BOSTON — MBTA officials are pouring cold water on a legislative push to make the opioid overdose reversing drug naloxone available at subway stations, citing a lack of proper staff and a shortage of funding.
The T recently wrapped up a federally funded pilot project that installed 15 kiosks with doses of the medicine – also known by its brand name, Narcan – at several Red Line stations to help reduce fatal drug overdoses.
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SALEM — A group of about 30 community members walked from the Salem Common to Riley Plaza on Thursday as a part of the annual Walk for Overdose Awareness.
The event included speakers stressing the importance of creating a larger support network for community members struggling with substance abuse and addiction.
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Doctors desperately need tools to battle the opioid epidemic, and they’re turning to cannabinoids for new ways to approach the problem of opioid use disorder (OUD). Recently researchers aimed to create an open-access framework designed to help people wean off and eventually replace opioids with cannabinoids as an alternative.
Last August, a study provided a clinical framework for cannabinoids in the battle against the opioid epidemic. The study, entitled “An answered call for aid? Cannabinoid clinical framework for the opioid epidemic,” was published in Harm Reduction Journal.
Researchers provided an evidence-based clinical framework for the utilization of cannabinoids to treat patients with chronic pain who are dependent on opioids, seeking alternatives, and tapering off of opioids.
“Based on a comprehensive review of the literature and epidemiological evidence to date, cannabinoids stand to be one of the most interesting, safe, and accessible tools available to attenuate the devastation resulting from the misuse and abuse of opioid narcotics,” researchers wrote. “Considering the urgency of the opioid epidemic and broadening of cannabinoid accessibility amidst absent prescribing guidelines, the authors recommend use of this clinical framework in the contexts of both clinical research continuity and patient care.”
Recent research has shown a role for CBD in treating cannabis use disorder, and likewise, the compound could be useful in treating OUD. Researchers are also exploring the potential of THC and acidic cannabinoids as well. Cannabis is known anecdotally for the treatment of low-to-moderate amounts of pain despite working in very different ways than opiates.
The open-access framework includes opioid tapering recommendations that are in accordance with the CDC’s latest clinical practice guidelines for managing opioids for pain.
“As opioid deaths continue to be a global problem, patients are increasingly self-medicating with cannabis while researchers struggle to standardize protocols and providers feel uncomfortable recommending cannabinoids amidst absent prescribing guidelines,” researchers wrote. “If we consider cannabis as a harm reduction tool that patients are already using without medical guidance, we can realign our focus to supporting researchers and providers with a clinical framework for standardizing research and recommending cannabinoids more informatively as safe, effective, accessible tools for assisting in the management of chronic pain. To our knowledge, this is one of the first comprehensive evidence-based peer-reviewed clinical frameworks for the safe use of cannabinoid products for chronic pain and OUD.”
The researchers acknowledged that many of their patients have already begun their own self-guided journey into pain management with cannabinoids.
The Devastating Toll of Opioid Overdoses
Opioids continue to wreak havoc on people in America, leading to confusion about who needs powerful opioids and who doesn’t, and overdose deaths continue a steady pace of devastation.
According to The National Center for Health Statistics (NCHS) under the U.S. Centers for Disease Control and Prevention, drug overdose deaths rose from 2019 to 2021 with over 106,000 drug overdose deaths reported in 2021. Deaths involving synthetic opioids—primarily fentanyl and excluding methadone—continued its death march with 70,601 overdose deaths reported in 2021. Fentanyl in particular kills 150 Americans per day.
Over-prescription of opioids could be part of the problem. A 2018 longitudinal analysis showed that prescriptions for all opioids in the U.S. fell by 14.4% when medical cannabis dispensaries opened—particularly for hydrocodone and morphine, but also for benzodiazepines, stimulants, and many other medications known to be over-prescribed and addictive.
In some states, opioid use disorder is a qualifying condition for the use of medical cannabis. Researchers are still learning about the efficacy of cannabinoids in animal and human trials.
Studies on Cannabis and Opioid Abuse Vary
Opioid addiction is a complex phenomenon, and studies vary in their results of whether or not cannabinoids are effective. One study concluded that there is “no evidence that cannabis reduces opioid misuse.”
