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Harm Reduction · Why We Do What We Do

• 0:03
  You're listening to Why we Do what we Do. Welcome to Why we Do
• 0:16
  what we Do. I am your compassionate caring host Abraham and I'm your Rational
• 0:22
  Solution host Shane. Or Psychology Podcast. We talk about all the things that
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  people and animals do, and lately we've been talking a lot about substance use
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  and dependency, and we are continuing that theme of topics and discussing some of
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  the things that are I think around this. So so far, what we've
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  covered is just a basic discussion about what addiction is. We've talked about the
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  War on drugs. We've talked about alcoholics anonymous, we talked about the disease
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  model of addiction, and we have more planned for this continued series of topics
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  that we are feeling we feel very strongly about. But today we're talking about
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  specifically a strategy for supporting people with addiction called harm reduction. This episode is
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  going to fall in line with a little bit of the myth busting episodes that
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  we like to do. Yeah, I think that's fair. There's going to
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  be a nice flavor of that to it. But yeah, I think there's
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  a lot of misconceptions about what harm reduction is, or at least what people
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  think harm reduction might be, and some of maybe the isolated interventions that are
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  done inside of that. And so you'll kind of see as we go through
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  what all this means and what that looks like. Yeah. Yeah, there's
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  kind of this ethos or orientation to thinking about the kinds of policies that should
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  be in place around things like substances, drugs, and dependency that have been
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  largely colored pretty much entirely by ideology and not at all backed by any amount
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  of science or research. And so that's why this is sort of the myth
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  busting topic is I think we've seen a pretty failed approach to how to handle
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  this throughout most of human history where drugs have been available and have been a
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  concern, So sort of worth taking a look at what alternatives there are and
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  what might work a little bit better. Right, absolutely, But before we
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  do that, we've got some holidays to celebrate. Yes, This episode publishes
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  April twenty fourth, and on April twenty fourth, it is Administrative Professionals Day.
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  We see you, thank you all for your help. Yes, thank
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  you so much. It is Ourmnian Genocide Remembrance Day, so super important day.
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  If you're not familiar with that history, please take some time to read
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  it and review it and understand that we do not want to repeat it or
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  continue to repeat something like this at all. Yes, genocide bad. Yeah,
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  I feel like that's an easy place to stand, but apparently people have
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  a very hard time saying that. Yeah, it seems like there seems to
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  be some sort of general genocidal maniacs running the world right now. And that's
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  bad, I think, yeah, very bad. But anyway, unrelated to
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  all of that, it is Denim Day, yes it is, and it
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  has also Help Animals Day. It is International Guide Dog Day. That's where
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  the animals help us. Yeah, I love those animals that help us.
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  It's National Skipping Day, which is really great because people forget how to skip
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  fair fair. I think also how to cartwheel. That's true. I don't
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  know that that one's coming back to me. It is New Kids on the
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  Block Day. Yeah, so you know, put on your Donni Wahlberg shirts.
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  I guess it's a seven Young Blanc Day, which you know, I'm
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  surprised I could even say that because I failed French terribly. That was pretty
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  good. Thanks. It is Scream Day, and this is not scream the
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  movie. This is not scream like Scream Out of Terror. It's meant to
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  be the Scream of Catharsis. But I like to think of it as like
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  hardcore metal music day. Yeah, go listen to Hope Conspiracy. It's a
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  stop food waste days, which I really like that. Yeah. World Day
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  for Animals and Laboratories. I don't want to say we're big fans of animals
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  and laboratories, but I think that our field has gotten a lot out of
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  animals and labs. That is true. That has been a very big part
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  of our the basic research behind our science. I did see a great video
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  of a rat who had these that was in like a little like RC car
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  that would like press buttons to drive the RC car around to go get jorable.
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  It was the greatest. So I'm going to buy a rat go kart.
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  It is American Quitter Society Day. Big fan of that. I'm going
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  to join that. It is Animal Cruelty and Human Violence Awareness Week, which
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  is important is given that some of the animals and laboratories faced a lot of
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  cruelty. Yeah. Yeah, yeah, that's a whole that's a whole thing
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  that will probably unpack one day at some point. It's bedbug Awareness Day,
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  so yeah, they live in your computers. If you didn't know that,
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  animals, we probably could be cruel. Or Two, it is Cleaning for
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  a Reason Week. The reason is because that way the things are clean.
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  Yeah, I mean, I don't make up a reason, like, just
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  do it. It's also National Coin Week, but you know coins are fascinating.
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  Yeah, National Infants Immunization Week. Big fan of that. Yeah,
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  Andrew Wakefield not so much. It's a National Organ Tissue Donor Awareness Week,
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  so huge. I'm an organ donor saying please do that. You don't need
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  your organs after you die. Yeah, I collect them and then donate them
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  to other people. Yeah, I'm just kidding. And it is also National
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  Stop Snoring Week. I'm sure to go on board of that. Yeah,
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  good luck exactly. We do just like to mention those holidays. But we're
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  not actually a podcast that talks primarily about holidays. It's just a thing that
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  we do for fun. We're actually here to talk about the psychology of things.
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  And the thing that we were talking to psychology about this time, as
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  we mentioned at the top, is addiction, specifically around the topic of supporting
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  addiction with strategies such as harm reduction, and it's important, I think,
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  to unpack what harm reduction is. And let's actually start by getting into where
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  we came from on this issue and the sort of the history that led to
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  where we ended up. Yes, So, the vast majority of policies to
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  address drug use emphasize or are solely committed to its only programs just say no,
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  the DARE programs, they are explicitly designed to say just don't do it.
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  And the thing is, as long as people have been using illicit drugs,
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  the strategy to combat that has been to criminalize it and teach abstinence as
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  a solution, as we talked about in the War on Drugs, not working
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  so far. Let's talk about some actual data on this, right, Yeah,
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  the overwhelming majority of policies still to this day in most places around the
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  world, are to treat this as a moral legal issue in which people are
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  imprisoned. And we are still having record numbers of overdose deaths happening. So,
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  according to data aggregated by the US Department of Health and Human Services,
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  death in the United States due to overdose have been mostly increasing since nineteen ninety
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  nine, up to twenty twenty one and increasing significantly. Yeah, I mean
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  we're looking at I'm looking at this graph right now, and it is pretty
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  it's just a constant, just kind of rising. Yeah, it was like
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  in the thousands, now up to the tens of thousands, I mean,
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  like well almost eighty thousand as of twenty twenty one, up from like maybe
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  seven thousand, So huge, huge jump. Yeah, big big jump.
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  Now, the most substantial of these and the most and the drug most responsible
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  for or at least attributed to overdose deaths, which was zero at the time
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  that the data started being collected, is synthetic opioid such as fentanyl, which
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  represents a greater than ten thousand percent increase. The next highest drug is methamphetamine
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  and a similar high abuse psychostimulants, which sees a six four hundred percent increase,
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  followed by cocaine, which sees a seven hundred and sixty percent increase,
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  Then prescription opioids, which is increased by four hundred and sixty percent but was
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  on a downward trend at least as of twenty twenty one when these data were
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  collected, and finally heroin, which was on a rapid increase around twenty twelve,
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  but has actually been on a steady decrease since twenty seventeen, but still
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  represents a two hundred and fifty percent total increase from baseline. So across all
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  of these major drugs, there is a huge there's just a huge increase across
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  the board, even with those declining numbers in some of those. Yeah,
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  and really the only one of those that was really in decline at the time
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  that they finished aggregating these data was heroin. Pretty much everything else was continuing
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  to increase or at least maintain relatively stable levels which were just very very high.
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  Right, Okay, So this is a major concern for a lot of
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  people. I mean, we're talking about a lot of lives here, and
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  even conservative politicians tend to want to allocate money toward this problem because so many
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  people fall victim to the scourge of dependency. I mean, and this is
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  regardless of your faith, your politics, of your other values. We all
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  know someone who has struggled with addiction at some point, sometimes as right within
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  our inner circle. Sometimes is just one maybe two nodes away from a friend
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  of a friend out about that far as usually as far as you need to
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  go before you have found someone one who has suffered from some kind of addiction,
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  disorder or dependency at some point. And so because of the widespread nature
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  of this, many people have a vested interest in trying to manage this in
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  some way. And even people who generally think the government's not for that,
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  the government's not for anything, and then they work on the government, they
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  are still like, all right, this is a thing that we should use
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  government funds to try and address. Right. So one thing, though,
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  there is this one approach that I think is really fascinating. That's what we're
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  talking about today, is this idea of harm reduction. And harm reduction is
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  a public health strategy to support people suffering from addiction by implementing risk reduction,
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  prevention, and health support systems. Simply put, it is intended to reduce
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  the harm that may happen from high risk behaviors and activities. High risk here
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  specifically meaning substantial increases in the potential for serious medical complications or death. So
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  harm reduction is designed to be a set of procedures or a set of intervention
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  or a set of policies that are explicitly designed to reduce the adverse effects that
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  go along with addiction and substance use and all the things that we've been talking
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  about exactly. Yes, this is mitigating the kinds of fallout that can happen
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  from using substances. This is trying to avoid the worst of the worst kind
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  of outcomes. And particularly there's a huge focus on trying to reduce death,
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  death by overdose or death by spread of communicable diseases, etc. And we'll
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  get into a lot of that. But there's been a lot of misunderstandings and
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  misconceptions about harm reduction and what it does and what it's meant to do,
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  and how it's implemented, and we will get into all of that during this
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  conversation. We're in a specifically unpack I think the aspects of this that are
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  what you might consider or people would think of as being controversial, even though
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  I think if we just look at this from a purely I think, values
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  based and science based direction, right, there's a pretty clear way to go
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  on this, right. I mean, the primary view of harm reduction is
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  a compassionate care approach with the primary objective to save as many lives as possible.
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  And I think if you are looking at it from that perspective, in
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  reducing harm, we want to save as many lives as possible by setting up
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  a situation so that people can avoid not only just the risks of substance use,
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  but all of the tangential kind of side effects or these other things that
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  come out of it too, which people don't realize is actually a significant problem
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  too. So this means that people in the harm reduction orientation have implemented strategies
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  that sometimes appear counterintuitive or confusing it first blush, but are actually designed to
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  specifically minimize all of the harm that comes with different types of substance use.
