Hi, everyone. My name is Kevin Savette. I'm the president and CEO of the Foundation for Drug Policy Solutions, as well as Smart Approaches to Marijuana. A little bit of background about myself. I've been in this field almost 30 years. I got my start in drug prevention as really a teenage advocate and activist on prevention and awareness in my local community. My community was one, like many around the country, that really denied that there was even a problem in the first place. Drugs were something that happened over there, not over here. And it was something that we really had to wake up to in order to deal realistically with the issues that were going on back then. And since then, I've been lucky enough to serve in three different White House administrations. Most recently as senior advisor in the Obama administration, in the beginning of the Obama administration. And then in 2013, I founded a group called Smart Approaches to Marijuana, SAM, with former Congressman Patrick Kennedy. And then about two years ago, founded the Foundation for Drug Policy Solutions, also with Patrick Kennedy, to really look at issues related to all drugs. And so you can go to our website, gooddrugpolicy.org, to get a lot more information, as well as our SAM website, which I think the SAM website, learnaboutsam.org, is probably the best resource online for marijuana issues. I'm not talking about marijuana today, I may a little bit at the end, but I'm really talking about the issue of harm reduction, and situating it along the continuum of care for people with substance use disorder. I have no financial relationships to disclose, so I think that's very important, because there's a lot of financial interests here in the drug policy field, but I have none. And at the conclusion of this seminar, you should be able to describe the aspects of harm reduction, including strengths and limitations, explain how harm reduction interventions fit into a broader continuum of care, and evaluate the policy landscape. And I am really going to focus on policy, really international, not just state and federal, all of it, to really learn about what can we learn about harm reduction, and what is happening out there. So another objective here I think it's important to raise is that the Biden-Harris administration's National Drug Control Strategy acknowledged the stigma of those working in health care towards substance use disorder, said the reason why most of those with substance use disorder have not received treatment is that they did not seek it. Harm reduction programs have the potential to reach out to people, individuals, and offer them a level of care they are ready to accept. Many people with substance use disorder also face stigma from public and health care professionals. It also mentioned that stigmatizing attitudes exist throughout society, including in health care. And so they went on to talk a lot about the importance of harm reduction. And I think it's really important to define what harm reduction even is, and really understand that in some ways it can mean many different things to many, many different people. And what we're trying to do with the foundation, and where I think actually harm reduction can lead us, is to really a culture of prevention and a climate of recovery. We really see harm reduction as a means, not as the final end. And what I mean by that is that it should be a means to get people into recovery. That's what we want to see. And I'm going to go into a little about the history of harm reduction, but I think what's important is that, you know, harm reduction is something that should be applied to one part of the spectrum, really the hard to reach population, in order to gain their trust and to really do that outreach that's necessary. Unfortunately, though, what's not talked about really hardly ever, and I think it should be, is that harm reduction is often used for much wider agendas, really agendas linked to the legalization of all drugs. And I'm going to talk about exactly what I mean by that. What we think really the pillars and our pillars, but also the pillars of a good drug policy is science-based policies throughout all levels of government, research, education, and advocacy. That's what we're working on with the foundation. We invite you all to join us in that, but we think that's very, very important. We're actually in the middle of putting together a blueprint for effective drug policy, we're calling it, with the pillars of prevention, intervention and treatment, equity and social determinants of health, international cooperation and supply reduction, recovery support and criminal justice. Now, you might say, well, where is harm reduction on that? Shouldn't that be in there? Harm reduction, again, we see as an element in, frankly, really the intervention and treatment side and the recovery side, in order to get people the help that they need, those that are really, again, those harder to reach populations. The way we think about harm reduction, you could think of it, especially with the way that the administration has been talking about it, as it has emerged as a response to the unprecedented drug-seeking, drug crisis, seeking to reduce but not eliminate the inherent harms of drug use. Think about Narcan, which is the naloxone overdose reversal