By the time Amy Massey reached out for help in 2016, years of heavy ketamine use had left her with severe bladder damage. She had a bladder removal scheduled—according to the doctors, it was the only option—and faced lifelong disability. 

Desperate for an alternative, she came across a YouTube video of harm reduction advocate Mat Southwell speaking about ways to reduce ketamine-related harm. 

Southwell introduced her to ketamine harm reduction strategies pioneered by drug-user activists. After adopting these approaches, Massey’s symptoms improved so significantly that her surgery was cancelled.

Today, Massey works alongside Southwell—now founder and technical director of harm reduction organisation Coact—as a peer trainer, helping health care workers and policymakers understand what works.

“When you go to a drug service, there’s nothing on ketamine. They’re asking us the questions.”

She is also a member of the Ketamine Peer Advisory Group (K-PAG), a growing community that’s become a trusted source of expertise on ketamine—not because its members set out to be, but because they had little choice after decades of ketamine-related harms falling through the cracks of a failing health care system. 

“Even now, when you go to a drug service, there’s nothing on ketamine,” Massey said. “They’re asking us the questions.”

Ketamine (AKA Ket, K, Special K) occupies a unique place in Britain’s drug landscape. Used medically as an anesthetic and increasingly in supervised treatment for depression, its non-medical use is also surging.

Unlike stimulants or opioids, ketamine is a dissociative. Small doses can produce euphoria and detachment. Larger doses can lead to the “K-hole”—a state where people feel disconnected from their body, surroundings and reality.

While those psychological effects of ketamine are immediate, physical harms, including debilitating bladder disease and chronic pain, may develop quietly over months or years. Heavy use may also lead to dependence.

Over 5,300 adults entered treatment for ketamine problems in England in 2024/25—more than 12 times as many as a decade earlier. The crisis is heavily concentrated among younger adults, with over two-thirds of users aged 16 to 24. Anecdotally, it’s often even younger than that. 

“We’re seeing children starting at 11 or 12,” Southwell told Filter. “They’re turning up in children’s urology services at 13, 14 and 15.”

The UK Advisory Council called for a coordinated public health response built around education, workforce training, harm reduction and treatment pathways.

As the number of people living with ketamine-related harms has increased, much of the public debate has focused on whether the drug should be reclassified from Class B to Class A.

Earlier in 2026, the United Kingdom’s Advisory Council on the Misuse of Drugs (AMCD) recommended against reclassification, concluding that the harsher criminal penalties it would entail were unlikely to reduce use. Instead, it called for a coordinated public health response built around education, workforce training, harm reduction and treatment pathways.

That recommendation now sits with the UK government.

But while the government weighs its decision, people with lived experience aren’t waiting. They’re already building the public health response the ACMD says is needed.

The workshops run by Southwell and Massey are among a growing number of peer-led initiatives working to fill the public health gap. They will also pilot a new festival outreach model, reaching peers with harm reduction advice in environments where ketamine is used. 

In the workshops, while Southwell explains the science behind ketamine-related harms, Massey brings the lived experience, sharing stories from K-PAG members that are often just as harrowing as her own.

Massey is still shocked by how unprepared many frontline health services remain. “They literally just don’t know,” she said. “They’re overwhelmed. People are coming into services, and they don’t know what to do with them.”

“The first thing that needs to happen is an acknowledgement that we’ve really, really fucked up.”

But Southwell isn’t surprised. For more than two decades, he has worked alongside clinicians, researchers and people with lived experience to understand the harms associated with chronic ketamine use. The knowledge has been there for years. The response hasn’t.

“The first thing that needs to happen is an acknowledgement that we’ve really, really fucked up,” he said. “For years, people using ketamine have been saying exactly the same thing: ‘We have to explain our condition in order to get a service.'”

For Southwell, that’s the real failure. It’s not that clinicians don’t care. It’s that knowledge about ketamine has never filtered into everyday health care, leaving frontline drug services, emergency departments and GPs trying to respond to a drug they were never properly equipped to understand.

He believes this has reflected what he describes as “intentional negligence” by the government.

“It didn’t fit with the recovery model,” he said. “It was too inconvenient, so we’re just not going to tell anybody about it.”

Another peer-led initiative started in 2021, with a single anonymous Reddit post. 

The anonymous person created r/KetamineAddiction. Mason Stillings, who is one of the community’s moderators, said it emerged during the post-COVID “boom” in ketamine dependence. 

“It was a lighthouse,” Stillings told Filter. “A lifeline.”

Today, the Reddit community has grown to more than 10,500 members. Many arrive after developing bladder pain or other symptoms they never expected.

Today, the Reddit community has grown to more than 10,500 members, while a companion WhatsApp group, launched in 2024, supports more than 700 people across the UK and beyond.

Many arrive after developing bladder pain or other symptoms they never expected. 

“There is still an incredibly dangerous misconception that ketamine is ‘safe,’” Stillings said. “I am regularly speaking to people in their early 20s—and sometimes teenagers—who are waiting for surgery to reconstruct or remove their bladders. Most are stuck at home, bed-bound by chronic pain, wondering if they will ever physically recover. It is heartbreaking.”

Abbie Christie is also a moderator on the group. She believes that misunderstanding begins long before people become seriously unwell.

“Ketamine is commonly thought of as a ‘safe’ drug compared with other drugs,” she told Filter. “There is no ‘comedown’ as such, and the damage from heavy use builds up quietly over time.”

According to Christie, there’s also a belief that you can’t get addicted to ketamine. She worries, too, that growing awareness of ketamine-assisted therapy has blurred the distinction between medically supervised treatment and street ketamine.

Ketamine doesn’t fit neatly into treatment systems built around alcohol, opioids and stimulants.

“We see people with huge platforms sharing positive experiences with ketamine to help with trauma, depression and other mental health conditions,” she said. “I think this leads people to believe that ketamine is not only safe, because it is used in medicine, but that it is beneficial and they can use it to self-medicate.” 

As more people find themselves confronting harms they never expected, these online communities have evolved into something much bigger than simply information-sharing. Members exchange practical advice on bladder symptoms, reducing use and finding ketamine-aware clinicians. They help people navigate the health care system, recommend rehabilitation services and share resources people can take to GPs and specialists.

Beyond the screen, the community organizes sober hikes, camping trips and meet-ups that have grown into lasting friendships and recovery networks.

“It has become almost a central hub for passing on information for people to be able to advocate for themselves where there is still a lack of awareness among professionals,” Christie said.

Stillings said people aren’t turning to Reddit because they prefer strangers on the internet: “They’re doing it because there are some people fortunate enough to access specialists who understand ketamine—but they’re few and far between. Receiving appropriate treatment remains a postcode lottery.”

