03/18/20 Mike Discepola

Century of Lies
Mike Discepola
San Francisco AIDS Foundation

This week on Century of Lies: Harm reduction for stimulant users, featuring Mike Discepola with the San Francisco AIDS Foundation, Mindy Vincent with the Utah Harm Reduction Coalition, Isaac Jackson with the Urban Survivor’s Union, Shilo Hassan Jama with the People’s Harm Reduction Alliance, Daniel Raymond with the Harm Reduction Coalition, and Lindsay LaSalle with the Drug Policy Alliance.

Audio file



MARCH 18, 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.

Indicators within the U.S. and internationally are showing a marked increase in the use of stimulants. Some time ago at a Drug Policy Alliance International Reform Conference there was a panel on harm reduction for people who use stimulants. We are going to hear some of what they had to say. The panel included. Mike Discepola with the San Francisco AIDS Foundation; Mindy Vincent with the Utah Harm Reduction Coalition; Isaac Jackson with the Urban Survivor’s Union; Shilo Hassan Jama with the People’s Harm Reduction Alliance; Daniel Raymond with the Harm Reduction Coalition, and the panel was moderated by Lindsay LaSalle with the Drug Policy Alliance

The next voice you hear will be that of Lindsay LaSalle.

LINDSAY LASALLE: Obviously one of the risks of stimulant use as with opioid use is the transmission of infectious diseases, HIV, and Hepatitis C. One of the primary interventions is syringe access but the question is that syringe access is generally tailored to meet the needs of people who use opioids, so how can we more specifically engage with the stimulant using population in our syringe access programs. Mindy, I will turn first to you.

MINDY VINCENT: Thank you. In Utah we have had a significant methamphetamine problem for about two decades and we also have a very significant opiate issue as well. We have people who use cocaine, but not very many so you will hear me talk about methamphetamines. There are so many layers of how we have to best serve them and one of them is our exchange model. The population I work with are methamphetamine users who inject significantly more times per day than our opiate users often do. Being able to fight for a needs-based program and handing out syringes is incredibly important for us. In my community there is a lot of chaotic injection behavior in the methamphetamine users and right now there is something going on with people doing what is called “(BEEP)-Rockets”, and they are injecting in their penis so we are having to do a lot of interventions around that suggesting that people not do that and perhaps “Booty Bump” instead. We have a lot of the “party in place” scene in our area as well in the rural areas where people don’t necessarily want to come out of any kind of closet whatsoever and trying to reach those people is difficult. We have to use a lot of peer driven approaches to reach a lot of our methamphetamine users because so many of them are in rural areas. There are a lot of oil fields and steel mills in our rural areas and those people work very long days, especially the oil field workers who work ten days on and seven days off. That is where a lot of our methamphetamine use is and it is hard to reach those folks because they don’t access services as often as our opiate users do. Our opiate users have overdoses or abscesses more often than our methamphetamine users so for many reasons they access services more so it is harder for us to find our stimulant users. Additionally, they are more paranoid about talking to us because where I live law enforcement is our greatest barrier so people are afraid to access services because of that. We have to find somebody who is in the community and then we can start reaching people from there, and it has to be the person who originally reaches out to these stimulant users has to have been a stimulant user themselves or they are not even going to talk to us. Luckily for me I spent 17 years building my reputation so people talk to me. We also have significant barriers serving all of our drug users because we don’t have access to services and Utah did not expand Medicaid. We have great treatment services if you are in Salt Lake City, but Utah is also a very abstinent based state. Everybody in Utah wants you to get sober and if you don’t get sober it is because you just don’t want it bad enough and this is what people will tell you all day long. If we are anywhere outside of Salt Lake City getting people in to any kind of detox or treatment services is extremely difficult and that is one of our greatest barriers just being able to serve these folks. Other thoughts on how we can tailor syringe exchange to meet the needs of stimulant users?