According to research published in the American Journal of Psychiatry, researchers instead found “no evidence” showing that cannabis may not be an effective long-term strategy for reducing opioid abuse.
“There are claims that cannabis may help decrease opioid use or help people with opioid use disorders keep up with treatment. But it’s crucial to note those studies examine short-term impact and focus on treatment of chronic pain and pain management, rather than levels of opioid use in other contexts,” Dr Jack Wilson, the lead author of the study and a postdoctoral research fellow at The Matilda Centre for Research in Mental Health and Substance Use at the University of Sydney in Australia, said in a statement.
“Our investigation shows that cannabis use remains common among this population, but it may not be an effective long-term strategy for reducing opioid use,” he added.
Recent studies show the vast potential of cannabis in the fight against the opioid epidemic that continues to ravage the U.S.
Despite the skewed messaging of the past suggesting that cannabis is a gateway drug or will lead to the use and abuse of more addictive and harmful substances, many today understand that cannabis may be utilized as a harm reduction tool.
Whether its individuals looking to reduce or eliminate their use of opioids for medical reasons or people who use drugs seeking relief from withdrawal symptoms and cravings, research is increasingly finding that cannabis may help.
In one of the more recent studies on the topic, researchers at the University of British Columbia (UBC) took a closer look at cannabis use and managing cravings to stimulant drugs. Ultimately their findings, published in the journal Addictive Behaviors, indicated that cannabis is not only widely used to manage stimulant cravings but that it may be an effective strategy to reduce stimulant use.
Cannabis as Harm Reduction for Other Drug Use
Researchers note how medical and recreational cannabis reform has opened the door for other conversations, namely how cannabis use interacts with other higher risk substances and that cannabis substitution is a commonly utilized method of harm reduction.
Given today’s ongoing drug toxicity crisis and the prevalence of fentanyl contamination in a number of substances, researchers say that investigating cannabis as a substitute for stimulant use could have “important public health and harm reduction appliances among people who use drugs at a heightened risk of overdose and other drug-related harms.”
To further analyze how cannabis use may affect people using stimulant drugs, researchers collected data from three cohorts in Vancouver, Canada: the At-Risk Youth Study (ARYS), the Vancouver Injection Drug Users Study (VIDUS) and the AIDS Care Cohort to Evaluate Exposure to Survival Services (ACCESS).
Researchers used a cross-sectional questionnaire alongside logistic regression models to analyze the relationship between cannabis use to manage stimulant cravings as well as self-reported changes in the frequency of stimulant use. A total of 297 participants reported cannabis and stimulant use over the past six months and were included in the study.
Cannabis a Common Strategy to Reduce Stimulant Use
Of the participants, 45.1% reported that they used cannabis to manage stimulant cravings and 77.6% of those participants said that cannabis use indeed decreased their use of stimulants, including powder cocaine, crack cocaine and methamphetamines.
Researchers noted that cannabis use to manage cravings was significantly associated with reduced stimulant use specifically among those who used crystal meth daily, though it was not significantly associated with reduced stimulant use among crack cocaine users.
While the study doesn’t provide all the answers, lead author Dr. Hudson Reddon noted the importance of the results.
“Our findings are not conclusive but do add to the growing scientific evidence that cannabis might be a beneficial tool for some people who want to better control their unregulated stimulant use, particularly for people who use crystal meth,” Dr. Reddon said. “This suggests a new direction for harm reduction strategies among people who use drugs.”
Adjacent Research and the Push for Further Investigation
While it’s surely an adjacent but far different issue, myriad research has explored the topic of cannabis as means to limit or replace opioids for medicinal use.
Recent studies have found that cannabis may be comparable to opioids in treating pain while providing more holistic relief and that patients largely reduce or fully replace opioid use after beginning a medicinal cannabis regimen. Another recent study also found that CBD curbed opioid cravings in rats.
There is far less research available regarding the relationship between cannabis and recreational drug use and abuse, though the UBC study’s findings are still echoed in past studies.
A 2021 study similarly found that cannabis is commonly used as a harm reduction strategy to substitute for stimulants and opioids. Another 2023 study found that cannabis was often utilized as a harm reduction strategy for those who had difficulty accessing addiction treatment or those using substances where effective treatments are limited.