medication. In some communities, the distribution of sterile needles for emerging responses. Some communities define it as safe injection sites, or actually what I would call supervised injection sites. Others would be, I'm going to talk about something called safe supply, which we've heard a lot about in Canada, and also a little bit in the United States. I think while certain harm reduction interventions have the potential to reduce harms of drug use, like the spread of HIV or hepatitis C, the broader addiction field must really remain focused on connecting people to treatment and help them achieve recovery. We see recognizing that harm reduction is not a long-term solution, it's not a blanket long-term solution to the drug crisis. It should really be seen as one avenue toward connecting people to treatment and recovery. I think, again, that is often really what is missing in a lot of the work that we see is that harm reduction these days, sometimes, is really seen as a standalone. I think we need to resist that entirely. The way that Patrick Kennedy, former Congressman Kennedy, puts it, which we really say all the time, is we meet people where they're at, but we don't leave them where they're at. That, I think, is really important because the clarion call for harm reduction is just meet people where they're at, period, full stop. Of course, by definition, we are meeting people where they're at. When we're doing outreach in the downtown east side of Vancouver, or at Skid Row of Los Angeles, or the Tenderloin in San Francisco, or in Southeast DC, or in certain parts of Manhattan, you are meeting people where they're at. That's the point of it. We really shouldn't leave them where they're at. I think sometimes harm reduction strategies, this might be controversial to say, but sometimes they are really just leaving people where they're at. We don't want that. It's really important to look at harm reduction's history, and really how some people have been weaponizing it for a very long time. I would say that it really grew this harm reduction movement. It's not new, even though it's new to the national drug control strategy, but it really grew out of, frankly, good intentions in the AIDS crisis. We had people dying left and right from AIDS. We had no functional cure like we do today. We had no medications to prevent seroconversion. We had no medications to prevent transmission and infection, and certainly none to deal with the later stages of AIDS when we were looking at things like carposysarcoma, and wasting syndrome, where you obviously just couldn't eat. What was important is to understand that that's where it grew out of. It grew out of those good intentions, and people wanting to help people. With HIV-AIDS, at that point, we needed to make sure that people who were injecting drugs were not also getting HIV, which was an incurable illness. The idea was, well, if they're going to use anyway, let's give them some sterile injection equipment, for example, to use. I think what's important is that the term has evolved and devolved, I guess, into basically meaning 50 different things to 30 different people. In other words, like I said that on purpose, I didn't make a mistake when I said that. In other words, there's just too many different definitions. I like to ask, what is meant by harm reduction when advocates for a permissive drug policy use the term? That's a really important thing to ask. When the Drug Policy Alliance, which I'll talk about here, uses the term, what do they mean by it? What is meant when scientists use the term? For example, the American Society of Addiction Medicine, that's adopted the term. What does that mean? What is meant by harm reduction when national drug policy officials use it? I think, actually, the Biden-Harris administration has been pretty good about defining what they mean because one of the reasons, frankly, we were very reticent to use the term a lot was because, first of all, the things that we would want to define, the science wasn't there yet. The idea, naloxone was not something that was widely used in 2009. We didn't have fentanyl. It was the prescription drug crisis. It was a very different issue that were going on, a lot of similarities, too, but some differences, material differences. When you use the term, when national drug policy officials use the term now, they actually define it pretty well, I think. They say, we're talking about naloxone. We're talking about certain syringe programs. We're talking about testing kits. I will talk a little bit about testing kits. In other words, should we test people's drugs to make sure that they're not fentanyl in it, for example? We'll talk about that a little bit later, but they have defined, for better or worse, you may agree with those interventions, you may not, but they have defined that. I think the definition is really important. I would just argue, whenever you're talking about this issue, to talk about those definitions. Proponents of legalization, of course, believe that illegal drug use is an inherent aspect of the human condition. When I've been to some of these conferences, they say, well, wanting to use a drug like heroin is just like a kid wanting to spin round and round and round and get a high from being twirled around. I don't necessarily agree with that. I