SHILO HASSAN JAMA: I think this is really important. Paul Harkin and Mark Hensley started to develop these services in the 90s and the fact that we are still talking about how to work stimulant users as a larger conversation is really disgraceful to the harm reduction community and it is about time that we wake up and realize that we didn’t invent shift. Drug users are the ones who had to implement these services for themselves and then they had to convince harm reduction groups to listen. We have only really focused on smoking stimulant use for the last seven or eight years and the fact that Paul and Mark developed this stuff before I even knew their names and when I started doing some of this stuff and was told that they were doing that in the 90s. I think it is really important that we understand that and we have to get over the fact that focused services on opiates do not work with services for stimulant use. We need specific services for them and every single program that serves anyone who uses stimulants should have these written in. It is not rocket science, it is getting some sort of liquids or food to do your metabolisms and having pipes so people can regulate their use better. It is actually showing them love and respect by not calling them “Tweakers”, and not using discriminatory language.

MIKE DISCEPOLA: I would also add that I have programs that coordinate closely with our syringe access services through the AIDS Foundation. Having specific harm reduction services right there at the syringe access sites for meth/stimulant users that are very low-threshold such as a book club that is narrative based where we read a short paragraph and then talk about how that relates to our lives. People can also come in and get some food. A lot of our services are around stimulant use and these low threshold services have a really high hospitality focus so we offer food, refreshments, socks, and syringes. We rely highly on bringing in networks of users who also bring in their buddies. The other side of the syringe access is really training our syringe access staff to really be able to endure the energy that comes in when speed users come to these sites along with some of the behaviors that speed users may have that others might find scary. So training for these syringe access sites should include basic mental health and dealing with psychosis – not necessarily wanting to fix it – and being okay with being around that behavior. People who are psychotic are generally not dangerous people and we have to be willing to be with people where they are. What I find at the lounge that we have with our syringe access site is that the stimulant users and the opiate users do okay together, they work it out. We have a quiet side where people are chilling and we have people emptying out their bags and doing their spinning in another area. I think we have to get more comfortable as providers dealing with that and being around people who are on the level some of our speed users can be.

ISAAC JACKSON: Hello. Working with crack smokers over the years has been quite an education for myself and people in my group. One of the things that is amazing is the stigma that crack smokers face as well as the misunderstanding even in public health and harm reduction communities. For instance, there is a stereotype that crack smokers are mostly black men. Since we started this we also started tracking data on who comes in as far as ethnicity and gender. It turns out that more black men are about half the number of people that come in, but the other half is black women, white men, white women, and others. In east San Francisco at our site black men are not the majority, so that means that any programs that you are going to create for this population you will have to go out and collect data to make sure that it is reaching everybody.

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

DANIEL RAYMOND: Thanks. To respond to Shilo; a different way of looking at it, which is not to devalue his way of looking at it is that in the history of syringe exchange programs in the United States, syringe exchange has been optimized not solely or specifically for opioid users but historically for programs operating in predominately larger urban areas and they have overlapped with progressive states. If you have a population that is using a drug that tends to be younger or more rural, or a heavier representation of LGBTQ populations as the syringe exchange programs evolved in the political context of the epidemic in the United States did not evolve in spaces where those were the main people that you are trying to reach. We have naturalized and normalized what a syringe exchange looks like in the Bronx, Chicago, and Boston and that doesn’t necessarily translate to doing it in Utah. Some of this is not so much about differences between the drugs but differences between the geographies and the demographics of who is using these drugs. All of these other points pertain if you want to reach youth. Young people don’t want to hang out with older drug users in general so having use-specific services, use-specific outreach, use-specific staff and volunteers is how you connect. This is the same with stimulants. If you find that most of the people you are reaching are opioid users than there might be some exceptions but in a lot of places people don’t necessarily want to mix because everybody observes some degree of stigma from their drug of choice and they don’t want to take on some degree of stigma from every other drug that is out there that is associated with who is hanging out in a drop in center.