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  Exactly right before we get into some of what these strategies are, as I
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  said, let's unpack the history a little bit. So I think it was
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  worth understanding what harm reduction is to unpack this topic. But I do want
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  to dig into the sort of timeline here, So I think the important thing
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  in understanding harm reduction as we've used it. Here we've been talking about drugs
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  specifically, but most of us have been using some form of harm reduction strategies
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  for a very long time, and I mean it kind of spans anything you
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  think of as being a risky activity. People wear armor when going into battle.
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  Battle is an inherently high risk activity, and armor reduces the likelihood that
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  weapons will be effective against the armor wear it reduces the harm. Right,
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  So harm is reduced by wearing armor. And there's lots of examples like this,
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  where like there's a lot of inherently risky activities that we can try and
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  mitigate the danger of those activities. So as some examples of different types of
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  harm reduction activities. One of the things is that sometimes we will maybe give
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  people for warnings before we start playing ads. We are back, you are
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  alerted. Now we have returns, so now you can stop doing all the
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  fest forward and you were probably are maybe doing or maybe not, I don't
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  know, maybe you like listening to ads, maybe you like ads. Anyway,
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  we were talking about the various strategies that people have used to try and
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  reduce harm. One of them I mentioned was wearing armor when going into battle.
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  But there's also like a lot of things that I think that we do
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  just kind of naturally anymore. Wearing sun block, right, Wearing sunblock reduces
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  the risk of sun cancer by exposure to a lot of sunlight. That is
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  harm reduction. Right, There is a risk of exposure to sun causing skin
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  cancer, and we can reduce the risk of that by wearing sun block.
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  That's a one to one strategy. Yeah, filters on cigarettes actually reduce the
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  size of the amount of chemicals that are able to enter the lungs. Although
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  there is some debate in a scientific community about how effective this really is at
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  preventing lung disease, there's probably at least some argument that the filter is probably
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  at least delays it to some degree. Yeah. Yeah, cars are a
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  very inherently risky thing that we engage in. We're barreling down the road at
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  super high speeds and these small little metal boxes that crumple really easily, and
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  so we have built in some harm reduction strategies. Seat belts and air bags
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  significantly decrease the risk of bodily injury in the event of a car crash.
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  And there are increasingly more and more features sensors and alarms and specific like aspects
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  of vehicles that they've started to build in that are meant to reduce harm.
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  There's like lights on your mirrors that might or on your dash that might show
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  up if someone's in the lane next to you, so you know, not
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  to change lanes in case they were in your blind spot or you didn't see
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  them. There are rear view in front facing cameras to help sort of monitor
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  the road for debris for some cars that have those features. There are these
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  lane assist features where if you start to drift from your lane, it'll just
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  sort of gently pull the steering will back toward the center of the lane by
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  those cameras that are watching the lines on the road. YEA. So like
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  there's all kinds of these things that have started to reduce the danger that is
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  built into operating something like a vehicle, which is just fantastic just thinking about
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  like when I was a kid, wearing a seatbelt wasn't even required, right
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  like, and that was just to be clear, that was like in the
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  nineties. Yeah, that was a new thing in the nineties that they were
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  like, we should probably make people do this. I'm kind of surprised actually
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  that Florida does have that law. But I guess at this point is that
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  a federal law. Now I'm not sure. I don't know, but I
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  mean I think that something that people don't know about Florida is that we do
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  have the Yeehawk clause and all of our laws, which means that we can
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  just do whatever we want. It's kind of a Wild West type of thing,
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  but every single law it's like, okay, well you could wear a
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  seatbelt, but if you invoke the yeehaw clause, then you don't have to
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  do anything. You know, oof, Okay, so that's fine anyway.
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  Ear plugs, So, ear plugs reduce the risk of hearing loss when exposed
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  allowed sounds. As musicians, I am a huge fan of ear plugs.
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  I wish I would have worn them earlier. Same the living with tinatus is
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  not my favorite thing in the world. Nope. Sunglasses reduce the damage to
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  our eyes from bright, consistent ambient sunlight exposure. It can help prolong the
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  longevity of the functionality of our eyes. So that's a harm reduction strategy.
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  Yeah. For those of us who like to go take a dip in the
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  ocean on a weekly basis, especially swimming with sharks, being in a shark
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  cage will actually prevent the sharks from eating you while you are doing this.
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  So it's just kind of a regular activity that all of our listeners engage in.
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  So, you know, just make sure that you've got that sturdy cage
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  so that that shark can't bite you. Yeah, condoms are extremely effective at
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  reducing the risk of sexually transmitted diseases or infections and unwanted pregnancies. So again,
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  reduction and harm. There. These are some examples of the fact that
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  harm reduction, broadly speaking, is something that we have mostly taken on and
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  various circles of policy and products and capitalism, and in so many places we
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  have engaged in harm reduction strategies and campaigns to try and get people to try
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  and promote a general attitude of I'm going to do a risky thing anyway,
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  right this way, I make that thing less dangerous to me. Living comes
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  with inherent risks, but like we have as humans engineered our way through those
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  risks. I mean, honestly, just washing your hands with soap is like
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  a fairly new invention that was a huge game changer for humans. Yeah,
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  and reducing disease and illness like that was a harm reduction strategy that has saved
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  so many lives. Oh my god, what a wild thing to think about.
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  The hand washing is like the life saving thing. You know. There's
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  a really great study and I believe it was the sixties or seventies. It
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  might have been the same, it could have been in the eighties. But
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  there was a study that they had looked at the effect of a free cond
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  of dispenser inside of a drug rehab clinic to help reduce STIs and unwanted pregnancies
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  inside of like a cocaine treatment center, and it was effective in reducing all
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  of the things like just having free condoms available for people. And you might
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  be going they shouldn't be having sex, they should be focusing on their reapb
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  Well, they were gonna do it anyway, so at least they were doing
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  it safely and not hurting each other, you know, yeah, exactly,
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  And that is what this all comes down to. It's sort of like you
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  could lock someone in a cage, but don't ever get exposure to sunlight.
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  They only get the food that they that is the most nutritious for them.
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  They aren't allowed to use any substances or expose their eyes or body to anything
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  that could be potentially harmful, and ensure that they engage in a rigorous and
• 18:26
  sustainable amount of exercise to promote their optimum overall health. And if that is
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  you, that's the way you would like your life to be lived where someone
• 18:34
  else controls all of your decisions and you don't get to go anywhere and do
• 18:37
  anything other than the things that are immediately going to ensure you have the highest
• 18:41
  amount of health, then please let us know, because I don't think that
• 18:44
  that person exists. And so we understand that, like there is a high
• 18:48
  motivation to engage with this world, and we are trying to just reduce how
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  dangerous that can be. And we don't need to like transform everything into an
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  urban area to do it. All we need is some basic strategies to reduce
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  how much harm it could be brought to us by doing things that carry with
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  them some amount of inherent risk. Right, harm reduction strategies as it relates
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  to addiction. What we know of harm reduction strategies starting to kind of begin
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  in the nineteen sixties. The Vietnam War was still raging between the US and
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  Vietnam. Lead exposure was still on a massive increase, and the hippie movement
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  was in full swing. Heroin was rapidly becoming the drug of choice among hippies,
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  military service members, and a wide spectrum inside of and around those groups.
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  So there was a lot of spread around that drug. Heroin was one
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  of the biggest problems in like the early punk scene too, and a lot
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  of like famous musicians, famous punk musicians died from heroin overdoses well before they
• 19:44
  kind of got their do and whatnot. Correspondingly, though, drug overdose deaths
• 19:48
  were suddenly directly in the face of ignorant conservative American populace. So we started
• 19:53
  to see kind of that became like the big scary problem, and then we
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  started seeing this and stuff kind of pop up. Yeah, I mean,
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  essentially it was hard to alcohol addiction, I think was well known and understood
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  and had been around for a long time, and a lot of people had
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  dealt with it different types of drugs like heroin or really any other kind of
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  illicit what would be considered illegal in those cases substances. Most people weren't around
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  it and it was fairly infrequent. All of a sudden, it was like
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  everywhere everyone knew someone and in this case we mean ignorant as in just naive,
• 20:29
  like they just really they kind of weren't exposed to it. So in
• 20:33
  response to these massive this massive increase in deaths due to heroin, one form
• 20:40
  of support to reduce the public health crisis of heroin overdose deaths was to provide
• 20:45
  a safer alternative of that drug, and so people with heroin dependency could receive
• 20:49
  free access to methadone. And they had set up these methadone clinics as a
• 20:55
  functional replacement for heroin, and people could go to these clinics and receive them
• 21:00
  to try and avoid using heroin to which they now had a physical and often
• 21:04
  emotional dependency. And this successfully reduced not only overdose deaths but also drug related
• 21:11
  crimes that were associated with heroin. So by the nineteen seventies, this was
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  a widely federally funded campaign that had bipartisan support until Ronald Reagan. Of course,
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  this episode is not about Ronald Reagan or the failed Conservative ideology that needlessly
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  killed so many people and basically disbanded the methodone maintenance plan, because this wasn't
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  even called harm reduction at this point in time, so we're still kind of
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  like this is proto harm reduction at this point. Yes, however related to
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  heroin, but still loosely to Reagan in a way. The nineteen eighties were
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  characterized by another emerging, crippling public health crisis, and this is the HIV
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  AIDS epidemic that started to and that's when it's got its name, Like it
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  had been around before this, but nowhere near the levels that we saw in
• 22:00
  the eighties and didn't actually have a medical term associated with it. Initially,
• 22:04
  people was trying to figure out what it was, and then they discovered they
• 22:07
  realized it was this immune system disease, and that's why it was called HIV.
