Report on drug policy

[Interviewer]: I know. [inaudible] [inaudible] [inaudible] [inaudible chatter] [inaudible] [inaudible] [inaudible] [inaudible] I registered you too. [Woman]: Registered outside? [Interviewer]: Yeah. I registered all of you. [inaudible] [inaudible] [inaudible] [Interviewer]: Yeah, outside there. But you can speak to... [inaudible] I just found out. She can speak. She can speak to me. Black people who are incarcerated in this country. Okay. Just light statistics. You know. [Interviewee]: Well, there are more African-American adults under correctional control today in prison, or jail, on probation or parole that were enslaved in 1850, a decade before the Civil War began. The rates of incarceration for all Americans have increased dramatically over the past few decades, but no group has experienced a higher rate of incarceration in the United States than African-American, specifically Black men.

[Interviewer]: And the reason for that being is this so-called war in drugs? [Interviewee]: Well, the primary engine of mass incarceration has been the war on drugs. Nearly three quarters of the increase in the federal prison population in more than half of the increase in the state prison population between 1980 and 2000, the period of the greatest expansion of our prison system was due to drug convictions alone. Drug convictions have increased more than 1,000 percent since the war on drugs began. I mean, to get a sense of how large a contribution the war on drugs has made to mass incarceration, you know, consider this. There are more people in prison or jail just for drug offenses today than were incarcerated for all reasons in 1980. Our prison population is exploded due to a drug war waged almost exclusively in poor communities of color. [Interviewer]: And I'll ask, I'll be a, how do you say, play devil's advocate.

Is it because in our communities there are more drug, how would you say, traffic activities or what? [Interviewee]: Contrary to popular belief, studies have shown now for decades that people of color are no more likely to use or sell illegal drugs than whites. In fact, where significant differences in the data can be found, they frequently suggest that white youth are more likely to engage in illegal drug dealing than Black youth. Now, that defies our basic racial stereotypes about who a drug dealer is when we think about a drug dealer. We typically imagine a Black kid standing on a street corner, and drug dealing certainly happens in the ghetto, but it happens everywhere else in America as well. But unfortunately, in many states, nearly 80 to 90 percent of all drug offenders sent to prison have been African-American, even though they're not any more likely to violate drug laws.

[Interviewer]: And is there a reason there's something called 'sidewalk justice'? If I'm a white person, many times, and I commit an offense or something, I'm a youth, especially a young kid, I get what's called 'sidewalk justice.' Is there a problem with our judicial system the way they treat our youth that makes, that's another reason for this heavy incarceration rate? [Interviewee]: Absolutely. It's biased law enforcement that has produced the astonishing racial disparities in drug law enforcement. People of all races use and sell drugs, but a white kid walking down the street isn't perceived as a potential drug user or dealer, but a Black kid walking down the street in his neighborhood is likely a target of being, you know, stopped, surged, frisked, interrogated about potential criminal activity.

You know, the Supreme Court has given license to the police to fan out into poor communities of color, stopping, frisking, searching folks without any evidence of criminal activity. It used to be that, you know, police actually had to have probable cause or reasonable suspicion to stop, interrogate, and search one, but to someone. But today, as long as the police getting, you know, quote unquote, consent, the Fourth Amendment doesn't even apply to the police interaction at all. Now, what's consent? When a police officer approaches a kid on the street with one hand on his gun and says, "put your arms up in the air so I can search you," and you say yes and comply. That's consent. No evidence of any criminal activity is necessary for the police to have that encounter. So by fanning out into poor communities of color, stopping and searching, extraordinary numbers of young people of color in particular, we've managed to fill our prisons and jails with low-level drug offenders, not violent drug offenders, low-level drug offenders.

[Interviewer]: And that leads to another question. I'm going to ask you about the Supreme Court and the way they have ruled on some cases and the case, you know, our rights, on rights of people like you talk about the probable cause. Could you just expand a little bit more on that? The Supreme Court's role. [Interviewee]: Sure. Well, you know, the United States Supreme Court has really facilitated the war on drugs, far from being a check on the exercise of arbitrary or discriminatory police power. The U.S. Supreme Court has given license to the police to stop interrogate search people, even in the absence of any criminal activity whatsoever, as long as they get consent, which really means compliance. They can, you know, interrogate, stop search just about anyone, anywhere for, you know, imagined drug activity. In New York City, you know, it was recently reported that, you know, police have been stopping hundreds of thousands

