 Hi, everyone. Welcome to the Addiction Recovery Channel. I'm Ed Baker, and I'm your host. I couldn't be more pleased today. We have our distinguished guest, Maya Slavitz, with us. Maya is the author, most recently, of Undoing Drugs. How harm reduction is changing the future of addiction. I read the book. I read the book fully. I will read it again. I can't even recommend it highly enough to everyone that's watching the show. You can be a seasoned harm reductionist or a brand-new recovery coach, a state legislator, a person who uses drugs, a person in recovery. I recommend the book to everyone. I think the book is being released at a pivotal time in America, and it's going to change the way we see addiction and the way we see people who need our help. Maya's previous work, New York Times bestseller, Unbroken Brain, a revolutionary new way of understanding addiction, wove together neuroscience and social science with Maya's personal experience of heroin addiction. The book won the 2018 media award from the National Institute on Drug Abuse soon to be renamed the National Institute on Drugs and Addiction. Thank you, Nida, for changing your name. So, Maya, you know, just thank you for being on the show. Oh, thanks so much for having me. I'm just going to do one thing and adjust my shades because otherwise my face is going to be lit very quickly. So, hopefully you can just cut this part out. Yeah, it's getting towards sunset around here. Well, thank you so much for having me. Yeah, I guess I'd like to begin with that, just a brief, like I get to know you with your personal history of addiction. I've read about it, I understand it. I stood right next to you during that era and went through exactly the same experiences so I identify with you. Tell my viewing audience a little bit about yourself. Sure. So, I got addicted to drugs starting in high school. I was a really geeky, nerdy kid who later discovered she was on the autism spectrum and before I discovered that I just felt like a horrible weird selfish person and I was sort of always obsessed with one thing or another and always like an autistic person going on about whatever my special interest happens to be. So, when it became drugs, people actually wanted to listen to me and I actually had friends and I felt connected. And so, that ultimately led to disaster when I got arrested. I had gotten expelled or suspended from Columbia. I had to drop out in college. I began selling cocaine as well as using it. And then when I got suspended from school, I thought my life was already over so I may as well do heroin. And so, that became a nightmare and for many years afterwards I was trying to figure out sort of how I went from being like an honor student and somebody who like never broke any laws or rules as much as possible to ending up being like selling drugs and facing serious prison time. So, I kind of immersed myself in everything just the way I always had with whatever I was obsessed with. So, recovery, I was involved in 12-step programs in my early recovery. I basically discovered that I needed help when I found myself shooting up about 40 times a day and facing serious legal consequences. So, I went into treatment and in treatment I was told that the only way to recover was through total abstinence and going to 12-step meetings. And so, I threw myself into that initially. And I thought that everything that I was being taught was based on evidence and data. And then I discovered that that was not exactly the case. I still think that there is great value for people who voluntarily participate in 12-step programs. I think being could probably benefit from taking moral inventory and all of that sort of thing. But, you know, there were many ways of understanding addiction and many pathways to recovery and we should never have a treatment system that teaches you that the only alternative to this one is jails, institutions, and death. I mean, that's a terrible, hopeless message you give to people for whom it isn't working for whatever reason. And we now know in the opioid crisis that, you know, the best treatment for opioid addiction is staying on an opioid, either methadone or buprenorphine. Those are the ones that are available here in the United States. And if you don't do that, you're twice as likely to die. And especially now with the fentanyl. So I basically learned one set of myths about addiction, you know, from drug educators and prevention people. I learned another set on the street. I learned another set in rehab. And the only way I was able to finally make sense of it was by reading the research and not just in, say, neuroscience, but also sociology and history. And addiction is the thing that crosses over many disciplines. You have to look at many disciplines to be able to understand it because any one lens, you'll end up like the blind people and the elephant. And just thinking that it's like this one thing and not realizing what the rest of it is. Well, thank you. Thank you for your candor. And I like you was beat up by the war on drugs. I came with you through that in that time period in that generation. And, you know, I mean, you're touching on a couple of the different places that I want to go with this interview today. One of them specifically is the war on drugs, the punitive approach, the judgmental approach, the law enforcement approach and how that beats people up and drives them further into addiction. Now, the way I see it at this point in our history is this is the main problem today with approaching people with problems that result from drug use. I want