Hornets and hummingbirds and other buzzy things with wings are energy movers, keeping the flow going. Cats are interdimensional travelers who bear secret messages of the multiverse if you learn how to listen. All those 20-something white boys who look and act alike were actually grown in a lab. Lady bluehair who glared me down on the bus that one time, the whole way to the Port Authority, just because I tripped on her shoe, she’s probably still sitting around thinking how much she loathes me. And that guy I like who didn’t text me back for three days… Wait, no; even then, I knew better than to go down the rabbit hole of that storyline. 

Point being, forget New York; my mind was the city that never sleeps.

Until ketamine. 

I wasn’t taking it for that purpose. I also wasn’t taking it just to get high, though I have in the past. On the particular occasion when ketamine first taught me how to quiet my thoughts, I was taking it to help me get off buprenorphine.

I didn’t have a bupe prescription and was winging it at home with a regimen of illicitly hoarded supply.

Buprenorphine, the main ingredient in Suboxone and Subutex, is a partial opioid agonist prescribed to mitigate withdrawal and reduce cravings in people who are addicted to opioids. Ketamine is a dissociative anesthetic with psychedelic properties that is commonly used in veterinary medicine. It has more recently begun to be prescribed for the treatment of various mental health conditions. 

I’d been on and off buprenorphine for several years to treat what was then a recurring addiction to heroin and fentanyl. But at the time I first tried ketamine to help minimize withdrawal, I didn’t have a bupe prescription and was winging it at home with a regimen of illicitly hoarded supply.

The reason for that? The abysmal state of addiction care in the United States, overrun by abstinence-based modalities that rely on punishment as enforcement and an obsession with watching patients urinate, left me unwilling to ever set foot in a medical establishment again. As proof of my resolve, I still have part of a needle in my thigh that broke off when I was injecting three years ago. 

When I decided to get off fentanyl in January 2021, I relied on buprenorphine I’d stashed from my last script. Which meant my supply was limited. Over the course of about eight months, I tapered myself down to a quarter-milligram of buprenorphine and jumped off from there. A therapeutic dose of buprenorphine ranges between 8 and 24 milligrams, so a quarter-milligram is low. But buprenorphine is a powerful chemical. There would still be withdrawal.

That’s where ketamine came in.

Even when I first began injecting heroin 10 years earlier, I’d heard from fellow users that ketamine could be used to dampen the symptoms of withdrawal, but it wasn’t something I’d ever much looked into. At the time, I was using opioids to put distance between myself and the PTSD, which I developed as the result of a physically and sexually abusive relationship when I was a teenager. I wanted to get away from the overwhelming feelings and memories. A psychedelic experience sounded like the last thing I needed.

Turns out, I was really wrong about that.

Ketamine is a Schedule III drug in the United States, which means it is considered to have “moderate to low potential for physical and psychological dependence” or “abuse,” and can be legally prescribed by licensed physicians. Currently, ketamine is FDA–approved for anesthesia, while Spravato (esketamine)—a ketamine-derived nasal spray formulation—is approved for treatment-resistant depression. But physicians are also able to prescribe ketamine for off-label uses. In some cases, that includes substance use disorders (SUD).

“I worked in conventional treatment models for eight years, I was the clinical director of a residential treatment center … [but] I got frustrated with relapse rates,” Craig Salerno, a psychotherapist with a practice in Boulder, Colorado, told Filter. He now provides counseling services for ketamine patients. “When I moved to private practice and started using psychedelics in the healing and recovery of addiction … it was super effective. I am seeing great results. It’s been pretty magical.”

In Salerno’s practice, oral ketamine lozenges are prescribed by a doctor and self-administered by the patient during a therapy session. This, according to Salerno, can help give patients perspective on their addiction and deeper understanding about issues they may be struggling with. 

“[Clients use] the altered state and ketamine experience to do deep work and get new angles … Even if we don’t do therapy, ketamine tends to instigate spiritual experiences and shift perspectives,” Salerno said.

More commonly, ketamine is prescribed for treatment-resistant depression.

“Successful treatment is when people’s emotions become appropriate for the world around them. Nothing about ketamine makes you feel good when you wake up in the morning. It makes you feel ‘normal.’”

“Well over 90 percent of all medical research for ketamine has focused on depression, bipolar disorder or suicidal thinking,” Dr. Nicolas Grundmann, medical director of New York-based ketamine treatment provider Ember Health, told Filter. Ember Health gives patients with depressive disorders intravenous infusions of ketamine.

“What’s important to tease apart is that most people dealing with depression also deal with something else like trauma, substance use, etc, and those clients are perfectly appropriate to proceed with care,” Grundmann said. But he noted that the vast majority of research around ketamine for mental health has not focused on conditions like SUD or PTSD.

Studies have shown, he continued, that over a certain number of visits, IV ketamine “triggers a regrowth of neurons in the emotional reward system of the brain, and triggers what feels like a reset of the person’s emotional reward system.” 

“Successful treatment is when people’s emotions become appropriate for the world around them,” Grundmann said. “Nothing about ketamine makes you feel good when you wake up in the morning. It makes you feel ‘normal.’”

Some studies have shown initial promise for ketamine as a substance use disorder treatment. More research would be welcome, but there appears at least to be a strong evidence base that ketamine is helpful for many of the issues faced by people with SUD, including myself. 

Of course, I did not have access to a ketamine prescription. Even if I had sought one, I would have been unlikely to get it to aid in buprenorphine withdrawal—despite some evidence that ketamine is effective at reducing the intensity of opioid withdrawal. Even Salerno admitted that SUD patients typically have to detox in order to get their script, prior to coming to him for ketamine therapy.

My ketamine experience was therefore likely very different from those of Salerno and Grundmann’s patients. I had to use a non-medical-grade, illicit-market supply that I dosed out myself and put up my nose. Which, I gotta admit, was kinda fun.

Achieving that feeling was also quite the feat. There’s nothing fun about opioid withdrawal. Even withdrawing from a low dose of buprenorphine involves chills, restlessness, insomnia, anxiety and a general sense of ennui—still a considerably milder experience than withdrawal from heroin or fentanyl. 

Without a prescription, prescriber, or any kind of guidebook besides the general street advice that “ketamine helps,” I didn’t know how often to dose, or how much. I basically just did a line whenever those symptoms started to get too uncomfortable. 

And then, before long, the feeling that I wanted to crawl out of my skin was replaced by the sensation that I was a note in the song that was playing on my phone, a note in the song of my life, of the universe. My body felt numb and peaceful and undisturbed, but I could still feel myself. Which made me acutely aware that my “self” wasn’t my body. There was another part of me, a flowing, tingly energy that existed both within and beyond the opioid-dependent body laying in the bed. I felt my connection to everything, like my energy had become elastic, winding and stretching across my surroundings. I felt that I was someone powerful, whose place on this planet actually mattered. I hadn’t felt that in a long time. Maybe never. 

Eventually, the stories stopped entirely. The visions, the background noise, that interminable negative storytelling, all of it.

The stories didn’t stop right away, but the ones that came to me were a lot of fun. I saw strange, brilliant flowers growing in stacks on a planet populated by humanoid cat people who communicated telepathically using gold crowns that hung over their foreheads. I saw a glowing carnival populated by blue-skinned magicians and many-armed dancers. At one point, the room around me dissolved into an electronic grid of symbols, like a scene from The Matrix, except that instead of binary, the symbols were some kind of intricate, alien language.

Several months later, a friend would describe having almost the exact same vision during an ayahuasca ceremony. Maybe that’s a real place. Maybe they all are.

Eventually, the stories stopped entirely. The visions, the background noise, that interminable negative storytelling, all of it. Leaving me with just peace.

That didn’t last forever, but the impacts on my life have continued ever since. Ketamine brought me from a place of pain and unease to a place of connection and calm. It gave me access to the space between my thoughts, and helped build a roadmap toward that place again—something I still use now, a year removed from buprenorphine and almost two years off IV opioids. It quieted the stories in my mind that tormented me, and opened doors to new stories. 

It was certainly not a cure for any of the mental health issues that led to my addiction, but it opened something necessary within me, and helped get me through the pain of withdrawal without opioid cravings or returning to use. 