of overwhelmingly Black and brown people for imagined criminal activity. And of those 500 plus thousand arrests, only about 6%, I mean, of those stops, only about 6% ever result in arrests. But to make matters worse, the U.S. Supreme Court has closed the courthouse doors to claims of racial bias at every stage of the criminal justice process from stops and searches to plea bargaining and sensing. It is now virtually impossible to challenge racial bias in the criminal justice system in the absence of conscious intentional bias, like an admission, a racial slur. And so you can't even file a claim of race discrimination in the criminal justice system today, unless you get some law enforcement officer to admit, "yeah, the reason I stopped him was because he was Black" or "yeah, the reason I didn't give him that plea deal was because he was Black."

So in this way, the U.S. Supreme Court's really immunized this system of mass incarceration from judicial reviewer or challenge for racial bias. [Interviewer]: The other thing that you talk about, and this is the semantics, 'class and caste,' you use that word 'caste' in your book. Just, if you just talk just a little bit about that. [Interviewee]: Yes, well, you know, for many years, sociologists have been talking about the problems of the so-called underclass. And the assumption has been that their pathological behavior is what has kept them trapped at the bottom of the American, you know, hierarchy and totem pole. But I argue that we do not have a class system in the United States. We have a caste system, an extraordinary number of African Americans in the United States are locked into a permanent second class status. By law.

You know, once you've been swept into the system and branded a criminal or felon, you are then stripped of basic civil and human rights. Many of the rights, supposedly won in the civil rights movement, you may be denied the right to vote. You're automatically excluded from juries for the rest of your life. And you may be legally discriminated against in employment, housing, access to education and public benefits. So many of the old forms of discrimination we supposedly left behind are suddenly legal again once you've been branded a felon. So for the person released from prison, unable to find work because they have to check the box on employment applications for the rest of their life, unable to get housing because they are barred by law from public housing. Unable, perhaps even to qualify for food stamps which aren't available under federal law to drug offenders for the rest of their lives. These folks struggling to survive, barred from housing, barred from employment, barred from even food for the rest of their lives. Why?

Because they were once caught with drugs. And the reason they were caught is because they were poor, Black and brown and not fortunate enough to be insulated by living in a predominantly white suburban community where drug use is for all practical purposes virtually legal. Because almost no one ever gets caught. [Interviewer]: The other thing you talk about jail population is something interesting. I don't know if I read it in your book or I read it in other things about the district, you know, the count. They can't vote, but they're counted in the census in the jails. And what happens to that white community? Well, I didn't know that white communities welcome the construction of jails and prisons. I should say prisons. [Interviewee]: Yes, most new prison construction has occurred in predominantly white rural communities. Communities that are already economically vulnerable and often desperate for jobs and employment. Very often prisons are advertised as providing far more benefits than they actually deliver to those communities.

But still, communities have been competing for prisons and hopes of jobs in their communities. Who is housed in those prisons, though? Our folks who are rarely from those communities, but are shipped there from inner city, overwhelmingly Black and brown communities. And once they are housed in those prisons, they are often counted in the census as residing there, which gives those rural communities additional population for purposes of the census count. And the census count is what determines the number of representatives in the legislature. So these communities actually gain political power in the legislature in addition to additional resources, potential jobs as a result of housing, you know, thousands of poor Black and brown folks. And of course, the communities from which they came now lose population, lose political power and representatives in the legislature.

And the folks who are housed in the prisons can't even vote themselves. [Interviewer]: Also, the Jim Crow. The old Jim Crow versus the new Jim Crow, the new, the old Jim Crow, I think, really was an advantage for the white citizens in this country. And you talk about this new Jim Crow is detrimental to the white population, where I should say the majority of America, not so much anymore, but, you know, soon. [Interviewee]: Well, yeah, you know, the war on drugs was born with Black folks in mind. There's no doubt about it. If you trace the history of the war on drugs and the get tough movement, the person, the people that they defined as the enemy, were poor Black and brown folks. But once this war on drugs kicked off, you know, it began to destroy the lives of people and communities of all colors.

And so there are now white folks who have been swept up into the system and are suffering as well as African Americans, but no group has been harmed more in the war on drugs than poor African Americans. And the movement that must be built to end the war on drugs has got to be a multiracial, multi-ethnic movement that includes poor and working class whites, includes Latinos who have become a primary target of the drug war and many states, as well as African Americans, if we're going to succeed in ending this war. [Interviewer]: There's two more questions. And the last question, I just want you to react a Black Baptist church having this. And we also had the Safe Surrender program where we had like thousands of men outside, mainly men who wanted the nonviolent offenders to clean up their records so they could vote. So they could, you know, we did that.

