How a Policy of Abstinence Shaped Irish Drug Health Information Material in the 1980s And 1990s

Festival Season is upon us, and the Health Service Executive (HSE) in Ireland recently launched a new drug campaign targeted at festival-goers. The design and imagery of the Reduce the Harms at Festivals campaign takes a playful approach. Borrowing heavily from 1970s animation, the campaign features images of anthropomorphized objects and colourful cartoons; a smiling first aid kit high-fives a heart in platform shoes patched up with a plaster (‘Medics are your Mates’); a snail in festival style staples – bum bag and bucket hat (‘Start Low and Go Slow’).

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Intolerable Normalcies: Multiple American Methadones

“To what extent can social problems be circumvented by reducing them to technological problems? Can we identify quick technological fixes for profound and almost infinitely complicated social problems, fixes that are within the grasp of modern technology and which would either eliminate the original social problem without requiring a change in the individual’s social attitudes or would alter the problem as to make its resolution more feasible?”

Dorothy Nelkin asked the questions above in her  slim volume, Methadone Maintenance: A Technological Fix (New York: George Braziller, 1973), where she argued the practice would have a tenuous future as a “chemotherapeutic ‘fix’” for heroin addiction. The latter, she wrote, was an “adaptive response to real and overwhelming social or psychological difficulties that cannot be resolved by a simple technological fix” (3, 152). But methadone was no simple technological fix. Programs developed in a “climate of conflict extending from the level of policy down to the actual operation of individual clinics” (8). The Dayton, Ohio, methadone clinic where James Klein and Julia Reichert shot their film Methadone: An American Way of Dealing is a Black space full of energy and music—even as no-nonsense white nurses refuse to disclose to Black patients the dosage they are serving up in their “free cup of methadone.”

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The Points Methadone Marathon

Methadone Movie Title Card

Welcome to the home page for the Points Methadone Marathon!

January marks ten years since the launch of the Points blog, and to celebrate this historic milestone, we’re invoking another, larger anniversary: passage of The Drug Abuse Office and Treatment Act of 1972 (Public Law 92-255). The ramifications of this law were far-reaching, not only in the “war on drugs” but also in the less-scrutinized evolution of substance abuse treatment. Methadone was the place where theorists of criminal justice and treatment met and—briefly—danced. In the shadow of the radical critiques both had suffered during the 1960s, they looked to find a cost-effective and empowering way to combat heroin addiction. But like so many grand ideas from this particular moment in time, things didn’t quite work out according to plan.

The reasons for that are many, of course, and the ramifications are legion; the Points Methadone Marathon aims to unpack them all. We kick off with an exclusive screening of James Klein and Julia Reichert’s outstanding 1974 film Methadone: An American Way of Dealing. This cinema verité classic was deemed too controversial for wide release back in the day, and has long been out of circulation. Thanks to the generosity of James Klein, you can see it here now at the link embedded below.

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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?

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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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Points 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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