 Good morning. Thank you, Joanne, and thank you to the Harm Reduction International and the Eurasian Harm Reduction Network for bringing us together in this beautiful city. So the question that was put to me is, what's going on in America? And how does it fit in with what's going on or not going on in the rest of America and the rest of the world? So what I want to try to do in this short time, and without speaking in a New York clip, is to explain what I think is going on and where this can and should be headed. Now, and I also want to take that opportunity to think about what it means to be building a movement in which harm reduction and drug policy reform coexist, intermix, weave in with one another, are distinguishable from one another only for tactical reasons, but never for strategic reasons. Maybe distinguishable in our advocacy when it serves our purposes to distinguish between harm reduction and drug policy reform, but that should be as much as possible integrated in our own minds, our own thinking, and our own strategy. It's interesting. Sometimes I think you look at the reforms that happen around the world, and it's good to focus on the positive, and it's good to focus on the negative to see where we need to fix things. And I also understand that for some people, how we perceive things, it's about not the reality, it's about our own internal emotional makeup. Is the glass half full or is the glass half empty? Is the fact that we are moving towards the legal regulation of marijuana in the United States entirely a good thing? Or do we have to be careful? Who knows? The legalized marijuana and the crackdown on the other drug users. The legalized marijuana and the drug policy reform movement in America will forget about everything else. Always that fear, but I think it's important to focus on the upside, to focus on the positive. I've been involved in drug policy reform for a long time. I've been accustomed whenever I speak outside my country to apologizing for the actions of my government around the world, for standing up and saying, I am sorry for the fact that my government of the United States of America has wreaked havoc with its global war on drugs everywhere. I am sorry for the violations of human rights and civil liberties and the mass incarceration. I am sorry for the environmental degradations. I am sorry for the role my government has played in impeding the spread of harm reduction to reduce HIV and hep C and TB. I am sorry for the role that my government has spread in promoting drug courts and coercive treatment and opposing easy access to methadone. I am sorry for creating the first global police network all around the enforcement of drugs. I am really, really sorry. And I'm also accustomed when I go outside the United States and my compatriots around the world say, why don't you just crack down in your own country? And my response to them is, shut the fuck up. You have no idea how much this war on drugs is in my own country as well. Because if we see the consequences of the failures of prohibition and the crime and the violence and the corruption and the spread of disease and the violations of human rights around the world, well, we see them in my own country as well. In a policy of mass incarceration unprecedented in the history of democratic societies. In the tenfold increase of people for the violation of drug laws between 1980 and 2010. In the incarceration of young men of color at rates of incarceration that grossly exceed the rates of incarceration in the Soviet gulags of the 30s, 40s and 50s. In the allowing of hundreds of thousands of people to die of HIV because we could not find ourselves capable of embracing harm reduction. In the massive arrests and the criminalization of whole sectors of society. So we too in America know the drug war. We know the drug war. But that said, I'm beginning to feel proud to be an American. I mean my god, you know what we're doing? We are leading the world when it comes to the issue of ending cannabis prohibition. We are leading the world and it may not be our federal government that is leading the world. This is coming up from the ground up from the grassroots, no pun intended, and civil society and public opinion and state government. It is coming up when public opinion is changing faster than anybody can believe from one third of Americans in favor of ending cannabis prohibition just ten years ago and two thirds against to now a majority of Americans saying it is time to end prohibition. And where the majority of that majority are people who do not smoke marijuana. Many do not like marijuana. Every one of them who has a child worries about their child with marijuana but who nonetheless believe that this is a policy that has failed that cannot work and where the alternatives with all the risks of legalization are preferable to continuing with a failed prohibitionist policy. That transformation is inspiring. Now do I worry? Do I worry that the most entrepreneurial and dynamic elements of capitalism ever seen in human society which exist in my country for better and worse will take this over and create the moral burialization and the Budweiserization of marijuana? Yes, I worry. Will I do what I can to avoid that end result? Yes, I will. But do I also believe that even if that is the end result which I hope it is not, that even that end result will not be so bad as continuing with a policy of prohibition that arrests 750,000 people a year that is enforced in grossly racially disproportionate