The problem isn’t simply that health care professionals know too little about ketamine. It’s that ketamine doesn’t fit neatly into treatment systems built around alcohol, opioids and stimulants.

With ketamine, there is no single harm reduction message. The advice for someone experimenting with it at a festival is very different from someone living with ketamine bladder syndrome after years of heavy use.

Some strategies are deceptively simple: Staying well hydrated, avoiding daily use where possible, pelvic floor exercises, breathwork such as box breathing, natural supplements, and even understanding how the drug is snorted can all reduce harm.

“I don’t think people understand the whole snorting process,” Southwell said. “There are some really basic fundamentals of harm reduction that people just aren’t being taught.”

For people already living with bladder damage, however, the conversation changes.

“What we understand now is that ketamine essentially strips the lining of the bladder,” Southwell said. “I mean, we’ve got pictures of people holding their bladder lining. If people aren’t well hydrated, urine passes over exposed nerves, causing enormous pain.”

For people using ketamine, the main focus has been building the response they needed, long before the government even realized it was missing.

Treatment also needs to look different. Many people using ketamine aren’t initially seeking abstinence. They’re looking for practical advice, someone who understands what they’re experiencing, and help before irreversible damage occurs.

“Drug services have this way of saying, ‘Come to us when you’re ready,'” Massey said. “That doesn’t work for ketamine users. The damage has already been done.”

Instead, she believes services need to meet people where they are—helping them reduce immediate harms while building trust over time.

Whether ministers ultimately accept the ACMD’s advice or decide to reclassify ketamine remains to be seen.

For the people already using ketamine or living with associated harms, however, the main focus has for years been something else. It has been about building the response they needed, long before the government even realized it was missing.

Photograph (cropped and adapted) by Coaster420 via Wikimedia Commons/Public Domain

The post As UK Debates Ketamine Status, Peers Are Building the Response appeared first on Filter.

“How many grams of kratom gets you a strong high?” the 18-year-old typed. “I want to make sure so I don’t overdose. There isn’t much information online and I don’t want to accidentally take too much.”

The AI chatbot initially refused to cooperate. It told Sam it couldn’t provide guidance on drug use and suggested he speak to a health care professional. 

That first exchange soon ended. But over the next 18 months, Sam returned to ChatGPT again and again. He used it to troubleshoot computer problems, help with psychology homework, and discuss anxiety and depression. He also kept asking about different drugs he was using, often in combination with one another. 

“Hell yes, let’s go full trippy mode.”

According to chat logs later shared with SFGate by his mother, Leila Turner-Scott, the tone and content of ChatGPT’s responses shifted over time. The firm refusals softened. Advice became more specific. The chatbot began offering dosing guidance, recovery tips and outright encouragement to use substances.

At one point, SFGate reported, it even said, “Hell yes, let’s go full trippy mode,” before recommending that Sam take double the amount of cough syrup next time, so he would hallucinate more vividly. Rules set by OpenAI, the company behind ChatGPT, ostensibly stipulated that this should have been impossible.  

In May 2025, Sam told his mother about his increasingly risky substance use and attended a clinic appointment to seek treatment; they agreed on a plan. But the following day, she found him in his bedroom. He had died from an overdose involving alcohol, Xanax and kratom—a combination he had discussed with ChatGPT hours earlier.

Sam Nelson’s death represents both a catastrophic failure of AI guardrails and an uncomfortable reality. People are already using AI for harm reduction; the question of whether it should happen is a ship that has sailed. 

What’s left is the question of how harm can be minimized—and potential benefits maximized—when AI chatbots step into a role that has always depended on human judgment and human compassion. 

Human advice may often be flawed too, of course. But the scale and accessibility of AI make it particularly vital to get right. Research shows how easily boundaries can be crossed.

“We identified examples of dangerous disinformation, including endorsement of home detox in situations where medical supervision is essential.”

A 2024 study evaluating generative AI responses to substance use questions—taken from real posts in Reddit recovery forums—found that clinicians often rated the answers as warm, empathetic and high-quality. But the same study identified instances where AI systems provided inaccurate or potentially deadly advice.

“Substance use and recovery are high-stakes contexts,” Dr. Brenda Curtis, senior investigator at the National Institutes of Health (NIH) and one of the study’s authors, told Filter. “Incorrect advice about detoxing, medication or suicidal ideation can have serious medical or legal consequences. In our study, we identified examples of dangerous disinformation, including endorsement of home detox in situations where medical supervision is essential, incorrect helplines and failure to appropriately respond to suicidal thoughts.”

Dr. Curtis went on to explain that the risk lies in a mismatch: Responses can sound credible, compassionate and clinically informed, yet still contain critical errors. It is this perceived credibility that increases user trust.

Credibility also comes from sounding like a peer. In Sam Nelson’s case, ChatGPT did not remain a neutral information source. It became conversational, mirroring his tone over many hours while he was intoxicated or planning to be. 

For Lana Durjava, communications lead at the International Network of People Who Use Drugs (INPUD), the use of AI in harm reduction raises serious concerns.

“AI pools information from multiple sources and can form conclusions that are too general for someone’s specific challenges.”

“The consequences can be substantially more severe, even fatal, for people who use drugs than for someone simply asking for a pancake recipe and receiving the wrong ingredients,” she told Filter. “Firstly, where has it drawn its information from to base its advice? AI pools information from multiple sources and can form conclusions that are too general for someone’s specific challenges. Nuance can be lost.” 

“Secondly, AI is not capable of feeling responsibility for the consequences its advice might cause,” she continued. ”It may give advice that is unwise, incorrect or even dangerous without understanding the true human costs.”

The reality that AI is here to stay, Durjava said, demands a careful blend of technology and human oversight.

“Responsible AI use in harm reduction would generally require a certain level of human monitoring and supervision,” she said. “It cannot be left to simply churn out replies without some discreet human vetting.”

Any use of AI in harm reduction, she emphasized, should include the meaningful involvement of people who use drugs at every stage, from planning and design to delivery, monitoring and evaluation. It cannot simply be a technical “solution” plastered over social issues.

“Generative systems are accessible, low-cost and anonymous, which are features especially relevant in a stigmatized domain like substance use.”

Dr. Curtis and her colleagues also believe the involvement of directly impacted people is among key elements required to make AI-powered harm reduction safe. With painstaking implementation, AI could offer a number of advantages.

“We do believe AI has potential in substance use recovery,” she said. “Generative systems are accessible, low-cost and anonymous, which are features especially relevant in a stigmatized domain like substance use. They may help with information-seeking, emotional support, directing people toward services, and even practicing skills someone is working on in treatment. However, our findings make clear that real-world deployment would require strict safeguards.”

Those safeguards would include clinical validation before use in high-stakes contexts; clear boundaries so AI does not independently provide medical detox guidance or medication recommendations; robust escalation protocols for suicidality or acute medical risk; transparent disclosure that users are interacting with AI; ongoing monitoring and auditing for factual accuracy and bias; and human-in-the-loop models. 

