation’s first legally authorized supervised consumption facility. Safehouse, which is a Philly nonprofit won its first round of court battles against the feds late last year. Safehouse is not PAHRC, but could you tell our listeners a little bit about supervised consumption facilities and reasons why municipalities should be allowed to legally authorize them?
DEVIN REAVES: Absolutely. Let’s compare a supervised consumption facility with syringe service programs. Syringe service programs are programs where people can get sterile syringes, information on avoiding overdose, testing for HIV, Hepatitis C, and connection to treatment. We know that people that engage in syringe service programs are five times more likely to enter treatment, and were much more likely to stop injecting drugs beginning their journey to wellness. That is an intervention that we have known for 30 years has worked rather effectively with many different markers of success. The problem with that intervention is that people need to keep themselves well and their community well and we allow them to go shoot up in the alley and they die. A supervised consumption facility takes it one step further by allowing the drug user to come to a safe, clean space with recovery coaches, nurses, and doctor’s right there to help. Far too many people are ending up dead and this is why we need these facilities.
DOUG MCVAY: Last week the National Academies of Science, Medicine, and Engineering issued a new report on opioid use disorder and infectious diseases and among their recommendations they called for a federal ban on funding for syringe service programs to be lifted. Do you agree with that?
DEVIN REAVES: Yes. Hindsight is 20/20 and it is time to get politics out of (UNINTELLIGIBLE). We know that syringe service programs save money and we live in trying times. The rate of endocarditis, which is a disease linked to unsterile injecting practices have more than doubled and they cost hundreds of thousands of dollars and the untold cost of the loss of life when somebody dies from that. All of these diseases including Hepatitis C, and HIV are 100% preventable and cost hundreds of thousands of dollars to fix when a syringe costs all of eight cents could fix that. It is the right thing to do from a humanitarian perspective, it is the right thing to do from a Christian perspective, but it is also the responsible thing to do. No party that claims they care about healthcare or marginalized populations can say that they oppose this and yet it is an issue that is not discussed enough.
DOUG MCVAY: I recall back in 2007 at a methamphetamine conference in Salt Lake City that was actually a point of contention with Dave Purchase. He was arguing that no federal ban means no federal strings.
DEVIN REAVES: Here in Pennsylvania we have people who are living almost avoiding poverty that are working with a population that nobody else is able to reach and that is not right. We shouldn’t have to rely on people’s charity towards this totally rational evidence based public health intervention. In other states where there is a public health concern we see public dollars fueling that intervention. However, people who use drugs are highly discriminated against and therefore we don’t give them the best scientific intervention. We see this on many levels whether it is how people who overdose are treated in the hospital, treatment centers refusing to use the gold standard of medications for opioid use disorder and it is a travesty that is causing far too many people to lose their own lives.
DOUG MCVAY: What should activists be doing in their communities and at the legislatures to encourage support and funding for harm reduction programs?
DEVIN REAVES: I hope there is a harm reduction organization in your state or in your community and they are going to know what is best on how to get involved. Pennsylvania Harm Reduction Coalition has sister organizations all over the country are doing really good work. Plenty of your listeners are passionate about this project. Reach out and get involved. If there is not a harm reduction facility in your area, become an engaged citizen and reach out to your state reps and senators and tell them that this is something that needs to be tackled. Go on to the CDC website and see what they say about syringe service programs and how they help to keep law enforcement community safer by decreasing the chances of being stuck by a needle, they prevent disease and save people’s lives. Print all of that out and go talk to your legislators. Ask them why they are not doing what the CDC recommends in our state. There are 12 – 15 states in our country that do not have statewide access to syringe service programs.
DOUG MCVAY: One of the things that everybody runs in to is that no one wants one of these facilities in their back yard or in their neighborhood while they may feel badly for those who suffer. How do we deal with people like that?
DEVIN REAVES: I don’t know how to make people care about other people. I think one of the biggest things that we can do is sit down and talk about what is going on in our community. There is no shame around having a mental health diagnosis. We have got to start embracing the science if we want to beat this.
DOUG MCVAY: You do a lot of really great work there with Pennsylvania Harm Reduction Coalition. Do you have a website or other way for folks to contact you?
DEVIN REAVES: Sure. You can check us out on Twitter and Instagram at: @PAHarmReduction, or my personal handle on those same sites is: @Devin_Reaves, you can also reach out to us on the web at: www.paharmreduction.org and we have a lot of great resources there.
DOUG MCVAY: Terrific. Once again, we have been speaking with Devin Reaves who is the Executive Director of the Pennsylvania Harm Reduction Coalition based out of Philadelphia. Do you have any closing thoughts for my listeners?
DEVIN REAVES: Absolutely. With the election coming up I encourage everybody to ask elected officials and leaders in their communities what they are doing to address the overdose epidemic. We are seeing overdoses linked to methamphetamine going through the roof and if we are not talking to legislators and letting them know that this is something that we care about as constituents because if we don’t care, they are not going to care about it to the level that it is needed. Please get involved, get engaged, get out there and protest is how you make your voice heard.
DOUG MCVAY: Thank you, Devin Reaves.
DEVIN REAVES: Thanks a lot for having me on. I appreciate the opportunity.
DOUG MCVAY: It has been a pleasure. That was my interview with Devin Reaves, the Executive Director of the Pennsylvania Harm Reduction Coalition. For now that is it. Thank you for joining us.
You have been listening to Century of Lies we are a production of the Drug Truth Network for the Pacifica Foundation Radio Network. You can find us on the web at: www.drugtruth.net. I am your host, Doug McVay, Editor of www.drugwarfacts.org
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