ways that has led to death in mayhem and the profiteering of Mexican and American criminal organizations that legalization and decriminalization may contain risks but those risks are taking because oftentimes the potential devil that we do not know is better than the devil that we know and that we live with. And that's why I want to come back to what it is that we believe here, what we think here. I think what really bonds and builds and empowers of movement is freeing ourselves of our own ignorances and prejudices. We come together and we believe that we are the enlightened and indeed we are the enlightened because we see and understand the evils of the drug war and the ways that so much of the world does not but inevitably we have our own prejudices. We have our prejudices of the opiate users against the stimulant users and of the cannabis users against those. We have the prejudices that we carry in our own personal lives in ways that do not involve drugs. We have our prejudices against the every sort of one and we have our fears as well. I want to think of what the world looks like if we focus on the positive and try to connect those dots. I think about in the 1960s, do you want to have some water please? When two brave doctors, Dolan Nyswander, fought against prejudice and stigma to create the notion of methadone maintenance and were demonized for doing so. I think about the Netherlands which began the pragmatic policy of cannabis regulation, the coffee shop system in the late 1970s and early 1980s and demonstrated that you could take this illegal plant and bring it above ground maybe not the back door but the front door and that you could do so without seeing significant increases in cannabis use and you could demonstrate that such a policy would actually reduce the so-called gateway effect of young people trying cannabis first and other drugs later. I think two of the Netherlands when HIV began to spread among injecting drug users and they pioneered needle exchange even before the scientific evidence was there to say drugs are spreading with people, AIDS is spreading with people sharing syringes and so put the bucket there and the bucket there, dirty needles there, clean needles there and don't just put them in a harm reduction program because almost nobody knew what a harm reduction program was put them even in a treatment program. Leadership came from pragmatic people. It came from a British minister of health coming to the Netherlands saying tell me what to do and going back and saying Prime Minister Margaret Thatcher, here is what you need to do and here is the conservative approach to reducing HIV, AIDS it's called harm reduction and needle exchange. It is leadership in Australia starting with brave physicians and then others who said we don't we want Australia to lead the world in keeping levels of HIV as low as possible among injecting drug users. It was Switzerland standing up and saying we're tired of chasing our junkies around town. Why don't we try something new? Let's put them all in a park behind the train station, needle park. That worked for a year or so and then it lost control but when they lost control of that they didn't say go back to the stupid old policies of lock them up they said let's try something else new. Let's try to innovate to a safer injection room so that people have a safe place to use can reduce public nuisance. Let's experiment with allowing people to obtain pharmaceutical heroin in clinics where they can also get treatment services and other help and in challenging basic notions of addiction it happened when the people who did that stood up as drug coordinators in individual cities in Frankfurt and Hamburg and Zurich and Bern and Rotterdam and Amsterdam and created the European cities on drug policy in the early 1990s to articulate for almost the first time a comprehensive harm reduction vision for cities. It was always about in so many respects individual leadership, individual leadership coming from each level of society. People seeing what was right and proceeding and proceeding. It happened just a few years ago with people in Denmark who said you know something heroin maintenance has worked in Switzerland and the Netherlands and Germany and England and the trial in Canada you know what we don't need another research trial. We don't need to waste precious dollars researching this and besides aren't there ethical issues involved when every time you do a heroin maintenance trial the people who receive the pharmaceutical heroin do better and live better than the people in the control group who did not and the Danes say to themselves we're not so different than the Swiss and the Germans and the Dutch why do we need to do it and just go ahead and do it right. It's the individual physicians who dare to risk the laws by prescribing opiates on a medical basis in those countries where it is illegal to do so and the other brave physicians who prescribe oral stimulants in ways where that is not quite legal for people trying to put an addiction to smokable or injectable stimulants behind them. It's that sort of leadership. It's people standing up from Myanmar to organize peer and a locks on intervention and organizing needle exchange programs in Kenya and Tanzania and saying we will oppose that crazy policy. It is people recovering from their drug addictions in Kabul and deciding they will commit their lives to helping fellow drug users in one of the most oppressive and corrupt places that one could ever