I won’t credit ketamine with all the immense changes that have taken place within myself over the past two years, arguably the biggest of which is that I never experience opioid cravings. In the past when I had periods of sobriety, they were always heavy with the desire to use again at some point. I would have to use thought exercises like “playing through the tape,” reminding myself that opioids are unmanageable for me and eventually lead to chaos, addiction and withdrawal. Now, I just don’t want to feel the effects of heroin anymore.   

There have been much bigger contributors to that than ketamine. But it was certainly a medicine that acted as a stepping stone. For that, I will be forever grateful.

Photograph by Ajay Karpur via Unsplash

The post I Used Ketamine for Buprenorphine Withdrawal; It Gave Me Peace of Mind appeared first on Filter.

This is the opening line for the trailer to Four Good Days, a movie about addiction recovery set to release this spring. It’s a telling choice of statistic, considering that it’s completely fabricated. 

Even if we forgive the clumsy semantics and assume the silver-bearded doctor means to say the rate for people with opioid use disorder (OUD) is 97 percent, we still have to ask: What population is this referencing? What time frame? And under what, if any, treatment model? 

We know people with OUD can have very good outcomes when they have reliable access to methadone or buprenorphine—certainly much higher than 3 percent. While other methods like forced abstinence and detox have a comparatively high failure rate, that shouldn’t factor into the math for someone voluntarily seeking treatment. 

But judging by the trailer, that’s only the beginning of the movie’s reliance on stigmatizing hyperbole to depict opioid addiction and recovery.

As the doctor speaks, the camera pans over to the pair sitting in his office. Many viewers will easily identify Glenn Close, but Mila Kunis, playing Close’s daughter Molly, is almost unrecognizable. She’s skeletal, with sunken cheeks and bleach-fried hair. Her scab-covered face is pallid except for dark red circles around her eyes. When she opens her mouth to ask the doctor whether the medication he’s prescribing—naltrexone—is safe, we get a strategic glimpse of missing and rotted teeth. 

The film has already been dubbed a “sensitive addiction drama” that would “compassionately approach and strive to understand both addicts, and those who love them.” 

“It is really fun to do something so outside the norm,” Kunis told Deadline. “When you go see the best special effects guy, who makes the most beautiful meth teeth, it sounds so weird to say, but you put it on, and you’re like, ‘Well, this is fun to play with.’ Then, you have to be able to teach yourself to speak with this mouth, and not sound like you’re lisping,” 

Kunis, who nonetheless lisps her way through the trailer and appears to struggle to close her mouth, has inadvertently identified one of the film’s myriad false and problematic tropes: “Meth teeth,” which as many actual users of meth could tell you is an inaccurate stereotype.

Tooth decay is popularly associated with both methamphetamine and the prescription medication for opioid use disorder (MOUD) methadone. But in reality, dental issues arise from lack of access to dental care—one of many side effects of being poor in the United States. Maybe we should be calling it “lack of access to socialized health care mouth.”

“That’s the part that irritated me the most out of all of this, because I have messed up teeth,” said Megan, a video game tester from Oceanside, California, who asked to be identified by their first name only.

Megan is in methadone-based recovery from opioid addiction, but doesn’t attribute their tooth decay to drug use. “It’s from genetics and depression and poor self-care during depressive periods,” she said. “[Kunis] is saying she’s having fun putting on ‘meth teeth,’ but she can take them off. It’s not fun. It sucks, [and] it sucks to hear someone make jokes about that.”

“The people that come into the methadone clinic where I go, they all look like they’re ready to go to work.”

Like Kunis’s words, her character’s appearance displays a lack of empathy for the very population of whom she is supposedly providing a compassionate view. Variety described her appearance as a “gruesome vision” and a “living-dead specimen.” That’s not actually what most people who use drugs look like—even those whose use is chaotic.

“The people that come into the methadone clinic where I go, they all look like they’re ready to go to work, even the ones that are there to get their first dose,” Megan said. “Some of them may look a little tired because it’s early in the morning, but it’s very rare to see anyone that looks like they are coming out [of] a zombie movie.”

Four Good Days is based on a true story, detailed in a 2016 Washington Post article with a mixture of vivid narration and stigmatizing language. That article included photos of the real person, Amanda, whom Kunis portrayed in the movie. But in the photos, Amanda looks nothing like her cinematic counterpart.

She’s not emaciated. Her hair is long and lustrous. We don’t see her teeth, but her skin is clear. If the photos hadn’t accompanied an article about her struggles with recovery, they wouldn’t overtly suggest she used drugs at all, apart from cigarettes. 

The conflation of drug users with “zombies” fuels a long-standing stereotype that people who use drugs are incapable of self-agency. That they are half-dead, self-harming monsters who lie and steal and manipulate to get their next fix—the only thing they care about. That this behavior is why they need to be locked away in prison, or at least rehab, and why their children need to be taken away. 

Of course, there are people who use drugs whose behaviors are problematic. That’s also true of plenty of people who don’t use drugs. When we continuously see images of people who use drugs and people with substance use disorders that show them exclusively as the worst possible specimens of humanity, we forget that people who use drugs are everywhere, and of no better or worse character than anyone else. 

A Problematic Focus on Naltrexone

It is egregious and unethical that Four Good Days makes no mention of the existence of methadone or buprenorphine. The specific MOUD touted in the movie (though it never actually mentions it by name) is the least evidence-based of the three most commonly used in the United States: naltrexone (brand name Vivitrol). 

Vivitrol is an opioid antagonist, delivered as an injection that lasts about a month. Induction protocols usually involve giving patients a shorter-acting naltrexone tablet to ensure they don’t have a negative reaction, but once the shot goes in, patients can’t undo it—even if they change their mind, or become injured enough to need opioids for pain relief. It works by blocking the effects of other opioids—similar to buprenorphine, another MOUD with a more robust evidence base.

But unlike buprenorphine, naltrexone is not also an opioid agonist, meaning it does not help with cravings or withdrawal. And it requires at least a week of opioid abstinence before it can be used—hence the premise of the film, which takes place when Kunis’s character has four days until her induction. 

Because of the high-barrier induction requirements, naltrexone can be more difficult to begin using than methadone or buprenorphine. People who use naltrexone can—and do—still overdose if they attempt to circumvent its blocking effects, or if they use again after its effects wear off.

In 2019, the Food and Drug Administration issued a warning letter to Alkermes, the manufacturer of Vivitrol, for failing to adequately inform the public about the overdose risk associated with the medication. It remains the MOUD of choice for law enforcement and criminal justice programs, including correctional facilities and drug courts.

“In the trailer, it was just so focused on Vivitrol [and] that makes me nervous,” said Rory O’Brien, the digital communications director at Students for Sensible Drug Policy. “It’s just more marketing for Vivitrol, and because it’s pitched as being ‘non-addictive,’ it’s going to be really appealing to, maybe not necessarily to people who want to stop using opioids, but [to] those parents watching it and people who are on the more paternalistic side.”

“There’s a lot of hesitancy for people of color to tell their stories—especially if they are still using drugs.”

Kunis’s character’s race and upbringing are highly relevant. Although Black people in the US are overdosing at higher rates than their white counterparts (despite both populations using at around the same rate), Black people and other people of color have markedly less access to evidence-based treatment. They are also disproportionately subject to incarceration and the foster system. But if we were to gauge our understanding of addiction and recovery solely by what we see on film, we would think it’s a white, middle-class problem.

Four Good Days exists because a white family impacted by addiction felt safe sharing their experience on a national platform. “There’s a lot of hesitancy for people of color to tell their stories—especially if they are still using drugs,” O’Brien said. “It’s a privilege to be able to tell your story. Some people just don’t have that ability because [their story] can be weaponized, especially … if you’ve been formerly incarcerated or if you have children.”

Photograph via YouTube

The post “Four Good Days” Is a Mess of Addiction Stereotypes and Stigma appeared first on Filter.

Not long into my use, the doses and prices dramatically changed. Where once I was paying $20 for a gram, I was now paying that same amount for a “point”—a 10th of a gram, smaller than the tip of my finger.

The potency had changed, too. Half of one of those points was enough not just to stave off the withdrawal that I would experience if I didn’t use an opioid daily, but to get me very high for hours. Taking a quantity as large as a “20-bag” would have killed me.