you to comment on that a little bit. I mean, the statistics are just mind boggling. And then I want to move into harm reduction. You know, it's kind of the opposite. Harm reduction to me is the actual polar opposite of the war on drugs. So maybe comment on that and then we'll go into it a little bit more deeply. Sure. So addiction is defined by like the diagnostic and statistical manuals of psychiatry and by the National Institute on drug abuse, which thankfully is finally changing. It's outdated and stigmatizing name. The so addiction is defined as compulsive behavior that continues despite negative consequences. So basically within the definition of addiction is the fact that if punishment work to fix it, it wouldn't exist by definition because negative consequences is kind of another way of saying punishment, although it's a little bit broader. So the idea that we could use punishment to fix a condition that is defined by its resistance to punishment is pretty stupid. And so, but we've been trying to do that for the last 100 years. And so when you think about that, you have to think about like, well, this is an obvious fail. Like, it hasn't worked. We've developed the worst rate of incarceration in the entire world. We still have the worst overdose crisis in the entire world. And we still probably do more drugs per capita than everywhere else in the world. So this is obviously a major fail. So you have to look at like, well, why do we continue with this policy? And that's basically where racism and political use of racism comes in, because this policy is great at locking up bracket black and brown people and poor people. It's terrible at treating addiction, preventing addiction, stopping drugs. It's bad at everything it says it's supposed to do, but it's really good at getting people elected by saying they're going to be tough on crime and implying that that means, and in fact it does end up meaning being tough on black people. So, you know, we have this whole sort of symbolic use of policy. And the media is a horrible player in this and we can see this happening again right now where you look at harm reduction. And as you said earlier, harm reduction is basically the opposite of the war on drugs. It says like what we care about is not whether you're getting high, but whether you're getting hurt or hurting someone else. And so our policy focus has to be on reducing global harm. And when you do that, you have to look at the harm associated with policy. And when you look at the harm associated with policy, mass incarceration is a terrible harm. We know that locking people up, I think for every one year you're incarcerated, you have two years taken off your life expectancy. 13% of all the COVID in the United States was spread via prisons and jails. Like, it's crazy. We have more prisoners than anybody else in the world. And you know, you could argue, well, maybe Americans are uniquely bad people, or maybe we're making a big mistake with this policy, right? You know, I mean, I don't think Americans are uniquely bad people. I just think we've made terrible policy choices and we continue to do so because of the way politicians use tough on crime, tough on drugs to win elections, and they don't care if it actually works to help people who have drug problems or to reduce crime, which it does not do. So in America there's this incredible momentum that's built up over decades. I think you cite the Harrison Act in your book, kind of forcing the medical profession to abandon its patients. You cannot prescribe drugs to provide comfort. You have to let people suffer. The more people suffer, the more likely they'll stop taking drugs, which is just not true. And we're replicating that right now on pain patients. I'm actually working on a piece of The New York Times about this again, because, you know, right now, since 2011, we basically cut the medical opioid supply in half. And we're back down to pre-OxyContin rates of opioid prescribing. Now, what happened to overdose during that time? It actually doubled or more. So basically we made things dramatically worse by simply stopping patients' opioids, regardless of whether they were in pain or addiction or both. And, you know, we end up with this mess. So that is exactly what happened when the Harrison Act came into place. People had been used, maintaining their patients on opioids who were already on them, and they decided no accident is the only way. Cut them off. Lots of people died. Lots of doctors went to jail. And of course, the opioid problem was solved forever. We do not have one now because of how effective the Harrison Narcotics Act has been, and I'm being sarcastic very definitively. No, I understand. I understand. So when you segue that into speaking of the war on drugs, so that was what, 1915, I think, the Harrison Act? I think it was 14, but yeah. So you fast forward to 1970, 71, 72 in the Nixon administration, and that's when, in my view anyway, the war on drugs really went into war on drugs 2.0. Really, let's get them. Somebody in the Nixon administration, I think you cited in your book, the quote is, We couldn't make black and being against the war illegal, so we made drugs illegal. We had marijuana as a Schedule 1 narcotic. People spending decades in jail for possession of marijuana. How, I mean, how crazy is this in America? That's a war on drugs. I mean, yeah, it's completely nuts. And what's, I mean, it's just infuriating on so many levels because it replicates racism. I mean, I don't understand how anybody could say there's no systemic racism. When you look at