DOUG MCVAY: We are listening to a discussion about harm reduction for people who use stimulants. Speakers included Mike Discepola with the San Francisco AIDS Foundation; Mindy Vincent with the Utah Harm Reduction Coalition; Isaac Jackson with the Urban Survivor’s Union; Shilo Hassan Jama with the People’s Harm Reduction Alliance; Daniel Raymond with the Harm Reduction Coalition, and the panel was moderated by Lindsay LaSalle with the Drug Policy Alliance. We will have more in a moment. You are listening to Century of Lies. I am your host, Doug McVay.

Loyal listeners may recall that I live in Portland, Oregon. The state of Oregon has gone in to a lock down as has my hometown of Portland. We are going to hear just a bit of a news conference that was recorded on Tuesday, March 17th.

FEMALE VOICE1: Has anyone thought of using (UNINTELLIGIBLE) jail for any of these services that you are talking about?

MALE VOICE: Everything is on the table in the time of a crisis. There are many offers that are coming to the city and to the county. We are gratefully accepting all of those offers of assistance and we will weigh those through the Joint Office of Homeless Services if it is related to homelessness. If it is related to public health we will rely on our public health authorities and medical experts.

FEMALE VOICE2: The (UNINTELLIGIBLE) moratorium is not enough. The 19,000 and counting legislators just petitioned to demand a rent freeze during the State of Emergency (UNINTELLIGIBLE). (UNINTELLIGIBLE) health care system. The loss of work means extra expenses will only add up during the pandemic if there is a moratorium that allows eviction to continue based on rent unpaid during the pandemic is of no use to the people (UNINTELLIGIBLE). The people of Portland, the United States, and the world are bracing against the impact of COVID19 and our lives. In the wake of a slowing economy and in an attempt to responsibly contain the spread of the virus, landlords and mortgage holders need to respond to the epidemic in kind (UNINTELLIGIBLE) and not endangering the people by forcing them to work or by tossing them on to the street as soon as it looks like the virus is abating. Neither the virus nor the housing crisis will disappear at the end of the month, or in three months, or in six months. Freezing rent until the economy can safely recover is the way to keep thousands more Portlander’s off the streets. San Diego and the state of Texas are already considering similar measures. Local organizations avoiding the measure include the International League of Peoples Struggle, (UNINTELLIGIBLE), Revolutionary Party, FRSO and Red Rainbow PDFs. An eviction moratorium is good in that it will keep people in their homes during the peak of the pandemic. I wanted to point out that right after three months or six months we will still be in danger and the economy of Portland will still limp along as it attempts to recover from the virus. CHANT: FREEZE THE RENT, BLUNT THE CURVE! FREEZE THE RENT, BLUNT THE CURVE! FREEZE THE RENT, FLATTEN THE CURVE! FREEZE THE RENT, FLATTEN THE CURVE!

REPORTER1: Are you saying that people who currently own homes and buildings including businesses who are relying on the private sector for help right now and that there is no public help at this point?

MALE VOICE: At the city level we do not yet have a strategy in place, we are in the early stages of this. Everything is going to be on the table which is part of the reason I called together this Economic Impact Task Force to hear ideas and strategies. I am asking people to be creative and to think outside of the box. With regard to the specific question that was asked around mortgage payment, I am going to ask our banking institutions who are the holders of that debt what they can do to help us get through this crisis.

REPORTER1: Do you think it is realistic that they will help?

MALE VOICE: Unprecedented times require unprecedented leadership and we are taking steps at the city, county, and state level. People in the private sector are already taking this crisis on the nose and many of them are stepping forward to protect their employees and they are working hard to protect their families. I believe this crisis will bring out the best in all of us and I am asking people to think broadly about strategies that can help us ride the wave of the economic impact that has been created by this public health crisis.

DOUG MCVAY: That was portion of a news conference in Multnomah County in Portland, Oregon. I am not sure who the interrupting individual was but the other speakers were Ted Wheeler who is the Mayor of Portland, and Deborah Kafoury who is the Chair of the Multnomah County Commission. You are listening to Century of Lies, I am your host, Doug McVay.

