Side event: Adult drug use and regulation: the future of drug policies?

Julián Quintero (ATS): Muchas gracias a todos y todas por estar aquí esta mañana… 6:12 de la mañana en Colombia, creo que las 7:00 en Nueva York, la 1:00 en Viena. Bienvenidos y bienvenidas a este evento alterno que lleva por nombre “Uso y regulación en adultos: el futuro de las políticas de drogas”, realizado por la corporación Acción Técnica Social de Colombia e Instituto RIA en México, en el marco de la CND 2021 que por razones de pandemia nos convoca de forma virtual este año. Damos un saludo especial a los delegados de los gobiernos, las agencias multilaterales, las organizaciones de la sociedad civil y las personas consumidoras de drogas en todo el mundo que nos ven virtualmente. Queremos enviar un abrazo, afecto y fortaleza a todas las personas que se han visto afectadas por la pandemia de manera directa o indirecta, haciendo también un llamado a la solidaridad y a la empatía con quienes más han sufrido. Hoy vengo a presentarles una conversación tranquila y pausada de tres colegas y amigxs que durante los últimos años hemos podido materializar en proyectos, comportamientos, actitudes, servicios y prácticas cotidianas, las ideas de formar la políticas de drogas, el derecho al libre desarrollo de la personalidad, la regulación de los mercados ilegales, el consumo responsable, la reducción de riesgos y daños, el placer, la felicidad, el papel que como consumidores de drogas jugamos en las políticas de drogas todos los días. Vengo a plantearles una conversación entre adultos y de cómo nuestro uso y consumo en un contexto de prohibición, puede aportar de manera significativa a lograr la regulación de todas las drogas. Contamos con la presencia de mi amiga Zara, *menciona su semblanza que se encuentra en la página de RIA*. El Dr Carl Hart nació en Miami, es neurofarmacólogo, profesor en la Universidad de Columbia en Nueva York y una de las figuras internacionales más conocidas en impulsar la reforma de las políticas de drogas desde la evidencia científica en su laboratorio, elaborando discursos con una alta carga política y social, para completarlo con su experiencia de vida con las sustancias desde su lugar en el mundo como un afroaemericano, acaba de publicar su libro “Drogas para adultos: persiguiendo la la libertad en el país del miedo que ha generado un revuelo en todas las esferas preocupadas por la guerra contra las drogas. La última vez que pude interactuar con él fue hace poco más de un mes, cuando lamentamos juntos como periodistas de las principales emisoras de Colombia, atraídos por el amarillismo que generó que un profesor de su nivel, de su talla, reconoció el consumo de heroína y además ser ampliamente funcional. Ellos no lo podían creer y perdieron la oportunidad de conocer los provocadores y atractivos postulados de su libro. Además, tuvo la oportunidad de evidenciar el desconocimiento de la prensa sobre los temas profundos de drogas, pues terminó dándoles una lección de legislación colombiana, recordándoles que en Colombia está despenalizado el porte y consumo de la dosis mínima de la que él tenía un amplio conocimiento por haber estado en el país. Cuando hablamos de consumo de drogas en adultos hay varios puntos donde nos hemos encontrado con Zara y el Dr. Hart y creo que cada uno lo abordará de diferentes maneras. Hablar de adultos significa hablar de responsabilidad de nuestros actos, en ese sentido qué puede ser responsable frente al consumo de drogas, por ejemplo: buscar siempre la funcionalidad, la incorporación de hábitos de reducción de riesgos y daños y autocuidado, el monitoreo constante de nuestra salud física y mental, hacer análisis de sustancias, saber manejar una crisis, conocer síntomas de intoxicación, saber dosificarse. Ser responsable también es preocuparse por las políticas que no permiten un disfrute libre y seguro de drogas. El segundo aspecto es el placer y la felicidad, la satisfacción como efecto positivo para reconocer, estudiar y gestionar. Nadie usa drogas para tener una mala experiencia y pocas personas lo hacen para gestionar un problema de su salud física y mental, para olvidar o responder a un trauma. La búsqueda del placer es un objetivo legítimo que se debe defender y maximizar. La representación de los medios de comunicación al hablar del consumo no es hablar de consumo problemático, dependencia o adicción, no se ocupan del 89% que no los tiene. El fracaso de la guerra contra las drogas es el fracaso de los medios de comunicación al ponerse al servicio del poder prohibicionista y no de la evidencia reformadora. Salgamos del clóset psicoactivo para derribar los estereotipos con confianza y apoyo para los que no lo han hecho, respetando también a quienes no lo han hecho y nunca lo van a hacer. Dos preguntas para el Dr Hart: ¿cuál es el mensaje que enviaría a esos burócratas, técnicos y funcionarios públicos jóvenes para que puedan impulsar y gestionar el cambio desde adentro? y ¿cuál es el llamado que le haría a los jóvenes que apenas inician en el consumo para que lo hagan de forma responsable, reduciendo riesgos y daños, así como maximizando el placer?