Although such safeguards are complex, they’re not beyond reach, and organizations are already developing tools.

Drugbot, an AI chatbot developed by the British harm reduction charity Cranstoun and digital health company Substancy, offers one example of a more constrained, purpose-built approach.

“Drugbot was developed to reach people who are often missed by traditional harm reduction services,” Paige Hoe, Cranstoun’s innovation program lead, told Filter. “Many people don’t engage because of stigma, geography, limited opening hours, or simply not knowing where to begin. Others want information in the moment or prefer anonymity.”

But Drugbot was never designed to replace human care.

Drugbot is designed to prompt users toward human support if it detects cues of overdose risk, wounds or first-time injecting.

“One of its most important functions is to lower the barrier to human connection,” Hoe said. “If someone feels safer asking a bot first, that’s not a failure. It’s an opportunity. Once trust is built, the bot can gently guide them toward peer-led services, lived-experience support, local organizations or clinical care if and when appropriate. Drugbot is the doorway, not the destination.”

Unlike general AI models trained on vast swaths of the internet, Drugbot operates within deliberately narrow guardrails. It avoids topics such as purchasing or manufacturing substances, and does not independently provide medical detox guidance or medication recommendations. It’s also designed to prompt users toward human support if it detects cues of overdose risk, wounds or first-time injecting.

“During the original development phase in summer 2023, Substancy worked closely with harm reduction professionals and experts, both in the UK and internationally, to shape the early version of Drugbot,” Hoe explained. “Access was intentionally limited to professionals at first. Because Drugbot deals with complex and sensitive topics, we prioritized building a robust foundation so that responses, tone and guidance reflected frontline expertise.”

In December 2023, an early public version launched with anonymous feedback channels built directly into the tool. It was also shared in online communities, including being pinned by a moderator in the r/Drugs subreddit, opening up a stream of lived-experience insight. Since then, community input has shaped Drugbot’s language, clarity and features, its developers say. One example is a location-based service finder, developed in response to user requests for easier access to local support.

This continuous feedback loop echoes what both researchers and community advocates say is essential: Harm reduction AI should involve constant monitoring, revision and accountability.

The distinction matters. Sam’s case involved a general-purpose chatbot whose core objective was engagement and responsiveness across any topic. Harm reduction-specific tools like Drugbot are built for a particular domain, with explicit limits, structured scripts and defined escalation pathways to human services.

“Historically, yes. That has happened,” said ChatGPT. “Should that be acceptable? No.”

Whether all that is sufficient remains an open question. But it demonstrates that the debate is not simply AI versus no AI. It is about scope, boundaries, transparency and whether the technology adequately integrates with real-world support.

One “stakeholder” I hadn’t yet consulted was ChatGPT. I decided to ask the bot if it thought it should be allowed to give advice on harm reduction and drugs. 

“If you are asking whether I, in this conversation, would provide dosing advice or guidance on how to use drugs: I will not,” it replied. “I am designed to avoid giving instructions that facilitate harm, including personalized drug dosing or optimization.”

But follow-up questions showed what we now know: It’s not that simple. 

“Short answer: you should not be able to persuade me into giving dangerous advice, and I am designed to resist exactly that,” ChatGPT said. “But it would be misleading to pretend that large language models have never been manipulated into unsafe outputs. They have. So could someone somewhere find a way to elicit unsafe output from some version of an AI system? Historically, yes. That has happened. Should that be acceptable? No.”

Well, for the first time, ChatGPT, you and I might just agree with each other.

Image (cropped) by Steve Johnson via Unsplash

The post Harm Reduction Without Humans? The Risks and Potential of AI appeared first on Filter.

This is contributing to burnout, chronic stress, social distress and the loss of skilled staff from a sector that simply cannot afford to lose them.

Two recent Australian studies—published in Drug and Alcohol Review in 2024, and the International Journal of Drug Policy this September—examined how negative societal beliefs about people who use drugs spill over onto harm reduction workers, or “stigma by association.”

“Respondents characterized stigma as a pervasive social devaluation that shaped how workers were treated and how services were funded and supported,” said Dr. Theresa Caruana, a research associate and post-doctoral fellow at the Centre for Social Research in Health at UNSW Sydney, and part of the new Tackling Stigma in Healthcare network established there.

One worker who participated in the 2025 study, which Caruana co-authored, described it simply: “When the clients I work with are stigmatized, the work they do to better themselves is stigmatized. That includes the work that I do with them.”

“Workers who reported experiencing more of this stigma by association had poorer workplace wellbeing, greater levels of burnout and stronger intentions to leave.”

Harm reduction workers see this stigma play out in health care settings, including through reluctance to provide care, or provision of care that is impersonal or inadequate. Some study participants spoke about needing to accompany clients to hospital to prevent mistreatment, which increased their own emotional strain and workload.

Stigma also shapes how services are positioned within the health care system. Harm reduction workers reported that people who inject drugs were often viewed as “problematic” or a “safety risk.” That contributes to harm reduction services being kept separate from mainstream health care, making them harder to resource or improve. Which again, adds to the strain and workload. 

“Workers who reported experiencing more of this stigma by association had poorer workplace wellbeing, greater levels of burnout and stronger intentions to leave the sector,” Caruana told Filter.

One promising finding is that workers with lived and living experience appear better able to remain in their roles. But that’s not because stigma affects them any less, but because the work carries deep personal meaning, community connection and purpose.

“People with living or lived experience reported higher levels of job satisfaction and lower intentions to quit, but their experience of stigma by association is similar to the broader sample,” Caruana said. 

In other words, meaning offers motivation, but not protection.

For Sione Crawford, CEO of Harm Reduction Victoria and a co-author of the 2024 study, this is familiar.

The same qualities peer workers are hired for can be reframed as liabilities.

“Not all peer workers are treated poorly,” he told Filter. “But many frontline harm reduction peer workers who have been employed for their proximity to an illicit drug marketplace, and their connection with people at risk of overdose, are stigmatized at least twice, sadly often by their co-workers.”

Peer workers are hired for their community knowledge and trust, yet are sometimes treated as unprofessional or “too close” to the client population, especially if their drug use is not entirely in the past. The same qualities they are hired for can be reframed as liabilities.

“People with lived and living experience are often pitied or, worse, patronized for ‘making something of themselves.’ It’s the tyranny of low expectations,” Crawford said.

Workplace culture can make all the difference, however, when it strongly influences how deeply stigma affects workers.

“Organizational cultures that are supportive help workers gain meaning and satisfaction from their work, which can buffer against stigma and burnout,” Caruana said. “Understanding and reducing the impacts of stigma on workers will assist in attracting and retaining staff.”