This was years before media outlets began to report findings of fentanyl in street heroin supplies, but word of fentanyl, and a whole new level of potency, was already in the mouths of heroin users.

By now, if you read the news at all, you’ve heard about fentanyl. How this powerful, short-acting opioid, used in medical settings for anesthesia and pain relief, has—in its illicitly manufactured form—become more and more prevalent in unregulated supplies of heroin and other drugs across North America. And you know that fentanyl has been linked with high and sharply increasing rates of overdose deaths.

“The problem is consent.”

“Some people call fentanyl ‘evil,’ especially coming from a place of being traumatized by their own, or a loved one’s, disordered use,” acknowledged Avi, a community-based harm reductionist in Eugene, Oregon, who has experience of using licit and illicit opioids, including fentanyl. “I understand this…[but] I cannot agree and find that reductive. Pharmaceutical-grade fentanyl has been an important breakthrough for high-threshold pain. And using outside of the medical institution isn’t innately wrong either. The problem is … consent.”

In many areas, fentanyl has saturated the supply to the point that it’s virtually impossible to procure heroin or other opioids that don’t contain fentanyl or its analogues. In others, it’s hit or miss—creating a dangerous guessing game out of the use of drugs that many people can’t go without.

This supply shift has multiple impacts beyond the headline death rates. Put together, they call for one solution above all: Offer people access to tested, regulated and safe drug supplies. Until that happens, people who use opioids, and who seek treatment or safer options, face a variety of underreported and dangerous complications.

When I eventually went to treatment, I didn’t pop positive for fentanyl on my drug test. That doesn’t mean much: I don’t know if they tested for fentanyl, since it has to be tested for specifically. But based on what I would experience later, I don’t think there was fentanyl in those black-tar points; perhaps they were just cut less, or contained something else. Fentanyl is difficult to mix into black tar, which is one reason it has been less prevalent in the West.

By the time I began using IV opioids regularly again in 2019, the street market had completely changed. I was also in Florida by then, which likely contributed to the difference. Reports of fentanyl adulteration had been popping up around the country, but particularly on the East Coast, where it had always been available to some degree in the form of “China white.”

This time, my dope came in baggies of powder—either white or tan or occasionally tinged a lovely but disturbing lavender color. It was so strong that I almost overdosed off a pinpoint of powder cooked down in water the first time I tried it, and spent the night vomiting like someone who was opioid-naive. I didn’t develop an addiction again right away, but when I did, and when I was finally able to access evidence-based treatment, my drug test this time came up positive for fentanyl.

Precipitated Withdrawal

I’ve previously written for Filter about my experience with precipitated withdrawal, after I attempted buprenorphine induction a little over 24 hours after my last fentanyl use, as I had many times with heroin in the past. I expected that, as fentanyl is a short-acting opioid, 24 hours would be more than enough time. It wasn’t.

“Fentanyl has a very high lipid solubility, so in comparison to things like morphine or heroin it will cross over your blood-brain barrier … very quickly and then crosses back out very quickly. It’s known to have a very fast onset but short duration,” explained Ryan Marino, an emergency medicine physician and medical toxicologist in Cleveland. “That means it’s picked up in peripheral tissues, not just fat and adipose tissues but different organs and stuff, where it’s not really having effect per se but whole body stores can be increased.”

Marino, who created the viral Twitter hashtag “WTFentanyl,” aimed at dispelling myths, emphasized that, due to a lack of rigorous research data on people who regularly use illicit fentanyl, a lot of this information is coming from inferences, observations and patient anecdotes.

In Canada, physicians are able to prescribe a conventional opioid alongside measured microdoses of buprenorphine … [this] is illegal in the United States.

But it suggests to him that for some people, the time needed to successfully induct on buprenorphine is much longer than it is for more typical short-acting opioids like heroin or morphine. Microdosing methods offer some promise, by allowing fentanyl users to take tiny doses of buprenorphine over time, thus building up the levels of the drug in their system gradually instead of pushing out all the fentanyl at once.

In Canada, physicians are able to prescribe a conventional opioid alongside measured microdoses of buprenorphine to help keep their patients comfortable during induction, but co-prescribing buprenorphine for addiction and a conventional opioid is illegal in the United States. And those pre-measured buprenorphine microdoses aren’t available either.

This is a potentially deadly problem, because buprenorphine is one of two highly effective pharmacotherapy treatments for opioid use disorder available in the US. The other, methadone, doesn’t share the risk for precipitated withdrawal, but frequently requires, thanks to US regulations, daily in-person dosing at clinics that can be difficult or impossible to access for some. While buprenorphine comes with its own restrictions and barriers, patients can typically pick up weekly or monthly doses from a pharmacy.

Marino described a modified version of microdosing, using measurements created from the buprenorphine doses available in the US—one that doesn’t involve co-prescribing another opioid—as a way of legally inducting fentanyl-dependent patients onto buprenorphine in the US. But it’s still not a widespread practice here, and while some patients can induct onto buprenorphine from fentanyl within hours or days without issue, those who can’t are often left in the hands of care providers who don’t know how to treat them.

Other Harms, Loss of Agency

Underreported complications arising from the opioid-supply adulteration stretch far beyond buprenorphine induction—for example, to withdrawal in general. The lipophilic properties of fentanyl—its tendency to combine with, or dissolve in, fats—make it essentially function, in some people, like a long-acting opioid in the body, but not in the brain. This means they will experience the analgesia and euphoria of fentanyl for short lengths of time, but may still experience extended withdrawal.

She was hospitalized for withdrawal-related dehydration between days four and eight.

Avi, for example, described being acutely sick from withdrawal for about two to three weeks after discontinuing fentanyl use. She was hospitalized for withdrawal-related dehydration between days four and eight. She reported having used heroin cut with fentanyl for about eight months, and also suspects that it may have been cut with benzodiazepines—a phenomenon that Marino has also been aware of on the West Coast. Benzodiazepines are known for producing severe, sometimes fatal withdrawal in people on high doses who are suddenly cut off.

Avi’s experience raises another point about sheer uncertainty. “Fentanyl kind of showed up as this unknown, originally unwanted thing,” said Marino. “We really don’t know what else is in the drug supply that we could be attributing to fentanyl and could actually be from other opioid derivatives. There are other fentanyl analogues that could have lipid effects and solubility… There could also be other things we are not detecting readily.”

And then, there are the people who don’t intend to use an opioid at all.

“Last year, I overdosed on some fentanyl-contaminated cocaine,” recounted Jes Cochran, executive director of the Never Alone Project, a drug-user led harm reduction organization in Indianapolis. “I’m not a never-opiate user … but the prominence of [fentanyl] in [methamphetamine] and cocaine supplies here … we’ve found it in MDMA and pressed pills too of course, is alarming for those of us who not only aren’t using opioids regularly (if at all) but it’s also bogus as fuck. Like if I want to go fast, I don’t really want a system depressant in the mix.”

“When you have well-meaning policy making pharmaceutical-grade opioid access near-impossible, the illicit market is flooded with customers,” added Avi, referencing crackdowns and restrictions on opioid prescribing. “Some of them may enjoy fentanyl, or certain fentanyl analogues. Others may not. The bottom line is, all of these people would prefer to have a clear understanding of the contents of their drugs … None of these people are getting that agency.”

Fentanyl required countless injections a day to keep myself stable, and my tolerance built fast.

When I was using in Florida, I knew enough to know that heroin didn’t look like white powder but fentanyl did. So I knew what I was consuming (although I couldn’t actually test for it—harm reduction programs didn’t exist in my county, so any supplies I needed I had to buy myself online, and fentanyl test stips were a luxury I couldn’t afford).

But I didn’t know its strength, I didn’t (and still don’t) know what it was potentially mixed with, and I certainly didn’t know what impact it would have—how different the experience of using and stopping would be from heroin.

Nor had I requested it. During the height of my addiction to heroin, I spent $40 on myself per day, and that was only for a few months. Most of the time, I could get by just fine on $10 or $20 if I needed to. But fentanyl required countless injections a day to keep myself stable, and my tolerance built fast. It wasn’t long before I was spending $50 on myself per day. The day before I quit, I did $200 worth of fentanyl in one 24-hour period. That’s a long way from almost overdosing on a pinhead of powder—but it only took a few months to get there.