Dr. Zach Walsh, a clinical psychologist and professor at the University of British Columbia Okanagan, called the findings of the UBC study “promising” while emphasizing the need for further research on the topic.
“[The findings] underscore the need for more comprehensive studies to understand the full potential of cannabis in the context of the overdose crisis,” Dr. Walsh said.
Remember the “epidemic” of underage nicotine vaping? For years, activists, politicians, and public health officials have been warning that a surge in e-cigarette use by teenagers would hook a generation of young people on nicotine and encourage them to smoke.
That never happened, as new federal survey data confirm. But policies adopted in response to that overblown threat continue to undermine the harm-reducing potential of vaping products by making them less attractive to current and former smokers.
According to the latest National Youth Tobacco Survey, which is overseen by the Centers for Disease Control and Prevention (CDC), 10 percent of high school students reported past-month e-cigarette use in 2023, down from 14 percent last year and more than 27 percent in 2019. Among middle school students, the 2023 rate was 4.6 percent, less than half the 2019 rate.
How many of those past-month vapers might reasonably be described as addicted to nicotine? A quarter of them—less than 2 percent of all respondents—reported vaping every day in the previous month, meaning that, as usual, the vast majority were occasional users.
This does not look like an epidemic of nicotine addiction. Nor did the fear that vaping would lead to smoking pan out.
Even at the peak of underage vaping, the downward trend in adolescent smoking not only continued but accelerated. In the 2023 survey, less than 2 percent of high school students reported smoking cigarettes in the previous month—down from 16 percent in 2011 and (according to a survey of 10th- and 12th-graders) more than 30 percent in 1997.
The CDC describes vaping as “tobacco product use,” even though e-cigarettes do not contain tobacco, and lumps it in with smoking, even though it does not involve combustion. But while the CDC is loath to admit it, the shift from smoking to vaping—in any age group—is indisputably an improvement in terms of health risks.
The Food and Drug Administration (FDA) acknowledges that vaping is far less hazardous than smoking, and it supposedly is committed to maintaining the availability of what it calls “electronic nicotine delivery systems” (ENDS) as a potentially lifesaving alternative for cigarette smokers. Yet to deter underage use, the FDA so far has approved only tobacco-flavored ENDS, even though former smokers overwhelmingly prefer other flavors.
That policy makes ENDS less appealing to people who already have switched from smoking to vaping or might be interested in doing so. The results are predictable: A recent FDA-supported study of sales data from across the country found that state and local restrictions on ENDS flavors were associated with increased purchases of conventional cigarettes.
“We find that ENDS flavor policies reduce flavored ENDS sales as intended, but also increase cigarette sales across age groups,” the researchers reported. “As cigarettes are much more lethal than ENDS, the high rate of substitution estimated here suggests that, on net, any population health benefits of ENDS flavor policies are likely small or even negative.”
Although “flavored ENDS products remain widely available in states that do not prohibit their sales,” the study’s authors noted, the FDA seems to be “paving a path towards a de facto national ENDS flavor prohibition.” That policy, they said, entails an “inequitable tradeoff” because it “prioritizes youth over the 11.2% of US adults [who] smoke.”
Since the FDA has not made a serious effort to enforce its de facto ban against the thousands of suppliers who are theoretically violating it, adults can still purchase ENDS in a wide variety of flavors from vape shops, tobacconists, and online vendors. Preserving those options for adults is consistent with efforts to reduce underage consumption, as the ongoing decline in adolescent vaping shows.
The flavor restrictions embraced by regulators and legislators threaten to harm public health in the name of protecting it. To save teenagers from an exaggerated danger, bureaucrats and politicians are sacrificing the interests, and perhaps the lives, of adult smokers across the country.
This article was featured in One Story to Read Today, a newsletter in which our editors recommend a single must-read from The Atlantic, Monday through Friday. Sign up for it here.
Three years ago, while the nation’s attention was on the 2020 presidential election, voters in Oregon took a dramatic step back from America’s long-running War on Drugs. By a 17-point margin, Oregonians approved Ballot Measure 110, which eliminated criminal penalties for possessing small amounts of any drug, including cocaine, heroin, and methamphetamine. When the policy went into effect early the next year, it lifted the fear of prosecution for the state’s drug users and launched Oregon on an experiment to determine whether a long-sought goal of the drug-policy reform movement—decriminalization—could help solve America’s drug problems.