think that there are some major differences there, but basically, it says that the society should accept the fact that people are going to use drugs anyways, and so it's in everyone's best interest to teach them how to use safely, promote safe use. I think to some of us, that's a bit of an oxymoron, especially with fentanyl, that the idea that you could use some of these deadly drugs in a way that is safe, when we've seen, like the DEA reminds us, that one pill can kill, I think that's something we really need to think about. When you look, when you take it deep into the next level here, in terms of what harm reductionists were doing, you had Ethan Nadelman basically saying that, I think quoting actually Arnold Traybock in this case, saying that even the black blessing of AIDS is helping us move forward. In other words, at the time, in the 80s, this was a way to advance drug legalization. Make prohibition work on our terms, not their terms. Work within the mainstream to move it in the right direction. Any step for harm reduction by the government is a move closer to legalization. That is what Ethan Nadelman said, and he founded the Drug Policy Alliance. What is the Drug Policy Alliance? Just real quick, it was essentially founded in 2000. It merged with another organization, and it's been given hundreds of millions of dollars to advance the legalization of drugs. I will talk about that in a little bit, but I would say they, more than any other national group, even the National Harm Reduction Coalition, they have been the most, the biggest proponents for harm reduction. It's sort of interesting to think about that, because you think on the one hand, this group that wants to legalize all drugs is talking about harm reduction, but also very earnest workers on the ground level are also talking about harm reduction. Probably a lot of those people don't want to see the legalization of drugs. It's really important to define what we're talking about. As I mentioned earlier, harm reduction interventions are a means to reducing drug-related harms, rather than an end in themselves for supporting the lifelong continuation of drug use. I think to some advocates, harm reduction is enough, and that's it. I actually remember a very famous scientific article called, Needle Exchange is Not Enough, which I thought was interesting. Actually, it was written by a needle exchange proponent, but it was saying that it's, don't think that it's going to solve all these problems, and it's for one part of the spectrum. Again, we think that to promote public health and public safety, drug policies, which again, there is a spectrum, but they must remain oriented towards preventing initiation, so prevention in the first place, and then supporting users to get into recovery. That's really what we're talking about. What is some of this mitigation that we've also talked about? Well, naloxone, as I mentioned, it's administered to reverse an overdose. You often need multiple doses these days. You often need, it's not just one that's going to work. Now, with some of the things that are being cut into fentanyl, even though fentanyl itself, you could argue it's a cutting agent, those are not responding to naloxone. Yes, we need naloxone. We need more of it. We need people that know how to do it. I know how to do it. I have it. It's important. It can save someone's life, and then they can hopefully get into recovery. But we can't think of it as the end all, because what happens afterwards? What happens, what are we doing with that person afterwards? That I think is the key question. I think that's more important than just leaving people as they are. Fentanyl test strips, we know that fentanyl is very prevalent in drug use. A recent study showed 80% showed a positive test. About half of the people in the study said that they got rid of it or reduced its dose, but the other half did nothing. And I think it's important to look at that other half, because when people are seeking out fentanyl, fentanyl testing strips, if anything, it might encourage them to use it, because we know a lot of people are seeking fentanyl out. They want fentanyl because of the fact that heroin's not doing much for them anymore. Again, you think of a city like Vancouver, and I'm going to talk about British Columbia in a minute, because I think it's an important neighbor, important to learn from our neighbors. This is a city that has always traditionally been a city of heroin, and in the last basically eight years, it's a city of fentanyl, and heroin's hard to find. It's fentanyl and methamphetamine. That's what we're dealing with, and I do think it's important to remember we are dealing with multiple drugs. So again, naloxone's not working on methamphetamine when you get a heart attack. So it's really, really important to know that some of these mitigation strategies are useful. I'm not saying we shouldn't use them, but they're not going to solve the crisis for us. Let's talk about where we are in 2024 in terms of drug policy and where harm reduction has moved policy-wise. Well, Oregon adopted what they thought was the best kind of harm reduction driven by the Drug Policy Alliance, who funded it, to basically decriminalize all drugs and also legalize some psychedelics. But the main issue they did is legalize drugs for