the disparities in drug enforcement, and you look at the way black people have been incarcerated at rates, you know, triple or more compared to white people, even though, and we have the data, they do white people do just as much drug using and drug selling as black people do. And so it's, it's just this horrible policy mess. And, you know, so harm reduction actually comes into play at the height of the war on drugs. And so like, when AIDS is hitting, people very clear people in Europe very rapidly realized that AIDS was a greater threat to their population. Than drugs, because, you know, you can spread it to other people. And at that time, it was almost universally deadly. And so people in the UK and the Netherlands thought, well, you know, we got to like just, we got to just focus on fighting AIDS. And they knew that people actually prefer clean needles to dirty ones like people prefer clean things to dirty things in general. And so they started distributing clean syringes and realized that this actually is an incredible way of helping people rather than enabling them. What it does is it keeps them and brings them into touch with services. And so when they become ready to stop, if they become ready to stop or cut back, they have the support to do it. And we know now from, you know, it's like at least three decades worth of data that syringe exchange does not increase drug use. It does not keep people using any longer than not providing it. It just keeps them alive and free of bloodborne illnesses. So, so the idea comes out of people who use drugs themselves and gay people and gay people who use drugs, and scholars, some of whom also use drugs themselves. And they start to create this whole philosophy of harm reduction. And they find that all of these things that involve being compassionate and focusing on keeping people alive, first of all, and putting life first, they realize that like this works so much better than trying to stomp people into the ground in hopes that they will hit bottom and get better. You know, I mean, this whole concept of bottom is really, you know, even AA in the very early days they recognize that there was a problem with this concept because they suddenly had high bottom and low bottom people, which basically throws the whole thing out if you think about it for a minute, right. But, you know, this sort of got into America's law enforcement culture and it kind of, it gave support, not wittingly, but it ended up supporting this idea that if we crush you, then you'll recover. But if we're nice to you, you will continue to be addicted. And what's really especially ridiculous about this is if you think about who's more likely to recover, somebody who's homeless and jobless, and has no education, and is not connected with their friends or family, and really has, you know, a horrible situation, or somebody who's like a CEO who's got tons of money, and tons of friends and resources. Now I'm going to put my money on the CEO, right? It's like, you know, but we have convinced ourselves through the drug war of all these completely illogical things. And then when I go around saying things that actually make sense, they don't make sense to other people because they've been so indoctrinated into this. Very, very good. Thank you. Thank you. You know, I think one of the concepts that you're capturing is this idea of what's really the driving value. In the way I see it, and it's from my reading, the driving value in harm reduction is we would rather keep you alive than try to force you to stop taking drugs. The driving value with the war on drugs is we don't care whether you die or not. We're just going to make you stop taking drugs. So the question becomes, would you rather have a dead person or a person alive taking drugs? And the obvious to us, I mean the answer to us, is obvious. And that's the harm reduction approach in my view and in your view, I believe the primary purpose is to keep people alive while we're engaging them. And we're seeing this more and more. Absolutely. And I mean, there is no conflict between that and the original 12 steps and the whole idea. Like the whole thing in, if you read the literature, it's all about how do you attract people into recovery, not how do you stomp on their face until they get better. You know, it's all about this work for me, maybe you want to try it, which is the fundamental, you know, harm reduction doesn't automatically say, well this works for me, so it must work for you. But it does have this, hey, this works for me and this works for this guy, maybe you want to try one of these things, see which approach works for you. It's interesting that you bring AA into it, because people don't usually do that, but you're correct. Because the literature, the 12 steps are suggestions. They're not mandates, they're suggestions. They make it easier for people to embrace as a suggestion. No, I mean it's like, I find it infuriating how the system has sort of corrupted the steps in a way and tried to force something that was really good on people and turned it into something that can be oppressive when it's forced on people. But I think, you know, harm reduction is really all about right, we're going to put, we're going to keep you alive first because we care about you. And one of the things that is sad about this is that when we care about people, if we think for example that they're white people, we're open to harm reduction. If we don't care about people, we want them to die as an example to our kids, and we don't care. And so I'm just hoping that as we sort of start to