Early results of this reform effort, the first of its kind in any state, are now coming into view, and so far, they are not encouraging. State leaders have acknowledged faults with the policy’s implementation and enforcement measures. And Oregon’s drug problems have not improved. Last year, the state experienced one of the sharpest rises in overdose deaths in the nation and had one of the highest percentages of adults with a substance-use disorder. During one two-week period last month, three children under the age of 4 overdosed in Portland after ingesting fentanyl.
For decades, drug policy in America centered on using law enforcement to target people who sold, possessed, or used drugs—an approach long supported by both Democratic and Republican politicians. Only in recent years, amid an epidemic of opioid overdoses and a national reconsideration of racial inequities in the criminal-justice system, has the drug-policy status quo begun to break down, as a coalition of health workers, criminal-justice-reform advocates, and drug-user activists have lobbied for a more compassionate and nuanced response. The new approach emphasizes reducing overdoses, stopping the spread of infectious disease, and providing drug users with the resources they need—counseling, housing, transportation—to stabilize their lives and gain control over their drug use.
Oregon’s Measure 110 was viewed as an opportunity to prove that activists’ most groundbreaking idea—sharply reducing the role of law enforcement in the government’s response to drugs—could work. The measure also earmarked hundreds of millions of dollars in cannabis tax revenue for building a statewide treatment network that advocates promised would do what police and prosecutors couldn’t: help drug users stop or reduce their drug use and become healthy, engaged members of their communities. The day after the measure passed, Kassandra Frederique, executive director of the Drug Policy Alliance, one of the nation’s most prominent drug-policy reform organizations, issued a statement calling the vote a “historic, paradigm-shifting win” and predicting that Oregon would become “a model and starting point for states across the country to decriminalize drug use.”
But three years later, with rising overdoses and delays in treatment funding, even some of the measure’s supporters now believe that the policy needs to be changed. In a nonpartisan statewide poll earlier this year, more than 60 percent of respondents blamed Measure 110 for making drug addiction, homelessness, and crime worse. A majority, including a majority of Democrats, said they supported bringing back criminal penalties for drug possession. This year’s legislative session, which ended in late June, saw at least a dozen Measure 110–related proposals from Democrats and Republicans alike, ranging from technical fixes to full restoration of criminal penalties for drug possession. Two significant changes—tighter restrictions on fentanyl and more state oversight of how Measure 110 funding is distributed—passed with bipartisan support.
Few people consider Measure 110 “a success out of the gate,” Tony Morse, the policy and advocacy director for Oregon Recovers, told me. The organization, which promotes policy solutions to the state’s addiction crisis, initially opposed Measure 110; now it supports funding the policy, though it also wants more state money for in-patient treatment and detox services. As Morse put it, “If you take away the criminal-justice system as a pathway that gets people into treatment, you need to think about what is going to replace it.”
Many advocates say the new policy simply needs more time to prove itself, even if they also acknowledge that parts of the ballot measure had flaws; advocates worked closely with lawmakers on the oversight bill that passed last month. “We’re building the plane as we fly it,” Haven Wheelock, a program supervisor at a homeless-services provider in Portland who helped put Measure 110 on the ballot, told me. “We tried the War on Drugs for 50 years, and it didn’t work … It hurts my heart every time someone says we need to repeal this before we even give it a chance.”
Workers from the organization Central City Concern hand out Narcan in Portland, Oregon, on April 5. (Jordan Gale)
Measure 110 went into effect at a time of dramatic change in U.S. drug policy. Departing from precedent, the Biden administration has endorsed and increased federal funding for a public-health strategy called harm reduction; rather than pushing for abstinence, harm reduction emphasizes keeping drug users safe—for instance, through the distribution of clean syringes and overdose-reversal medications. The term harm reduction appeared five times in the ballot text of Measure 110, which forbids funding recipients from “mandating abstinence.”