The first question is drugs. I cannot see deep down in my heart how the drug traffic can get, I mean, they can find the egg shells that you used to make your omelette last week in the garbage. After 9-11, you know, you can't take shampoo through the, you know, the airport. Why can't they stop the illegal drugs? I mean, there's other, there's other problem before you start. I know there are other problems too because you have prescription drug problems in this country. You have all kinds of things, but somewhere something's failing, okay? And stopping it. And then there's another thing too. And I'll add that on, but you don't have to talk about it, is that the people who do have drugs need, of course, problems need special treatment that they're not getting. But the whole thing, who does this? Who's doing this? [Interviewee]: Well, you know, most people assume that if the government really wanted to stop drugs from entering poor Black and brown communities that it could, it could stop it. They could, you know, shut off the faucet at any time.

And there's reason for that concern and suspicion. I mean, given the fact that the CIA has admitted, you know, knowledge of drug from Nicaragua and drug traffickers bringing, you know, drugs into inner cities and doing nothing to stop it. And so there's reason for that, you know, concern. But, you know, what's interesting is that if you take a look at what has worked and hasn't worked in the war on drugs, the research shows that efforts to stop drugs from coming in, coming in to the United States have been the most unsuccessful programs that have been implemented. Because if you shut down a poppy field in one place, another one pops up elsewhere. I mean, the same dynamics that lead the replacement effect, create the replacement effect on the street where you take one dealer off the corner and another one pops up. When people are poor and are desperate, and there's a demand there will be replacement.

And it's true that when, you know, our government tries to destroy, you know, a source of drugs in one country, another country begins to be the source for those illegal drugs. We have got to reduce the demand for drugs in the United States. And, you know, we've spent a trillion dollars trying to, you know, lock up people, lock our way, punish our way out of this problem. But we have got to reduce the demand for drugs. And that means providing treatment, providing support, providing education. And moving away from this model of punitiveness and treating drug use and abuse is a public health problem rather than as a crime. After 40 years of the lock them up approach and a trillion dollars spend and millions of people being branded criminals and felons and ushered into a permanent undercast, we have failed to reduce drug addiction or abuse to any significant degree. So, this model has failed and it's time for us to ask ourselves whether we should move in a radically different direction.

[Interviewer]: Okay, this conference here today, what do you think about it so far, you know? [Interviewee]: I think it's fantastic that we are having a conversation about the obvious failures of drug prohibition in the United States and what kinds of alternative public health driven approaches would better serve our communities. You know, the violence associated with illegal drugs is primarily due to drug prohibition, not the drugs themselves. You know, marijuana doesn't cause people to go on shooting sprees. Drug prohibition does lead to violence in the drug trade. We've seen it in Mexico, we see it in our streets here in the United States. And the billions of dollars we have spent locking people up might well be better spent trying to treat those who have addictions and serious problems of drug abuse and reducing the demand for drugs. We've seen charts earlier this morning showing that the United States has, you know, among the highest rates of drug demand and drug use in the world.

And yet we also have the harshest and most punitive policies, whereas countries that treat drug use and abuse as a public health problem and do not criminalize those who use drugs have far lower rates of demand. So we've got to approach this more sensibly and less emotionally and punitively. And I think we've also got to reckon with the fact that our drug policy in the United States is rooted in our racial divisions and anxieties. This war on drugs would not exist, but for the racialization of the enemy, you know, if the enemy in the war on drugs had not been racially defined, our prison population would not have quintupled. We would not have the world's largest penal system in the world.

We've seen what happens when drug abuse and drug addiction has a white face. And what happens in those situations is that we tend to respond with compassion as a nation. We tend to provide treatment and intervention. But when drug abuse or drug addiction or problems associated with illegal drugs has a Black or brown face, our nation has responded with overwhelming punitiveness. So we're going to have to reckon with those racial divisions and anxieties which gave rise to the drug war if we're going to end this cycle of criminalizing those who use and sell drugs. [Interviewer]: Anything else you want to say? I think you said everything. [Interviewee]: Nope. [Interviewer]: Thank you so much. [Interviewee]: Thank you. [Male interviewee]: Federal criminal cases in New Jersey. [Tim]: His name is Jerry and mine is Tim and people both call us Chris. [Interviewer]: Is it a something? [Interviewee]: No. [Interviewer]: Okay.