recognize that this is a much more humane, kinder, more effective approach, the benefits of that will extend to everybody. I pulled a quote out of your book. I pulled two quotes out of your book. One was from 1993, the 1993 harm reduction working group. And then the second one is from the harm reduction coalition. I'll just read the second one. It's very concise. This is Dave Purchase. You're quoting Dave Purchase. Quote, harm reduction is against harm, neutral on the use of drugs per se, and in favor of any positive change as defined by the person making the change. Close the quote. That to me is sheer beauty. That's really accepting people, embracing people, being there for people, not judging them and joining them. No, and I mean to me like this is like this is another thing that breaks my heart because you know people of faith really want to give love and just be there for people and connect right like the whole thing is supposed to be about love. It's not supposed to be about judging people. It's not supposed to be about harming people so that they will help themselves. It's supposed to be about unconditional love and about serving people. And this is exactly what harm reduction is. And this is why like a lot of people really sort of find a spiritual thing in it because what you're doing when you are working in harm reduction is you are saying I value you exactly as you are. You don't have to change to deserve to live. You just have to be you and we want to help you and we're not asking for anything in return we aren't going to require you to do this or that. All we want to do is like make sure you stay alive. And we've been there often. And, you know, so it's it's just really beautiful when you see that kind of interaction, and you can see that same kind of interaction in people and recovery where it's just like, you know, I want to share this with you. I want to, you know, bring you into a place that I think might be better for you. I don't know. But I think, you know, maybe you want to try this if you feel like it. And what's so interesting to me about this is that like, for every other group of people, we understand that nobody likes to be told what to do. And that in fact, if you tell somebody to do something that they already want to do, they're less likely to want to do it. On the other hand, if you help them see why doing the thing that you want them to do will also help them. That's a much more effective way of making any kind of behavioral change. And that's really what harm reduction is about. And it can encompass everything from abstinence to providing prescription heroin. It is really just, let's be pragmatic and let's try to, you know, stop trying to hurt you to help you. And this punitive approach that we're discussing is so common and this humanistic approach, harm reduction approach, you know, unconditional positive regard, acceptance approach is extremely rare. I think, you know, Anne Livingston, I had the good fortune of speaking with Anne Livingston. And, you know, what she does full time is organize drug users. That's what she does. And she told me this story. She said, you know, when you get a group of drug users in a room and you are there with them and you ask them, how can I help you? What do you need? She said they weep. That's their first response. They weep because no one has ever asked them that. They're so beaten. They're so accustomed to being judged and looked at in certain ways. They're just harmful that when somebody sees them and cares enough to ask them what they need, they weep. I just thought that was a beautiful, beautiful story. And that, I mean, that is just very true throughout harm reduction. I mean, from the very earliest days, like when John Parker would go out illegally giving out needles. You know, people were originally like, why are you doing this? What's your angle? You know, what do you want? But when they realized that, hey, here's this guy, he's risking himself his own freedom in order to just try to help me stay alive. They were weeping or just deeply moved because it was like, yeah, nobody ever asked them what they wanted or before demanding something of them. And this is often the same for unhoused people who will many times also have drug problems, but not always. But when you're constantly treated as like something that we should walk across the street to avoid, it, you know, it's it's very mentally unhealthy. Like we have all kinds of research about neuroscience of, you know, having low status, and that's probably the ultimate you can have in low status and high stigma. And it's bad for you. It just it's not healthy. Like making it worse does not make you better. Yeah. Yeah. And we're so with the other culture we've some we've come so far in the in the wrong direction that one of the things that I like so much about your book, you mentioned John Parker was was was you you had a way of just pulling out these names and people and personalities that you've never heard of. But when you read about the sacrifices that they made and the risks that they took, you know, breaking the law, clearly breaking the law to dispense cleanser hinges, sterile syringes to people with and and and and just being so like committed to to like a like like a spiritual kind of momentum that was incredibly unpopular. Very, very, very special people. No, I mean, it's a part of the goal of the book was to, you know, bring some recognition to those people. One of my terrors when writing the book was just like there were so many of them that I couldn't include because otherwise it would