Matt Sutton, the director of external relations for the Drug Policy Alliance, which helped write Measure 110 and spent more than $5 million to pass it, told me that reform advocates viewed the measure as the start of a nationwide decriminalization push. The effort started in Oregon because the state had been an early adopter of marijuana legalization and is considered a drug-policy-reform leader. Success would mean showing the rest of the country that “people did think we should invest in a public-health approach instead of criminalization,” Sutton said.
To achieve this goal, Measure 110 enacted two major changes to Oregon’s drug laws. First, minor drug possession was downgraded from a misdemeanor to a violation, similar to a traffic ticket. Under the new law, users caught with up to 1 gram of heroin or methamphetamine, or up to 40 oxycodone pills, are charged a $100 fine, which can be waived if they call a treatment-referral hotline. (Selling, trafficking, and possessing large amounts of drugs remain criminal offenses in Oregon.) Second, the law set aside a portion of state cannabis tax revenue every two years to fund a statewide network of harm-reduction and other services. A grant-making panel was created to oversee the funding process. At least six members of the panel were required to be directly involved in providing services to drug users; at least two had to be active or former drug users themselves; and three were to be “members of communities that have been disproportionately impacted” by drug criminalization, according to the ballot measure.
Backers of Measure 110 said the law was modeled on drug policies in Portugal, where personal drug possession was decriminalized two decades ago. But Oregon’s enforcement-and-treatment-referral system differs from Portugal’s. Users caught with drugs in Portugal are referred to a civil commission that evaluates their drug use and recommends treatment if needed, with civil sanctions for noncompliance. Portugal’s state-run health system also funds a nationwide network of treatment services, many of which focus on sobriety. Sutton said drafters of Measure 110 wanted to avoid anything that might resemble a criminal tribunal or coercing drug users into treatment. “People respond best when they’re ready to access those services in a voluntary way,” he said.
Almost immediately after taking effect, Measure 110 encountered problems. A state audit published this year found that the new law was “vague” about how state officials should oversee the awarding of money to new treatment programs, and set “unrealistic timelines” for evaluating and funding treatment proposals. As a result, the funding process was left largely to the grant-making panel, most of whose members “lacked experience in designing, evaluating and administrating a governmental-grant-application process,” according to the audit. Last year, supporters of Measure 110 accused state health officials, preoccupied with the coronavirus pandemic, of giving the panel insufficient direction and resources to handle a flood of grant applications. The state health authority acknowledged missteps in the grant-making process.
The audit described a chaotic process, with more than a dozen canceled meetings, potential conflicts of interest in the selection of funding recipients, and lines of applicant evaluations left blank. Full distribution of the first biennial payout of cannabis tax revenue—$302 million for harm reduction, housing, and other services—did not occur until late 2022, almost two years after Measure 110 passed. Figures released by the state last month show that, in the second half of 2022, recipients of Measure 110 funding provided some form of service to roughly 50,000 “clients,” though the Oregon Health Authority has said that a single individual could be counted multiple times in that total. (A study released last year by public-health researchers in Oregon found that, as of 2020, more than 650,000 Oregonians required, but were not receiving, treatment for a substance-use disorder.)
Meanwhile, the new law’s enforcement provisions have proved ineffectual. Of 5,299 drug-possession cases filed in Oregon circuit courts since Measure 110 went into effect, 3,381 resulted in a recipient failing to pay the fine or appear in court and facing no further penalties, according to the Oregon Judicial Department; about 1,300 tickets were dismissed or are pending. The state audit found that, during its first 15 months in operation, the treatment-referral hotline received just 119 calls, at a cost to the state of $7,000 per call. A survey of law-enforcement officers conducted by researchers at Portland State University found that, as of July 2022, officers were issuing an average of just 300 drug-possession tickets a month statewide, compared with 600 drug-possession arrests a month before Measure 110 took effect and close to 1,200 monthly arrests prior to the outbreak of COVID-19.
“Focusing on these tickets even though they’ll be ineffective—it’s not a great use of your resources,” Sheriff Nate Sickler of Jackson County, in the rural southern part of the state, told me of his department’s approach.