Let’s hear more about harm reduction for people who use stimulants. This panel includes Mike Discepola with the San Francisco AIDS Foundation; Mindy Vincent with the Utah Harm Reduction Coalition; Isaac Jackson with the Urban Survivor’s Union; Shilo Hassan Jama with the People’s Harm Reduction Alliance; Daniel Raymond with the Harm Reduction Coalition. The next voice you hear will be that of the moderator, Lindsay LaSalle with the Drug Policy Alliance.

LINDSAY LASALLE: I want to turn now to mitigating the risks of the mode of administration. Shilo, I want to turn to you to talk about the ways you were able to help some folk’s transition from injecting to smoking.

SHILO HASSAN JAMA: We did a small survey and asked if we provided pipes would they use them and would they likely inject or smoke more. Since no drug user is the same and as someone who has historically been an opiate drug user, when they said that they would change their behavior I would have said that I doubted that people would go from injection to smoking. I was completely and utterly wrong. This is why I listen to my participants and I don’t listen to my opinions. They started smoking more instead of injecting and the first thing they would say was that they were able to make their doctor’s appointments and do all of these things. As Dr. Hart said, I think that a lot of it is if you don’t use enough it is not very fun and if you use too much, it is very scary and then there is that middle point. If all of us used meth we would all have our different middle point, which is our comfort level. So providing those things drops your rates of all of the blood borne infections by just providing a pipe. A lot of people would come to our program and tell us they need syringes because they don’t have access to a pipe so now they are using riskier behavior in order to administer the drug because we didn’t think of pipes. As we talk about safe consumption rooms we need to include smokers on the ground force. If we do not include smokers on the ground force we are telling smokers that they have to inject in order to be safe and have a safe space. I think it is really important as we develop those programs that smokers be included in the ground force.

LINDSAY LASALLE: Isaac, I wonder if you would like to talk about the crack pipe distribution that the Urban Survivor’s Union in San Francisco did from the ground up and what some of the results were from that and how you engaged folks in that process.

ISAAC JACKSON: One thing that we did from the very beginning is that we ordered our own pipes to specific specification in terms of being a mixture of Pyrex and glass so that they don’t break as easily and they also don’t heat up as fast. This allows us to enter in to a conversation with people because they ask us when they come up to us what they are made out of and just like any drug has its fan base and experts, we get in to long conversations about Pyrex versus glass, etc. What is important about that is that you develop a rapport with the community that you are working with and you learn things from people. You hear arguments about Brillo and things like that and it is really interesting and it proves that drug use is more than just chemical reaction in your brain as a social process. This allows us to enter in to the social process of people that are using. A lot of the people that come in to our site are homeless and it is just a way for the community where we have been working. We have our own pipes and I think they are probably one of the better ones in the city. That is how we started with engagement and some of the funny things that people like to talk about and we want to expand on that.

LINDSAY LASALLE: Thank you. Obviously, transitioning from injection to smoking has its own harm reduction benefits but for those who might not know but for people who are already smoking, why is it still important that you provide clean and sterile supplies. We had this question at the stimulant conference, which seems very basic but it is important for people to understand. I know that Shilo will say it is because his participants ask for it but ultimately what are some of the benefits of just providing the clean supplies?

ISAAC JACKSON: I think that it is an equity issue. Why not give them out? We are giving out tons and tons of syringes every year but more than just the why not, which feels logical, there is the actual disease prevention mode. Hepatitis C has been found on crack pipes that have been discarded and tested later on. When people say that there is no proof that people have gotten Hepatitis C from crack pipes, I tell them that is because there hasn’t been a lot of study on it so they are probably right. If we are wrong in the end and all we have done is give out a thousand pipes and there is actually no prevention of Hepatitis C, shame on me. At least we tried to do something.