become this giant 1000 page book that would be worried. But I really did want to draw attention to the enormous courage that the early and still many harm reduction activists now especially in the south where there's still a lot of opposition. But what was also especially moving to me was to see how, you know, back then there were like, you know, 20 of us in the world who knew what this thing was and we're trying to like get the message out. And then, you know, now it's like the White House says harm reduction is part of their policy. Now, we're nowhere near as far as we need to go. But we are we have come from the fringes to the mainstream and we have shown that what we do works. I wanted to look into that a little bit, you know, so starting with AIDS, you know, for the purposes of this interview anyway, we're starting with AIDS in America. What was then called clean needle exchanges, which is now called safe syringe programs. It's a proven fact that I think within the first 10 years, age transmission had dropped by something like 80%. And it was completely attributable to safe syringes being distributed. And a lot of it in the beginning was illegal. Yeah, no, I mean, it's it's New York State is sort of an amazing example of this. Because when I was injecting back in the 80s, at least 50% of people who injected drugs were already HIV positive. And I was very lucky that I met a harm reductionist and they taught me to protect myself. Can you talk about bleaching bleaching. Yes. Yes. So, um, so yeah, a woman who was visiting from San Francisco, who I later tracked down when I was writing the book. She taught me to use bleach right before I was unwittingly about to share a needle with somebody who was probably already HIV positive at that point. So, you know, I'm enormously grateful to her. And this is why I got into this area and was able to be here to do it. But yeah, like the in New York State so at that time, at least half of injectors were already HIV positive. Now it's less than 3%. And it's because everybody died. We have plenty of people who inject drugs here. And in fact, there are tiny counties in the United States that have greater numbers of HIV cases in people who inject drugs than New York City does because they refuse to do syringe service programs. Now, so with that in mind, so this is a clear example of harm reduction at its best. So now we have, last year we had 108,000 people in America die of drug overdose. In my county, right here, Chittenden County, Vermont, we had 51 people die. It was a 300% increase between 2018 and 2021. Now, when you look globally, I want to change our focus over those prevention centers. When you look globally to overdose prevention centers, the, you know, people keep attacking the data. The data is unequivocal. They work. Nobody dies in them. People within a certain circumference around them are dying less of drug overdose. They connect people to services. They establish relationships with people that are caring, many of them for the first time. They work. Now, you're saying that the Biden administration, yes, Rahul Gupta, people have embraced this concept of harm reduction. And we have in Vermont too. But in America, harm reduction seems to stop just screeches to a halt right before overdose prevention centers. I'd like to give you a view on that. Why do you think this is, when, when, when worldwide, I think there's over, over 100 centers. There's never been a death. These places are successful wherever they're established. Why Canada, Canada has overdose prevention centers, you know, widely dispersed along with safe, safer supply, which we'll go into. Why are we so reluctant to embrace overdose prevention centers knowing that they work? What is it about us? Well, we still have this idea that they enable people and that if you, unless you make people inject on the street or at home, if they have a home, you know, you're sending the wrong message. We're still stuck on that same old idea. And so we think, you know, oh yeah, like, you know, you're going to make a safe injection center and nobody's ever going to quit because now they're happy because they can, you know, on inject and not die. The reality is, if you've ever visited one of these places, people who are injecting drugs and who visit these sites are often extremely traumatized, extremely poor, extremely marginalized. You would start crying before you heard half of the story of their childhood if he sat and listened to them. You know, the idea that they're not stopping injecting because they don't have a safe place to inject is just ludicrous. And so yeah, so we oppose them for the same stupid political reasons that we oppose syringe exchange in the first place, and that we, you know, continue to carry out the war on drugs and that it has been so hard to even legalize marijuana. So we still have this very puritanical idea that like, you know, punishment is going to stop people from doing things that we don't want them to do. And we don't care if we allow ourselves to do equally dangerous things, those people that do those things should die. And it's just, yeah. Now, I think the thing with safe injection or overdose prevention sites is they are difficult to scale. In rural regions, you're just not going to be able to have them as close together as you would need, because simply geography. So, you know, like in places like San Francisco in New York where there's very and a lot of places in Canada where there's very defined areas. A lot of people who use drugs are on those places are perfect for overdose prevention sites