operate. It is political leaders in Georgia saying enough with our massive prison populations better to cut the prison population in half and spend the money trying to reduce hepatitis and it is leaders like Otto Perez Molina in Guatemala and Santos in Colombia and Mujica in Uruguay standing up and saying we need to break the taboo. We need to open up the drug policy debate. We need to include the words legalization and decriminalization and alternatives to prohibition and the fact that each one of them may be flawed and that each one of their national policies may be flawed does not detract from the fact that they are providing leadership in that area. Those Latin American presidents you know what amazes me about them? They look at the public opinion polls and they see that support for what they are calling for is well below 50 percent well below 50 percent and they say I don't care. They say I need to do this for the future of my country. I need to open up this discussion. I need to break this taboo. President Mujica in Uruguay says to his advisors what do we do about this cannabis problem here? His advisors say well the sensible policy approach would be legal regulation but it's not possible politically and Mujica says why not? And his advisors say it's not popular with the public and he goes so what? I'm president once. I have a role to play. It's sometimes called leadership. It's my role to educate the public. Every one of them is persisting in the face of opposition by a majority of their population. That's called political leadership and the contrast with the United States where our political leadership does not provide our political elite does not provide the leadership is telling at this moment our drugs or stands up and he says now America we support a public health policy on drugs increasingly they co-opt the rhetoric of us reform world of us reformers and I like it a bit you know the people in power in government now want to sound like me and us that's good because sometimes when you begin to talk like other people eventually you begin to act like other people but it is also our obligation to press them on the hypocrisy because I have to say to my drugs are you cannot call yourself a promoter of a public health policy on drugs you cannot do that when you cannot utter the words safe injection or heroin maintenance when the evidence is conclusive from other parts of the world you cannot call yourself an advocate of public health when you still defend the criminalization of drug possession you cannot call yourself an advocate of public health when you believe that the way to treat poor people with drug problems is to force them into the judicial system and pretend that you can give drug treatment through the judicial system no that is not a public health policy so for those of you who think maybe my government is changing it is in small ways the fact that now our drugs are embraces naloxone and understands we must address the crisis of overdose is a positive thing the fact that he embraces our rhetoric is a positive thing but do not be deceived leadership comes from the ground up as well and what happened in marijuana comes from the ground up in the united states and can come into other countries as well it began in my country with a legalization of marijuana for medical purposes we pursued that always for two reasons first because the persecution and prosecution of people who use marijuana legitimately for medical purposes must be our first priority they get to go first in line in undermining the prohibition but secondly we pursued that issue because we hoped it would transform the broader dialogue around marijuana and that it has and now in america 18 states have legalized medical marijuana and two more will probably in the next month one and a half to two million americans have a i d card or a recommendation from a doctor for medical marijuana there are two or three or four times as many medical marijuana dispensaries in the u.s paying taxes regulated by the authorities as there are coffee shops in the netherlands and then you saw what happened in washington in colorado last year those were not accidents in colorado the vote last year to legalize marijuana got more votes than barack obama did and the one in washington state got almost as many votes as the president and more votes than the democrats who won the race for governor and attorney general and its young people pushing this and voting for it it is transforming mainstream american politics it is doing that for us in drug policy alliance who have fought so hard for so long to make this happen it is only part of what we push for though our next frontier already our next priority is to introduce what the portuguese have done and others it is to end the criminalization of drug possession and to put forward the policy that nobody but nobody can or must or should be incarcerated lose their freedom in any way simply for the drug they put into their body it is embracing the policy of serious commitment to treating addiction as a health issue and it is breaking through to because ultimately if you ask where where down the road does all this come together oh here's the way i would frame it you know you can define harm reduction in many ways as needle exchange as any intervention that reduces the harms of a risky or dangerous behavior you can define harm reduction in policy terms as that policy which seeks to reduce the harms of drugs and the harms of our failed prohibitionist policies