The Clear and Urgent Need for Safe Supply

The criminalization of drugs has always fostered a lack of transparency and consent for people who use them. But the rise of fentanyl and its analogues both reflects and has created a market volatility, accelerated by the COVID-19 pandemic, that demands immediate, actionable change.

From teens dying after trying what they thought was a pharmaceutical pill that turned out to be pressed with fentanyl; to people with opioid use disorder struggling to detox or induct on evidence-based medicine; to users of substances with radically different effects being forced to experience opioid sedation against their will—in any other field of health, such risks and harms would be seen as evidence of intolerable policy failures.

Even for people who do want to use fentanyl, the instability of the supply and inability to appropriately gauge doses creates circumstances in which even the most cautious are risking overdose. The situation was created by crackdowns on heroin trafficking, meaning more of the same won’t solve it. Nor will these issues go away on their own.

Which brings us back to the clear and urgent need for the safe supply of opioids that could, at a stroke, remove many of the worst harms.

As Marino pointed out, “We had good treatment protocols for heroin and withdrawal … Now we are having new issues because the drug supply changed so much. We can only really expect the supply to continue changing at an accelerated pace, so our treatments are going to continue to be inferior if we don’t address the drug supply. If we could standardize that or make it safer, that would probably help a lot more issues than trying to scramble on the back end.”

Photograph of heroin powder via Drug Enforcement Administration/Public Domain

The post Our Adulterated Supply: Underreported Complications for Opioid Users appeared first on Filter.

“I’m ugly,” she added. “I’m dumb.”

These aren’t things that she or her 6-year-old sister have been told at home—at least not that I’ve heard. Since the moment she was born and placed on my breast, where she immediately latched on and nursed contentedly for almost an hour, she’s been showered with love and affection. Neither child has ever experienced anything resembling abuse or neglect.

But in early 2018, a little over a month after I hauled my family from our home in Seattle to my in-laws’ home in Broward County, Florida so their father could recuperate from mental illness, he and I were removed from the home—and our daughters from our custody—by child services.

This followed an argument I had with my in-laws, after which they made allegations of abandonment and drug use against me. The abandonment charges would eventually be dismissed, and the claims of drug use negated by slews of tests. But by that point, my daughters were already living with them, I was already homeless in a strange state without resources, and we were ordered to complete numerous requirements within 15 months. When their father and I did not complete those mandates in time and to the court’s satisfaction, our parental rights were permanently severed. Our daughters were adopted out to their paternal grandparents.

When the removal first happened, my youngest had just been weaned from my breast; my sudden abduction from her daily life broke an unspoken covenant of love and trust between us. She has never received an explanation that she can understand. It’s become clear to me that she is doing what so many children in this painful situation do: blaming herself, and transmuting the pain into self-harm.

Traumatic Separations Within Our Borders

Sadly, what my babies are experiencing is not uncommon.

“I hated myself. There’s a lot of self-loathing because you feel like there’s something wrong with you. It’s like trying to fit a puzzle piece into a puzzle where it doesn’t belong,” recounted Pennie, who asked that she be identified by her first name only. Now 51, she was adopted out of the foster system by a Mormon couple at the age of 11, while her mother was undergoing psychiatric care.

“I don’t think [the adoption] was right. I feel my mother was vulnerable and they just kind of redistributed me to a wealthier [family] … [but] you need more than clothes and food as human beings and human children.”

The public is familiar with the concept that wrenching children from their families is harmful and wrong. When news broke about the Trump administration policy to separate children and parents at the Mexico-US border as a de facto punishment for seeking asylum, media responded with a flood of stories describing the extreme trauma inflicted.

These articles widely failed to address the parallels between the separations at the border and the separations within our borders.

The Associated Press reported children’s symptoms ranging from inconsolable crying, to chest pains, to delusions and night terrors, with the possibility of growing into depression or cancer in adulthood. Child psychiatrist Dr. Gilbert Kliman told the AP that he predicted, “an epidemic of physical, psychosomatic health problems that are costly to society as well as to the individual child grown up. I call it a vast, cruel experiment on the backs of children.”

Dr. Colleen Kraft, president of the American Academy of Pediatrics, was quoted in an article published by the University of Michigan School of Public Health: “We know very young children who are exposed to this type of trauma go on to not develop their speech, not develop their language, not develop their gross and fine motor skills, and wind up with developmental delays.”

But these articles widely failed to address the parallels between the separations at the border and the separations within our borders. Through the so-called child welfare system, children are not only wrenched from their families suddenly and without regard to their needs and desires; they are also funneled through an expedited adoption scheme that leaves children forever wanting their parents. These adoptions are often conducted in less than two years, even when the only issue facing a family was poverty or substance use.

“A huge problem in our field … is that in our obsession to achieve ‘permanency,’ we are often forcing families into arrangements they don’t want,” Vivek Sankaran, clinical professor of law at the University of Michigan Law School and director of the Child Advocacy Law Clinic and the Child Welfare Appellate Clinic, told Filter. “This is particularly acute in situations involving substance use, where it does take, as we all know, time for folks to heal and to recover and to address the trauma that might be contributing to an addiction.”

As Sankaran observed, this timeline realistically leaves very little space for recovery from substance use disorder.

Enormous monetary boons, built into the foster system via the Clinton administration’s Adoption and Safe Families Act (ASFA), require agencies to file for termination of parental rights once a child has been out of home-care for 15 out of 22 months, or else risk losing funding. Exceptions exist, including when a child is in kinship care, like mine were; or when it is not in the best interests of the child to sever ties to their parents, which some argue constitutes the majority of cases. But agencies are not obliged to make those exceptions.

The severing of children from their families takes place in a whirlwind procedure paraded as an act of necessary saviorism. “To me, adoption is ownership … Your birth certificate is like a title to your car, a deed to your house. I feel like I was literally signed over like a product. It turns children into commodities,” said Pennie.

And, as Sankaran observed, this timeline realistically leaves very little space for recovery from substance use disorder, which often involves the need to address co-occurring or pre-existing trauma and mental illness, and rarely results in total abstinence right away (if at all).

In fact, recent research out of Canada found that the act of separating mothers who use drugs from their children increased the incidence of chaotic substance use and non-fatal overdose. This was compounded for Indigenous mothers, whose overdose rates were doubled within the study’s cohort.

Pennie’s story offers another example of the extreme harm imposed by child services on parents who use drugs; although her mother previously struggled with mental health concerns and used substances, it was only after losing her child that she became addicted to heroin.

They were silent for a moment. What do you say to someone who is telling you that they would prefer to endure rape again, rather than what you’re doing to them?

Having undergone the violence of child removal and rapid, forced adoption, I know intimately how damaging the adoption system is to parents, particularly those struggling with trauma or substance use. During my required mediation prior to the termination filing, I looked the attorneys in the eye and told them that this was the worst thing that had ever happened to me. Worse than the sexual and physical violence that caused the post-traumatic stress disorder (PTSD) that they had trotted out as proof of my parental unfitness.

They were silent for a moment. What do you say to someone who is telling you that they would prefer to endure rape again, rather than what you’re doing to them?

Then, in a rather sheepish tone, the attorney for the state, a stand-in from the drug court system due to staffing issues, admitted that before the ASFA timeline, parents with addiction had “a chance.” But not anymore.

“Kids want their parents, they want their mother … This system has been allowed to develop to be a hammer and treat every case like a nail,” said Tracie Gardner, vice president of public policy at Legal Action Center and a mother who has been directly impacted by this system. “There is no subtlety, no assessment, preventative services that are weak, and there are few tools to deal with families where there is a parent struggling with their drug use. It’s zero-tolerance, it’s abstinence-only, it’s punitive and it’s scorched-earth.”

Widening Circles of Lasting Harm

Of course, the harms of these forced adoptions extend well beyond the child’s youth, and hurt other people besides the child and parent. When children are adopted outside of their family, they lose contact with their ancestry.