Dr. Carl Hart: Thank you, Julian – it is a pleasure to be with you and Zara. I guess the thing that I really would encourage the young people to think about, is the issue of justice. When we talk about justice in the US, we have a lot of problems with police killing black people, and the pretext for the police to interact with black people has a lot to do with drug law enforcement. Recently in Minnesota we had a kill – maybe three days ago, the police were trying to arrest him because of a minor marijuana violation, when we have a lot of states that have legalized it. Just because someone is trying to alter their consciousness or seeking pleasure and the police are trying to arrest them for that sort of thing, that is silly. I hope young people will stand up and see how stupid that is, how you can kill somebody because they want to alter their consciousness and to have a good time. As we move forward, I hope young people really advocate for changing the law, for decreasing law enforcement and decreasing their interaction with people, because in the US and around the world it has become so deadly. If we think that way, we are killing people just for putting a substante in their body, that doesn’t make any sense under any condition. My message for young people: stand up, show how ridiculous this situation is. Imagine if someone is killing you because you choose to put sugar in your body, that’s what’s happening around the world. And as young people trying to alter their own consciousness with psychoactive substances, I hope they seek out information, people that would help them to decrease any particular harms and enhance the pleasure that they are seeking, cause there is a growing amount of information on the subject. People feel more comfortable publishing and talking about it. I centarly feel more comfortable talking about it, and there are a number of people who have experience, in the scientific literature for example, helping people to stay safe when they are using psychoactive substances. I hope young people seek the best available information to stay safe and happy. 

Zara Snapp (Instituto RIA): Thank you – yeah, is one of the concerns we have in Mexico because even though a lot of folks commenting in the chat are working on this and it’s a global movement (…) and even with the legal regulation bill that’s been proposed around cannabis, it still open the door to interaction with the judicial system, you will still be able to be detained while they figure out how much you are carrying and while they determine is there a sanction or not, and that puts people at risk. The human rights violations in the War on Drugs and how we justify killing people, disactibly disappearing them, extrajudicial executions, because they have any substance in their body or because of the idea of they having a substance or they are somehow related to the market, because beyond just consumption, one of our concerns is about people engaging any production part as cultivation. You have contact with psychoactive substances and therefore the state and other non state actors have the right to take your life. I think your book (Dr. Hart) encourages folks to talk about this. You talk about the leaders that are justifying these executions, so I want to ask: how do you see this contradictions between government leaders who may have used substances, and now turn around ordering the killings of people using drugs? How to create coherence there? 

Dr. Hart: Yeah, we can think about some leaders that actively engaged in a drug war that is killing tens of thousands of people, for example The Philippines, their President Duterte he is going at (?) particularly people who use menthaphine, who sell methamphetamine, but at the same token he is a known user of opioids as fentanyl and he likes fentanyl and talks about the pleasure about opioids. So what we have to do as an international community is stop participating in drug exceptionalism and say things like “psychedelics are ok but heroin is not ok or cocaine is not ok” ¡NO! These are all chemical substances and there’s just chemical interactions in your body and brain, the meaning we put on these different substances is a human sort of phenomena but the body does not see chemicals in that way. There’s no good or bad drugs, just substances waiting for the biological system to interact with. Drug exceptionalism leads to specific drug users being arrested and being killed. 

Zara Snapp: Definitely, when we were working at the cocaine report in the 2016 for the UN special session, people said “oh, we are so far away from having that conversation, they are gonna regulate MDMA way before we ever get to cocaine”. We were forecasting what regulation would look like in 2034, because you have to be able to put evidence in place and someday, when policy makers and society are ready to have that conversation, the evidence will exist on how it works. And we are not talking only about coca leaf, we are talking about cocaine and how growns ups will have access to that, the restrictions.It was a hard conversation to have in that year, but in ATS and Instituto RIA we have been proposing side events from the beginning that kinda break with the mold, we started with drug checking, then cocaine regulation, peace building in drug policy, and know we are having a conversation of drug use in adults. One of the things I took from the book that was so important is: how do we begin to identify faulty science? It happens at the CND, it happens all the time. 

