2021: What a Long Strange Trip It’s Been

Smoke-em-if-you-got-em
January 6, 2021: Smoke ‘Em If You Got ‘Em.
Image Source: Ayamann Ismail, “What I Saw Inside the Capitol Riot,” Slate, Jan. 7, 2021.

Editor’s Note: Founding Points Co-Editor Trysh Travis wraps up 2021 for us and gives a preview of what’s to come on Points in 2022. See you in the new year!

As another Covid year closes out, Points readers may find themselves wondering whether a historical perspective on alcohol and drugs is really useful—or even possible, given the unprecedented nature of our lives right now. Maybe critique is overrated and use and abuse is where it’s at?

While the editorial team shares this existential quandary, we continue to live by those immortal words of Frederic Jameson: “always historicize!” Understanding The-Endemic-We- Are-Now-Living as a historical formation, rather than simply a swirling shit show with no end in sight, is of course challenging. I guess that’s why Jameson also reminds us that “history is what hurts.”

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The Instruments of Darkness Tell Us Truths: A History of Heather Edney & The Santa Cruz Needle Exchange

Editor’s Note: Today’s post in honor of Women’s History Month comes from Greg Ellis. Ellis and Heather Edney are currently writing an insider’s account about Edney’s early pioneering needle exchange work in Santa Cruz during the AIDS epidemic prior to the advent of protease inhibitors. Edney’s innovative ideas about harm reduction flourished in a male-dominated field and changed the face of modern healthcare and recovery. The memoir will be an imprint of Anthology Press.

junkphood - How to Spot a Coke OD
How to Spot a Coke OD, from the “Coked-Up Puffs” edition of junkphood, artwork by Brooke Lober, 1995. Image courtesy of Heather Edney

But ‘tis strange and oftentimes, to
win us to our harm, the instruments
of darkness tell us truths, win us with
honest trifles, to betray’s in deepest consequence.

—Macbeth act 1, sc. 3, l. 124-8

There is a simple principle in the field of harm reduction that drug users are the experts on using drugs. But what exactly does that mean? Strong governmental and institutional pressures to uphold systemic standards and anti-drug laws frequently foster mistrust between drug users and social service providers.

In her soon-to-be-published memoir and harm reduction manifesto, titled Sucking Dick for Syringes, long-time harm reduction activist Heather Edney recounts the history that led her to bridge the divide from the shooting gallery to the boardroom. Edney, who was instrumental in building the pioneering Santa Cruz Needle Exchange Program (SCNEP) in the 1990s, writes about the intersection of drugs, sex, and running an illegal syringe exchange. Her innovative risk reduction modalities ultimately created some of the most revolutionary and lasting changes during the infancy of the field. Her ideas and techniques have saved countless limbs from infection and loss, prevented unknown numbers of seroconversions, and introduced the concept of holistic healthcare to marginalized and criminalized populations.

Heather Edney operated in the world of drugs for much of her young life before landing in Santa Cruz, California, at the age of 19—where she learned about the fledgling needle exchange program run by a dedicated group of volunteers. Edney employed the skill set developed from a childhood of sexual trauma and familial dysfunction, quickly rising to a leadership position and ultimately creating an internationally renowned needle exchange model.

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Exploring Fentanyl Prevalence in New York City Heroin

Editor’s Note: Today’s guest post comes from Bilal Abbas, MPA, MSW. Bilal graduated with the MPA from Rutgers University in Newark and the MSW from Columbia University in New York City in 2018. He works at the Albert Einstein College of Medicine/Montefiore Medical Center as a Research Coordinator, facilitating research related to heroin or opioid use treatment.

Group of Stamped Heroin Bags, NYC 2019
A group of discarded stamped heroin bags collected by the author’s study in New York City in October 2019. Image courtesy of the author.

For over half a century in New York City, heroin bags have been distinctly branded with unique markings, including with rubber stamps. From the seller’s viewpoint, stamps create brand loyalty and identify a superior product that yields more psychoactive effects. Heroin-using communities also utilize stamps to identify potentially lethal supplies and raise awareness through word-of-mouth messaging. In the 1990s, users identified and alerted others about supplies, which had caused a number of overdoses and which they suspected to be contaminated with lethal adulterants including scopolamine. [1-3]