Pennie describes her birth certificate, which still bears the names of her now-estranged adopters, as a forgery. Though she’s been able to reconnect with her family as an adult, she was raised apart from her sister and extended relatives; people who may not fulfill the role of a parent or primary caregiver, but still make up an important part of one’s identity and growth.

Their adoption was committed with no thought to the network of love it would sever.

“When children’s rights are terminated as to their parents, and parent’s rights terminated as to them, we put the memories and history of a child in the hands of a system that knows nothing about that family and compiles a scrapbook through government records,” said Erin Miles Cloud, a former parent attorney and one of the co-founders of Movement for Family Power, a parent advocacy organization that did some pro bono work on my case. She described these physical scrapbooks, such as those created by workers in the New York City system, as an issue that is “enormously under-discussed.”

“I have always wondered what memories they create about [the child’s] family member, their parent, and how they navigated the War on Drugs,” she continued. “It perpetuates this insidious pathology with no actual healing and also no actual agency in the reckoning of memory, especially for young children who then become incredibly reliant on these other people to help them sift through some of their memories.”

When children are forcibly adopted within families, as with my daughters, it permanently alters the topography of that family. My daughters often discuss missing their Aba, my mother, and their elder half-brother; both live across the country, where we had planned to return once their father stabilized. My aunts constantly mourn their inability to see them, and my daughters have virtually no relationship with my father, who also lives across the country. Their adoption was committed with no thought to the network of love it would sever.

Dinah Ortiz is a grassroots harm reductionist and parent advocate in New York City, who has written for Filter about the structural racism of the child welfare system, which includes disproportionate targeting of Black, Indigenous and Latinx families for surveillance and removal. Ortiz lost her own daughter to forced adoption in Florida 18 years ago. She had planned to place her newborn daughter with her brother and his wife while briefly incarcerated. But child services removed Ortiz’ baby immediately after birth due to concerns about her substance use, and ultimately mandated adoption by her brother against her will.

Ortiz described returning to drug use after her baby was taken as a means to numb the pain.

“We were really, really close. That’s why I made the arrangement with them because we were very close, me and him and his wife,” Ortiz recalled. Now, however, she no longer considers him family, opting to call him simply “my daughter’s adopter.” She has not spoken with the couple in almost two decades, since they cut off contact with her child.

Fortunately, her daughter sought her out at the age of 16 and they are working to rebuild their relationship. But nothing can undo the trauma and wreckage of those lost years. Ortiz described returning to drug use after her baby was taken as a means to numb the pain.

The foster system “destroys families, destroys lives, destroys the very children they claim to be protecting,” said Joyce McMillan, a directly impacted mother, activist and founder of JmacForFamilies—an advocacy organization geared toward the abolition of the child welfare system.

“The violence of snatching a child from their parent as they scream mommy; the trauma of that gets forever sketched in their souls,” she said. “We talk about when people get shot and the hole it leaves; when a child gets removed from families it doesn’t just leave a hole in the heart, it leaves shrapnel… [in the form of] depression, in some cases mental breakdown, fear, loneliness [and] isolation.”

For my family, this gruesome violation hangs over everything, all the time. When I am apart from my daughters, my life feels like a small, windowless room. When I am with them, I feel like a ghost, haunting a life that is no longer mine. I can look at them, hold them, smell them, play with them, but nothing I say or do really matters, because their lives are now dictated by someone else, someone whose values are completely at odds with my own.

I can also see the hurt of my absence, how they try to reckon with it quickly so they can squeeze as much enjoyment as possible from our few hours together—but it still spills out in declarations of self-hatred, or accusations that I don’t love them.

Now my daughters have been given the same message: If you, too, struggle, you won’t be worthy of parenthood, agency or a full life.

On the morning after a rare holiday sleepover, my elder daughter woke up crying relentlessly. Her eyes were wild with fear and pain. For nearly half an hour, no amount of comforting could quell her loud, frantic tears.

Finally, I was able to calm her enough so that she could croak out a single explanatory sentence: “I don’t want a new mommy.” A few minutes of hugs and reassurances later, she finally revealed that she’d dreamed her father and I were taken away, and I was replaced by a stranger.

When the state took my daughters, they confirmed my worst fears as an abuse survivor: that I was made lesser by having been the victim of sexual and physical violence, and am no longer worthy of participation in regular society because of it.

Now my daughters have been given the same message: If you, too, struggle, you won’t be worthy of parenthood, agency or a full life.

What if, instead, they had been allowed to share in my recovery, to watch me struggle and work and overcome? This could have been an opportunity to teach them about resilience, resolve and recovery. Instead, it has become a powerful lesson in self-loathing. The state chased permanency—but the only permanency achieved is the grief that now permeates all of our lives.

Photograph courtesy of Elizabeth Brico

The post Forced, Rapid Adoptions Are a Weapon of the Drug War appeared first on Filter.

The next, my friend was falling into the bathroom behind me, his words slurring into mumbled gibberish. At first, it was almost comical, the way his legs jerked and his body lurched, his mouth distended, like a grotesque, over-the-top dance. But when his knee banged the counter and his torso slumped over the sink, I realized this wasn’t one of his characteristic off-color jokes.

I managed to lead my friend out of my small bathroom while he was still upright, but it was clear he needed more help. He was nodding hard, frozen in a pose that looked like a fall suspended mid-way. I tried to guide him to a sitting position on the bed, but his legs began to jerk again. I wasn’t sure if he was seizing, but then he slipped from my grip and fell to the ground.

I began carrying naloxone everywhere with me a few years ago, after having several of my own overdoses reversed by people with the drug. But I had not been called upon to use it on someone else.

The day my friend overdosed in October this year, I knew what to do from training, from reading about it, and from hazy memories pulled from the less severe of those overdoses. Narcan, the brand name for intranasal naloxone, is fairly easy to administer. Pop it out of the container, place it into one nostril while holding the other closed, and squeeze down. You can hear it release—a soft spraying sound—so you know it’s deployed. Of course, administering it during a true emergency is quite different from practicing on empty air with a dummy vial.

The instructions tell you to wait two-to-three minutes before administering a second dose. Those few minutes are agonizing.

I ran for the naloxone and cradled my friend’s limp head in my arms while administering the dose. His face was a dingy purple-grey, and his lips were violet. He had urinated on himself. He wasn’t making any noise, and he wasn’t breathing.

I tried to open his mouth to administer rescue breathing, but his jaw was clenched shut. I pushed my fingers in between his teeth, and managed to pry his jaw open enough to push in a breath before it locked shut again.

The Narcan instructions tell you to wait two-to-three minutes before administering a second dose. That’s because the drug takes that long to start working. Those few minutes are agonizing.

“That’s a long time. It’s not comfortable seeing someone who’s blue. If you’re trying to help them breathe, that feels like forever, but it still takes three minutes to work,” commented Taliesin Magboo Cahill, nursing team lead of the safe consumption site at Sandy Hill Community Health Centre in Toronto, Canada.

I didn’t have a phone, and I didn’t know where my friend had put his. Even if I had known, I didn’t have his passcode and he didn’t use biometric locking. So I had to guess how much time had passed—not an easy task under dire pressure. Every breathless second felt like a minute. Knowing I had only one more dose and no way to call emergency services made it that much worse. This had to work.

After what I estimated was three minutes, I administered a second dose. I’d been afraid before then, but having used my last dose of naloxone, I began to truly panic. I had a choice to make: stay with him and try to get his mouth open to do rescue breathing, or run outside and bang frantically on neighbors’ doors until someone opened and agreed to dial 911.

Although I didn’t supply the drugs, this had happened in my home. And this was in Florida, which has drug-induced homicide laws that can carry the death penalty.

Besides the danger of leaving my friend alone, there were other potential consequences to going out and trying to alert the authorities. There was the social stigma of drug use; the fear and disgust the neighbors might have felt toward me, particularly during the pandemic, and the threat of eviction from my month-to-month lease. There was also the fear of police action.

Although I didn’t supply the drugs or really have any part in his using them, this had happened in my home. And this was in Florida, which has drug-induced homicide laws that can carry the death penalty for certain opioids—including fentanyl, which my friend had used. The state does have Good Samaritan laws, which are supposed protect people from prosecution if they dial 911 during an overdose—but they don’t supersede drug-induced homicide laws.