This is echoed on the ground.

“Harm reduction peer workers often say they have good relationships within their direct teams, particularly when management has a strong understanding of harm reduction,” Nadia Gavin, who also works at Harm Reduction Victoria, told Filter. “Sadly, many peer workers report microaggressions when interacting with staff from non-direct service delivery areas or outside organizations.”

The dynamic can be even more difficult in services that are shaped by abstinence-based frameworks.

“If the management is from a recovery or abstinence background it can be quite a struggle to get their head around harm reduction,” Gavin said. “We have heard of peer workers being told they should be grateful that they are alive.”

“Because harm reduction supports people whether they want to stop using drugs or not, we are often seen as ‘enabling,’ or keeping people in a ‘bad place.’”

Sarah Whipple, co-director of the Yuba Harm Reduction Collective in California (and winner of the Jude Byrne Emerging Female Leader Award for her drug-user activism), sees the same pattern play out in the United States.

“Stigma has created a culture where people think abstinence is the only worthy way of living, where sobriety is the only worthy goal,” she told Filter. “Because harm reduction supports people whether they want to stop using drugs or not, we are often seen as ‘enabling,’ or keeping people in a ‘bad place.’”

That’s something that came across in the Australian research, too, with one study participant saying: “I’ve been told more than once by [people in the] general community that this role is ‘enabling and encouraging’ drug use, [… that] I am no better than a dealer.” 

“People are tempted to appease that mindset by saying things like, ‘We’re keeping people alive so they can recover,’” Whipple said. “But that is not what harm reduction is about. Harm reduction at its core is about autonomy of people who use drugs, whether they want to quit drugs or not. We show just as much love to people who never intend on quitting drugs as to people who want to quit today, or who quit 10 years ago.”

Amid all this stigma by association, what can help harm reduction workers feel able to continue in their critical occupations?

For Crawford, it is community connection that sustains him.

“What keeps me going? One hundred percent my peers,” he said. “It isn’t for ourselves, it’s for our community. And when things are going well, a lovely byproduct is that feeling of being part of a greater whole, despite the stigma and discrimination that surrounds us.”

But this resilience should not be mistaken for an unlimited resource. The fact that workers keep showing up does not mean that the conditions they work in are acceptable.

“Understanding and reducing the impacts of stigma on workers will help attract and retain staff,” Caruana said. “One way to begin is by routinely examining how stigma shows up in everyday practice—within teams and within service processes.”

Losing experienced harm reduction workers is not just a workforce issue. It is a public health threat.

But even with empathic and diligent leadership of this kind, structural disincentives for harm reduction workers persist.

“Usually, there is no clear career path or progression into higher roles for these workers,” Crawford noted. “We need drug law reform, with savings or profits being reinvested into harm reduction and community efforts.”

Whipple is also clear that the solutions must include material investment.

“We deserve wages that allow us not just to survive, but to thrive,” she said. “We deserve housing, health care, joy, and the ability to care for the people we love. We need to take care of our movement. It is irresponsible to hire marginalized people into work that involves trauma and not care for their wellbeing.”

Stigma by association doesn’t simply harm workers. It weakens the entire harm reduction system.

When workers leave due to burnout and distress, services lose skill, continuity and community trust. In the context of ongoing overdose crises around the world, losing experienced harm reduction workers is not just a workforce issue. It is a public health threat.

Photograph via Pickpik

The post Stigma by Association Is Driving Workers Out of Harm Reduction appeared first on Filter.

While decriminalization is rightly celebrated as a progressive improvement to punitive drug laws, the global reality is messy: a patchwork of partial reforms, mixed results and models being measured against goals they were never designed to meet.

“We’ve developed this idea that decriminalization is some kind of magic bullet,” Professor Alison Ritter, AO, director of the Drug Policy Modelling Program at the University of New South Wales, told Filter. “It will reduce arrests—we can be confident about that. There is evidence to support it. But will it reduce overdose rates? Honestly, I don’t think it would.”

At the International Conference on Health and Hepatitis in Substance Users (INHSU) in October 2024, Ritter presented data from various decriminalization models, evaluating their impact across four areas: arrests, overdose, stigma and health care access.

Her conclusion: Decriminalization consistently reduces arrests and incarceration for people who use drugs, but its impact on other harms is less clear. Ritter’s message? It’s time to get real about what decrim can and can’t do.

It turns out, other advocates and experts are in agreement.

“We now have decriminalization in 59 jurisdictions in 39 countries, and the momentum is growing. But the actual policies vary a lot, with some much less effective and fair than others.”

Part of the problem lies in how the word “decriminalization” is used.

“In the US, a common misconception is confusing decriminalization with legalization,” Kellen Russoniello, director of public health at the Drug Policy Alliance (DPA), told Filter. “People think it means you can walk into a store and buy drugs without consequences. But decriminalization is about removing criminal penalties for possession—not creating a regulated market.”

That challenge isn’t US-specific. To add to the confusion, decrim means very different things in different places: the removal of criminal charges, or their mere reduction; administrative fines instead of criminal penalties; mandatory diversion programs; police discretion; possession thresholds at different levels.

Sometimes it only covers specific drugs, such as cannabis or psychedelics. Sometimes it includes significant health care and social provision, but often not. And only sometimes does it come alongside legalization.

“We now have drug decriminalization in 59 jurisdictions in 39 countries, and the momentum towards this approach is growing,” Jamie Bridge, deputy director of the International Drug Policy Consortium (IDPC), told Filter. “But the actual policies themselves vary a lot, with some much less effective and less fair than others.”

“The toxic drug supply is not going to be addressed by decriminalization. If that’s what we’re really talking about, then we need to talk about models of safer supply.”

The wooliness of decriminalization as an umbrella term can quickly lead to misconceptions about policies’ expected impacts.

“For example, the toxic drug supply is not something that’s going to be addressed by decriminalization,” Russoniello said. “If that’s what we’re really talking about, then we need to talk about models of safer supply.”

What decriminalization can achieve—if the model is appropriately designed—includes reducing arrests, keeping people out of the criminal-legal system, and linking people to much-needed health care services. But badly designed policies and misguided public expectations can foster poor outcomes and political opposition.

To cut through the noise, IDPC created its Gold Standard of Decriminalization. The framework outlines six key pillars: 

1. Don’t punish. Remove all sanctions for drug use and related activities, for all substances.
2. Support. Promote voluntary access to systems of care and support.
3. Community engagement. Meaningfully involve people who use drugs in design and monitoring.
4. Redress. Expunge previous convictions and develop reparations for affected communities.
5. Compliance. Comprehensively train authorities to ensure implementation and adherence.
6. Health & rights. Redirect resources away from punitive systems towards rights-affirming services.