• 22:12
  Right, So the HIVA disease started ravaging the planet in the late seventies
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  nineteen seventies specifically, and it wasn't officially recognized until for what it was until
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  about the nineteen eighties when it was also kind of in full swing and had
• 22:26
  a devastatingly wide and long path of bodies behind it. And so once again
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  the disease didn't really care who you were. It could come for anyone,
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  but its primary means of transmission were unproducted sex and needle sharing, so a
• 22:38
  lot of kind of bodily fluid transmissions, but specifically those spaces. But it
• 22:44
  was fairly it was pretty communicable, like it was pretty easy to get you
• 22:48
  if you did have some kind of bodily fluid exchange. And of course this
• 22:52
  is not unique to the United States. This is a worldwide issue that HIV
• 22:57
  AIDS spread around. Then countries around the world were scrambling to figure out what
• 23:03
  to do about this disease that seemed to pop up out of nowhere, was
• 23:07
  aggressively fatal and highly contagious. Right, Medical professionals really didn't know much about
• 23:11
  the disease at all, but they were starting to understand how it spread at
• 23:15
  least so in the Netherlands, scientists proposed and implemented a surprising strategy to try
• 23:18
  to combat the spread of hepatitis B and C overdose deaths and later HIV and
• 23:23
  eights, all primarily due to heroin use and needle sharing. And that strategy
• 23:29
  was give the users clean needles. Yeah, So I want everybody to stop
• 23:33
  for a second and think about that, because I think this is the part
• 23:36
  where people go, what, Right, So remember that what we're talking about,
• 23:41
  things like hepatitis B and C, overdose, HIV AIDS, all of
• 23:45
  these we've kind of already talked about the idea that these are issues of bodily
• 23:49
  fluids, specifically blood borne pathogen type of situations. Right, So to prevent
• 23:56
  that from happening, if you give people clean needles, we can reduce that.
• 24:00
  But let's talk. We got to unpack that a little bit more.
• 24:03
  We can't just be like just get people needles. Let's unpack what that means.
• 24:07
  Right, Yeah, but exactly as you said, like, this is
• 24:10
  the thing that I think caught people off guard. But the scientists are the
• 24:14
  people who are sort of paid to sit and think about these things. And
• 24:17
  they correctly reasoned that people were going to use the drug one way or another.
• 24:22
  Right, if they didn't have access to clean needles, they'd simply share
• 24:25
  the needle that they were already using and possibly keep the same needle to use
• 24:29
  again later. Right, they were going to do that drug whether or not
• 24:32
  they had access to needles. They would just keep using the same needle,
• 24:36
  or they'd share needles that they found that other people did have access to.
• 24:40
  So the scientists proposed, Okay, let's ensure that they have access to clean
• 24:45
  needles. That way we can at least reduce the transmission of these diseases with
• 24:52
  hepatitis specifically and also later HIV AIDS, and they called their program harm reduction.
• 24:57
  Right, you may still be having kind of that thought that like this
• 25:00
  feels like enabling and stuff like that. Please stay with us, because I
• 25:04
  think that there is a convincing argument for why this is the better approach than
• 25:10
  absentence training and all the stuff that we've been talking about before. So,
• 25:14
  this program, this harm reduction program, also had mental health and welfare programs
• 25:17
  to support people with addiction, and it was likely this combination of strategies that
• 25:21
  helped significantly reduce the spread of HIV, AIDS and hepatitis and rate of crime
• 25:26
  and had the surprising effect of actually reducing how many people chose to use the
• 25:30
  drugs at all. So not only just to be clear, not only did
• 25:34
  it reduce this communicable disease and crime, it also reduced the use of the
• 25:41
  drug in general. Right, huh, weird it does. It seems counterintuitive,
• 25:45
  It seems surprising. It seems like you'd hear that and be like,
• 25:48
  there's no way that that is true. But that is what happened, Like
• 25:52
  it reduced those things. Now, recognizing the benefits of this program, the
• 25:56
  United States adopted a similar needle exchange program and of course saw the exact same
• 26:02
  benefits. It works, like this is a strategy that works, but it
• 26:06
  was also highly criticized by politicians now not criticized by scientists or public health officials,
• 26:14
  but by politicians who saw drug use more of an issue of morality and
• 26:18
  specifically one that is best addressed and maybe only address a bowl in their mind
• 26:23
  by punishing users, by imprisoning them, by charging them fines, by arresting
• 26:29
  them, by condemning them, by telling them stop it, right, that
• 26:33
  is the solution. Like why didn't we try that when people tried to go
• 26:37
  to war with us? We just pointed them and say stop it. And
• 26:41
  now yeah, we've had it. No like that, just telling people to
• 26:47
  stop it does not work. Right to give any sort of grace on this,
• 26:52
  the most grace I could give is that in the nineteen seventies, maybe
• 26:56
  they just didn't have enough data to say this is an effective treatment. I
• 27:00
  mean there was, don't get me wrong, there was. But now we
• 27:03
  are fifty years on and we have demonstrated time and time and time and time
• 27:08
  again that A the War on drugs didn't work. Go listen to the episode
• 27:11
  on War on Drugs, and B harm reduction does work. So at this
• 27:15
  point in time, it's willful ignorance. But we'll unpack all of that as
• 27:18
  we go yeah, and willful ignorance also in the form of ads. Okay,
• 27:30
  so we've been talking about I think the history, the timeline, and
• 27:34
  unpacking just what harm reduction sort of is conceptually. So let's actually go through
• 27:41
  and talk about the specific strategies used in harm reduction. And there are a
• 27:45
  lot, so we're not going to try and go through all of them here.
• 27:48
  We're gonna hit the main themes, the ones that come up the most
• 27:52
  often and I think are the most critical for the keys to success, and
• 27:55
  mostly try and give like an overarching this is what happens in the harmorduction sphere,
• 28:00
  if you will. Let's start by just unpacking sort of what strategies exist
• 28:06
  inside of harm reduction and why. Yeah. So these strategies that are used
• 28:10
  in harm reduction approaches are specifically designed to save lives and reduce the spread of
• 28:14
  disease. So I think those are two incredibly valuable goals when it comes to
• 28:18
  any sort of program that has to do with social services, human services and
• 28:22
  people in general. Right, save lives, stop the spread of disease.
• 28:25
  Everybody benefits from that. These strategies inside of harm reduction THO include needle exchange,
• 28:30
  which we talked about, and what happens is people who use injection based
• 28:33
  drugs can bring their used needles and receive sterilized, sharp, clean needles for
• 28:38
  free with no judgment. This doesn't mean that you're trading needles with your friend
• 28:41
  who's also a user. You're going in and you're getting clean kits, is
• 28:45
  what they'll say. And the administrators at these locations also give advice for safe
• 28:49
  needle use and disposal of use syringes. So not only do you get a
• 28:55
  clean kit, but you get some coaching on how to stay safe, how
• 28:57
  to make sure you stay clean, to prevent the diseases, and how to
• 29:00
  get rid of needles so that nobody else contract a disease as well. Right,
• 29:04
  users can access all kinds of clean drug administration equipment that might otherwise be
• 29:10
  contaminated. They'll also have materials sometimes for how to smoke something that you're trying
• 29:15
  to smoke that is again clean and not riddled with you know, it's not
• 29:18
  been shared, doesn't have diseases. They'll have various bandages and like cotton swabs
• 29:23
  and sterilization equipment and band aids and all kinds of things. So like people
• 29:29
  can in the various ways that they might be trying to administer drugs to themselves.
• 29:33
  Those ways can be done in a cleaner, more sanitary way in these
• 29:37
  facilities, right, users can also have access to a safe drug use space
• 29:44
  which they can actively use their substance of choice in privacy while being monitored by
• 29:48
  supervising medical personnel to prevent complications or overdoses. And so these kind of look
• 29:52
  like doctor's offices. You can go in and have like a room where you're
• 29:56
  being monitored, and some of them are very plain. They have practical furniture
• 30:00
  pieces, lots of cleaning and sterilization chemicals, and a bunch of basic medical
• 30:03
  and emergency resuscitation equipment in the event that you overdose, I mean a lot
• 30:07
  of times, a lot of drugs that are used, and one of the
• 30:11
  things that happen with overdoses is respiratory suppression. So you end up in this
• 30:15
  space where somebody can literally not breathe because of they have too much of this
• 30:19
  drug in their system. And so there is these equipment that's in place to
• 30:22
  prevent that from happening. So and again you might be going, well,
• 30:26
  isn't that just enabling Well, let's have a conversation about this. All right,
• 30:30
  we already know that this is reducing harm and reducing disease and reducing use.
• 30:37
  So now we are saving lives and we're keeping it in a space where
• 30:41
  HIV and AIDS is not spreading due to intravenous drug use. Yeah, and
• 30:44
  we will talk more about the sort of enabling side of the argument when we
• 30:48
  get the sort of myths and misconceptions aspect of this discussion. Another strategy inside
• 30:55
  of harm reduction in some of these designated spaces is that they will actually check
• 30:59
  drugs for dangerous chemicals and contaminants to ensure their safety. And note that drug
• 31:03
  checking is specifically used here and not drug testing, which is when people are
• 31:08
  tested for having used drugs, like at a job. And so a lot
• 31:11
  of places will try and specifically call themselves drug checkers and not drug testers.
• 31:15
  So like, for example, urine tests that work would be a drug test.
• 31:18
  There's lots of different strategies for drug testing that exist. The more expensive
• 31:23
  and longer laboratory ones they take a long time to give a return, but
• 31:27
  they have these ones that can basically give you instantaneous information that are pretty good
• 31:33
  and they're very inexpensive, and they'll use like these little test strips. They
• 31:36
  can quickly determine if some sample of drugs contain harmful chemicals like fentanyl or xylazine,
• 31:41
  which is a veterinary drug, or if they contain other drugs, like,
• 31:45
  hey, is there meth in my heroin? I'm not trying to do
• 31:48
  I'm trying to do heroin. I'm not trying to also do meth right,
• 31:52
  right, And so they can test them and see what else is in there,
• 31:55
  and they just need a small sample, just a little bit, and
• 31:56
  they'll they can quickly determine, like from the things that they have available tests
• 32:00
  for what contaminants might be in there that are particularly dangerous. Right, And
• 32:06
  these drug checking practices are not solely in medical facilities. In some countries where
• 32:13
  you might go to like a large festival where you might find party drugs or
• 32:15
  drug uses kind of expected, they might have drug checking tents where you can
• 32:20
  go in and get your whatever you've got, Like if somebody gives you something
• 32:22
  so you can prevent the overuse or whatever it is, you can go in
• 32:24
  and check like, hey what is this, Oh yeah, no, that's
• 32:27
  definitely LSD. You're good, go have fun, be careful, you know,
• 32:30
  like that kind of thing. So like they have it set up to
• 32:32
  kind of prevent the overuse and kind of those types of problems that happen at
• 32:37
  festivals as well. They might have something like that at Burning Man. I
• 32:39
  didn't check to see, but I'd be willing to bet that they do.