Dr. Hart: One of the things people should recognise is that all the drugs we are talking about are substances that we give in the laboratory for human research, and we’ve been doing this for decades. If these are so awful as some people say, then we wouldn’t be able to give these drugs to human research participants with the blessing of so many institutions. We have the data of this kind of studies and it overwhelmingly shows positive effects, but those results are not empathized, instead they show us brain scans without contemplating brain measure, structure, is there behavioral outcome or not and how these people perform cognitively. People need to ensure that the participants are useful for each specific study, they need to ask that kind of questions: educational baggage, age, etc. Another thing people should ask is if researchers talk about the negative effects as a result of drug policy: do they talk about the number of people arrested for drugs? Sometimes they present animal data and human data as if they are the same thing and they are not. Is easy to talk about neurotoxicity in laboratory animals because you give them 20 times more than a human would take, all of these points are critical. If the results are based in drug policy and law enforcement, they are not giving you a comprehensive understanding of the situation. 

Zara Snapp: Hugely important, these are the tools we need to be able to cuestion what we know about drugs. And when you think about university students or folks who are getting this  training as psychologists or as neuroscientists or within any of these disciplines(…)  I know that in my university we were taught about how substances function in our body and there’s also no space for neurodiversity, our brains work differently already without substances and your brain will react differently than mine. We always talk about how policy affects us and how does this substance affect if your interactions with government and the state have been always negative. When you take a psychoactive substance your setting is so different from the setting of someone who has lived privilege around them, which in my case living in Mexico, I’m able to talk about my use openly and I have been for many years but it’s because I’m a white woman who is not being stopped on the street, but there are billions of people who, because they’re young, they look a certain way, they live in certain geographical parts of the country, are stopped and there’s just a stigma and discrimination that is inherent in how our laws are applied in a discriminatory way,  and that is why we try to apply social justice principles to any policy, but really when we’re talking about regulation we bring it up that’s the first principle. You have to recognize the dynamics of privilege and oppression that already exists. How do we begin dismantling those stretch structural inequities? How do we talk about the George Floyd case? How do we talk about what’s happening right now around the world? 

Dr. Hart: Unfortunately, there are no shortcuts, if we’re going to have change in the world for any sort of thing where people are being oppressed, power concedes nothing without a demand so we have to demand change, and oftentimes that mean you might have to put your body out there, you might have to sacrifice something yourself. If I’m writing a book talking about my own drug use, is not because I want people to know what I do privately, it comes a point in your life where you have to lay something on the line, because if you don’t, it’s not going to change the problem in opinion makers, the media, the people in politics. The people all around the world who are opinion makers in our society are the most privileged people. Drug law enforcement is not working, and if folks are not coming out of the closet, they’re not putting anything on the line, so we have to call out the opinion makers people, especially journalists. When people make bad movies about drugs,  about drug trafficking, we need to call that out, all that nonsense when comedians make fun of drugs when they really don’t know what they’re talking about. We have to call out all of this nonsense because the more they produce it, the more people are dying. Folks are going to jail because of somebody stupid joke that they continue to perpetuate because of somebody’s awful documentary or film. We have to call those film makers and journalists who write stupid stories about the opioid crisis. We have to call out people, scientists who perpetuate this nonsense without talking about what policies are doing to communities. If we don’t call people out, it’s not going to happen, if we don’t lay our bodies on the line, it’s not going to happen, so I really encourage people to be active, to think about the people like George Floyd, the people who are being killed, because we oftentimes think about people going to prison and in the United states with drug law enforcement, you don’t go to jail, you get shot up and killed, so I can’t say it more passionately: join us in calling out these people!