because they people are already all there. It's not going to make them have to like spend an hour going to the center and then drive back. So that is sort of a limit on the scalability. I still think for the areas where they are feasible, it makes a ton of sense to have them. But this brings us to safe supply. Let me just clarify something because we had Nora Valkov on the show and Dr. Valkov mentioned the same thing, this idea of morality. And what I pointed out was that all of Vermont is sometimes considered, you know, like a rural state. Burlington is a city where I live. It's 45,000 people. Chittenden County is the biggest county in Vermont. We have 51 deaths, one a week in 2021. We have a heat map showing the concentration of those deaths. We have a heat map showing public transportation coinciding with those deaths. And it's just a perfect location for an overdose prevention center that could be scaled to a city of this size. So I think these things are scalable. I'm not saying like in a situation like Burlington where you have exactly shown that they shouldn't be. I'm just saying that if we're talking about dealing with reducing over 100,000 deaths a year, we have to do things that, you know, because the other problem of course with overdose prevention centers and one of the reasons there's so much opposition to them is the MIMBY thing. Oh yeah, for sure. And so frankly I think, you know, syringe exchanges, syringe service programs where they now exist shouldn't be able to be overdose prevention centers. That would be what we would try to do here. Yeah, because an overdose prevention center is basically a syringe service program with a place where people can inject other than the bath. Exactly. Now I heard you mentioned safe supply. Let's go into safe supply because I think safer supply is really an important concept. We're not talking about it yet in this state, but some people are looking at it. Certainly we're reading about it. I'm looking into Canada. I'm speaking with people in Canada. Let's talk about it because I think it's a very important concept, especially in a rural state where people can't get to an overdose prevention center. What do we do with these people? How do we keep them alive? Well, and that's why I think that actually can be a nationally scalable idea. The problem, which is a massive one, is our controlled substances act and the Harrison narcotics act. In fact, because the history of allowing prescription drugs for people who are addicted is one of, no, we can't do that. Like if you are not addicted, you could have them. And if you have pain, you could have them maybe. But if you are addicted, oh, no, we can't come for you. So, you know, in Canada, they do not have the Harrison narcotics act, and nor do they have it in the UK. And the UK, now they've gotten very backwards. But for the most of the history, they instead of creating the Harrison narcotics act, they explicitly legalized maintenance prescribing by doctors. And so from the 19 teens to the 70s, you could be prescribed cocaine or heroin or other opioids if you were addicted. And so basically, like one of the people in my book would go to doctors to get opioids. And one of the times they basically said, look, I know you're faking here, you can have the prescription anyway, because that's legal there. And they recognized that making that legal for people who are already addicted, and he was very clearly so, you are protecting them from the street market. And you're also reducing the chances that the street market will expand. Because a lot of times people who use drugs like, for example, me will sell drugs in order to... Yeah, for sure. Absolutely. If you reduce that pool of people, you are going to reduce new users. And so we had this whole panic over opioid over prescribing, and there certainly was over prescribing in some cases. But a lot of what happened was the opioids that were prescribed to one person went to someone else. So 80% of the people who became addicted during the prescription phase of the opioid crisis were already using other drugs. And the prescription that they were using the first time they tried opioids was not theirs. They were not legitimately prescribed it. They got it from somebody's medicine cabinet or a family member or friend or something like this. So, you know, we just have this misconceived idea that the people who became addicted are all innocent white pain patients whose doctor addicted them when in the vast majority of cases... Well, first of all, there's no innocence or guilt when it comes to addiction, but in the vast majority of cases, there were people who already had a history of serious drug use, 80% of them had used cocaine or methamphetamine, who got introduced to opioids diverted from the medical system, and then this happened. So now we crack down on the medical supply and what happens? Well, we developed this massive fentanyl market because we cut everybody off. We didn't help the pain patients. We didn't help the people with addiction. We just cut. And then we were surprised that we developed this massive cartel-led, you know, market. If you read, I'm certain you've read Sam Quinones' books and he does an excellent job of kind of like dovetailing the idea of a decreasing pharmaceutical opioid supply and an increasing supply of heroin coming in from... And then he draws the completely wrong conclusion that we need more law enforcement to solve it, and that like people with addiction need to be... I'm not talking about the solution, but I mean this idea of the way that opioids became less