possession, so they legalized possession or they decriminalized, whatever word you want. It's another word that's very important. There is a difference between decriminalize and legalize. Legalize usually means legalizing the sales, but in this case in Oregon, they talked about legalizing the possession. It didn't fully legalize the possession because on paper, you were supposed to be given some kind of ticket, but it de facto legalized possession because people weren't given those tickets. I'll talk about that in a minute. The push to legalize something called safe supply in basically everywhere in Canada. What is safe supply? I'll talk about that in a little bit. Some people call them pill programs, and really this idea that drug user rights are more important than everyone else's. That's a really important point that we've been seeing with harm reduction policy. And then finally, a push to legalize psychedelics. I'm not going to dwell on psychedelics because it's really an issue that it's sort of a separate issue. Bottom line is, we're certainly not opposed to drugs that go through the FDA process, but I think they do need to go through that process. And whether it's marijuana for medicinal purposes or psilocybin for medicinal purposes, we don't think we should be voting on medicine. It is relevant to this discussion because harm reduction and legalization advocates have long sort of used medicalization to promote their agenda. So I do mention it here, but I don't want to go into a lot of detail about medical marijuana or medical psychedelics. But there's a lot on our website about that if you're interested in it. I do want to talk about a tale of three places, starting with, as I alluded to before, British Columbia. What's been going on in British Columbia? Well, essentially, what British Columbia, specifically Vancouver, and this was started by the mayor of Vancouver, Philip Owen, essentially what they did is they talked about four pillars of drug policy are needed, prevention, treatment, harm reduction, and enforcement. You know, these days, that sounds very sensible. These days, that sounds very balanced if you're truly going to balance it. Back then, it was a little bit more radical because harm reduction hadn't really been tested a lot. And it was the fact that it was being adopted like this was sort of a big deal. And actually, the groups that helped adopt what I would say is a sensible drug policy pillars, they, you know, they were actually groups that wanted to push legalization to some of them, not all of them. But but but some of them got onto this bandwagon. They thought, yeah, we'll do the four pillars because we can get our thing in and then we'll, you know, try and make it only one pillar. And actually, they were extremely successful because essentially what's happened in B.C. is that we have one pillar, harm reduction. That's essentially all that's been done. Now, people will say, no, we've invested in recovery and treatment. But if you're not investing in how to get people to treatment and recovery, if you really don't have the capacity for detox, if you don't have the capacity to work on those kinds of issues, if you don't have widespread prevention and awareness in every school, you're not really focusing on that, on the other pillars, are you? You're really just focusing on harm reduction. And so we have to think about, you know, what's been the result? Well, the results have not been very pretty. When you look at opioid drug deaths in British Columbia, they have risen exponentially. You know, almost exponentially, I should say, since the 2000s. And they had a four pillar approach in Vancouver, needle distribution, which replaced the needle exchange. They had a needle exchange, but then they said, no, we don't want to do an exchange. We'll just do a distribution. And they had as a result, you know, the deaths in Canada really were driven by a lot of these deaths in British Columbia, because throughout Canada they adopted this. It wasn't just in B.C. And actually, if you compare B.C. and Canada, you know, you see, you know, you see the overdose deaths are tracking. But of course, B.C. is more than than Canada. It's extremely high. It's higher than the U.S. It's 50 percent higher than the U.S. average. And if actually you look at the death rate in British Columbia versus the United States versus other industrialized countries like Norway, Germany, the Netherlands, Finland, Sweden, Turkey. If you want to look at the sort of Southern Europe, Mediterranean Europe or the Middle East, you know, you're really seeing that there's no comparison when you compare B.C. and the U.S. and everywhere else. So this has been a uniquely B.C. and U.S. issue, big problem and something that. I think we really need to think about, you know, why is that? What are the policies that led us here? You know, right now there's 13 percent of the Canadian population living in B.C., but B.C. is accountable to 46 percent of those overdose deaths occurred. So disproportionately represented. We have children. And I think this is really important when you talk about harm reduction. You know, it's it's thought about as harm reduction to the individual. But I think we need to also think about harm reduction to the you know, how do we reduce harm for the family? How do