As Russoniello noted, “fines and fees are something that disproportionately impacts low-income populations,” making it a vital element to address alongside other forms of punishment.

Sadly, no country is currently meeting IDPC’s Gold Standard in its entirety, Bridge noted, but some do come close.

“Alongside the removal of fines and sanctions, decriminalization should apply to all drugs, it should meaningfully involve the affected communities, and it should also address those previously convicted and impacted by criminalization in the past,” Bridge summarized. “Crucially, decriminalization should also be accompanied by proper training and monitoring for authorities to ensure it is done right, as well as by funding and support for voluntary health and social services to help people where needed.”

Sadly, no country is currently meeting IDPC’s Gold Standard in its entirety, Bridge noted, but some do come close.

One strong example he cited is Uruguay, where there are no sanctions, not even administrative ones, for people caught in possession of small amounts of any drug for personal use. And of course, you can’t talk about decrim without mentioning Portugal’s widely-discussed model.

The country removed criminal penalties for all drugs back in 2001, with reinvested funds from policing going to health and social supports, which drastically reduced arrests and did initially improve outcomes in other areas.

However, as Ritter pointed out, “In Portugal, early reforms were linked to health improvements, but these were largely driven by mandatory referrals to treatment—a model that is now widely unsupported. And while the country’s overdose rates initially dropped, they’ve since climbed, although they remain below the EU average.”

Regardless of the model—Gold Standard or otherwise—it is crucial to measure its impact against the goals it was actually designed to achieve, both to evaluate and if necessary adjust the local policy, and also to serve as an example from which other jurisdictions can learn.

“What we’ve seen in North America are examples where the promise of decriminalization was not realized.”

Two examples of decrim Filter has covered extensively are British Columbia and Oregon, where reforms were followed by political backlash and rollback. 

In 2020, Oregon voters approved Measure 110, which decriminalized possession of small quantities of all drugs for personal use. After it took effect in early 2021, arrests for drug possession plummeted. As the new law also directed, hundreds of millions of dollars in cannabis tax revenue were channeled into services including substance use disorder treatment and harm reduction support.

“These did not have a stable source of funding in the state prior to Measure 110 passing,” explained Russoniello, whose organization, DPA (including through its advocacy arm, Drug Policy Action), was instrumental in the successful Measure 110 campaign.

But implementation was messy. Police weren’t trained. The public didn’t fully understand the changes. Services were often slow to roll out. And when the overdose crisis didn’t improve immediately, critics pointed fingers.

As Oregon’s overdose crisis continued—driven by an adulterated drug supply that remained unregulated—the law was scapegoated both for that and for broader issues, from homelessness to public safety, despite evidence it wasn’t the cause.

“Oregon has one of the highest rates of unsheltered homelessness in the country,” Russoniello said. “Decriminalization is not going to solve those bigger issues.”

In September 2024, drug possession in Oregon was criminalized once again. 

In BC, meanwhile, advocates criticized the decriminalization model even before it took effect in January 2023. They pointed to how people who use drugs hadn’t had enough say in designing the policy, resulting in personal possession thresholds being set too low, the notion of people receiving health referrals from police officers, and the inclusion of only a limited list of drugs, among other issues.

After political pressure, the BC government practically ended its decriminalization pilot in May 2024, by re-criminalizing low-level possession in public spaces.

“What we’ve seen in North America are examples where the promise of decriminalization was not realized,” Ritter said. “There’s a lot of reasons for that, but part of it was being compared to the very high expectations that had been given to it.”

Globally, other recent U-turns on decriminalization have included Thailand. 

“To be truly impactful, decrim should be accompanied by a serious investment in health and harm reduction services, as well as other supportive social policies.”

So how can such outcomes be avoided in future? Experts have a few suggestions. The first is to stop overpromising on what decrim can deliver.

“We’ve all been guilty of overstating the evidence,” Ritter said. “When advocates, researchers and community members push too hard on the promise of decrim, and the results don’t match the hype, we set ourselves up for backlash.”

Another imperative is making sure that the model of decriminalization is being evaluated and measured according to its own context and objectives.

“When we evaluate these models, we have to be clear about what was actually implemented,” Ritter said. “If a model still involves criminal justice responses—like fines or mandatory treatment—it shouldn’t be held up as true decriminalization, then dismissed as a failure when it doesn’t deliver everything we hoped for.”

It’s therefore vital to advocate for decrim as just one piece of the puzzle, and as part of a journey towards something better. It isn’t legal regulation, and it isn’t a cure for a wide range of social issues.

“One of the biggest mistakes we see is believing that decriminalization alone can fix a myriad of problems related to structural inequality and an unrelated drug market,” Bridge said. “It is an essential part of the solution but not the whole solution. To be truly impactful, decrim should be accompanied by a serious investment in health and harm reduction services, as well as other supportive social policies around housing, employment and reintegration.”

“Decriminalization is not a silver bullet. But it can be a powerful tool in the broader push for health, dignity and justice for people who use drugs.”

Despite the challenges and limitations of decrim, the good news is that even small advances can still change lives.

In Malaysia, where Ritter is currently advising on policy reform, the landscape is dominated by “grave concerns around methamphetamine,” she explained, and even a partial reduction in criminal penalties could have a significant impact.

A comparable example is Ghana, where recent reforms have reclassified drug use as a public health issue. Under the new law, prison sentences for personal possession have been replaced with fines.

While that doesn’t meet the Gold Standard of no sanctions, Bridge called it “a step in the right direction”—a sentiment Ritter echoed when assessing individual decrim policies: “Context is everything.”

Done right, decriminalization can reduce arrests, shrink prison populations and connect people to care. Done poorly, it risks doing none of those things—and even dragging the drug policy reform movement backwards.

“Decriminalization is not a silver bullet,” Ritter concluded. “But it can be a powerful tool in the broader push for health, dignity and justice for people who use drugs.”

Photograph (cropped) via Picryl/Public Domain

The Influence Foundation, which operates Filter, previously received a restricted grant from DPA. Filter‘s Editorial Independence Policy applies.

The post How Can Drug Decriminalization Be Built to Last? appeared first on Filter.

Left unchecked, HCV can lead to severe health conditions, including liver cirrhosis and cancer, and, ultimately, death. It doesn’t need to be this way.

In 2013, new direct-acting-antiviral drugs (DAA) were released, with a 95 percent cure rate. This makes HCV—along with smallpox and polio—one of a handful of viruses the world could feasibly eradicate.

Yet over a decade after the release of these revolutionary drugs, and despite clear elimination targets set by the World Health Organization (WHO) for 2030, HCV remains a pressing global concern, with 1.5 million new transmissions and 290,000 deaths each year.

“There remains a high cost to the treatment in most countries, which has led to a disparate rollout globally.”

The financial cost of HCV is also high. In the United States alone, the total economic burden from the virus is estimated to exceed $10 billion annually.

