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

Audio file


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 DrugPolicy.org.

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.