we reduce harm for the community? How do we reduce harm for kids? You know, the B.C. Rep for Children and Youth have said that we have a grief and loss phenomenon that is not being addressed. Virtually nobody's talking about is the kids who are left behind when their family members are passing away. We have 10 children a month in the BC child welfare system because they've lost their parent to overdoses. Fatal overdoses. And that's something that I really think we need to think about. That's something that, you know, we think about harm reduction to the individual. We need to think about harm reduction to others. It's really important. Now what's interesting is after decriminalizing, so taking harm reduction to the next level, they decriminalized drugs. Basically, folks said that, you know what, there are big time problematic drug use occurrences happening in public places, beaches, park, public transit, playgrounds. And so basically the province, and this is the same government, this is the same politicians, exact same ones, wasn't different, that asked to decriminalize the possession of drugs. So that's what they asked to do. I should have mentioned that. And they were finally granted it by the federal government a few years ago. Less than a year or two later, they basically said, this is not working. We need to rethink our drug policy. And I think it's a result of really extreme harm reduction. It's not just a result of decriminalization. And so they did ask for those public spaces to be recriminalized. That doesn't mean people are going to go into prison, by the way. That doesn't mean that at all. It just means that law enforcement can tell someone who's using fentanyl on a swing set next to a kid that they have to move along. And if they don't move along, they can confiscate their drugs. They're not going to put the person in prison. That's very different than the extreme harm reduction. And I do call it extreme harm reduction policy that happened essentially before, which would allow the continued use. This became such a big deal that the B.C. nurses essentially said, we have to define what harm reduction and decriminalization really mean, because right now people think it means you can use drugs in hospitals. They couldn't get some people to stop using crack or fentanyl or methamphetamine in hospitals. And that's a big, big issue, obviously, for obvious reasons. But this is what happens when I think the extreme of harm reduction takes hold. Then there was something called safe supply. And this is an idea that came about during the pandemic, during COVID-19, the height of that, where essentially you had the government saying, because we don't want people sort of interacting with a lot of folks and just because we think it's a good idea, it wasn't only because of the pandemic, we're going to allow, we're going to prescribe very heavy prescription opioids to current opioid users. In other words, if people are misusing opioids and using fentanyl, heroin or whatever, we're going to prescribe them like a drug like hydromorphone with the theory that they will end up using that instead of using what they call a toxic drug or with the toxic drug supply. By the way, I don't love the term toxic drug supply, because it implies that if you have that there's untoxic heroin, non-toxic methamphetamine, non-toxic heroin, whatever. And there's no such thing as that. Non-toxic cocaine, there's no such thing. So I don't like the word, the term toxic drug crisis, but a lot of people do use it. Essentially what you had when you started the safe supply, and I think safe supply, again, it's a term that's very problematic because the idea that you're going to prescribe hundreds of pills to somebody, this is what happened in the United States in the height of our prescription drug epidemic, right? We've been there. So the idea that you're going to do this, and this is going to be your response when 63% increase in poisonings in BC hospitals. An outreach worker in Ottawa is saying that 90% of the safe supply patients, and then they're now calling it safer supply because they're admitting it's not safe. So they're saying safer supply patients divert and resell their prescriptions of hydromorphone. Well, think about that. Of course they do, because if you really want fentanyl and you're given a valuable bottle for really cheap of dilaudids that they call dillies on the street, and you can sell those dillies at a 300% profit, you're doing pretty well for yourself, and you can buy the fentanyl you need. That's perfect, right? Because where are you getting money for all this fentanyl, right? I mean, it's gotten cheap, but when you want to maintain an addiction, it becomes not cheap very quickly, especially if you don't have a job. And so this is what's been happening, is that this has been being sold, and this is an idea of harm reduction. This is an element of very extreme harm reduction, obviously not harm reduction that we're seeing in the U.S. as much yet, but it's something that's been called for by a lot of people. So it's interesting how harm reduction can mean multiple different things. It can mean decriminalization, it can mean safe supply, or as some people say, pill programs, because that's what they are, they're programs that prescribe pills. That's really the way