• 32:43
  I wouldn't be surprised if they did. Yeah. Now, finally, as
• 32:45
  with methodone, you just can perceive chemical replacements to help reduce the pain of
• 32:49
  withdrawal and the need for their substance with a functional alternative. So there are
• 32:53
  opportunities for methodone style spaces beyond just kind of what we unders in the seventies
• 33:00
  and eighties. Yeah, and we'll talk a little bit more about some of
• 33:02
  those specifically here in a minute. Versions of harm reduction exist in many parts
• 33:08
  of the world, including parts of the United States. Most of the places
• 33:13
  that harm reduction policies are in place, there is more to it than simply
• 33:15
  ensuring that people have access to clean materials and medical staff. That is a
• 33:21
  feature and is I think a critical feature. But most of them they take
• 33:24
  sort of a multi pronged approach to trying to build a comprehensive strategy to understand
• 33:32
  drug use, addiction and trying to reduce harm with I think an additional goal
• 33:38
  as we'll get to of reducing use as well in many cases exactly. So
• 33:44
  let's just use Australia as an example, which you know, maybe you don't
• 33:46
  think of Australia as the example for things sometimes, but actually Australia is pretty
• 33:52
  rad. Yeah they do three Pillar, Yeah, they do fun stuff.
• 33:55
  I mean, we've got the imports of Hugh Jackman. Know, so we
• 34:00
  get Wolverine because of Australia. So I think we need to give Australia a
• 34:02
  little bit more credit. We get Koalas, which are a blast even though
• 34:06
  they carry leprosy and they scare the hell out of everyone because it's what they
• 34:07
  sound like. But there could be a pretty good job with many of their
• 34:12
  policies I think over in Australia that have had a really huge net benefit that
• 34:15
  would maybe be worth unpacking at some time, at some point in the future.
• 34:20
  We're just going to do a whole episode on Australia. I love it.
• 34:22
  I get Wait, We'll do a whole suite. We'll do we'll do
• 34:24
  addictions, we'll give it a little break. We'll do some fun stuff in
• 34:28
  there, and then we'll do Australia. It'll be great. Why we do
• 34:30
  what we do? Does Australia? So Australia specifically uses the three pillars of
• 34:36
  harm reduction. They do this by considering the drugs, the individual, and
• 34:38
  the environment. So you've got the substance, the person, and the context
• 34:43
  in which they're doing it. They strategically consider that the information given must be
• 34:46
  simple and factually correct. Ah. I love that that they're not just spreading
• 34:52
  misinformation or scare tactics right as was done during the War on drugs. They're
• 34:55
  doing the polar opposite of that, which is probably if that's a hemisphere thing,
• 35:01
  like maybe, So they don't just announce this information, but they target
• 35:10
  their information to people that need to hear it. So not only are they
• 35:14
  dissemining this information, but they're specifically targeting who gets the information and who needs
• 35:19
  that information to increase the effectiveness of that harm reduction program. Yeah, I
• 35:23
  think it's both cost effective and more I think reasonable to assume that, like
• 35:29
  where you want to go spread informational campaigns about strategies around understanding and making choices
• 35:36
  around drug use are places where people are already using drugs, Like there's no
• 35:39
  point to go to a kindergarten and like start spouting this or honestly even like
• 35:44
  a high school unless you know there's like a huge amount of drug use in
• 35:46
  that high school. Like you probably want to go find the specific communities and
• 35:51
  areas where people are actually doing this and administer your information there. It's just
• 35:55
  a more filtered approach where you don't even have to spend as much time and
• 36:00
  energy and have more impact. So like right, duh. So one of
• 36:05
  the considerations that was part of the three pillars is considering the drug. And
• 36:08
  when they talk about considering the drug here, it means that they are giving
• 36:14
  education with respect to and considering what their policy is modeve ingestion so needles,
• 36:19
  pills, smoking, et cetera, and how frequently the drug is consumed and
• 36:23
  at what dose and what the drug does, and so specifically with those considerations
• 36:28
  to reduce harm, they may educate users on understanding how the drug works in
• 36:31
  their body. They may suggest or provide alternative safer waves to consume the drug.
• 36:37
  So for example, if people were ingesting it via needle, but they
• 36:39
  could instead take pills. That's a much less dangerous way to ingest that drug.
• 36:45
  They might teach them about that, and they'll also teach them what signs
• 36:49
  of overdose are. So their one pillar here is considering the drug, and
• 36:52
  then they focus their harm reduction campaign around the understandings and considerations of that drug,
• 36:59
  right. And the second pillar is this considering the person, which means
• 37:01
  providing education to that person regarding how they can mitigate the likelihood of overdose,
• 37:06
  such as staying hydrated and eating before using. The interaction between the listit and
• 37:09
  prescribed drugs that they may also be taking, because they may be on some
• 37:13
  other drugs that are prescribed and known, so it's important to understand that and
• 37:16
  help them consider their body weight when evaluating their dose. So when they're starting
• 37:21
  to look at reducing overdoses, for example, the part of the reason for
• 37:24
  overdoses is because somebody is using too much for their actual body so looking at
• 37:30
  this is probably a safer dose, or this is the dose range that you
• 37:32
  should look at if you're going to do this, yes, And then the
• 37:37
  final pillar is considering the environment, and this means educating users on strategies such
• 37:42
  as using a safe space where they can use their drug, make sure that
• 37:45
  they've got a place that they can go, making sure that they're around trusted
• 37:50
  people and not strangers or people who might be trying to take advantage of them.
• 37:52
  Ensuring that they arrange transportation after they've used their drugs so that they are
• 37:57
  not trying to drive themselves around or walk like ridiculous distances or through dangerous terrains
• 38:02
  or territories, and then using known and trusted dealers to obtain their drugs.
• 38:07
  So there's just sort of these other environmental aspects of drug use meant to try
• 38:13
  and reduce the likelihood that they're going to end up in a dangerous situation that
• 38:16
  could be deadly. Right when you kind of look at this as like a
• 38:20
  harm reduction thing. If you even if you took like, let's say like
• 38:23
  elicit illegal drugs out of that for the environment, one, wouldn't it be
• 38:27
  good to just do that for like, I don't know, alcohol, So
• 38:30
  you go, okay, so you're using it in a safe space around trusted
• 38:34
  people, a rain transportation and only get it from people that you know,
• 38:37
  Right, makes sense? It makes sense, So like you're already probably doing
• 38:42
  this thing, or like even like thinking about we know what the drug does
• 38:45
  or you know the alcohol does. So as an example, like maybe you
• 38:49
  don't drink a certain type of liquor because you know it makes you mean or
• 38:53
  it makes you party. You know, you might be one of those people.
• 38:55
  So you're kind of already considering the drug and an alternative mocktail and stuff
• 39:00
  which are delicious, Like you're looking at, you know, the person,
• 39:02
  how much you should drink, making sure that you eat before, you know,
• 39:07
  liquor before beer. You're in the clear. That whole, Like,
• 39:08
  all of that is the same type of the three pillars that you're doing when
• 39:12
  you're going out to party on a Friday night. So just you know you're
• 39:15
  not doing it's not much different. You're already doing it with alcohol, but
• 39:17
  it's more widely accepted with alcohol because it's a legal drug here in the United
• 39:22
  States. So just some stuff to think about as we're doing this now.
• 39:24
  Harm reduction should include multiple components. First, destigmatizing drug use and addiction,
• 39:30
  which we've kind of talked about all I mean, that's part of the reason
• 39:31
  why we are even doing this suite of episodes anyway, is to help destigmatize
• 39:36
  this, but also destigmatizing drug use and addiction for the people who are using
• 39:39
  because there's so much shame that goes into that, which means that that people
• 39:43
  will often avoid getting resources because they're so ashamed of what they're doing. Right.
• 39:47
  Another aspect of this, which we've talked about, but just I think
• 39:51
  this is sort of the like the summary of understanding harm reduction strategies is that
• 39:55
  because we have this destigmatizing thing, we also have safe drug spaces, needle
• 40:00
  exchange, drug checking programs with professional kind staff, and then ensuring that the
• 40:05
  infrastructure built around these promotes participation in those services. So, for example,
• 40:10
  someone's not going to go to a safe drug use space if they have to
• 40:15
  like schedule three weeks in advance, and if they're five minutes late, they
• 40:17
  can't go. Like, they need to ensure that they allow walk ins,
• 40:21
  they've got flexible times, they've got as low a barrier to entry as humanly
• 40:25
  possible. If it's something where someone has to go in and pay them fifty
• 40:30
  dollars to use that space, those people probably aren't gonna make that choice.
• 40:34
  So they need to be free or as close to free as they can make
• 40:37
  it. And so like everything that would prevent something to get in. They
• 40:40
  want to try and clear those hurdles, but that's an aspect of the harm
• 40:45
  reduction strategy here, is to just have safety built in to the use side
• 40:52
  of drugs or substances of any kind. So it's like setting aside any other
• 40:57
  decisions or ideas about what should be going on. The fact is we're now
• 41:02
  at the point where someone's using now that we're there, and there's nothing that
• 41:07
  we can safely do about that, because if we try to stop them,
• 41:10
  they are going to no longer come to us voluntarily. Right, So we're
• 41:14
  already the point that they're using. Now, how do we make that safer
• 41:16
  for them? Yeah, and for the people around them. Honestly, you
• 41:20
  know, you've heard it say the word safety a few times, and I
• 41:22
  think from a physical standpoint, that's very clear, right, physical safety for
• 41:27
  this, But we're also talking about psychological and emotional safety too, because a
• 41:30
  lot of times we're talking about people who are using to avoid psychological distress.