available, heroin became more available, and then heroin and fentanyl became even more available. We haven't really touched on fentanyl as yet, but fentanyl is I think one of the main reasons for this idea of a safe supply or safer supply becoming, you know, kind of like an obvious solution to the rate of death in America. Let me just read something from...this is from the Canadian government's website. It says about safer supply services. Safer supply services provide prescribed medications to people who use drugs, overseen by a healthcare practitioner with the goal of preventing overdoses and saving lives. They are provided in a less clinical and more flexible way compared to other care options for substance use. So how beautiful is that? Then they go on to say these services are intended to reach people at risk of overdose for whom currently available care options have been ineffective or inappropriate. And this is, I mean correct me if I'm wrong Maya, but isn't this who we see dying in America? People who for some reason or other are not able to really kind of engage with established healthcare facilities. One of the reasons that may be keeping them from engaging could be stigma. Like in Vermont, we have a hub and spoke system that has worked really well here. We have over 10,000 people on medication for opioid use disorder through this hub and spoke system. We have no waiting list for the hub and spoke system. At the same time as we have no waiting list, we have another estimated 10,000 people with opioid use disorder who are not seeking treatment. The question becomes why are they not seeking treatment? Are they so damaged, so beat up, so stigmatized that they're afraid to seek treatment? Are we going to develop treatments for them that are effective like overdose prevention centers or safe supply? I think there's several reasons that people don't get treatment. It's not that they're having so much fun using in the vast majority of cases. It's not that they need to be brought down to earth so that they can realize how bad it is. They know it's just that for them, the drugs seem like the solution to their problems. If you're not providing something that seems like a solution to what is happening for them, they're going to be like, well, you're going to take away my only coping mechanism and you're going to give me what? The other thing is that historically we've had very lousy treatment. A lot of it has been humiliating. The idea has been to force people to hit bottom. It has been crushing. It has actually caused PTSD in a lot of people. It's been sexually abusive. There's all kinds of issues because so much treatment was serving the criminalization system and it was the alternative. So basically you had no choice like jail or treatment. So a lot of people would pick treatment and then they'd find out in some cases that the treatment was worse than jail. That the treatment was more psychologically damaging. And so a lot of people who use drugs now are just like, I don't want to sit in a room and get yelled at. And that's what treatment historically has been for a really long time. Alternatively, they're like, I don't want to have to show up at a clinic every day and pee in a jar in front of people, which historically has been how medication for opioid use disorder has been. So trying to, you know, it's really good to hear how many people that they that your state actually has in treatment. But the people who are still out there, for whatever reason, they need to be reached in a different way. And there are definitely some people for whom, for example, they are so traumatized that abstinence may not be possible for them. That like certainly if you take away their drug before you provide care for their trauma that is actually helpful, which is hard to find, they're just going to get worse. So helping those people again involves this harm reduction idea of we want to help you the way you want to be helped. We don't want to hurt you more. And we want to provide things for you. And so what's really interesting about the heroin prescribing programs in other countries is that, you know, if the idea of enabling was true, then providing free heroin would be a pretty darn strong form of enabling right like how more enabling do you get than actually giving the people free drugs right. So you would think that people in heroin treatment would just stay there forever and never stop. In fact, they go to more traditional treatments at rates comparable to or greater than people who are just on the street. So that idea is just wrong. It is falsified by the data. And so, you know, our fears about prescribing for people or providing, you know, supportive care are fear that this will mean they will live in this horrible limbo instead of getting into glorious happy absence. That's what happens like, you know, it's possible that there's an edge cases where that is true. But if you look at the data, it just doesn't show up. And basically also like what what you see with people in heroin maintenance in particular is often that like, when they don't have to spend their entire life chasing the drug. They find that, oh, I got exactly what I wanted and it didn't fix me. And this happens like, you know, you get successful, you think you're going to be fixed and all is going to be well forever. And then it doesn't and then you have to deal with you. And perhaps people in that situation can begin to feel a sense of confidence and build a base. And then that that idea of positive movement defined by the person from that base decided I want to move a