to talk about it. Or it can mean legalization. This picture of the heroin there, 40% heroin, 60% caffeine, this is a picture of an actual outreach worker handing out, and not outreach work, I should say, it's actually somebody who is part of, they have drug user unions in Vancouver in B.C., they're handing out pure heroin. And by the way, they got this illegally, and now they're being investigated. I mean, it's a real issue. But for a while, this was tolerated as a version of harm reduction. We're going to give people something that's 40% heroin and 60% caffeine. And there's a little logo there, it's DULF, it's the Drug User Liberation Front, that's the logo. But that's what they're doing. And so I think that's something that we really need to think about, whether we want that. What about Portugal? You hear a lot about Portugal having harm reduction, and a version of decriminalization that's like legalization. But I think what's important in Portugal is a few things. One is they did not legalize drugs. Number, you know, they kept the supply illegal. So you can't just buy drugs in Portugal. You know, number two, they divert users to what they call dissuasion commissions. That's how it translates into English. And those dissuasion commissions try and get people to, you know, exactly what it sounds like, dissuade them from using drugs, and from getting help and getting into treatment. They also have done a huge investment in treatment and prevention, where, you know, a lot of places have not done it. British Columbia, we were just talking about has not done it. Something that's very important here is culture. Culture, culture, culture. You know, what is the culture of drug use in a predominantly Catholic country? I mean, let's be honest, the mainly homogeneous, you know, Catholic country of 6 million people. Well, it's a culture that actually is not in favor of drug use. That is a very different culture than, let's say, the West Coast of North America, right? And it's something that is integrating harm reduction in a culture that's trying to get people into recovery. And they've admitted, they've had mixed results. In fact, last year, the Washington Post had this headline, which is they, which, you know, 22 years after decriminalization was implemented, you couldn't imagine they were going to have this headline, but they did, where they're having some doubts about decriminalizing, because even that, without the wraparound services, without the investment, because they've invested less lately in prevention and treatment, they've been hurting without accountability, actually. And that's really a key word that I think, I think it separates those who want extreme harm reduction and those who want evidence-based harm reduction is this word accountability. I think that that is a key difference. Also, this idea of meeting people where they're at versus meeting people where they're at and not leaving them where they're at. I think that is also something that separates people in terms of, you know, their belief for things. And then let's get to Oregon. I don't want to dwell, didn't want to dwell too much on Portugal, but well, let's get to Oregon. What happened in Oregon? Well, Oregon said, we're going to take harm reduction to the next level. And so they passed the Drug Decriminalization and Addiction Treatment Initiative, known as Measure 110. It passed by 58% of Oregon voters in the middle of the pandemic. What did it do? It decriminalized the personal use of all drugs, so you couldn't be sent to jail for any reason. And instead of arresting even, and people weren't sent to jail before, by the way, for low level possession, but there at least was some kind of arrest that could happen in terms of getting them to help and diverting them to a treatment program. But they couldn't do that anymore. What Measure 110 did is basically give people a $100 fine maximum, or which was never followed up on by the way, or they could call a hotline to complete a health assessment. I think it's really important to learn what happened. First of all, so few people called the hotline that the hotline ended up shutting down, number one. Number two, so few people followed up on their $100 fine that in terms of paying for it, that cops just stopped giving those tickets. It wasn't worth it anymore by 2022 or so, because it didn't come into effect until 2021. And essentially what happened was, you know, fewer than 1% of those helped with those dollars, even entered, that should say fewer, not greater, and fewer than 1% helped. And 53% of drug deaths were a result of drugs. When you look at young people, drugs are the cause, two years after Measure 110, of young people dying. And, you know, three out of the five of the deaths result in drugs, accidental overdose and poisoning or suicide related to drugs. Look at, you know, you can see how much is fentanyl involved. It's huge. Overdose has increased 75%. There were more than 200% of the national average. The increases were happening before too, let's be honest, but not at this level. And yes, fentanyl changed the game, but fentanyl, you know, Measure 110 was supposed to address all of these issues. In fact, from 2020 to 2022, fatal overdose has increased 18%. And in Oregon, they increased 75%. So really, really, really something to