Advocates have celebrated a plunge in arrests. “For reducing arrests of people of color, it’s been an overwhelming success,” says Mike Marshall, the director of Oregon Recovers. But critics say that sidelining law enforcement has made it harder to persuade some drug users to stop using. Sickler cited the example of drug-court programs, which multiple studies have shown to be highly effective, including in Jackson County. Use of such programs in the county has declined in the absence of criminal prosecution, Sickler said: “Without accountability or the ability to drive a better choice, these individuals are left to their own demise.”
The consequences of Measure 110’s shortcomings have fallen most heavily on Oregon’s drug users. In the two years after the law took effect, the number of annual overdoses in the state rose by 61 percent, compared with a 13 percent increase nationwide, according to the Centers for Disease Control and Prevention. In neighboring Idaho and California, where drug possession remains subject to prosecution, the rate of increase was significantly lower than Oregon’s. (The spike in Washington State was similar to Oregon’s, but that comparison is more complicated because Washington’s drug policy has fluctuated since 2021.) Other states once notorious for drug deaths, including West Virginia, Indiana, and Arkansas, are now experiencing declines in overdose rates.
In downtown Portland this spring, police cleared out what The Oregonian called an “open-air drug market” in a former retail center. Prominent businesses in the area, including the outdoor-gear retailer REI, have closed in recent months, in part citing a rise in shoplifting and violence. Earlier this year, Portland business owners appeared before the Multnomah County Commission to ask for help with crime, drug-dealing, and other problems stemming from a behavioral-health resource center operated by a harm-reduction nonprofit that was awarded more than $4 million in Measure 110 funding. In April, the center abruptly closed following employee complaints that clients were covering walls with graffiti and overdosing on-site. A subsequent investigation by the nonprofit found that a security contractor had been using cocaine on the job. The center reopened two weeks later with beefed-up security measures.
Portland’s Democratic mayor, Ted Wheeler, went so far as to attempt an end run around Measure 110 in his city. Last month, Wheeler unveiled a proposal to criminalize public drug consumption in Portland, similar to existing bans on open-air drinking, saying in a statement that Measure 110 “is not working as it was intended to.” He added, “Portland’s substance-abuse problems have exploded to deadly and disastrous proportions.” Wheeler withdrew the proposal days later after learning that an older state law prohibits local jurisdictions from banning public drug use.
Despite shifting public opinion on Measure 110, many Oregon leaders are not ready to give up on the policy. Earlier this month, Oregon Governor Tina Kotek signed legislation that strengthens state oversight of Measure 110 and requires an audit, due no later than December 2025, of about two dozen aspects of the measure’s performance, including whether it is reducing overdoses. Other bills passed by the legislature’s Democratic majority strengthened criminal penalties for possession of large quantities of fentanyl and mandated that school drug-prevention programs instruct students about the risks of synthetic opioids. Republican proposals to repeal Measure 110 outright or claw back tens of millions of dollars in harm-reduction funding were not enacted.
The fallout from Measure 110 has received some critical coverage from media outlets on the right. “It is predictable,” a scholar from the Hudson Institute told Fox News. “It is a tragedy and a self-inflicted wound.” (Meanwhile, in Portugal, the model for Oregon, some residents are raising questions about their own nation’s decriminalization policy.) But so far Oregon’s experience doesn’t appear to have stopped efforts to bring decriminalization to other parts of the United States. “We’ll see more ballot initiatives,” Sutton, of the Drug Policy Alliance, said, adding that advocates are currently working with city leaders to decriminalize drugs in Washington, D.C.
Supporters of Measure 110 are now seeking to draw attention to what they say are the policy’s overlooked positive effects. This summer, the Health Justice Recovery Alliance, a Measure 110 advocacy organization, is leading an effort to spotlight expanded treatment services and boost community awareness of the treatment-referral hotline. Advocates are also coordinating with law-enforcement agencies to ensure that officers know about local resources for drug users. “People are hiring for their programs; outreach programs are expanding, offering more services,” Devon Downeysmith, the communications director for the group, told me.
An array of services around the state have been expanded through the policy: housing for pregnant women awaiting drug treatment; culturally specific programs for Black, Latino, and Indigenous drug users; and even distribution of bicycle helmets to people unable to drive to treatment meetings. “People often forget how much time it takes to spend a bunch of money and build services,” said Wheelock, the homeless-services worker, whose organization received more than $2 million in funding from Measure 110.