little bit more into a healthier place. Can you help me? And then the response is yes. We were very fortunate to have Cailin C, the program director at On Point in New York City on the show. And when she, I haven't visited On Point yet, I will. But but but but when you talk to her and hear about the services, they have a barber. They have a showers. They have a laundry. You know, they will sit. She has social workers coming in that will actually sit with a person while they're self administering a drug and just be with them, engage them in relationships. Lots of referrals for housing, lots of referral for for medications for opioid use disorder, all kinds of linkages. They have they have massage. And importantly, one day a week that massage is limited to the staff. Like dealing with an incredibly dramatic workplace because a lot of people get lost. We still use losing a lot of people and they can't serve. They can't meet the need, but they can meet the need of people who show up. Apparently they've engaged thousands of people. There's been 50,000 uses. I think just around 2000 participants that come in repeatedly and they teach them how to safely use drugs. But they're always always there. And they're and if there's an overdose, they reverse the overdose. They were reversed over 500 overdoses. Not to mention the savings to the city in terms of. No, I mean, it's like it's really, you know, when you when you think about, you know, what would you want if you were feeling at the lowest point of your life. Right. That's what they have there as much as possible. Yeah. And that is really, you know, that's how all health services should be. Um, it is, you know, I mean, obviously like we don't live in an ideal world or whatever, but I'm being welcoming and and trying to make people feel like they matter. It matters an enormous amount and that's what you do see I visited there and and yeah, I got exactly that same feeling of like, these people are really here. Just trying to serve. And they are, you know, for lack of better word doing God's work. No, I agree with you. This idea you mentioned it a little bit earlier, like the futility of hitting bottom. You know, you can hit bottom 100 times and be met with a punitive response and it just drives you deeper into the darkness. When when I when I listen to Kailin in the way and I know you know it because she was there, it's it's more of a hitting safety. You know, you walk into that place and you hit safety and you know you're safe and you want to go back. It's so engaging. There's hope in that slow moving, you know, not not quick moving, slow moving, but at least moving in the right direction rather than in the wrong direction. So I think we I know we see it the same way we feel like there's hope, hope there. We have a few minutes left. I want to thank you for being on the show. I wanted to I wanted to give you the opportunity and this is a little bit of a surprise, but you know, I wanted to give you two opportunities. One would be to say to say to people who are using drugs what would be your message to people who are using drugs. And then the other thing I would love to hear from you is what is your message to us out here, advocates, activists, people who are committed to changing this system. So first people who use drugs and then us. Okay, so for people who use drugs, I would just say you matter, you are valued. Don't listen to all the crap that people say about you. And please, please know that there is hope and that you can. You can do amazing things, whether you continue using or not, but you are valuable and you have stuff to give and, and that is just, you know, I mean, I really, when I was, you know, at the worst of my addiction. I just thought it was hopeless. And I didn't know any other way of coping. And I just thought well, I'm going to go somewhere they're going to yell at me it's not going to help me figure out how to, you know, and it took me a long time to figure out what was going on. But for me, actually being on anti-depressants has been enormously helpful and finding people that will support me and that have been through, you know, what I've been through in many cases. And so, you know, I just do I always want to say there's hope and, and you can do it you can, like, most people do get better. You just have to keep yourself alive and I'm sorry that society is doing such a lousy job at doing that. But saying to activists, read the history. I'm not trying to sell my book. But if you look at the history of harm reduction, it's hard not to have hope, because you see how very marginalized it was, and how much it's expanded. We still have an enormous way to go. But this activism has been very successful. And it, you know, there's always going to be roadblocks, there's always going to be people trying to create a backlash. But we have progressed enormously. And it's very, very hard to see that in the day to day, because in the day to day you're still fighting those battles. But when you look at it as a large on a larger scale, it's like that business that Martin Luther King said about the arc of history being able to bend towards justice. Well, you guys are the people who are trying to bend it towards justice. And we need you to continue doing that and also to take care of yourself. Oh, beautiful. Thank you so much. Bending the arc of the moral universe. I like that. Here we go. You know, you're great, Maya. Thank you. Thank you so much for your energy. And, you know, to my viewers, I mean, what a gift. Merry Christmas to all my viewers. Happy holidays. And thank you.