understand. Violent crime increased 4.5%. Oregon violent crime increased 17.3%. So, you know, Oregon was beating the national average on this. And now some people said, well, didn't Oregon follow the Portuguese model going back to Portugal? And the answer is an astounding no, it wasn't Portugal at all. Portugal places very heavy social and legal pressure on people to seek treatment, whereas Oregon did not do that at all. Oregon allowed for public use, and there was really nothing you could do. Portugal is very anti-public use. Overdose rates compared to neighbors, Portugal is slightly lower, Oregon is significantly higher. Use trend is in both places are increasing, but in Oregon increasing higher. And then so one of the things that we did is we asked people whether Measure 110 should be repealed. And what was interesting is that, first of all, the vast majority thought it should be repealed in 2023, basically a year ago, from when I'm recording this almost. And parts of Measure 110, they thought should be repealed. But the group that thought it should be left as is, were whites, which was interesting, because this was promoted as social justice, Measure 110. And I think that's something we hear about a lot, is that this is going to be racial justice if we implement very extreme harm reduction. And the reality is, it's those same groups of people of color, disadvantaged groups, that really hurt the most when you have some of these extreme laissez-faire policies. You talk to the recovery community in San Francisco, by the way, they'll tell you. I mean, 90% Black community in many of these neighborhoods in San Francisco, they'll tell you they want recovery more than they want extreme harm reduction. So again, there's a place for harm reduction on the continuum, but it can't be the entire thing. And so by the way, after this poll happened, Measure 110 was repealed. It was repealed by the governor and the legislature. They agreed that they have to do it. And so what did that mean? It meant that they were going to reinstate penalties for possession. But that doesn't mean people are now going to prison or jail in Oregon. They're not. I mean, as much as decriminalization is a misnomer, recriminalization is somewhat of a misnomer as well. Because what's really happening is that they're now being able to be diverted to treatment programs. And treatment programs with accountability. You know, people say, well, people just have to go to treatment. And this is some of what the harm reduction, extreme harm reduction folks say is, people need to just go to treatment when they're ready for it. You know, we have to remember that addiction is a brain disease of epic proportions insofar as these chemicals hijack your brain. And it's a very pleasurable activity, right? That's why people continue to use drugs. It's pleasurable. And so you have to have some accountability there. You have to have some carrot and stick to get those people that are not motivated to get treatment, to get treatment. And there is where there's room for harm reduction, is where you can get people with these kind of interventions, establish that rapport and relationship. They're not going to go to treatment tomorrow, maybe, or today, but they might next week or next month or next year. And it should be your job to get them there as fast as possible. And sometimes you need an incentive, positive or negative, to get people to make that kind of change. So that's important. Well, I did want to talk briefly about drug checking as well, because this is, you know, fentanyl testing strips, again, nothing against those things. I think people, if you want to check drugs, that's fine. But we should not think that they are accurate all the time. And we should not think that they give a sense of security. If anything, they might give a false sense of security. You're not able to test for all the additives and adulterants that are out there. And again, it might be helpful for preventing unintentional overdoses. I mean, kids at parties. I understand that. But these programs should really aim to discourage drug use and encourage treatment. So even this harm reduction intervention can be used as a learning to discourage use and connect people to treatment. I don't think enough of that is going on. I think that's what's very, very problematic. So where are we with the road ahead? Well, I do think it's important that, you know, understand that I'm not talking about harm reduction means legalization in all instances. And also legalization. There are things that are not legalization and things that are legal. Portugal is not legalization. Eliminating tough sentences is not legalization. Medical use via the FDA process is not legalization. But there are different kinds of, you know, legalization that are out there that are also not alike. So we do need to define things. And frankly, we need to define where we are on the spectrum. There's a whole spectrum here of, you know, what is the degree of criminal justice involvement? There's all kinds of policies that can be put on the spectrum. And I think we really need to understand what those policies, what those policies are. I do want to give a push to a couple of things that are a little bit outside the harm reduction side, but they are related. I mean, the bottom line is prevention