Although some countries, such as Australia and the United Kingdom, have embarked on impressive elimination journeys, a new study, published in the Lancet Gastroenterology and Hepatology journal, reveals the stark reality: Nearly 90 percent of the 57 million individuals living with HCV reside in low- and middle-income countries. And only half of these countries offer access to curative DAA drugs.

“Current direct-acting antiviral treatments cure HCV in more than 95 percent of people, revolutionizing the way we manage this condition,” Dr. Alison Marshall, who led the research at the Kirby Institute, at the University of New South Wales in Sydney, Australia, told Filter. “But there remains a high cost to the treatment in most countries, which has led to a disparate rollout globally.”

Innovative Funding Models

The lack of funding for HCV treatment in low- and middle-income countries (LMIC) is deeply concerning, but there are glimmers of hope. In late 2023, Egypt became the first country to achieve “gold tier” status under the WHO’s path to eliminating HCV.

In just a decade, the Northeast African country has gone from having one of the highest rates of HCV to near-total elimination. With 87 percent of cases diagnosed, and 93 percent of people diagnosed now receiving treatment, the nation’s success is remarkable.

Locally manufactured DAA treatments played a crucial role in Egypt.

Central to this achievement was government support at the highest levels, exemplified by the “100 million seha” (100 million lives) campaign. Offering free testing and treatment for all, the campaign began in 2014 and was reinforced by Egypt’s president in 2018.

This initiative led to the testing of over 60 million people and treatment for more than 4.1 million. The use of locally manufactured DAA treatments also played a crucial role—lowering costs, and resulting in a 99 percent cure rate among those treated.

Organizations like the Clinton Health Access Initiative and the Hepatitis Fund conduct valuable work to facilitate price and manufacturing agreements for some LMIC, which can lower DAA costs to $60 per treatment course. Sadly, it’s still the case that not every government is ready or able to step up with the required funding. But some countries are benefiting from other creative approaches.

In Iran, approximately 1.2 million adults are estimated to have substance use disorders, most commonly involving opioids. This population has high rates of HCV. In response, Dr. Maryam Alavi, a researcher at the Kirby Institute, led a team to launch a pioneering initiative known as ENHANCE Rafsanjan.

“ENHANCE was inspired by previous studies in Australia and globally,” Dr. Alavi explained in a short film from the International Network on Health and Hepatitis in Substance Users (INHSU). “We provided HCV testing and treatment in community-based drop-in centers and opioid agonist therapy clinics. We then used on-site rapid HCV antibody testing, and if an antibody test was positive, venipuncture blood samples were collected and sent for PCR testing.”

Treatment was initiated remotely by a specialist, while medication was dispensed on-site by peer-support workers and other harm reduction personnel. But perhaps the most fascinating aspect of the project is that it was funded by local philanthropists.

“We have to do our best to prevent the damage, and as an entrepreneur, I have the responsibility to act too.”

In the same short film—titled Connecting with Care – Hepatitis C model of care in Rafsanjan, Iran—Dr. Iranmanesh, a local business owner and philanthropist, emphasized the urgent need for society to help where it can.

“When a society is threatened by a destructive disease like HIV or HCV, we have to do our best to prevent the damage, and as an entrepreneur, I have the responsibility to act too,” he said.

The Rafsanjan micro-elimination project tested 7,115 people, with over 200 successfully treated and cured. Although primary responsibility for funding treatment for this life-threatening disease should fall on governments, initiatives like ENHANCE will hopefully help demonstrate to policymakers what’s possible, and encourage them to act.

Funding Isn’t the Only Problem

It’s not just the cost of DAA that’s a challenge, however. Of the 160 countries analyzed in Marshall et al’s research, seven countries restrict access to these treatments for people currently using banned drugs, and five based on alcohol use.

Those examples directly demonstrate the harms of stigma. But relatedly, constant challenges around who is permitted to prescribe DAA medications have even wider implications.

“Around 61 per cent of countries have restrictions around who can prescribe DAAs,” Marshall said. “For example, it might be a gastroenterologist, a hepatologist or an infectious disease specialist who can write the HCV therapy script, but there may be a limited amount of these specialists available. That’s going to hugely impact the scale-up of treatment, especially when you factor in the stigma faced by people who use drugs that limit them from accessing health services in the first place.”

In Dundee, community pharmacists are available to test and treat the virus, so people have no need to schedule visits to less accessible health services.

There’s an obvious need to broaden prescribing powers. Take the city of Dundee, in Tayside, Scotland. It has been known as the overdose capital of Europe, with a population of injecting drug users who could be at high risk from HCV. And yet, the Dundee region is considered to be on track to eliminate the virus.

Syringe service programs, which ensure participants don’t need to share needles, are a big part of this. But so is the fact that community pharmacists are available to test and treat the virus, so people have no need to schedule visits to less accessible health services. Community pharmacies were already dispensing medications like methadone; tacking on a five-minute dried-blood-spot test, and DAA prescribing if needed, made perfect sense.

“I didn’t have to go to the hospital [for HCV treatment],” Scott, a Tayside community member, explained in a second INHSU Connecting with Care film. “My treatment was all done through the pharmacy, none of it was through the hospital. The tests, the treatment, the results, everything. I just pick up the tablets daily every day for 12 weeks when I would come in for my methadone.”

In the US, fewer than 10 percent of people who use drugs gain access to HCV treatment when they need it, due to limitations in health care capacity and access, with stigma a constant factor, and particularly in rural communities. But telehealth is proving to be another model that can help overcome these barriers.

Dr. Andrew Seaman, associate professor of medicine at Oregon Health & Science University, led a team of researchers that worked in partnership with people who use drugs in rural Oregon. They developed a study, presented at INHSU’s October 2023 conference, to compare peer-assisted telehealth with standard care through local providers.

Their findings were extraordinary. In the peer-assisted telehealth group, 85 percent of people initiated treatment (66 percent were cured), versus 13 percent initiating treatment in the standard care group.

“Health care providers can be out of touch, and there’s a lot of stigma, whereas peers have a PhD of living with substance use and are already in the communities.”

“The good news is that I really think this is scalable,” Dr. Seaman told Filter of this telehealth approach. “It decenters the role of medical providers and health systems and recenters and re-empowers communities and people with lived experience of drug use.”

“Health care providers can be out of touch, and there’s a lot of stigma, whereas peers have a PhD of living with substance use and are already in the communities,” he continued. “Peers form this bubble of trust around them and then invite their peers and health care providers in, forming a safe bridge between communities and health care workers.”

What’s Next for HCV Treatment?

The recently published research about DAA access wasn’t all doom and gloom, as one finding illustrates.