Still, even some recipients of Measure 110 funding wonder whether one of the law’s pillars—the citation system that was supposed to help route drug users into treatment—needs to be rethought. “Perhaps some consequences might be a helpful thing,” says Julia Pinsky, a co-founder of Max’s Mission, a harm-reduction nonprofit in southern Oregon. Max’s Mission has received $1.5 million from Measure 110, enabling the organization to hire new staff, open new offices, and serve more people. Pinsky told me she is proud of her organization’s work and remains committed to the idea that “you shouldn’t have to go to prison to be treated for substance use.” She said that she doesn’t want drug use to “become a felony,” but that some people aren’t capable of stopping drug use on their own. “They need additional help.”
Brandi Fogle, a regional manager for Max’s Mission, says her own story illustrates the complex trade-offs involved in reforming drug policy. Three and a half years ago, she was a homeless drug user, addicted to heroin and drifting around Jackson and Josephine Counties. Although she tried to stop numerous times, including one six-month period during which she was prescribed the drug-replacement medication methadone, she told me that a 2020 arrest for drug possession was what finally turned her life around. She asked to be enrolled in a 19-month drug-court program that included residential treatment, mandatory 12-step meetings, and a community-service project, and ultimately was hired by Pinsky.
Since Measure 110 went into effect, Fogle said, she has gotten pushback from members of the community for the work Max’s Mission does. She said that both the old system of criminal justice and the new system of harm reduction can benefit drug users, but that her hope now is to make the latter approach more successful. “Everyone is different,” Fogle said. “Drug court worked for me because I chose it, and I wouldn’t have needed drug court in the first place if I had received the kind of services Max’s Mission provides. I want to offer people that chance.”
In July of 2019, I took an Amtrak train from my home in Boston to my father’s apartment outside of New York City. I had one intention for this visit: to help my father, who is an active crack cocaine user, prevent a fatal drug overdose. Specifically, I was traveling to New York to provide him Narcan (the opioid overdose reversal medicine) and fentanyl testing strips, as well as to teach him how to use them effectively.
I had been spurred to action after he had shared with me that his most recent batch of cocaine had likely been spiked with fentanyl, the potent synthetic opioid fueling our nation’s overdose crisis. Rather than produce its usual, energetic high, the cocaine he had taken caused him to immediately black out. He had woken up hours later on the chilly concrete floor of his basement apartment, unaware of the time that had elapsed. Fearing for his life, I quickly booked a ticket.
That weekend, I distributed several boxes of Narcan and a bagful of testing strips to my father. I showed him, for example, how to break down samples of his crack cocaine with vitamin C to ensure accurate testing. We passed the time by chatting about harm reduction, drug policy and my own burgeoning advocacy work in the addiction and mental health fields. It wasn’t a conventional parent-child visit by any means. However, it was a necessary one to protect his health and safety.
Though I returned home to Boston comforted by the knowledge that I had acted positively to improve my father’s well-being, I would soon come to understand how important this brief visit truly was: Not only did it set the foundation for a fundamental transformation in our relationship, it also began to engender my father’s own advocacy and sense of empowerment as a drug user.
Prior to making this trip, my interactions with my father regarding his substance use were fraught, secretive and argumentative. I had spent most of my adolescence alternating between periods of feeling actively hostile toward him and periods defined by my desperate attempts to “save” him by pleading with him to become abstinent. Though I was acting from a place of sincere worry and deep love, this pattern often drove us into conflict. We yelled at, we fought with and we spoke profoundly hurtful words to each other.
My behavior was fueled by the messages I had received (from my family, from our culture) about my father’s substance use, which were unambiguous: that it was his fault, that it was a reflection of his character or his commitment to me, that he could stop if he wanted to ― if he would only love us enough. Ultimately, I came to believe that his continued substance use and our ability to build a relationship were fundamentally dichotomous. From my perspective, if we were to have a chance at an authentic relationship, he would first need to stop using.