SHILO HASSAN JAMA: This is a bad assumption but assuming that pipes don’t have any health benefits the point I would argue is that smoking, if that was even the case, then at least injecting you wouldn’t jump to that injection. We want people to (UNINTELLIGIBLE) things and that is why we now give out snorting kits for people who want to snort. We don’t want to push them to smoking if that is not what they want. We want people to use the way they want for as long as possible and as safely as possible. I don’t want to bash injectors and I think it is important that we don’t stigmatize people who inject while also promoting smoking and snorting equipment.

LINDSAY LASALLE: Daniel, did you want to add anything?

DANIEL RAYMOND: I will just say that I think one of the places where this disease transmission concern comes from is cities with Hepatitis C. With HIV and drug use we have mostly been concerned with shared syringes. Hepatitis C is a sturdier virus and it lives longer outside of the body. It is not just syringe sharing but people sharing other forms of drug injection equipment and people translated that concern to what happens to people who are sharing equipment to smoke or to snort and because Hepatitis C lives outside of the body for longer than HIV does, there is more plausibility that this might be a mechanism for biological transmission. I think one reason that this area has lagged behind both in terms of research and practice is that we have invested a lot of public health resources in the United States and other countries for control of the spread of HIV. We have not made parallel investments or elevated the priority around Hepatitis C, so to the degree that we can assume that there may be some transmission we have had less surveillance to document it and we have had less resources steered toward mitigating those risks.

ISAAC JACKSON: I think one of the reasons why there hasn’t been a lot of resources in to crack smokers is because it is perceived as a black practice and I think just in general where African Americans and people of color have been marginalized in health care and other areas; this is just another example of how this is happening. Someone once told me that they may be interested in working with me because they wanted to reach black people and I thought that was a weird contradiction because on one hand I don’t want to say crack smokers are black people and if you had money for something, maybe and on the other hand – you know what I am trying to say. Ideally one would go to a store or a truck and not matter what drugs you use, you can get something that will help you use more safely because you don’t have any public health information when people go there and come out with burnt fingers and lips. That is what happens with smokers.

LINDSAY LASALLE: Mindy, I will give you the last word and then we will move on.

MINDY VINCENT: I just wanted to say that I do a lot of work with people trying to help them switch their route of administration and it is not because I have any judgement about any way that they do it, it is because there are real harms for people associated with some of the ways that they do drugs. I feel like I am doing a disservice to people if I don’t tell my client who is also been my client for three years and I love this guy. He shows up and he is completely picked from head to toe and I feel like I am doing a disservice to him if I don’t tell him that he is harming himself. We have to talk about a different way to do this or maybe you need to do less. Some people that smoke dope will smoke on a pipe all day long and get nothing done so for some of those people that say that they have to shoot or they can’t get anything else done. I try to always meet those people where they are at and talk to them about what is best for them and how do we reduce the harms in the way that you need to do it so that you can be as productive as possible because the less you are being productive, the more you are probably likely to destroy your life. I want to help you destroy your life as little as possible or not at all. I believe that you can do that and still use drugs, if that is what people want to do.

DOUG MCVAY: We have been listening to a discussion about harm reduction for people who use stimulants. It took place at the Drug Policy Alliance’s International Reform Conference. The panelists included Mike Discepola with the San Francisco AIDS Foundation; Mindy Vincent with the Utah Harm Reduction Coalition; Isaac Jackson with the Urban Survivor’s Union; Shilo Hassan Jama with the People’s Harm Reduction Alliance; Daniel Raymond with the Harm Reduction Coalition, and the panel was moderated by Lindsay LaSalle with the Drug Policy Alliance.

That’s all the time we have for this week. I want to thank you for joining us. You have been listening to Century of Lies, we are a production of the Drug Truth Network for the Pacifica Foundation Radio Network. You can find us on the web at: www.drugtruth.net. I have been your host, Doug McVay, Editor of www.drugwarfacts.org.

MALE VOICE: Thank you! Doug McVay, give it up. This guy is on the stage every year, too, helping us out and teaching you the truth so you can go on to teach it to others.

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