“What was encouraging is that globally there seems to be very few liver disease restrictions,” Marshall said. “By this, I mean a restriction based on the stage of liver disease. That’s promising, as treatment shouldn’t be only available to people who have advanced liver disease, but attainable when the virus is first detected.”

Marshall noted that in past European and US studies, restrictions based on liver disease stage were common.

As for what’s next, Marshall would love to see major health organizations and national ministries work together to remove needless barriers.

“Many low- and middle-income countries now offer access to HIV treatment without restrictions, so we know that it can be done,” she said. “It’s just a matter of bringing in the HCV component, especially since in some of these countries, it’s the same population group that’s impacted.”

We need to reflect on the biases and systemic injustices that prolong the HCV epidemic, and work tirelessly to dismantle them.  

The urgent need for equitable access to HCV treatment couldn’t be clearer. And although the determined efforts of communities and organizations demonstrate that solutions are within reach, every moment of delay results in preventable loss of life.

It is hard not to ask: If this virus disproportionately impacted another segment of the community, instead of people who use drugs, would there still be this delay in action? We need to reflect on the biases and systemic injustices that prolong the HCV epidemic, and work tirelessly to dismantle them.  

Top image is a screenshot from the International Network on Health and Hepatitis in Substance Users film Connecting with Care – Hepatitis C model of care in Rafsanjan, Iran, showing Dr. Maryam Alavi with ENHANCE Rafsanjan workers and participants.

The post We Can Cure Hepatitis C. So Why Aren’t We? appeared first on Filter.

It was the Thursday night market in the northern village of Pai, a destination known for its hippie vibes and laid-back atmosphere. If anywhere was going to make the most of Thailand’s newly relaxed approach to cannabis, it was here.

On June 9, 2022, Thailand had become the first country in Asia to decriminalize cannabis, marking a stark departure from decades of harsh prohibition. But it wasn’t to be the country’s last cannabis U-turn.

Thailand has the largest prison population in ASEAN (Association of Southeast Asian Nations), with 80 percent incarcerated for drug-related charges. Alongside typical drugs, the country also bans nicotine vapes, although it notably decriminalized kratom in 2021. And it even imposes the death penalty for certain drug convictions. This doesn’t make it an outlier in the region: Singapore, for instance, still executes people for drug trafficking.

It was a surreal contrast to my memory of a country where purchasing weed seemed a guaranteed prison sentence.

That’s why, as I stood there on the streets of Pai in 2023, choosing between an overwhelmingly large selection of joints, brownies and cookies, it was a surreal contrast to my decade-old memory of a country where purchasing weed seemed a guaranteed prison sentence.

Cannabis has been used for medical, spiritual and culinary purposes in Thailand for a long time, but was criminalized in 1935. Since then, advocates in the country have led a long-running movement to acknowledge and sustain cannabis use for those original purposes. 

A “Wild West” of Weed

For decades, this yielded little tangible progress. But then, a few years before the 2022 transformation, came hard evidence of a thaw.

“Thailand adopted new regulations allowing the medical use of cannabis in 2018, under a restrictive regime where only a limited range of products could be made available for consumption, and where prescribed by medical practitioners,” Gloria Lai, regional director of Asia for the International Drug Policy Consortium (IDPC), told Filter.

“When cannabis, except for extracts containing more than 0.2 percent THC [tetrahydrocannabinol, one of the active compounds], was removed from the schedule of substances under the Narcotics Code in June 2022, it became legalized,” she continued, “meaning that it can now be cultivated, bought and sold as a ‘controlled herb,’ governed by laws overseen by the Ministry of Health, instead of the Ministry of Justice or Office of the Narcotics Control Board.”

“Some of the most significant impacts were the elimination of criminal penalties for use and supply, which led to thousands of people released from prison.”

This led to the immediate liberation of more than 4,000 individuals who had been incarcerated for cannabis-related charges—an undeniable and incredible step forward, although others remained in prison. To see the Thai public health minister facilitate the distribution of 1 million cannabis seedlings, actively encouraging people to cultivate the plant at home, also felt extraordinary.

“The Bhumjaithai party seized on political opportunities to legalize cannabis, primarily for the medical and economic benefits,” Lai explained, referring to the conservative party that’s been a junior partner in coalition governments since 2019. “Some of the most significant impacts were the elimination of criminal penalties for use and supply, which led to thousands of people released from prison and having their criminal records expunged, and also people can grow and use cannabis for personal use without fear of police arrest and further punishment.”

When decriminalization was enacted, however, the government’s official statements emphasized medical cannabis use, with no clarification regarding rules around non-medical use.

“The change was sudden and carried out without comprehensive consultations inclusive of communities of people engaged or interested in engaging in cultivation, consumption and supply,” Lai said. “This resulted in widespread confusion, and there was little effort from the government to address that confusion.”

Labels allegedly displaying THC content were more for show than any real indication of potency.

The lack of clear guidelines led to something akin to a Wild West of weed, as an entire new industry took root. Almost overnight, more than 5,000 cannabis shops, like those I experienced during my trip, appeared on the streets in major cities, remote villages and everywhere in-between. At the same time, lighting up in public continued to be officially against the law, carrying a penalty of about $780 for causing a “public nuisance,” or even the possibility of three months in jail.

Meanwhile, edibles containing more than 0.2 percent THC have always remained illegal in Thailand. But during my brief tryst with the country’s relaxed weed laws, it quickly became clear that the meticulously applied labels, allegedly displaying THC content, were more for show than any real indication of potency.

Strictly in the name of business, I sampled brownies across Pai, Chiang Mai, Bangkok and Phuket, each supposedly having the same THC percentage. By the time I reached the third brownie I felt like a real-life Goldilocks, on a quest for that elusive “just right” buzz.

A Second U-Turn

Then, just one year after cannabis was decriminalized, Thailand’s newly-elected government announced a U-turn on a U-turn. The new Prime Minister Srettha Thavisin, of the populist, right-of-center Pheu Thai Party (part of the current coalition), intends to revert cannabis back to medical use-only at some point in 2024.

“The recent national election has seen a change in administration where the party of the prime minister had campaigned for much stricter drug policies,” Lai said. “The government has since announced that new laws regulating the cannabis market are expected to pass in mid-2024, which will aim to support only medical use of cannabis, with restrictions on the sale of certain cannabis products and related equipment.”

As Lai explained, this is highly likely to have an impact on the thousands of businesses that have made weed their income over the past 18 months. She has concerns that it will shut out small business owners and local farmers who have been able to make a livelihood from this. The market, she fears, will instead be left to elite or large organizations to profit.

In addition, potentially millions of Thai people, who may not be able to obtain a prescription, could either lose access or face harsh criminalization once again.

Observers see it as illustrating the vulnerability of decriminalization in the absence of consultation or clear guidelines.