Zara Snapp: Yeah-  and I think it is part of how you have these conversations on a personal level when you are witness to this stigma. It’s the big people who make decisions, I like how you put the opinion makers and policy makers, those who are using in the privacy of their homes, but then also how do you know when we have greater tools for having that conversation with our families – is really where we start to change minds about very small things. And the thing about media is so key because we’ve watched the interviews that they’ve done with you. We often talk about how we’ve had to take over some of these media sources where they let us occupy these spaces we don’t have because reporters, journalists,  media companies aren’t saying the right things, they’re not asking those questions. We have the Cañamo Magazine, I have a TV show now on cannabis in Mexico, so it’s like these ways we have to be the voices, because otherwise you don’t know what’s going to come out. And probably all of us have been interviewed about drug trafficking, and who are the leaders of the drug traffickers, and the women who fled drug trafficking in history, and you’re just like “ this is not the conversation we need to be having”, but this is where the conversation sometimes goes, and you say yes to the interview, and then you answer the intelligent question you wish they had asked you, which is something that I think is important for all of us who are working in this field. I want to go back to what Julian mentioned at the beginning, the importance of happiness, the importance of pleasure. We spend a week at the CND where the governments are talking about all these horrible things that they’re doing: eradicating crops, incarcerating people, and then you also see people that you love, and you have this great global movement that’s working together, and I think even in the last couple of years more people who are in this global movement have been more comfortable talking about their use. Five years ago, people weren’t talking about their use, they weren’t talking about the pleasure that substances bring. With greater participation of young people we have also seen it change. So when we talk about the importance of happiness and the UN General Assembly approved in 2012, we invited member states to promote policies that include the importance of it. And you talk about this new book to grown ups, and what does being a grown up mean is being able to enjoy something. When I was using drugs in a parking lot in the middle of the night, I was not actually enjoying it to its fullest extent, just taking risks. So when we talk about that, how do we bring that message, how do we have this conversation with young people, I mean this is really about the education around whether you’re going to consume or not, how do we build this pleasure, happiness and the free development of personality. 

Dr. Hart: It’s been made  more complicated and more complex than it really should be, it’s very simple: you have the right to pursue pleasure, you have the right to pursue happiness. We’re not guaranteeing you happiness or pleasure, but we guarantee you the right to do so, however you decide to do so, as long as you are not bothering anyone or disrupting their ability to do the same, it’s cool. As we grow, we may choose various activities at one stage of life so it’s a dynamic process, you might for example do video games as an adolescent, then you get older you might do alcohol and then as you get even older, you may change to psychoactive substances. It’s a dynamic process and requires that you have a trial and error, you make mistakes, you try and get the best available information,  that’s part of being human. Safety isn’t not to allow people to make mistakes, but to make sure that their mistakes are not lethal or deadly. That’s one of the reasons why when I think about harm reduction and there’s nothing about pleasure in that title (…)  I mean of course what we do in harm reduction is important, we provide very important services, but that term is always paired drugs with drugs harms, so you can understand why our society might think of drugs only in terms of harm, you can understand why people who are ignorant about drugs may only think of drugs in terms of these harmful effects, these negative effects. That’s why I encourage people: let’s get rid of the term harm reduction so we can get rid of this pairing. Some people misunderstood and said “oh you don’t like harm reduction” as if didn’t like what we were doing in harm reduction, of course I love what we’re doing in harm reduction, it’s about the terms – we don’t want to pair ugly with Mary because Mary is not ugly, what we do on harm reduction is cool but the pairing of harm and drugs over and over, shapes our thinking, shapes our behavior shapes how we see this activity, and so we really have to think about getting rid of that term or modify it. Taking drugs is about happiness, about time with myself, for me to chill, to have a good time. It’s not about escaping pain, it’s about going to this place to be happy, to be pleasurable, it’s about enjoying my friends, it’s about enjoying my loved ones, so we have to make sure we correct that sort of pairing, also because the media is comfortable with folks – for example, taking psychedelics to achieve some spiritual enlightenment or to search for some healing and that’s OK, but many of us are doing that we’re doing it because we enjoy the pleasure and that’s OK, so we have to be OK with just having a good time, there’s nothing wrong with having a good time, we’re more likely to treat other people around us better. People who are happy: that’s a good thing not a bad thing. 

Zara Snapp: Exactly, there’s so many terms we have to reclaim. So even thinking about aging, when people have this experimental time in their lives and then they age out, is there anything we should say? There’s possibly a positive time in your life when you might incorporate certain psychoactive substances, when you have the time to reflect, when you’re not caring for small children, when you’re not going to school. As a mother of a young child, I don’t really have time sometimes to have a long (…) I have to figure out what are the moments I can really enjoy, and I think everybody has to examine what is the moment for them. Using substances sometimes feel like a connection to the universe and that’s what you are seeking really, and if what you are seeking is to treat pain, then there’s probably other pieces around, the situation, other conditions that we would need to be exploring beyond just substances, and this is something that in our societies were being taught, you know, I’ll take a pill every day and then I’ll be OK, but when the person who takes a pill or smoke something everyday isn’t within the medical model is not OK, and folks who have access to health care are getting prescribed legally a lot of these molecules and if you dont  you have to find them on an illegal market and that’s where all these risks come in, so it’s all part of this inequality that we’re seeing. I know we’re coming towards the close because we’re trying to be respectful of times of the UN, but also we know that they don’t have that much control over us ’cause they can’t kick us out of a room or anything. I want to ask when (…) you know, for many of us in Latin America we’re anxiously waiting for the book in Spanish: when will it be coming out? We’d love to give you a Latin America tour where we can really be talking about these issues and obviously we know that it’s so crucial for our region. 