• 41:35
  We are talking about the shame that goes along with this, sometimes the stigmatization
• 41:39
  that goes along with it. We are talking about safety in all regards,
• 41:43
  and if you are creating a space where if folks are feeling safe, they
• 41:45
  are more likely to receive education that you give them, they are more likely
• 41:49
  to be safer in what they do, they are less likely to harm somebody
• 41:52
  else in that space. So you're creating a space to actively avoid not only
• 41:58
  just the harm that this person will endure if they're doing it somewhere else,
• 42:01
  but the harm that they could cause other people intentionally or not right exactly through
• 42:07
  what they're doing. Very much. So yeah, so cast y net I
• 42:10
  love harm reduction. Okay, So some other critical features educational programs that specifically
• 42:15
  focus on safe drug use strategies, how to recognize signs of overdose, and
• 42:20
  overdose response strategies. We also talked about mental health counseling and psychological support programs
• 42:25
  that specifically emphasize reducing motivation for drug use and decreasing drug use. So this
• 42:30
  is a part of this that doesn't get taught about often. Right, people
• 42:34
  are like, oh, you're giving out free kids. But part of those
• 42:37
  programs include safe mental health services to help work on why the substance abuse or
• 42:44
  the substance disorder actually began to begin with. So you're getting services to help
• 42:47
  support working out of that space too, And then I think just generally having
• 42:52
  some basic welfare programs and other related supports, particularly thinking about places where drugs
• 42:59
  tend to throw, where there is very weak, poor infrastructure, where they've
• 43:02
  got relatively little oversight, where there are people who have very little money and
• 43:07
  very few resources. They may not even have access to clean drinking water,
• 43:10
  or not have very they might not be able to get to a grocery store
• 43:14
  to get fresh food. Like. These are places where the motivation is higher
• 43:19
  and drugs can move more easily, And so programs that support people either making
• 43:24
  those spaces safer for themselves or like building up those spaces so that they're safe
• 43:30
  for those people, are giving them the resources so that they have access to
• 43:32
  the kinds of things that they need so they don't have to turn to any
• 43:36
  other alternatives, and also considering like part of this includes things like medical care,
• 43:40
  like when people who are in pain and they can't afford to go to
• 43:43
  the doctor because they don't have insurance or whatever, like, these are all
• 43:46
  things whereas some of these programs help mitigate the motivations that exist and also help
• 43:52
  people just make more intentional decisions rather than sort of scrambling and sort of trying
• 43:58
  to just tread water to survive all the time, which is what happens in
• 44:01
  a lot of these spaces. Because I'm going to tell you right now,
• 44:04
  this is something that happened in Florida, not even a long time ago,
• 44:07
  several years ago under Rick Scott. Is this movement to drug test anybody who
• 44:14
  was receiving welfare. And I'm going to tell you that that has never in
• 44:16
  the history of humanity worked. That has just punished people who are already struggling,
• 44:22
  to drug test them, to put them, to take away their welfare,
• 44:24
  essentially saying like, oh, if you're on drugs, you don't get
• 44:28
  welfare. That is the opposite of helpful. Yeah, then like more likely
• 44:31
  to use drugs. Yeah. Anyway, since we had to drop the name
• 44:37
  of Rick Scott, it's worth having a palate cleanser and just stepping away.
• 44:40
  You could hear that and be like, all right, I heard Rick Scott's
• 44:44
  name. I'm out, and I do understand that. So let's just take
• 44:45
  a quick break for the ads and we'll come back to some more wholesome discussion.
• 44:57
  Now that I'm done dry heaving after having said that name, that should
• 45:00
  not be mentioned. It's worth I think, taking some time to look at
• 45:02
  the research because you might be listening to this and going, well, you
• 45:07
  know, Shane and Abraham, this sounds like a values based thing. This
• 45:09
  sounds like a moral opinion type of thing. Blah blah blah, bah blah
• 45:13
  blah. But let's actually like unpack the research part of this and talk about
• 45:16
  some of the ways that we have shown in demonstrated effectiveness as parts of this
• 45:22
  harm reduction type of programming. Yes, exactly, because yeah, you hear
• 45:25
  it, and you're like, all these liberals always talking about this, like
• 45:30
  and they're a big ideology thing and they're not considering things practically. Well,
• 45:34
  I it was actually funny. In preparation for this, we started getting talking
• 45:37
  about this and I prepared the notes for this, and Shane looked at the
• 45:42
  list of references and he's like, that's a lot of articles, And I
• 45:45
  said, yes, there were approximately four hundred and fifty quadrillion articles that have
• 45:49
  been published on this. The research on this is deep, yes, so
• 45:54
  huge, So let's give it quick. Some of these are going to be
• 45:59
  more like emphasizing a bunch of data down into a single piece of information.
• 46:02
  And some of them will reference specific studies. And the first one I'm going
• 46:07
  to talk about from the research is a drug called nalock zone, and Narcan
• 46:10
  is in the same sort of group of these, So if you've heard of
• 46:14
  narcan or no lockzone, they're very similar. The lockzone is a drug that
• 46:17
  binds to opioids and blocks further absorption of those opioids. And basically the way
• 46:22
  that this works and when administered is it very quickly reverses the effects of an
• 46:28
  overdose if one is like sort of in progress, there's too much in a
• 46:30
  system. Some research has shown that like as little as just one hundrednozone kits,
• 46:37
  coupled with some education on how to use those kits among opioid users,
• 46:42
  reduced overdose deaths by forty two percent. There was just one hundred kits and
• 46:46
  a population of over one hundred thousand people that were known opioid users reduced deaths
• 46:52
  by forty two percent, So they didn't even have enough kits for everyone there.
• 46:55
  They had that big of a reduction in overdoses. I think it's really
• 47:00
  important as we're talking about like what an overdose is. An overdose is is
• 47:04
  for the most part, most people are accidentally overdose, like nobody knew.
• 47:07
  Is like a drug user is like going and going, like you know,
• 47:10
  at least for the most part, it's not going and going. This is
• 47:14
  this will be the last time. So I think it's kind of important to
• 47:15
  unpack that too as we go through this. All right, So buper nephrine,
• 47:22
  Did I say that? Right? You did? That's right? Good?
• 47:23
  Look, Hey, I did it. I am terrible with drug names.
• 47:27
  I have struggled with that for years. So I I'm so glad that
• 47:30
  I did that in one try. You're like Mara Jiwani. I read that
• 47:35
  a hundred times while you were doing that last ballpoints, so I have no
• 47:37
  idea what you said. Souper Nefrin is a long acting opioid replacement drug that
• 47:43
  can be substituted for the fast acting opioids most users start with and they're accustomed
• 47:46
  to. So research is emerging, but one strategy, called the Bernese method,
• 47:52
  involves taking tiny doses of buper nephrine while maintaining the same level of opioid
• 47:57
  drug use, and slowly increasing the dose of the buper and nefrin once the
• 48:01
  user reaches a therapeutic dose. Of buper neffin, they stop using their original
• 48:07
  opioid substance and can more easily reduce the need for a buper differin. And
• 48:10
  the current data suggests that this has been effective at allowing people to discontinue drug
• 48:15
  use with basically no withdrawal symptoms. Right. That's one of the biggest barriers
• 48:21
  to getting off of a substance is that your body is physically like dependent on
• 48:25
  it, so the withdrawal symptoms are painful, if not deadly. It's basically
• 48:30
  a functional replacement that doesn't have the same like immediate high, but it blots.
• 48:36
  It prevents you from experiencing the kind of pain and discomfort that would come
• 48:38
  from withdrawal, and so people who are trying to specifically quit a drug can
• 48:44
  do so more easily if they're not faced with the consequences that can sometimes come
• 48:49
  with a rapid shift in like what kind of substances are in your system right
• 48:53
  now? A comprehensive analysis conducted by the United States CDC on the existing research
• 48:59
  on syringe service programs sometimes called I Think I saw SSP for Syringe Service programs
• 49:06
  and then Needle Service Programs NSP, something like that anyway, they concluded that
• 49:12
  not only do needle exchange programs not increase crime and drug use. So there's
• 49:16
  the people who are saying, like, you give people needles, they're going
• 49:20
  to do a lot of drugs, and then there's going to be all this
• 49:22
  increase in crime. Not only do needle exchanges not increase crime or drug use,
• 49:28
  but users were three times more likely to reduce their drug use or stop
• 49:32
  all together in these needle exchange programs, and crime decreased as well. I
• 49:37
  mean it's you know, but it's data, and people don't like data,
• 49:43
  I guess now. A twenty thirteen study found that simply providing a drop in
• 49:46
  center, which is a safe drug use space, significantly decreased crime. Eighty
• 49:51
  two percent of drug users committed crime versus only twenty one percent when the safe
• 49:54
  space was provided. So, just to be clear, having a drop in
• 49:59
  cent which is a space that people can safely use drugs, significantly reduced crime
• 50:05
  by a little over sixty percent. Yeah, it was I mean huge.
• 50:08
  I mean if you took out like eighty Basically they had a group of people
• 50:12
  who didn't have access to it and a group of people people who did,
• 50:14
  and it was like eighty two percent of the people who didn't have access to
• 50:17
  it engaged in crime and only twenty one percent. So I was like,
• 50:20
  honestly, if you took that out of the total, it's like a seventy
• 50:22
  five percent reduction at the rate of crime. Yeah, depending on how you
• 50:25
  choose to slice up that math, but it was really substantial. Seems like
• 50:30
  a pretty worthwhile investment. Speaking of investments, one of the things I was
• 50:34
  curious about is, like, what's the return on investment in programs like this?