Yet, when I boarded that train to New York City, I made the choice to flip this corrosive script. By choosing to practice harm reduction, I made the decision to prioritize my father’s safety and dignity — and our unconditional love for each other — over his abstinence. I ceased my attempts to force him to change in ways that he might not be ready or able to, making it possible for us to trade bitter, unproductive arguments for open dialogue and non-coercive support. Most important, through my actions that weekend, I communicated meaningfully to him: I love you, I value you, I want to be in a relationship with you precisely as you are right now, and I will no longer judge you.
The author on their grandmother’s lawn with their dad (1997/1998).
The impact on our relationship was transformative. My father immediately began to feel more comfortable sharing his experiences with substance use and addiction with me, which was important for two reasons: On a practical level, this honest communication meant that I had accurate information about what he was using and how it was affecting him, making it possible for me to provide effective harm reduction guidance, but, importantly for our relationship, it also meant that we were no longer operating under the pressures of secrecy, avoidance and lies. As my father was able to trust that his disclosures would be met with curiosity and support instead of strife and critique, there was no longer any reason for him to hide or deny that he was using. Instead, we were able to talk about what was happening directly, act to preserve his safety and prepare to face it in partnership.
However, what has been most meaningful to me has been the effect these relational shifts have had on the time that we spend together. No longer preoccupied with convincing him to become abstinent, I have instead been able to focus on simply enjoying my father’s companionship and personhood. I have been able to appreciate our spirited political bantering, the lively stories from his youth that he retells time and time again, and the tender moments of care, love and pride that are shared between us, such as when he eagerly printed copies of my first published article to share with his friends. In addition, now that I understand addiction as a health concern ― rather than a moralistic one ― my father’s continued substance use is no longer wounding to me. I know that he loves me fiercely and profoundly, and always has; his substance use and addiction never had anything at all to do with that.
More recently, I have observed an additional, deepening change in my father’s behavior ― one that addresses not only how we relate to each other but also how he relates to himself and the communities within which he participates. Historically, my father has harbored deep feelings of shame surrounding his substance use, referring to it as his “bad behavior,” and his life as a series of cumulative mistakes. These sentiments had been perpetually heartbreaking to hear, and I longed to find the means to eliminate his internalized stigma. I wanted him to see what I knew: that he was a deeply compassionate and gentle human being who would offer you the shirt off his back without a second thought and who had filled my childhood with history, learning and adventure. Thankfully, these harmful beliefs are also finally shifting.
Instead, in their place, my father has begun to develop a political and moral voice amid our nation’s drug war and overdose crisis. Throughout our conversations, he speaks up about the harms and needs he has borne witness to as a drug user: the friends he has lost to overdose and mass incarceration, the importance of educating clinicians and policymakers about addiction and harm reduction, and the need to move substance use “out of the shadows” and into open discussion. He has also taken action. He shared with me that he has distributed Narcan and fentanyl testing strips to his drug dealer, who now carries them and offers them to people who use substances on the street. My father has become an empowered advocate, and it is helping to save lives. I could not be more proud and gratified.
If you have a loved one who is presently struggling with an active substance use disorder, I share this story to show that there is a different and healthier approach we can take toward relating to them and their ongoing substance use: one defined by the dignity, compassion and connection we all deserve, a truth no less inclusive of people who use substances. You don’t have to choose harmful ultimatums and “tough love”; instead, you can make the choice to foster a loving, nonjudgmental relationship with your loved one precisely as they are right now. Not only is it possible to support them as they continue using, when faced with the violence of social stigma, criminalization and a toxic drug supply, that is the time they will likely most need your care and presence.
When I boarded that train to New York City back in 2019, I had desperately wanted to save my father’s life. Hopefully, the harm reduction I practiced that weekend has helped actualize that possibility. Yet it has already done much more: Harm reduction has saved and transformed my relationship with my father, making it possible for us to have a meaningful, open and tender connection no matter where he may be with his substance use. For that, I am profoundly and perpetually thankful.
If you would like to learn about harm reduction and how we can create a compassionate, dignified world for all people who use substances, please visit the National Coalition for Harm Reduction’s Principles of Harm Reduction.
Eri Solomon (they/them/theirs) is a harm reduction advocate and service provider residing in Boston. Their professional background is in community organizing, social justice education and human services. They live with their best friend and two feline companions, Bug and Ringo.
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