Such justified fears are part of the reason why Sarah Wakeman, an addiction medicine physician at Massachusetts General Hospital, says it’s so important that people who use drugs have liberal access to naloxone.

“People who use drugs are the frontline responders when it comes to overdose. Unfortunately because of our racist and punitive drug policies, even despite Good Samaritan laws, some people who use drugs may be hesitant to call 911 for fear of criminal legal sanctions or simply being treated poorly,” Dr. Wakeman told Filter. “Even if they do, it will take time for an ambulance to arrive and every second counts when it comes to an overdose, particularly in the current era of fentanyl adulteration of the drug supply.”

I chose to stay with my friend. I struggled to get his head tilted back and his mouth opened so I could breathe for him. His jaw was less rigid this time, and I managed to get in a few puffs.

I don’t know if that air was the kick-start he needed, or if the naloxone took effect at just that moment, or both—but it was then that, like a miracle, his face flushed, his eyes rolled open, his chest began to rise, and he began to stand. I’ve never felt more relieved in my life. 

Laws and Law Enforcement Restrict Access

“It’s kind of amazing how well it works,” said Cahill of naloxone. “If you’ve seen someone use you can be almost 100 percent, if not 100 percent, effective at keeping people alive.”

She also noted that because her site is equipped with other resuscitation tools like oxygen and experienced staff, they are sometimes able to reverse less severe overdoses without using naloxone. But sites like the one Cahill runs in Canada, where people can inject drugs under medical supervision, have struggled to open legally in the United States.

Even the simple distribution of naloxone is tangled in red tape, the extent of which varies from state to state and sometimes even between counties. Even in states that allow for prescription-free naloxone distribution, many people who use drugs don’t have the extra cash to buy an antidote that can cost upwards of $100.

The US has been inching its way toward a harm reduction approach. Legal syringe distribution programs—which often also give out free naloxone—have been implemented in most states, though not widely enough. Semi-legal or technically illegal operations—like the Church of Safe Injection in Maine, founded by Jesse Harvey, who passed away this year, reportedly from an overdose—try to fill the gaps.

“Technically it is illegal [in Iowa] to dispense naloxone to laypersons without a pharmacist.”

“Naloxone distribution is so important to target directly to people who use drugs and I think that has been really successful in some states and some communities,” said Sarah Ziegenhorn, the founder and former executive director of Iowa Harm Reduction Coalition, which also runs a naloxone distribution program that sometimes operates outside of Iowa’s strict dispensing laws. “But for most of the US it’s still not really a reality, and people are still really struggling to get naloxone in rural communities I think in particular, and in the plains and prairies states like Iowa.”

“Technically it is illegal [in Iowa] to dispense naloxone to laypersons without a pharmacist,” Ziegenhorn told Filter—adding that local medical and pharmaceutical communities have helped by essentially “looking the other way.”

Anti-syringe laws are another unexpected barrier to naloxone distribution in some areas. Although Narcan is applied intranasally and therefore doesn’t require a syringe and needle, naloxone can also be injected. More expensive formulations come in preloaded shooters (some of which talk you through the process!), but the less expensive varieties better suited to meet heavy demand on a slim budget come in liquid vials that require the use of an intramuscular syringe and needle.

“Here in Myrtle Beach, we don’t have any kind of [harm reduction] services … Because of our syringe laws, you can’t go to the pharmacy and buy syringes; if they think you’re a drug user you will not get syringes,” explained KC Nicole, a harm reductionist in opioid addiction recovery who does freelance syringe and naloxone distribution in South Carolina on a shoestring personal budget.

“Our syringe laws are so bad [that] I’ve had problems with law enforcement with giving out [intramuscular] naloxone,” Nicole told Filter. “I gave some IM naloxone to a friend of mine—who is not a drug user, who had no criminal record or anything like that—and they got pulled over.” When the friend admitted to having naloxone in his glove box, the police “used the syringes as probable cause to search his vehicle.”

In at least one county in Indiana, as Filter reported, naloxone administration itself can be used as probable cause to support drug prosecutions.

The Pandemic Makes Things Worse

And of course, any overdose prevention difficulties that existed prior to 2020 have been worsened by the pandemic. Isolation is one important factor: Naloxone will not help if you are using alone. Fear of viral contamination is another; it’s impossible to stay six feet apart while engaged in the very intimate task of saving someone’s life, with mouth-to-mouth rescue breathing sometimes necessary.

But as Brooke Feldman, who manages CleanSlate Centers in Philadelphia, told the Kensington Voice, “This is a public health concern, and the chance of someone dying, if you see them experiencing an overdose, is much higher than the chances of most of us dying from contracting COVID-19.”

“I definitely hear that access to harm reduction services, including naloxone, is down.”

“There is concerning data that both fatal and non-fatal overdoses are increasing in the context of COVID,” said Wakeman. “In my work with patients, I definitely hear that access to harm reduction services, including naloxone, is down. And of course the social isolation, stress, despair, and lack of economic opportunity that we are seeing during the pandemic can be deadly for someone who uses drugs.”

And at her safe consumption site, Cahill reported “a huge increase in overdoses”—all of them reversed—despite COVID-related staff shortages forcing the site to close earlier, resulting in fewer overall visits.

“COVID has complicated Narcan distribution so much,” said Zeigenhorn. “People really had to get outside of the office, moving around the community. But without funding for staff to do that, they couldn’t necessarily make that happen. I think that the biggest challenge of naloxone access and distribution right now is figuring out how the heck to get to it to people at all.”

Mail-order services already existed before the pandemic to help fill in some of the access gaps. And Wakeman argued that COVID has presented “a real opportunity to learn from innovations … to deliver services in even more flexible ways.”

“For example,” she said, “some service industries have pivoted in the face of COVID to offer more delivery, takeout or virtual services. We could learn from those examples to offer delivery services for naloxone, utilize the US postal service, have self-serve takeout venues where people could access naloxone, and have naloxone readily available in every healthcare touchpoint.”

“The priority should be getting naloxone to people who use drugs and it should be hiring people who use drugs to distribute the naloxone.”

“We are in the middle of a pandemic and a lot of the services, especially county services, have shut down, and people are being encouraged to shelter in place, and the places where you used to go to get naloxone are closed,” said Tracey Helton, who is on the board of directors for Next Distro, an organized mail-order naloxone distribution service.

Helton has also offered independent mail-order services for several years out of her home base in California. She advocated for the use of mail services for naloxone, and also espoused a new bicycle delivery operation in the Bay Area that began in response to pandemic-related service closures. Yet she’s quick to point out that most grant or government funding doesn’t go toward these vital services, but instead to treatment agencies and other facilities that require people to engage in lengthy training seminars, show up at difficult-to-access or stigmatizing locations, or present other barriers to people who use drugs.

“The priority should be getting naloxone to people who use drugs, and it should be hiring people who use drugs to distribute the naloxone,” Helton told Filter. “I’ve sent people large quantities of naloxone and they’re in the trap house giving it out; I’ve had drug dealers who I sent naloxone to giving it to customers; shooting galleries where you give people a bunch of naloxone to set up there, and everybody is saving each other’s lives.”

I am all the more conscious of the callous, stigma-fueled cruelty of laws that continue to make it inaccessible.

I carried naloxone, even when I had no expectations of using it, because if someone else hadn’t done the same, I wouldn’t be alive today. Because I did that, my friend (who gave me permission to share his story anonymously) is also now alive and well.

As an overdose survivor, I’ve known the importance of naloxone for a while. But now that I’ve also had the experience of cradling another person’s prone body in my arms and actually seeing naloxone take effect—in the form of the color returning to his face, malleability returning to his limbs, his eyes re-opening, and his chest resuming its rise and fall—I am even more aware of the miraculous utility of this drug.

And I am all the more conscious of the callous, stigma-fueled cruelty of laws that, in too many parts of the country, continue to make it inaccessible while people are dying for want of it.

Photograph by Elizabeth Brico of her naloxone refill, provided by Keri Ballweber, director of peer advocacy at Point to Point Kane County.

The post I Recently Used Naloxone to Save a Life. Limiting Access Is Unforgivable. appeared first on Filter.