Dr. Hart: It comes out in Spain this summer. Nuria is making sure that they don’t screw up the title, because they already tried to screw up the title. So when that happens, I will be happy to come to Latin America, you know that and I can’t wait till the world opens back up so I can come to places like Mexico and Colombia, so I can see my people again, I’ve missed hanging out with Julian and an everybody who takes care of me when I’m down there, I really miss it. 

Julián Quintero: Creo que más que pregunta, es que me voy muy animado como siempre. Me gustó mucho llamarlos a rendir cuentas, creo que es algo que marca mucho el tema en Colombia, desde lo público pero también desde los ciudadanos. También me voy con otra provocación, creo que hay que pedirle a nuestros colegas que si usan sustancias, intenten empezar por la práctica y no hablar en tercera persona, que se atrevan ocasionalmente a hablar en primera persona, y es que creo que reconocernos como usuarixs, como consumidores de sustancias en un contexto de reforma de política, es una claridad también. Y es que yo no estoy aquí de pie por ser un consumidor de sustancias, yo estoy aquí porque soy un sociólogo que tiene como objeto de estudio las políticas de drogas y me drogo ocasionalmente, entonces creo que empezar a avivar eso, me gustaría mucho con mis colegas. ¿Qué lecciones crees que debemos aprender de todo lo que pasó con el alcohol y la nicotina? Vemos que fue algo muy liberal en un momento, se salió de las manos el capitalismo salvaje lo cogió y lo administró totalmente, y pues terminamos viendo las consecuencias que terminamos viendo. Hace  años empezaron las regulaciones estrictas sobre el tabaco, las regulaciones sobre el alcohol, la restricción de la publicidad, los impuestos, todo eso en el proceso de regular las sustancias ilegales. ¿Qué creerías tú o si has hecho el análisis de qué podemos aprender de la experiencia que tuvimos tan desafortunada con el alcohol y con el cigarrillo? Que hoy en día son los que más ponen los muertxs, en términos de de uso de la sustancia, y que la categoría de legalidad hace que no nos fijamos mucho en ellas ¡Gracias!, y por acá te espero cuando tengamos libro. 

Dr. Hart: Thank you, Julian –  When I think about the lessons that we can learn from alcohol and tobacco in the US (…) between 1920 and 1933, we banned alcohol, we had tens of thousands of people who were maimed or killed from drinking tainted or poisoned alcohol, contaminated alcohol. When we reversed the prohibition of alcohol, when we made it legal again, those deaths went away, so the lesson from that is that when we have a safe supply, when we regulate the market such that people have access to pharmaceutical grade drug, you decrease deaths by contamination, and that’s where most of the deaths occur. When we think about what’s going on with overdoses in the US, for example with the opioids, we have tainted drugs that people don’t recognize, those will go away if you have a safe supply and regulate the market. When I think about tobacco, oftentimes people conflate the tobacco, the product, the plant, the tobacco itself from the tobacco companies and the industry. In the US, we were upset with the tobacco companies because they misled the public, they lied about their product, they lied about what they knew in terms of cancer potential of the product, they lied in terms of dependence producing potential of the product. They also manipulated the tobacco product such that they added various chemicals in order to enhance the nicotine delivery from the tobacco plant to the brain, they lied about those sorts of things, but please understand the natural tobacco plant itself is not a bad product, it becomes bad when we have people manipulating and lying about the product. The thing is we just need all of the information so people can make an informed decision, and when we have tobacco, alcohol or any other product that humans can engage in, we can expect that you will have some risk and that means that some people might get hurt dealing with those substances, just like people will get hurt driving in automobile. In the US, every year we lose 40,000 Americans because of car crashes, but we don’t ban cars, what we do is try to work to enhance the safety of driving a car. We’re trying to keep people safe so we can decrease the likelihood of people getting injured when taking that substance, so we have to understand that life is not without risk and we’re not going to decrease every possible risk, that’s impossible, anything worth doing carries some risk. Then what would happen if we regulated the drugs, we need to make sure we have a safe supply, taught people how to use them, brought people out of the shadows such that the stigma is decreased. Any regulation of where the substances are available is far better than what we’re currently doing. 

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