Fentanyl has been of increasingly paramount importance in tens of thousands of preventable deaths among Americans since 2013. Fentanyl seizures in the US increased 7-fold from 2012 to 2014, while overdose deaths involving fentanyl and its analogs increased almost 47 percent from 2016 to 2017. [4] A 55 percent increase in fatal overdose was observed in New York City (NYC) between 2015-2017, and in 2017, 55 percent of overdose deaths involved fentanyl. [5]

Due to the availability of rapid fentanyl test-strips, the novel study described in this post, Exploring fentanyl prevalence in New York City, used an exploratory framework to examine and understand the fentanyl contamination in NYC stamped heroin. Examining fentanyl prevalence in NYC heroin by stamp or “brand” can raise awareness about tainted supplies and can help to reduce opioid overdoses. My team collected samples of used and discarded heroin glassine bags in NYC neighborhoods known for heroin use and sealed them within a separate plastic bag to avoid cross-contamination.

We then used fentanyl test strips, which use immunoassay technology to quickly and reliably detect the presence of fentanyl and its analogs, to test trace amounts of heroin in each bag. According to the American College for Medical Toxicology (ACMT), it is a near scientific impossibility to overdose on fentanyl from airborne or transdermal exposure. Therefore, there were no safety risks involved in executing this study. [6]

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SHAD Interview: “Just Say Know: A Social History of How Naloxone Came to Matter,” with Nancy Campbell

Editor’s Note: Starting today and running periodically over the next month, Points will feature interviews with authors from the latest issue of ADHS’s journal Social History of Alcohol and Drugs (vol. 34, no. 2; Fall 2020), published by the University of Chicago Press. Today’s post by Dr. Nancy Campbell reflects on both her keynote address at the 2019 ADHS biennial conference in Shanghai and on learning how to promote a book during the early days of a global pandemic. Dr. Campbell is Professor & Department Head, Science and Technology Studies, at Rensselaer Polytechnic Institute. You can see her keynote address here. Contact the University of Chicago Press to subscribe to the journal or to request access to this article or any other article from SHAD

Nancy Campbell in Shanghai
Nancy Campbell at the Humble Administrators Garden in Suzhou, China.

Delivered steps from Shanghai University, my 2019 ADHS keynote address in the Fall 2020 issue of SHAD foreshadowed my latest book OD: Naloxone and the Politics of Overdose (The MIT Press). The David F. Musto Center for Drugs and National Security Studies was the event’s host organization, and the SHAD editorial trio (editor’s note: Nancy Campbell, David Herzberg, and Lucas Richert) was in town for the first ADHS conference held in Asia, “Changing Minds: Societies, States, the Science, and Psychoactive Substances in History.” Thus my memories are bound up with an evening at Healer in Shanghai, where Phoebe Han mixes ritual, baijiu aged within live bamboo, creativity, and incense into exquisite concoctions (pictured). Even reading the page proofs of the keynote brought that moment of contemplative refreshment back to me like Proust’s imagined petit madeleines dunked in tea.

Multi-modality drink at Healer.
Multi-modality drink at Healer; photo by the author.

The keynote address condensed the book, which came out on March 5, 2020—right before institutions shut down in the face of COVID-19. Fumbling around Zoom and jerry-rigging cables to ease home WiFi traffic while pivoting my class “Drugs in History” online, I leaned into co-editing SHAD, heading a department, and maintaining a brisk writing and walking schedule with COVID buddy Marion Roach Smith. I learned more about promoting books than I ever wanted to know in the basement corner that became my pop-up studio. To up my audio game, I hid beneath a blanket to record, while coordinating my video outfits with a teal couch and russet walls.

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Review: “Drug Use For Grown-Ups: Chasing Liberty in the Land of Fear”

Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University.

Cover of Drug Use For Grown Ups

Dr. Carl Hart’s timely Drugs for Grown-ups: Chasing Liberty in the Land of Fear attempts to ignite a shift in our collective consciousness—much like the psychoactive substances he chronicles. Credentialed academics and other elites tend to deny using drugs, or, if they want to pass as authentic for political reasons, they might admit to a few youthful indiscretions (e.g., then-candidate Barack Obama’s “inhaling was the point” comment in 2007).

Defying this taboo, Hart, Chair of the Department of Psychology at Columbia University, owns up to his affection for an expansive medicine chest. He reveals dabbling in amphetamines, discloses his use of the unfairly-maligned drug heroin, and discusses sampling 1990s club drug—and soon-to-be FDA approved medication—MDMA, along with other more obscure compounds like 2C-B, which was popularized by virtuoso, chemist, and psychonaut Alexander Shulgin.