is the best thing for our buck. It doesn't mean it's going to prevent drug use in all cases. But 95% of people who do not initiate drug use by 21 are unlikely ever to do so. That's really important, I think, to understand. It's important to understand that if we invest money in treatment, we save social costs. But again, how do we get people to treatment once you build it is the important question. And that's where law enforcement has a role. First of all, law enforcement keeps prices of drugs high. And we know that drug users, even those with substance use disorders, they are sensitive to price. We need to utilize effective interventions along the justice continuum. For example, drug courts. If you haven't heard of a drug court, it's basically a place that both you have the doctors and the lawyers working together with the judge, with the social worker, with the treatment center, to get people to show up to treatment. And if they don't, they might have a day or two in jail. But often, that's all the incentive that they need to actually go there and stay there. And then we need to prioritize community-based services that look at individual needs, risks, and responsibility. Because drug use does happen on a continuum, and not everyone's drug use is the same. What kind of treatment do you need? Do you need intensive treatment? Do you just need a brief intervention? We want to make sure we don't also overspend and overkill in an area where that wouldn't be of use. And again, what is good drug policy? We know drug policies manifest themselves on the local and national level. Use reduction is what we've always just talked about, reducing drug use. Harm reduction, what I might call and what actually Rob McHugh and Peter Reuter call micro-harm reduction on the individual done to users and some ways non-users. You can actually look at something that they call 25 years ago, which I think is important, total harm reduction, where you take into account both goals, right? If you have an intervention that reduces average harm, but increases total harm, that might be a problem. Think about this. If you could somehow replace drugs today and had everybody take a regulated source of heroin, but you were going to increase addiction tenfold by doing that, everyone on average might be a little bit better off on average because they're getting something that they know what it is. And maybe they don't have to steal to get it because maybe the government will give it away or whatever. I'm just imagining this for this exercise. The total harm would still be not worth what's happening on the average harm level, because on the total harm, you'd have a country of 50 million heroin addicts, which what effect does that have on a country's productivity, on roadway safety, on family break? I mean, you can go on and on. But the point of that extreme exercise is to really understand you cannot look at harm reduction alone when you look at these kinds of interventions. What are the solutions? I think we have solutions. I think we have a lot of solutions that can work in prevention, intervention and treatment, recovery, smart enforcement, and of course, international efforts. Those things are really, really, really important. So if you want to get more details, you can go to our website, which is learnaboutsam.org if you want. That's on marijuana. You can also scan here. You can go to gooddrugpolicy.org. We also have a new podcast called the Drug Report podcast, as well as a weekly and biweekly emails called the Drug Report and the Friday Fact, where we do a Friday Fact, sort of one fact, what's going on in the drug policy world straight to your inbox. The Drug Report is a curation of already published news stories on what's happening in drug policy in the news. So that's really important. You can scan to get all of that. You can also scan to access our resources. We have a lot of toolkits, resources, both on marijuana and other drugs. If you scan there, you'll get it. Of course, our website is gooddrugpolicy.org, as well as learnaboutsam.org. So I wanted to make this shorter rather than longer because I felt like they're, you know, it's easy to get lost in this. And, you know, there is this, in some ways, really this false dichotomy that's been out there between harm reduction and recovery and harm reduction and treatment. It doesn't have to be a false dichotomy. Unfortunately, people who want to advance legalization agendas, that false dichotomy works in their favor. Because if you say, you know, harm reduction or recovery for somebody who, you know, is very not close to entering treatment, then people will say, oh, yeah, well, we just have to only ever focus on harm reduction. And that, again, that means we will kind of lose what we need. And what we really need is a balanced approach that really looks at all of these issues, all of these levels, and does so in a very holistic way. So I want to thank you all for being here. It was really, you know, a pleasure to be with you for AOAAM. And please reach out to us at gooddrugpolicy.org and learnaboutsam.org. Thanks so much.

Kevin Savette

Foundation for Drug Policy Solutions

harm reduction interventions

evidence-based drug policies

naloxone distribution

fentanyl testing strips

safe supply programs

comprehensive drug policies