• 50:38
  One study did an analysis where they specifically looked at the cost of healthcare,
• 50:43
  treatment and other issues related to funding for people with HIV AIDS, and
• 50:49
  with a budget of only five hundred thousand dollars, they found that if you
• 50:52
  prevented just three new HIV cases, that would be a cost saving measure just
• 50:59
  three. All they have to do is successfully prevent three cases of HIV and
• 51:04
  the five hundred thousand dollars would have already paid for itself. And how much
• 51:07
  cost it saved. But not only does it prevent more than three, These
• 51:12
  actual these programs decreased HIV cases by fifty four percent and hepatitis C cases by
• 51:17
  fifty five percent, So there was a huge precipitous drop off. So the
• 51:22
  return on investment happens pretty much immediately and then just continues going on, like
• 51:27
  you just save more and more and more and more money as the program goes
• 51:30
  on. Right, speaking of saving money, about four seven hundred dollars is
• 51:35
  saved per one hundred injection drug users through these programs. Yeah, the needle
• 51:39
  exchange specifically, needle exchange program specifically, So you're finding that, like just
• 51:44
  having a needle exchange program saves thousands of dollars, hundreds of thousands of dollars
• 51:50
  over time, like the amount of money that is saved through this. And
• 51:52
  also not just money, because you know, I think a lot of people
• 51:57
  speak in money, but it's not just money, but it's like the amount
• 52:00
  of stress an the amount of grief, and the amount of crime, and
• 52:06
  the amount of all the things, all the tangential things that go along with
• 52:08
  like folks who struggle with addiction, all of those things are also significantly reduced
• 52:14
  and it tends to lead to a better quality of life for literally everybody involved.
• 52:19
  Yes, so you got to finally got to the myth busting part here,
• 52:22
  and then I think sort of our big conclusions that I'm excited to talk
• 52:25
  about. But I always love busting a myth because I think misunderstandings are just
• 52:30
  one of these things that perpetuate poor policies that don't work and are often counterproductive.
• 52:37
  And so many believe, or at least argue that this harm reduction approach
• 52:42
  that it doesn't also include an orientation towards sort of abstinence or reduced drug use.
• 52:49
  Most harm reduction strategies actually do include a component of education with an end
• 52:53
  goal of decreasing substance use. Like that is often a component at least decreasing,
• 52:59
  if not quitting altogether. But again, it's not done through stigmatization,
• 53:02
  criminalization, and like making people feel bad or using something like telling them that
• 53:07
  you don't have control or you just need to have faith, like those things
• 53:12
  don't work, but they will do counseling, mental health and other support strategies
• 53:15
  with the eventually there it is better for those people not to be using drugs,
• 53:21
  and everyone agrees, including the users, right, right, So the
• 53:24
  main objective is to prevent death, but other objectives include decreasing the spread of
• 53:30
  disease, decreasing crime, and decreasing the use of drugs altogether. So,
• 53:35
  like those goals and orientations are built into it, and I think there's a
• 53:39
  fundamental misunderstanding that people have that harm reduction is like, oh, well,
• 53:45
  just we'll hand out free drugs to everyone, we'll show them how to use
• 53:47
  them. It'll be great, everyone will be high all the time. That's
• 53:51
  just not what it is, right, Like, the point is that we
• 53:53
  actually want to decrease drug use, and we have found that some of these
• 53:58
  strategies, like the needle exchange does specifically do that, and that we want
• 54:01
  to have educational programs that also are oriented to a reduce in drug use,
• 54:07
  just not through the sort of shame and self flagellating that I think is common
• 54:12
  in other programs. Right, yeah, exactly. Now, harm production strategies
• 54:16
  such as drug checking and needle exchanges are enabling drug use. That is the
• 54:20
  meth that we hear all the time. Okay, so you're checking drugs so
• 54:22
  people can use them or giving people clean kits is just going to perpetuate that
• 54:27
  issue. And so far we have demonstrated that's not even close to true.
• 54:30
  Our studies have shown that that is not even close to true. If that
• 54:32
  were true, then The implication is that people who are using drugs would have
• 54:37
  decided not to use drugs, but because this needle exchange program was available,
• 54:40
  they decided, now I'm going to use drugs more often, especially because the
• 54:44
  needles are available. It doesn't make any sense people are using drugs as is.
• 54:49
  So if you're providing a space, and we've already demonstrated and shown in
• 54:52
  the studies, a clean kit helps reduce HIV, helps reduce hepatitis, helps
• 54:58
  reduce all these things, and it's not an I think the other thing too,
• 55:00
  is people misunderstand that that needle exchange programs are just Okay, give me
• 55:05
  your dirty needles and I'll give you clean needles. That's not what it is.
• 55:07
  There's education, there's support around this, there's all kinds of things that
• 55:10
  happen. It's so frustrating that people just cannot wrap their heads around the fact
• 55:16
  that not only is this actively this is an active ingredient in keeping people safe,
• 55:22
  right, like this is truly showing that. And again, like I
• 55:27
  think you have to think, like, okay, so you've set up a
• 55:30
  safe space for them to do drugs, and they're like, we're just enabling
• 55:32
  them doing drugs. I'm like, okay, so you think that they would
• 55:36
  have chosen not to do drugs, but then they saw the safe space,
• 55:38
  like never mind, I'm all in now, I'm like, no, they
• 55:42
  weren't going to go do drugs anyway. Like what happened is we made it
• 55:45
  less dangerous for them, right or again, as you said, they're like,
• 55:50
  oh, well I wasn't gonna do heroin, but now that you've got
• 55:52
  a needle, I certainly will. And I mean the other implication is thinking,
• 55:54
  like for you, people saying that you're sort of implying that that's true
• 55:59
  for you, You're like, I would be out there using drugs, but
• 56:01
  I'm afraid of dirty needles. So I'm like, if I make clean needles
• 56:06
  available to you, you're just gonna start using heroin all of a sudden.
• 56:08
  No, nobody's doing that. I'm like, the barrier to entry here was
• 56:14
  not safety, it was not cleanliness. Like people were going to use drugs
• 56:17
  regardless of how safe we made it for them. And so understanding that the
• 56:22
  motivations are there, the availability is there, like, we can't do anything
• 56:27
  about it at this point. Let's try and reduce how bad the damage could
• 56:30
  possibly be and it just doesn't make any logical sense or through even the most
• 56:37
  childish understanding of how behavior works up through the most comprehensive like, you just
• 56:43
  can't even logic your way to that being the reasonable argument, because again it
• 56:47
  assumes that, like people were deciding not to use drugs until we made them
• 56:52
  available. What the has that ever been the case? Like, No,
• 56:55
  that has been the case. That has never stopped someone. People are like,
• 57:00
  Oh, we need to crack down and make it more penalties and more
• 57:02
  crimes. I'm like, as long as there's been policies around this, the
• 57:07
  policy has been to criminalize and imprison people. And what has that gotten us
• 57:10
  so far? Surging rates of overdose deaths, huge prison populations, People are
• 57:16
  doing drugs constantly. The policy to criminalize it has not only failed miserably,
• 57:22
  but we have had an increase in people who are using and a dying of
• 57:27
  overdose. So, Like, whatever effect you think the needle exchange is going
• 57:30
  to have on potentially making drugs worse, we were already making it worse.
• 57:36
  With whatever strategy we were using. We could literally not make things worse than
• 57:39
  they already were. And we already have seen that this doesn't make it worse,
• 57:44
  it makes it better. Right, not only is not having a program
• 57:46
  like this making it worse, it's making it worse and then some So we're
• 57:51
  finding that, like a needle exchange program is actively reducing use, in actively
• 57:54
  helping people get off of drugs. But without this program, not only are
• 57:59
  people using and are people committing crimes and people are overdosing, but people are
• 58:02
  getting hepatitis C and not recovering from it, and it's putting an additional burden
• 58:07
  on our current healthcare system, which is not very good to begin with.
• 58:10
  So what's happening is we are already struggling to keep up with the healthcare needs
• 58:14
  of Americans and the United States for a lot of different reasons. Now we
• 58:17
  have said here there is a program that can actually ease some of the burden
• 58:22
  on the healthcare system by reducing rates of HIV AIDS, by reducing hepatitis,
• 58:25
  by reducing blood board pathogens that come through needle sharing, and alsof that can
• 58:30
  reduce overdoses. We've said, hey, we can reduce at least some burden
• 58:34
  on this healthcare system. And everybody's going no, because it's enabling which is
• 58:37
  like this is actively doing the opposite of what people think it's doing. It's
• 58:43
  wild to me that people can't see that. It's wild. But I mean,
• 58:45
  we do live in a world where people think the planet is flat,
• 58:50
  so I guess that's a thing. Yeah, there's a threshold of ignorance that's
• 58:54
  hard to overcome. The fact that flat earthers think that the Earth is flat
• 59:00
  but the other planets in the Solar System are around is just the leaps of
• 59:04
  logic to get there. It just I wish that I were that athletic.
• 59:09
  I think that they think that there aren't other planets in the Solar System.
• 59:13
  There are some, oh okay, because I think I think my understanding was
• 59:15
  that we believe we live in like a giant cage of some sort giants not
• 59:22
  even the word for it. It would be colossally massive in a way that
• 59:24
  is unable to be built by the resources that exist on the entire planet.
• 59:30
  Assuming that something like that could possibly exist, I'm like, so what's outside
• 59:32
  of that? You think they think this space is water too. I've heard
• 59:37
  that too. So it's just a lot, there's just it's just it's just
• 59:40
  anyway, Okay, Well that's pretty insane. We weren't talking about flat earth
• 59:45
  though we were we were talking about drugs. But since we talked about flat
• 59:47
  earth, we may as well let the ignorance rain and pivot to ads.
• 59:58
  Thank you for giving me that break. I needed that break more than I
• 1:00:00
  think anybody else did. That's fair. Yeah, there's so much to say
• 1:00:05
  on this, and again, I just think it's so dumb, the whole
• 1:00:07
  idea that like it's enabling. I'm like, you think about that for just
• 1:00:12
  two seconds. I'm like, nobody here is choosing to use drugs just because
• 1:00:15
  they're now more available. And we're not even making drugs available, We're just
• 1:00:21
  making the equipment more sterile, like that's it, that's it, and like
• 1:00:23
  none of you are making that choice because that's not how that works. So
• 1:00:28
  that doesn't make any sense. So I think we've got through that. When
• 1:00:30
  I set it aside, I think some people will point to Orgon and say,
• 1:00:34
  aha, harm reduction failed because of what happened in Oregon. So let's
• 1:00:38
  talk about what went wrong in Oregon. Yes, so in twenty twenty,
• 1:00:43
  I don't know if y'all remember that year. We've lived several lifetimes since then.