You good? Then we're going to roll in the recording. What is a supervised injection site? [Tim]: A supervised injection site is a medical facility where people can come after they've obtained illegal drugs and inject under medical supervision. So the idea is that it's based on some of the principles of emergency medicine, right? So the idea is that if you are injecting under supervised medical supervision and you happen to have a drug overdose event or some other complications associated with it, they can revive you immediately. So basically in Vancouver, for instance, where the supervised injection site is over the past number of years, they've had supervised over 3 million injections. They've had over 3,000 overdoses in the facility and nobody has died. So if you had 3,000 overdoses on a street corner anywhere else in the world, I don't know what you expected mortality rate would be, but it would be much higher than zero. So there's about 50 or 60 supervised injection sites around the world, some call them consumption rooms.

But this is basically the idea that you go and obtain your drugs illegally, of course. You come and then they'll supervise your consumption of it. [Interviewer]: [coughs] Excuse me, I'm so sorry. [Tim]: That's okay. [Interviewer]: It's that time of year. Okay. I didn't, in reading about, I didn't understand because we certainly don't have that in this country. We're just getting around to many places with needle distribution, you know. [Tim]: That's right. Well, in Canada, there's only one. And the federal government is actually appealing that as well. So they're very unhappy that it exists. So they're appealing it to the Supreme Court of Canada arguing that it's not a form of treatment for addiction. So it's very controversial there as well. [Interviewer]: What do you think about that? [Tim]: I think that the government has no plausible argument. So there's clearly a values conflict here. So basically, you know, there's two forms of disagreement people can have. One is over facts and one is over values.

And the way you can determine the two is if everyone agrees on the facts, but we disagree about what to do, we have a values conflict. And the technical term for this is a fundamental disagreement. So here we have the federal government and the people running the supervised injection site who agree that no one's ever died in it. They agree that there's been over 3,000 overdose events. They agree that no one's gotten a bloodborne pathogen or any type of infection from that. But they disagree about whether things should continue or not. And this is where the federal government clearly value something different than other people associated with the site. And I would argue that value that they're exposing doesn't meet the relevant ethical standard because it's inherently bigoted. And it prioritizes the wrong thing. So like I said, if you have 3,000 overdose events in a supervised injection site and nobody dies, if you had 3,000 events on anywhere else in the world on a street corner, you're expected mortality rate would be much higher than zero. So avoiding premature and preventable mortality has to be the highest value. And they've proven that they can do it.

So if you ask what I think, I think they're opposition to it is inexcusable. [Interviewer]: [inaudible] harm reduction, you would say, in a supervised site? [Tim]: You can use that term if you'd like. Harm reduction is kind of a general term that people would use where you say, we're going to provide effective treatment to you or interventions without requiring you abstain from drug use. So this would be what harm reduction is basically. So a supervised injection site, for instance, would exist and say, we're going to provide an effective service to you even if you continue to use drugs. A needle exchange program would say, we're going to give you clean syringes and needles, even if you continue to use drugs. So really the precise term for harm reduction just means that we'll provide effective services to you, even if you don't abstain from use. [Interviewer]: Harm reduction versus abstinence. You've written about that. [Tim]: That's correct. I have, and it was published in International Journal of Drug Policy. That's right. And really that's the point is that if you want to look at, so first of all, as a philosopher and a scientist,

I have an allegiance to ethics and evidence. So it's not optional for me to go where the evidence, I cannot follow the evidence, so I have to. And the evidence shows that with a disease like addiction, chronic relapsing condition. And one of the issues with any chronic relapsing condition is there's only two ways to get rid of a chronic disease in your population. Death or cure. So if people don't die from the disease and they're not cured for it, guess what? They still have it. So as a result, we, abstinence is not a viable option. In fact, it has nothing but catastrophic events in many, many circumstances. So I would argue that if we have effective interventions that can help avoid the negative consequences associated with continued drug use, we're ethically and legally required to do it. And just as an aside, in the early 1990s, the federal government in Canada had the technology for screening blood, for bloodborne pathogens like HIV and hep C. And they knew this was a safe and effective intervention for screening blood, and they chose not to do it.