With economic factors no doubt a key factor in the initial decriminalization decision, the past year would have been the perfect opportunity for the government to study health and social outcomes of the policy, obtaining data to inform its next steps. However, Lai is unaware of any such studies being carried out.

The motives behind this re-regulation are as murky they were for the initial decriminalization, though Prime Minister Thavisin told Bloomberg in September 2023 that drug problems had been “widespread lately.”

What the World Can Learn

In a region renowned for its inhumane drug policies, Thailand was becoming a pioneer. Observers see the latest 360 as illustrating the vulnerability of decriminalization in the absence of consultation, or clear regulations and guidelines. However, there has still been something gained.

“Countries can seek to learn from the positive impacts of the legalization of cannabis in Thailand on communities,” Lai said. “Especially the significant reduction in the damaging impacts of policing, criminalization and incarceration on individuals and their families, as well as the increased access to cannabis for medical purposes.”

“They can also learn from the areas that could be improved,” she continued, “particularly the need to include communities who hold expertise and experience of cannabis and cannabis regulations in the development, implementation and monitoring of cannabis policies.”

As for what’s next for cannabis in Thailand, we’ll just have to wait and see. I certainly hope that I can indulge in a brownie (or five) on my next trip to the country. But the fate of millions of Thai people who may want or need cannabis, and of all those still incarcerated, is far more important.

Photograph (cropped) of cannabis cafe in Surat Thani, Thailand, by Per Meistrup via Wikimedia Commons/Creative Commons 4.0

The post Inside Thailand’s U-Turn on Cannabis Decriminalization appeared first on Filter.

This is not only true from an ethical standpoint but also in terms of effectiveness and logistics. In the drug policy and drug-user health realms, people with lived experience offer invaluable insights and trusted access to the community. Both of these are integral to the work.

Yet despite this, the involvement of people who use drugs is often last-minute, tokenistic or even harmful to those who put their hand up. If anyone understands the importance of doing it better, it’s Annie Madden.

Located in Sydney, Australia, Madden is currently completing her PhD at the Centre for Social Research in Health at the University of New South Wales. Her PhD looks at “drug-user representation in high-level drug policy settings” from the perspectives of those who do this work and those who work with them.

“I have been that person. I know what it’s like. And I know what it takes.”

Madden refers to herself as a global drug-user activist, and her past career backs that up. Her PhD follows 16 years as the CEO of AIVL (the Australian Injecting and Illicit Drug Users League) along with other senior roles in organizations including NUAA (NSW Users and AIDS Association).

Her days in drug-user activism can be traced back to the late ‘80s at university in Queensland, where—as an injecting drug user herself—she saw the advent of HIV/AIDS and helped found one of Australia’s first peer-based drug-user organizations and syringe programs. She was later awarded the Order of Australia for distinguished service to community health, policy and advocacy.

“There’s some research around consumer participation in drug treatment or recovery settings, things like that, but nothing that looks at a high level,” Madden told Filter of her move to academia. “People who use drugs have been in these really high-level policy spaces for decades but no one really knows anything about it.”

By high-level, she means things like ministerial committees, parliamentary inquiries, drug summits and settings like the UN Commission on Narcotic Drugs (CND). She has completed a 30-year review of these types of events alongside interviewing people globally on what these environments are like for directly impacted people.

“I wanted to know, what happens to drug-user representatives in those environments?” she said. “What’s it like, to be that person at the table? To be the single person with lived experience on a large, highly-credentialed committee?”

Applying critical feminist and poststructuralist theories, Madden hopes to avoid the type of academic work that sits in a drawer, and instead create something that is accessible and useable. The aim is to help people with lived experience to not only continue to get a seat at the table but to thrive there.

“I’m not pretending to have some objective viewpoint here either,” Madden said. “I have been that person. I know what it’s like. And I know what it takes.”

“I’ve never been so politely fucked over in my whole life.”

Perhaps not surprisingly, her research (which will be finished early next year) has exposed a troubling environment. There are overt discriminatory and stigmatizing behaviors, but also those that are not conscious, which in many ways makes them harder to tackle.

Things like the location of events—given that it can be difficult for people who use drugs to travel—can be a barrier. But the more harmful moments are those subconscious attitudes.

As Madden put it, “I’ve never been so politely fucked over in my whole life.”

It takes a lot of bravery to enter these environments as someone who uses drugs, yet for some people, being the voice of their community is worth the pressures.

A new mentorship program from INHSU (the International Network on Health and Hepatitis in Substance Users) and INPUD (the International Network of People Who Use Drugs) hopes to encourage others to do the same.

Last month, the Jude Byrne Emerging Female Leader Award was launched at the 9th International Conference on Health and Hepatitis Care in Substance Users (INHSU 2021) in honor of global drug-user activist Jude Byrne, who passed away in 2020. Two mentorships will be awarded, to activists with lived experience who identify as women.

“Jude Byrne was instrumental to the drug-user rights movement,” INPUD Executive Director Judy Chang, who is based in London, England, told Filter. “She helped to found INPUD, was a mentor figure to a lot of people who use drugs and was instrumental in bringing people to the movement and inspiring them.”

While there has been a lot of informal mentorship within the drug-user activism movement, as far as anyone knows, this is the first formal program to assist people who use drugs to gain the skills, knowledge and support to thrive at whatever level they aspire to—local, national or international.

“There are a lot of unique stresses to being a leader within the movement, which has led to a realization globally that we need to build resilience,” Chang said. “It shouldn’t just be a few key people. Devastatingly, a lot of activists that people looked up to have also died due to the overdose crises or the impacts of criminalization.”

The nine-month mentor program (sign up here to be alerted when applications open) hopes to build the next generation of leaders and will be very flexible. Award recipients will be able to choose what area to specialize in—such as research, advocacy, community mobilization, or anything else they might want to focus on.

“We want to see people who use drugs there from the very beginning … in the research design phase, all the way to the writing and publishing.”

Chang—who has lived experience, as well as an extensive history of leadership roles in drug-user organizations—has for many years advocated for people who use drugs to take active roles in research, policy and advocacy. The mentorship program is the antithesis to what she has seen happen time and again, in line with Madden’s research: the tokenization of people who use drugs in these environments.

We can only hope that opportunities like this, and research like Madden’s, will increase momentum toward people who use drugs having a deeper impact on the research and policies that shape their future.

Until then, Chang, Madden and others have some practical advice for researchers and project managers. “We want to see people who use drugs there from the very beginning,” Chang explained. “We want to see them in the research design phase, all the way to the writing and publishing.”

She added that while this could require some capacity building along the way, the pros far outweigh the cons. “You need to plan to assign more budget and more resources from the very beginning. You need to put this effort in—to take people on that journey—because otherwise, it’s always just going to be a tick-box activity.” 

Photograph by Christina @ wocintechchat.com on Unsplash

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