• 1:00:46
  There's a lot going wrong, and I think this is probably not the
• 1:00:49
  time to do this. But they voted to decriminalize all drugs in Oregon,
• 1:00:54
  right, and that was a big move. People were really floored by that,
• 1:01:00
  really had a hard time with that. But they voted to decriminalize all
• 1:01:01
  drugs in Oregon in twenty twenty. Now, there was supposed to be a
• 1:01:07
  lot of aspects about this whole decriminalization procedure, and some of them were enacted,
• 1:01:13
  but point being, that was essentially how it went. But there's a
• 1:01:16
  couple of caveats here. One is that just decriminalizing is not harm reduction as
• 1:01:22
  a matter of fact, and all of our discussion, at no point did
• 1:01:24
  we say decriminalizing drugs is a feature of harm reduction. I think it could
• 1:01:30
  be. I think you could, as a piece of this, say let's
• 1:01:34
  make this not a crime and address it in the ways that we're going to
• 1:01:37
  address it. But just decriminalization by itself is not harm reduction. So you
• 1:01:42
  can't point to that and say, look, harm reduction failed, because first
• 1:01:45
  of all, we have a mountain of evidence, several mountains of evidence,
• 1:01:49
  several planets of evidence at this point showing that it works. But this also
• 1:01:52
  wasn't harm reduction, so it didn't fail. Yeah, several flat planets of
• 1:01:55
  evidence at this point in time. Part of the problem too, is that
• 1:02:00
  this went into effect immediately without an infrastructure. So all of the key characteristics
• 1:02:04
  that we've talked about with harm production, the needle change programs, the education
• 1:02:07
  programs, the welfare, the psychological health, all that stuff did not exist
• 1:02:12
  in the way that it needed to in a place where everything was decriminalized.
• 1:02:16
  So you've got basically this context, which is drugs are not criminal anymore,
• 1:02:22
  but you have no supports to protect you for those of you who are using,
• 1:02:27
  right, that's ripe for problems. Also, like possibly the worst possible
• 1:02:30
  year for mental health twenty twenty, where people have been in lockdown their board.
• 1:02:35
  They're desperate, many of them are running out of money. They're like
• 1:02:37
  been living off of sick days and paid vacation time. Businesses are like fighting
• 1:02:44
  to try and stay open, and many of them are closing. Inflation is
• 1:02:46
  already starting to take a foothold. Like there was just a massive bad year
• 1:02:52
  for that sort of thing to take place. Motivation was high, so that
• 1:02:54
  was the other context that was going on. It also didn't address any of
• 1:02:58
  the systematic issues that led to drug use in the first place, such as
• 1:03:00
  like things like poverty, like transient or homelessness, any of the other harm
• 1:03:06
  reduction strategies that we would specifically recommend, like safe spaces and needle exchange.
• 1:03:09
  And then the other thing that happened is a huge surge and access to in
• 1:03:13
  fentanyl laced drugs made it in and so like there was a huge uptick in
• 1:03:17
  the amount of fentanyl that was being found, which led to overdose deaths.
• 1:03:21
  So there was like a massively I honestly think it's probably worth a whole episode
• 1:03:25
  or maybe a mini episode unpacking what happened in Oregon, because I think people
• 1:03:30
  are going to want to point to that and say, look, harm reduction
• 1:03:34
  failed, and the thing is like, I'm like, well, that wasn't
• 1:03:37
  harm reduction, so hard to say that it failed, But like, also
• 1:03:40
  there were many issues that went on. I think you make the argument that
• 1:03:43
  it failed because there was no harm reduction in place. Oh yeah, good
• 1:03:45
  point. Yeah. And so anyway, for those of you who aren't aware,
• 1:03:50
  is we said basically it was decriminalized, and now the state is recriminalizing
• 1:03:53
  drugs. They're rolling back their policies on this to try and address the massive
• 1:03:59
  spike and overdose tests that started happening, Right, So I think that's that's
• 1:04:03
  what where that story is in case people weren't all cut up on that one
• 1:04:06
  anecdote is not a scientific example, right, Like I think that's another thing
• 1:04:11
  too, is like organ is its own thing. Orgon is its own thing.
• 1:04:15
  So but I think it's just important to know that you know a lot
• 1:04:19
  of the sound bites that and especially for people who don't critically think about these
• 1:04:23
  types of things, will point to Orgon and say this is why it doesn't
• 1:04:27
  work, when the truth is is it probably would have been much better had
• 1:04:30
  harm reduction been there when they rolled this out. And that's just that's a
• 1:04:33
  simple fact. Like I mean, like, if you're going to decriminalize anything,
• 1:04:36
  then having a harm reduction program in place to replace the because basically the
• 1:04:42
  intervention up until this point was arrest them. Right now you've gone, hey,
• 1:04:46
  let's do no interventions for this. Right. Instead of going let's do
• 1:04:50
  no interventions, they should have gone, hey, arresting people didn't work,
• 1:04:55
  let's put harm reduction in instead and just switch out the interventions. They should
• 1:04:59
  have switched the interventions intead of just removing all interventions and that's the problem.
• 1:05:02
  Yeah, I agree, So maybe we don't need a many now, maybe
• 1:05:04
  we've covered it. But it was an interesting Yeah, it was an interesting
• 1:05:10
  little experiment that they did, and I think there was a lot to be
• 1:05:13
  learned from that. But I think the wrong lesson is that decriminalization doesn't work.
• 1:05:17
  I think the right lesson is the way they went about it didn't work
• 1:05:23
  very well, and there was like a poor context that sort of set them
• 1:05:26
  up for failure even if it would have had a more successful rule out in
• 1:05:30
  a different sort of time and history, including honestly now, but who knows
• 1:05:34
  anyway. So that's Oregon. I think I'm sort of eager, I think,
• 1:05:39
  to sort of give my final thoughts on this, and one of them
• 1:05:42
  is that we've been very clear about some of our biases on this episode,
• 1:05:46
  and I think one of mine. I come from a very humanist angle,
• 1:05:49
  and a lot of my philosophy is like how many lives is worth it for
• 1:05:55
  us to put in policies like this, Like if it saved X number of
• 1:05:59
  lives and it was worth it to put this policy in, And in my
• 1:06:01
  mind, one, yeah, if you have saved one person's life, then
• 1:06:06
  it was worth it. And the beauty of this is it saves a lot
• 1:06:10
  more than one, right And I mean, and you can take this net
• 1:06:14
  like net savings of one right like because these policies maybe more people on this
• 1:06:18
  side, but fewer people on this side. Whatever, I don't care.
• 1:06:20
  If you saved one life, then it was worth it. And these do
• 1:06:25
  a lot more than that. These have been saving thousands and thousands of people's
• 1:06:29
  lives. And so I think if we take at the outset that the goal
• 1:06:32
  here is saving lives, this is a tremendous success. It has been,
• 1:06:36
  it will continue to be as we get better at it. That's one I
• 1:06:40
  think important piece here is the value of human life is such that anything that
• 1:06:44
  we do that saves them is worth doing. Yeah, I honestly, I
• 1:06:49
  don't have another take on point beyond that. I mean, I think our
• 1:06:54
  science shows that this is the most compassionate way to help people. I think
• 1:07:00
  that we've demonstrated its effectiveness. I don't know what more we can do except
• 1:07:03
  for scream it from the mountaintops that this works. And it's absurd that we
• 1:07:09
  have to make such an argument for something that we have demonstrated time and time
• 1:07:14
  and time again that works for helping people. The fact that we have to
• 1:07:18
  make an argument for helping people is just categorically absurd. Yeah, but that's
• 1:07:25
  where we're at right now, Like we have to make that argument. And
• 1:07:28
  harm reduction is is just such a great way to help alleviate so many of
• 1:07:34
  the problems that are faced by folks that struggle with addiction, by communities that
• 1:07:39
  are ravaged by addiction. It's just the way to go. I think,
• 1:07:44
  Yeah, I do have a couple more things to say, go for it.
• 1:07:46
  That's okay, all right, we do one of the things here,
• 1:07:49
  and is sort of the other aspect about this is this is a win win.
• 1:07:54
  This is like, this is a win win win, win, win
• 1:07:57
  win. Everybody wins in the situation. Yeah, everybody wins. Everybody wins.
• 1:08:01
  The people who don't like spending money, they spend less money, a
• 1:08:04
  lot less money actually, so it saves money for government programs. The people
• 1:08:09
  who don't want people to die, there is a win. But people who
• 1:08:12
  don't like drugs to be around all the time, that's a win. For
• 1:08:15
  people who don't like ongoing homelessness crisis, it's a win. Like the people
• 1:08:18
  who are addicted to drugs win, The people who are medical professionals who are
• 1:08:23
  trying to help people win. The society at large wins. Everybody wins here.
• 1:08:28
  Maybe the only people who don't win are like drug cartels potentially, and
• 1:08:31
  like that's a win for the rest of us. So like, right again,
• 1:08:35
  this is a win win when win win win situation, everybody gets to
• 1:08:41
  win. Like it works across the board, is successful everywhere you put it.
• 1:08:45
  So it's like there's just no downside really on this. Like it does
• 1:08:50
  cost an upfront investment, but like that's offset by the amount of cost that
• 1:08:55
  is saved down the road by not investing in the infrastructure to prevent these issues
• 1:09:00
  from happening in the first place, or to mitigate the fallout from them happening
• 1:09:03
  once they do. Right. The one other sort of take on point I
• 1:09:06
  have about this that I think is important, and I don't I don't know
• 1:09:10
  if this qualifies as a take on point because I don't think that I made
• 1:09:12
  this inside of this discussion here is that one of the issues around this and
• 1:09:16
  where I think people point to this and say, why do we still have
• 1:09:19
  an issue with overdoses? If this is such a successful program. Well,
• 1:09:24
  the issue is that this has barely been rolled out. There is a tremendous
• 1:09:30
  issue of access to these services, like the first save drug use space in
• 1:09:35
  the United States as a whole. I was reading about this I think went
• 1:09:41
  up in New York in like twenty eighteen, maybe like it was brand brand
• 1:09:45
  new, Like, we have not invested in this in this country. Not
• 1:09:49
  really. We have done the method on clinics, those worked, We've done
• 1:09:53
  needle exchange programs, those worked incredibly well. There's not widespread access to this
• 1:09:58
  things. So people aren't going to use it if it's literally not available to
• 1:10:02
  them, right, and people do use it when it is, So I
• 1:10:05
  think one of the issues we need to address here, whether it's pointing that
• 1:10:11
  this has not been able to like people, I think will point to this
• 1:10:14
  and say, why are we We're having this huge increase in overdose depths.