And as a result, hundreds of thousands of people in Canada were infected with hepatitis C and tens of thousands of people were infected with HIV. So there was a public inquiry commissioned on this. And at the end of the day, they said that government is absolutely culpable for the devastation that their policy caused. In this circumstance, when it comes to addiction and avoiding the negative consequences associated with addiction or the negative outcomes, we have safe and effective interventions. And I think when the reckoning comes, the government's going to be found just as accountable because it's inexcusable. [Interviewer]: In Canada, do you all have the prison problems that we have here? Do - the drug, the drug, the quote unquote war, or the drug life, or whatever? [Tim]: Well, that's a really good question. So we have a prison problem in Canada. There's nowhere near the extent of what we have here in the US. And the people they pick on in Canada are the aboriginals.

So if you look at the proportion of Aboriginal people incarcerated, it would be per capita almost the same as the US here. So those are the people that are being marginalized. But I think both in Canada and the US, the similarity is the causes of crime. The similarity for addiction is similar, is the causes as well. And really, it's got to do with the social determinants of health. So if you look at the hierarchy of things that influence people's behaviors and their position in society, and whether they go to jail or not, whether they go to school or not, whether they become drug addicted or not. It's really got to do with these things. And the social determinants look at really 13 or 15 different things where you start looking at people's income and social status, their education level, their lifestyle, their coping skills, and all of these things intermix in a very complicated way to manifest in people going to jail, or people using drugs and that type of thing. So we have a similar problem in Canada. But like I said, the aboriginals are the ones that suffer the burden of this.

[Interviewer]: We talked about, and this is the last question. We'll next to last question. The thing about treatment, treatment of drug addiction, and for it to be such a problem, I think in this area, you can count on one hand the number of people who specialize in that. [Tim]: Well, this is really an understatement. So if you look at people that live with drug addiction, these people are all over the place, and they access all kinds of services, including family doctors. So if you go to your family doctor, in many cases this person will treat you for everything, but your addiction. Even though they know that the primary motivation for being there is related to your addiction, they will intentionally, willfully, blindfully, ignore that fact that's staring them right in the face. And as a result, very few of them are comfortable treating this complex disorder. And like I said, if you're a pregnant woman, they'll deliver your baby,

but they won't treat you for your crack, your crack problem, or your opiate problem. If you're a diabetic, they'll treat you for your diabetes, but they won't treat you for your addiction. And this is because not many people in Canada, we have to have a special license to prescribe methadone. So the number of people getting the license might be not be as high as it should be. And I think you would have to argue that if we take the idea of holistic treatment seriously, then family practitioners that have people that have substance abuse problems or substance dependent problems in their practice should be able to deal with those adequately as well. Yeah. [Interviewer]: Anything else you'd like to say about medical ethics and drugs and the whole, you know, whatever? [Tim]: Let me see. I'd just like to emphasize that we've got to accept the facts as they're given to us. So like I said, there's no magic bullet to get rid of addiction. I think it's a cop out and naive thinking that if we say to someone, we're giving a choice between treatment or jail, and then if you fail treatment, then you go to jail.

A predictable outcome of treatment is relapse to drug use, and people have to go through this cycle very often. I would argue if we're going to provide treatment, it's got to be evidence based and ethically justifiable. So that's where we're going to have to include things like methadone treatment, even heroin prescription and that type of thing. So if we want to get real about it, we have to accept the facts that addiction is part of our patient population, and we have to use safe and effective means for treating it. And we have them at our disposal. We just choose not to. [Interviewer]: What are some of the things that you would say are barriers? [Tim]: Well, the controversy around supervised injection site, controversy around needle exchange, controversy around methadone, silly restrictions we put on accessing methadone treatment. All of these things are completely unnecessary, and we don't put them on any other form of treatment. So with methadone, for instance, in Canada, we have physicians have to have a special license, and my understanding is that here, you're only allowed to have interim methadone for up to 120 days and after that, it has to be associated with counseling.

Those are nonsensical requirements. They're absolutely not based on anything in science or ethics. So we need to remove these barriers so that we can actually deal effectively, and we have effective interventions, so we should make them as widespread and available as possible. [Interviewer]: Thank you. [Tim]: My pleasure. [Interviewer]: Okay, thank you Dr. [Kristy?] Okay, you ready? [Camera person]: How much more tape do you have? [Interviewer]: Oh, gosh, I have another tape. Here. Yeah, we better. Thank you. Thank you.

Thank you. Thank you. Thank you.

Thank you. Thank you.