But while one outcome will certainly offer greater hope for positive change, neither is poised to do enough to assuage one of the biggest issues faced by the drug-user population: the confusion of punishment and coercion with addiction treatment.

Such measures might sound like progress when touted in a campaign speech, but those of us who’ve lived through them know otherwise.

During his term, Trump has thoroughly demonstrated his commitment to a heavy-handed, supply-targeted approach that defies the recommendations of research and has fostered increasingly dangerous, often lethal instability in the illicit market. Biden’s plan to address the “opioid crisis” includes promising measures such as universalizing access to medications for opioid use disorder, but more supply-side actions, too—and, just as concerning, emphasizes replacing incarceration with forced treatment and social-services interventions. Such measures might sound like progress when touted in a campaign speech, but those of us who’ve lived through them know otherwise.

I don’t remember what my husband and I were arguing about two years ago on a day weighted by the thick wet heat of South Florida. What I do remember is the agitation it incited in me that I could feel spiraling in my chest. It’s a discomfort I know well, anger mixed with helplessness. Since eighth grade, when I began coping with negative feelings by using substances, that feeling has been one of my strongest triggers. But instead of rushing out to score drugs that day, I went for a jog.

My two young daughters had been removed from my custody by the state of Florida in April 2018, a few months before that fight. After my daughters were taken, I was angry. Really angry. I was a good mom, and even the investigator who filed for the removal admitted under oath that my girls appeared well bonded to me and their father, and showed no signs of abuse or neglect. All of my drug tests had come back negative, including the hair test that was able to detect use up to three months prior.

It was totally unfair, but I still had hope. Various delays by the people in charge of my case meant I was unable to access formal trauma or addiction support for more than six months, but I was determined to get my daughters back, which meant remaining abstinent. I designed a personal support system that included writing, utilizing online supports and rigorous exercise.

When I got home from the run that day, drenched in sweat but buzzing from the endorphins and no longer angry over the argument, it hit me just how effective exercise was for my recovery. But the state of Florida would find a way to take even that from me.

At my next case review hearing, the judge decided that my low creatinine levels meant I was intentionally diluting my urine to hide drug use. I explained that I was hydrating due to exercise, and that I ate a vegan diet (which is sometimes associated with lower creatinine levels), but she didn’t care. She marked my slew of negative tests as positive, stated that I was noncompliant with my case plan, and refused to move my case forward, keeping me on once-weekly supervised visits with my daughters.

I felt as though everything had been taken from me, and then when there was nothing left to have taken, the state still managed to take more. It was not long after that hearing that I finally did what they had been accusing me of the whole time—I relapsed.

Negative reinforcement as a recovery motivator has become such a staple that it often goes unchallenged.

“When we look at individuals who are involved with, perhaps the criminal justice system or whatever… instead of actually putting more involvement with community support, we do the opposite. We isolate them and punish them and those are actually more detrimental,” said Nelson Perez, an addiction counseling instructor at Minneapolis Community and Technical College. “We continue to utilize those things when it comes to criminal justice-involved individuals … Those things are not evidence-based, and people know that, but they continue to utilize those punitive measures.”

Negative reinforcement as a recovery motivator has become such a staple in mainstream treatment and recovery circles that it often goes unchallenged, despite the fact that it defies best practice—and common sense. In my case, there was a clear (if unarticulated) belief among everyone, from the state to my and my husband’s families, that taking away my kids would throw me into the condition of rock-bottom despair that would serve as that final motivator to never, ever take a drug again.

Instead, it broke my heart, robbed my life of purpose, and eventually sent me seeking some sense of peace and pleasure elsewhere, through the opioids that had filled that role before my elder daughter was born.

“The concept that as a condition or illness or disorder that you know is a behavioral health condition, that it’s best addressed through aversion and punishment and isolation to me feels one: unethical, and two is not scientifically grounded,” said Mishka Terplan, an OB/GYN and addiction medicine physician who consulted on my case. “Then somewhere in all of this too is this idea that you can’t trust people with addiction. They lie, they manipulate, that sort of stuff. I think that’s also really common currency amongst those who endorse those punitive things.”

“The idea that someone with substance use disorder must reach rock bottom in order to recover: It’s an assumption that is not accurate,” he continued. “For what other human condition is the solution withdrawing love and support?”

The harms of this approach are exemplified by the various systems that intersect with drug use in the United States, all of which punish and disempower, and have become so normalized that punishment has become, for many, an expected part of an addiction trajectory.

“The criminal justice system and the [addiction] treatment world are even becoming more connected.”

Dinah Ortiz, a harm reduction and parent advocate, drug user and mother with prior child protective services involvement, described her own version of the ensuing helplessness in her recent account in Filter of the day her son, who used drugs, was sentenced to federal prison during the pandemic. “My hands and legs were shaking. The tears were already streaming down my cheeks … I just saw my son as a six-year-old boy, surrounded by adults who were there to scold him.”

“People don’t realize using punitive measures doesn’t work,” Ortiz said over the phone. “It’s kind of like the definition of insanity: doing the same thing over and over again expecting different results. We’ve been doing this for years and it hasn’t worked. Whenever they terminate your rights due to drug use, whenever they break up a family, whenever they put you in prison for drug use, they don’t realize they are doing more damage and more harm than good.”

“The criminal justice system and the [addiction] treatment world are even becoming more connected,” observed Perez. So-called treatment programs are “becoming more ingrained and joined up with the criminal justice system. It has a lot to do with that they still don’t want to get rid of the same type of mentality that has been going on since forever.”

For me, the impact has been a long, slow decline in my and my family’s quality of life. It has been over a year since my daughters saw their elder brother, my son from a different relationship, who lives in Seattle. He has nonverbal autism and attention deficit disorder, which make communication by phone or video extremely difficult. The last time I saw him was during a brief work visit to Seattle in January, just before the pandemic impeded transnational travel.

My parental rights to my daughters were terminated in March and they were forcibly adopted to the paternal grandparents who initiated the case against me, one of whom suffered an alcohol-induced injury a few months into the case that has left him without executive function, including the ability to consent to the adoption. Although I am seeking signatures for a petition requesting their return and/or a third-party investigation and reopening of the case, the termination is technically and legally final.

Their paternal grandmother is their sole caretaker. As such, she decides when and if we are allowed contact. Recently, when she found out that I referred to her as “ignorant” in an online thread, she cut off all contact between me and my daughters for several weeks without any explanation to them. I only recently regained my three-days-per-week visitation allotment.

“I’ve probably never had a patient who had child welfare involvement who didn’t think about suicide at some point in time.”

A new study out of Canada found that mothers who lost custody of their children were at heightened risk of fatal overdose, and that this risk was especially high for Indigenous mothers. Erin Miles Cloud, a former parent attorney in New York City and the co-founder of Movement for Family Power, an abolitionist-centered advocacy organization that provided pro bono consulting on my case, described the study as “tragic and also an awful truth that we all know to be true.”

“I’ve probably never had a patient who had child welfare involvement who didn’t think about suicide at some point in time, or didn’t think about using, many of whom did use or engage in some kind of self destructive behavior,” observed Terplan.

Last year, the obituary of a mother named Megan Webbley went viral after she overdosed following the loss of her child to the system. This year, on August 29, Dylan Stanley, Harm Reduction Ohio’s illustrious director of community outreach, also fatally overdosed following the custody loss of her beloved daughter.

During our last few correspondences, Dylan and I discussed plans to co-produce a podcast with another harm reductionist mama. She was hurting, but she had plans and goals for the future. We also commiserated about our shared loss; hers was especially painful because her child is medically fragile, which meant COVID concerns limited Dylan’s ability to even visit with her.

The last time we spoke, Dylan was trying to escape an unsafe housing situation, and faced the loss of her belongings due to the cost of storage. She had also been dealing with criminal-justice involvement and high barriers to accessing evidence-based opioid addiction treatment, despite her deep desire to find help.

Megan Webbley and Dylan Stanley are two examples of the insidious, often terminal impact these punitive systems have on people who use drugs, particularly if addiction is a factor. There are many, many more like them—and many, many more to come if nothing changes.

The final outcome of the election will not in itself remove the cloud of misery hanging over millions of us impacted by these systems.