• 1:10:17
  We started this episode by talking about that even though we've had harm reduction strategies
• 1:10:21
  in since the eighties, and the problem the reason that that we're still having
• 1:10:25
  this is because the access to these is so tremendously limited that like we're not
• 1:10:30
  investing in really building out the infrastructure for this, and in the meantime,
• 1:10:33
  our population is growing and more and more people are finding these drugs, right,
• 1:10:38
  and so like, this is not the problem with these programs. The
• 1:10:41
  problem is that people aren't putting in the programs. Like a seat belt doesn't
• 1:10:45
  do you any good if you don't wear it, right, Exactly, if
• 1:10:47
  I were to sell you a car without seat belts in it, like,
• 1:10:50
  it doesn't matter how much how safe you want to be, Like that has
• 1:10:54
  now become a very very dangerous vehicle. Right. So that I think is
• 1:10:58
  when people point to say, like, why are we having such an issue
• 1:11:00
  with overdose deaths if we have these programs, And it's like, because we
• 1:11:02
  barely have these programs. We almost don't, like functionally, we don't the
• 1:11:06
  amount of people that they help a handful, and it's great, I'm so
• 1:11:11
  happy that those people were able to get help, but like it is a
• 1:11:14
  tiny, tiny fraction of the number of people who are using on a daily
• 1:11:16
  basis yep, absolutely one, Okay, great, all right. So I
• 1:11:20
  think we ran so long on this, and it's because we're so passionate,
• 1:11:25
  but I think it was so important to cover this and help understand I think
• 1:11:29
  both break down the totally misconstrued and misunderstood logic that people are trying to use
• 1:11:33
  by calling this enabling. I'm like, that doesn't make that doesn't make any
• 1:11:36
  sense. Like, again, by that logic, you would be using heroin
• 1:11:40
  right now if I handed you a clean needle full of heroin. Yeah no,
• 1:11:43
  thanks, yeah, pretty much. No one's going to take me up
• 1:11:45
  on that, that I know at least, so anyway, I think we've
• 1:11:47
  addressed that sufficiently. Let's go ahead and wrap this up. Before we do,
• 1:11:50
  we always like to give some very fun recommendations, and before I get
• 1:11:55
  to recommendations, I get to do my acknowledgments and credits. If you like
• 1:11:58
  to support the show, if you like to reach out to us and tell
• 1:12:00
  us anything that we got right or wrong in this discussion, please email us
• 1:12:04
  directly at info at WWDWWD podcast dot com. You can also learn more about
• 1:12:11
  harm reduction by going to the National Harm Reduction Coalition at harm reduction dot org,
• 1:12:15
  where they've got more resources. Thank you for putting that in the notes
• 1:12:18
  here, Shane for sure. Otherwise you can support us. You can join
• 1:12:20
  us on Patreon. If you do, you get access to behind the scenes
• 1:12:24
  content. We had some graphs and like pictures of a safe use space in
• 1:12:27
  this so you could get access to our notes. We also have early release
• 1:12:30
  episodes at free episodes all kinds of bonus goodies you could get if you join
• 1:12:33
  us. Join us over on Patreon if you like access to those, and
• 1:12:36
  the wonderful group of people who've already made that jump includes Mike, Mmegan Leyla,
• 1:12:42
  Mike t, Justin, Kim, Joshua, Brad, Stephanie, Olivia,
• 1:12:45
  Brian Ashley, Kiara, Christy and Michelle. Thank you all so much.
• 1:12:48
  Love y'all, y'all are the best. If you don't want to support
• 1:12:50
  us over there, you can always pick up some merch. You can leave
• 1:12:53
  us a rating review, You can share this episode with friend just you know,
• 1:12:57
  subscribe if you haven't already, just do the things share us. I'll
• 1:13:00
  let people know that definitely helps a lot. In addition, I would like
• 1:13:03
  to thank my team of people without whom I could not do this show because
• 1:13:08
  although I am a small and powerful army of one, I am still am
• 1:13:11
  not powerful enough to make this podcast happen. And so that includes writing in
• 1:13:18
  fact checking from shaneon myself. Thank you so much for recording with me today,
• 1:13:21
  Shane, of course always. Our social media coordinator is Emma Wilson.
• 1:13:26
  And the guy in the chair who makes all the editing of these incredibly long
• 1:13:30
  episodes sounds like normal people talking without all the mistakes that we make is Justin
• 1:13:34
  Greenhouse, who does just a wonderful job. So thank you, Justin,
• 1:13:38
  Gustin Dreenehouse. That's right. I think that is all that. I have
• 1:13:42
  anything else that I forgot or that you would like to add before we get
• 1:13:45
  to our recommendations. No, take care of each other, you know.
• 1:13:47
  Indeed, all right, let's recommend some things. All right, Actually we
• 1:13:51
  have the time. Maybe I'll do ads first. Oh no, okay,
• 1:14:02
  now we'll do recommendations. Recommendations. I'm gonna keep this kind of short because
• 1:14:14
  we've gone so incredibly long. So I'm recommending a movie. It came out
• 1:14:16
  a year or two ago, I think maybe last year. It was directed
• 1:14:19
  by Elizabeth Banks. I believe this is her directorial debut, but I didn't
• 1:14:24
  actually check. That doesn't matter. It's called Cocaine Bear. I'm pretty sure
• 1:14:28
  this is rated RB. Yeah, just by the title alone. But anyway,
• 1:14:31
  there's definitely gore and illicit drug use and a lot of explicit language if
• 1:14:36
  you will. It's based on a true story, although fairly loosely if you
• 1:14:40
  know the true story. But yeah, fun, short little movie about a
• 1:14:43
  bear who finds a bunch of cocaine and does it and the fallout from a
• 1:14:45
  bear doing a bunch of cocaine. So it's a ridiculous, fun, over
• 1:14:49
  the top gory movie, pretty enjoyable. It's streaming on an Amazon Prime right
• 1:14:55
  now, but I'm sure people can get at other places. But yeah,
• 1:14:58
  Cocaine Bear was a lot of fun. Looks like a wild time. I
• 1:15:00
  haven't seen it yet, but it's been on my watch list. I want
• 1:15:02
  to see it so badly. It's a good one. It's pretty quick too.
• 1:15:05
  I think it's like an hour and a half or so. Okay,
• 1:15:06
  good, good, good. So my recommendation is a book and I just
• 1:15:11
  finished it recently, and I do absolutely adore this author, but I think
• 1:15:15
  he gets a little bit of a bad rap. And so that book is
• 1:15:16
  called Hollywood by Charles Bakowski. I think he gets a bad rap because he's
• 1:15:20
  kind of known as being like a little bit of an alcoholic and a little
• 1:15:25
  bit of a womanizer and not very great, and some of his language is
• 1:15:28
  a little bit dated and stuff like that, and that's fair. But I
• 1:15:30
  would also say that a lot of authors have very dated language, and so
• 1:15:33
  I think that's really important to remember that as you're kind of reading older authors.
• 1:15:36
  But I will say this more than anything, Charles mckowski's kind of known
• 1:15:40
  for being a certain type of author. Hollywood doesn't read like that. I
• 1:15:45
  think Hollywood does a good job of kind of showcasing that he was always a
• 1:15:47
  great author, even though his subjects and maybe the way he wrote about stuff
• 1:15:51
  was probably not always savory. Hollywood is about him aging in Hollywood. He
• 1:15:57
  writes his first screenplay and he's working inside of the Hollywood kind of machine,
• 1:16:01
  trying to get this thing to work, and how ridiculous it is, and
• 1:16:05
  how he's kind of aging and kind of settling into a comfortable life, and
• 1:16:09
  how he doesn't really he still doesn't really like people, but at least he's
• 1:16:12
  nicer about it. Okay. I think it's a really fascinating read and kind
• 1:16:15
  of the overall bibliography that is Charles Bakowski's work. You know, his poems
• 1:16:20
  are a certain way, it's a novel, it's it's not a book to
• 1:16:24
  poetry, and he's got a couple novels that are out. But I think
• 1:16:27
  it's a fascinating kind of look at like kind of end of career Bokowski and
• 1:16:30
  how much he's calmed down and gotten a little bit nicer and a little bit
• 1:16:33
  less grumpy and mostly drinks wine instead of whiskey and vodka anymore. Cool.
• 1:16:40
  Yeah, this, As I said, this one went pretty long. Thank
• 1:16:43
  you so much for listening. If you've stock with us through this entire thing,
• 1:16:45
  we really appreciate you join us next time. We're going to continue on
• 1:16:48
  this discussion about but addiction and various topics inside of addiction, So we'll be
• 1:16:54
  around for at least a few more episodes on this. We're not really calling
• 1:16:57
  them parts that are really intended to stand alone, but we would just wanted
• 1:17:00
  to stay on this topic for a little bit. And we've never done anything
• 1:17:01
  quite like this before. But I'm excited. It's been fun so far.
• 1:17:05
  Yeah, it's been really informative. I think so, and I think and
• 1:17:08
  we hope that it's informative for y'all as well. With that, I don't
• 1:17:11
  have anything else, so I'm gonna I'm gonna say oh, goodbyes. This
• 1:17:15
  is Abraham, this is Shane. We're out. So yeah, you've been
• 1:17:18
  listening to Why We Do What We Do. You can learn more about this
• 1:17:21
  and other episodes by going to WWD WWD podcast dot com. Thanks for listening,
• 1:17:29
  and we hope you have an awesome day