and that's to some extent the definition of drug policy reform you can retort define harm reduction in moral terms as that policy which requires us in dealing with people who struggle with drug addiction to reach out meet them where they are go there one step at a time whether their ultimate objective is abstinence or something else and to move in that direction a non-judgmentally and you can define it also in terms of pure human rights civil libertarian terms that core principle that nobody but nobody deserves to be punished simply for what we put in our body absent harm to others that nobody but nobody deserves to be punished simply for what we put into our bodies for what we do in the app i'm sorry in the absence of harm to others that core civil libertarian human rights principle has to be embraced no matter where we live and it is difficult to do it on the individual principle then go to the group principle that it is wrong and it is immoral for any one group of drug users who consume alcohol and nicotine and legal pharmaceuticals to discriminate and punish and prejudice against those who concern other substances as well but on one level the moral element of harm reduction is the one that needs to be advanced now drug policy reform how do we imagine that as a continuum i think from the most punitive policies the the Saudi Arabia Singapore lock them up whip them pull out their fingernails you know the russian quasi genocidal policy with respect to drug users down to the other end of the spectrum the most free market policies it is about moving the policies down the spectrum to harm reduction and decriminalize these policies while at the same time moving them from the other end of the spectrum with sensible public health initiatives and education efforts and taxation and regulation so we can reduce the harms of the legal drugs it is finding that proper place in the middle what ultimately do i think in the next generation will be the place that drug policy reform will be defined as will be defining a success i think it's three elements i think it is first to remove cannabis from the criminal justice system it has to be removed from the criminal justice system that's it are the risks of doing that a risk of increased levels of use and abuse yes but those risks are greatly are so much less than the continued harms of the current policy it is secondly ending ending the criminalization of drug possession that nobody but nobody will be punished by the system for what goes in here that we are all sovereign over our own minds and bodies whether we are a recreational user or an addicted user it is that commitment to treating addiction as public health and here i think thirdly is where we ultimately need to go because i don't think we're ever really going to sell cocaine or heroin or methamphetamine the way we do alcohol or cigarettes or the way we will one day do with marijuana i don't think so i just it's hard to imagine even if support grows for legalizing cannabis there is no slippery slope to the legalization of other drugs but ultimately the notion where we take what the europeans and canadians have done with the legal prescription of a drug like diamorphine aka heroin the creation of a policy where with where we say with respect to all of those who are so determined to obtain and consume a particular drug that they are willing to get it from the black market pay inflated prices use it in adulterated forms buy it from criminals have it scar their lives it's where we the population and the state say to those people if you want this drug so much we will offer you treatment we will offer you help we will offer whatever you need in order to get better and put this behind you but if you still want it you know what you can come and get it the best way ultimately to undermine the power of the criminal organizations that earn profits in the hundreds of billions of dollars a year the best way to undermine the power of the mexican and afghan and west african and american drug narco lords is to take away their market those who have sought to take away their market by punishing and stigmatizing and incarcerating and torturing the consumer their policies have failed and they violate human rights in any case the policy that says we now you the dominators the narco lords we will undercut your market not just providing treatment not just providing help but also by allowing the people who currently purchase your products in adulterated illegally overly expensive forms to come to clinics to come to places and obtain that drug from a legal source that is civilly liable for the quality of the product that that that is sold and we will use all of the hundreds of billions of dollars that we will save through that policy to help those people who most suffer from the current policy right now that i believe needs to be the long-term vision of drug policy reform and harm reduction we're in it we know it it's a multi-generational struggle we are barely entering the second generation and it will continue and then we will be pushed back and we will need to continue and pick it up again and we will need to mentor the next generation and pass on the baton we are fighting for drug policies grounded in science compassion health and human rights ultimately harm reduction drug policy reform we make the distinctions and how we advocate a message for tactical reasons but fundamentally deep down we are all harm reductionists and we are all drug policy reformers thank you very much