Hart’s self-doctoring is reminiscent of nineteenth-century medical ethics, embodied by such titans of the time as William Halstead and Sigmund Freud. His self-prescribing bridges the gap between his knowledge and his experience, which helps him better understand subjects visiting his Columbia University lab. Drugs also filtered into his other extracurricular activities, figuring into adventures with his wife and enhancing their relationship and strengthening their marriage.

Who Are Drug Users?

Hart considers himself the rule not the exception in terms of drug use. Drug users are not zombies, he emphasizes; they are not the flesh-eating monsters sometimes depicted on highway billboards accompanied by inane anti-drug slogans. Drug users are not unwashed psychos or crime aficionados who inexplicably love doing evil. No, most drug users are typical, normal, average Americans, gainfully employed and living undetected—maybe you or your neighbor. And that’s okay.

Generally speaking, Hart’s ideas are easy to understand, and he gives primacy to the crucial observation that most people’s experiences with drugs are positive. Drugs offer insight, increase euphoria, and provide pleasure. Drugs act as social lubricants, making social interactions easier to bear or more enjoyable; and drugs break down barriers, allowing some individuals to be more vulnerable than they otherwise would be. People use drugs to soften the edge after a stressful day working a job they hate, and, conversely, drugs can help those who love their jobs be more productive and work long evening hours.

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A Missed Opportunity: What Karen Bass Could Have Accomplished as VP for Communities of Color

Editor’s Note: Today’s post comes from Christiana Verdelus. Verdelus is a Haitian-American woman, feminist, and first-generation college student studying Health Education and Women’s Studies at the University of Florida. This work was inspired by her research on women of color and substance abuse treatment approaches and was completed through the Preston Haskell Faculty and Student Award program. 

My first presidential election is right around the corner and let me tell you—I am not looking forward to it. Don’t get me wrong: making Biden and Harris the next leaders of this nation is definitely a small step (or maybe a tiptoe) in the right direction. But I’m angry that it’s only my first election and I’m already tired of settling. 
 
Within our polarized society, Republicans administrations are known to exacerbate issues that disproportionately affect people of color. But Democrats have neglected important issues. Just getting Trump out of office isn’t going to single-handedly repair black and brown communities. I am happy that history is being made with a black woman nominee for Vice President. But “representation” won’t rebuild these communities either. Every four years we spend holding onto hope that the next election will bring real change is another four years of governmental abuse and abandonment of communities of color. As a nation we cannot afford it.  And as a black woman and a feminist, I won’t stand for it.

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The Forgotten Drug War: Unknown Malaria Victim (New Orleans, 1932)

“The real war will never get in the books”–Walt Whitman, 1875

On October 31, 1932, Charity Hospital in New Orleans admitted a comatose man, diagnosed with malaria and thought to be an opiate addict. The patient deserted the hospital after being revived. Two days later, he was once again brought to Charity hospital, again in a coma. He died the following day. Over the course of the next month, five more Charity Hospital patients, all injecting drug users, died of malaria. Over the course of the following year, a total of 48 injecting drug users were admitted to the same hospital with diagnoses of malaria, 10 of whom died.

***

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The Silences of Our Work, Part III: Alternate Paths to Recovery

EDITOR’S NOTE: Today, Points brings you the third in a series of posts on silencing and substance use by Heather Sophia Lee, PhD, LCSW, an Assistant Professor of Family Medicine and Community Health at Rutgers’ Robert Wood Johnson Medical School. You can read the first installment here and the second installment here

For my dissertation, I conducted a qualitative study of two harm reduction programs. The purpose was to describe the experiences of participants in harm reduction programs given that “outcomes” of such programs were difficult to measure.

At that time evidence existed for the efficacy of harm reduction practices, like needle exchange programs, in reducing the spread of sexually transmitted diseases like HIV and hepatitis C. Less was known about the impact of harm reduction as a model for addiction treatment. Its broad focus made it unclear which “outcomes” were most important to measure. Coupled with political resistance, many agencies often avoided calling their work “harm reduction” to avoid scrutiny which might interfere with meeting the needs of their clients.

As a novice qualitative researcher, I was intuitively curious about how harm reduction was being integrated into twelve step recovery experiences. I was also interested in the extent to which one might be just as likely to come to abstinence through harm reduction as abstinence-only based treatment. Harm reduction and twelve step models were often cast as mutually exclusive, and I knew there was a deeper story to be known though I wasn’t yet sure what it was.

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