During a recent conversation with my husband, whose parental rights were also terminated, I described my life as a small dark room—one with a small window that is occasionally opened to a view of a sun-drenched idyll that is no longer mine. Every day, I have to decide whether or not I want to continue my life in the small dark room, or take my final exit. Every day that I decide to keep going for one more lunar rotation, I also have to decide whether sobriety has any benefits anymore.

When my rights were terminated, it certainly didn’t seem to. I spent months after the termination injecting fentanyl until my supplier unexpectedly ran out due to a major bust in Florida. If that dry spell hadn’t happened—and if I hadn’t had buprenorphine to help me through the physical withdrawals—I could very well have met the same fate as my friend Dylan. I still could.

The final outcome of the election, even if it’s the one we hope for, will not in itself remove the cloud of misery hanging over millions of us impacted by these systems. It’s vital to remember that.

“It’s tearing me apart,” Ortiz told me of having her 26-year-old son, a father to five children, incarcerated in federal prison for almost three years over a nonviolent offense. “Every day I wake up and try to say ‘today is a new day, today is a day that’s gone by, that is another day off the calendar. But he’s my… son. It’s horrible. When I speak to him, there are times I just sit on my bed after the call and my tears just come down.”

Photo by Monty Allen on Unsplash

The post The Waiting Game: A Powerlessness That’s Long Harmed Drug Users appeared first on Filter.

We went around houses in her quiet, wealthy neighborhood claiming to be dressed as Kurt Cobain, teenagers, or creatures we clearly were not. It was ridiculous, and ridiculously fun. I can’t remember if I was high. Jana wasn’t, because she didn’t do drugs. But it’s possible I was stoned on weed or half a bottle of Robitussin, because I did.

Sometime not long after that, Jana told me she couldn’t be friends with me anymore, because her parents said she wasn’t allowed to be around people who did drugs.

In comparison to other traumas I’ve experienced, losing Jana’s friendship was small. By no means do I blame her, or her parents, for the downward trajectory of my life after that—but that also doesn’t mean it was an insignificant event.

Being told that my best friend was no longer able to spend time with me because of my drug use—use which she did not engage in with me, and which was the manifestation of my own, already-existent trauma and depression—made me feel like I was one of the so-called “bad kids.” And it happened at a time when I was using drugs heavily enough for it to be problematic, but had not yet developed any kind of dependency—nor moved on to some of the substances I would eventually develop a serious addiction to, like methamphetamine and heroin.

Jana and I were on opposite ends of the same messaging: That young people who use drugs are dangerous, bad and should be kept at arm’s-length.

Having and keeping healthy relationships at that crucial time might not have changed anything. Maybe my mental health issues were already severe enough that feeling valued by my peers, and being around others who were modeling healthy behavior, would not have been enough. I don’t know because that didn’t happen.

I do know that feelings of exclusion and unworthiness haunted me during my youth and continue to spring up even now, at age 32. And I definitely know that drug use and drug culture served as a balm for those feelings for a very long time.

Jana and I were on opposite ends of the same messaging: That young people who use drugs are dangerous, bad and should be kept at arm’s-length. Unfortunately, that messaging hasn’t gone away. It has not gone away in the sense that young people are still being given that advice—nor in the sense that adults are also being given the same general messaging, if packaged slightly differently. For young people, the need to keep a “safe distance” from drug users tends to be about the safety of the non-drug user. For adults, remaining friendly or supportive with a drug user gets called “enabling,” and framed as harmful.

“For young people especially, but for people of all ages, peer connection is a huge vector, and so one of the things that happens to young people in all stages of progression of [substance use] disorder … are successive waves of more and more deviant and problematic behaviors,” Marc Fishman, an addiction medicine physician who also teaches at John Hopkins University, told Filter. He added that, “each milestone and each stage of progression of severity is promoted by deviant peers.”

It’s true that young people are particularly prone to peer influence; mirroring behavior is built into our DNA. But the use of stigmatizing language like “deviant peers” highlights the exact problem with school-age anti-drug messaging, and how our society values the lives of some kids over others. As a former “deviant peer,” having such a label attributed to me damaged me emotionally and socially. I became isolated from anyone who didn’t also use drugs. While I valued those drug-using friends, and still have healthy relationships with some of them, I believe I could have benefited from a wider social circle.

“I didn’t know you did stuff like this. Everyone said you were just out selling crack.”

I certainly did not only identify as a “deviant.” I also saw myself as a writer, an artist, an intellectual, a music-lover, an actor, a vegan, a teenager, and so much more. But socially and by reputation, I was a druggie.

I remember, years after losing Jana, running into someone who’d gone to the same middle school. We hung out for a few hours, and at one point he exclaimed something to the effect of, “I didn’t know you did stuff like this. Everyone said you were just out selling crack.” I have never sold crack, by the way. 

Peer influence can certainly be a contributing factor to substance use among young people. I was subjected to it by my friends, and I’m sure I subjected others to it as well. But does that make us “deviant” or unworthy of the basic human connection that tethers us all to a sense of normalcy, worth and belonging?

When I asked Fishman whether he thought it was problematic to deprive kids who use drugs chaotically of friendship, he answered that “those people have plenty of friends. Don’t get me wrong; the culture of drug use and deviant culture has plenty of participants.”

A 2018 study, however, found that addictive behaviors among young people were associated with lower peer-group identification and higher psychological distress—suggesting that, contrary to popular messaging, young people who use drugs problematically could benefit greatly from strong social connections.

“We’re social beings and addiction … disconnects people from their communities, from other people. I think that when I think about addiction, I think about this shift from primary relationships being with other people to primary relationships being with a substance,” said Thomas Bannard, who runs Rams in Recovery, the collegiate addiction recovery program at Virginia Commonwealth University.

“For people that get well and heal they need to form new connections with other people, and so it’s really important for people to have a community to connect to,” he added.

It’s a concept that matches addiction author Johann Hari’s famous line: “The opposite of addiction is not sobriety. The opposite of addiction is connection.”

“Minimizing trauma would do way more than postponing first use.”

“For every one year you don’t start [using drugs], the burden, so to speak, of addiction in that age cohort decreases, so there is some relationship between age of first use and development of a use disorder, and that’s the argument behind ages for purchasing alcohol and tobacco or cannabis,” said Mishka Terplan, an OB-GYN and addiction medicine physician in Washington, DC. “But that’s a real sort of simplistic understanding obviously, and if you really want to prevent … addiction I think there might be other things to do, like support people in general, [or] … ensuring that children grow up in safe, stable households devoid of violence. Minimizing trauma would do way more than postponing first use.”

Unsurprisingly, I am not the only person who used drugs at a young age and feels that urging young people to avoid their drug-using peers is a bad idea.

Renae, who asked that only her first name be used, also began using drugs in her teens in the Pacific Northwest. Like me, that use eventually developed into an addiction to heroin. She is now in long-term remission, but recounts that “when I was super into heroin, the accepted advice was … to cut people out of your life if they’re doing drugs, using the removal of a positive relationship as a punitive measure.”

“Fortunately I had people who didn’t do this to me,” she continued, “but I had people who did and it was terrible. I needed regular people in my life … or drugs and drug people become your whole existence, so what the fuck do you have when that is taken away?”

Isolating drug users is not only dangerous in a social context. It also increases the likelihood of fatal overdose—particularly now, when the illicit drug market is in dramatic flux and inundated with fentanyl, even in products not marketed as opioids.

“The pandemic is isolating. How do you make new friends?” asked Nicole Reynolds, a freelance street-based harm reductionist in North Carolina and a member of the Urban Survivors Union. Fear of contracting the virus, coupled with destabilized drug supplies and decreased or wholly shut-down harm reduction and treatment services have thrown many vulnerable drug users into chaotic situations. These include increased physical isolation for people who were already socially isolated by stigma.

“Being alone taking opiates is already dangerous,” said Reynolds. “Not a lot of people I know use the don’t use alone number.”

Although some of Fishman’s language and messaging felt derogatory to me, particularly as someone who experienced the very social rejection he seemed to be prescribing, when I pressed him a little more about what young people could do besides abandoning their friends who used drugs, he suggested, “Talk to your friends, look out for your friends, steer your friends right. If you see your friend doing risky things, say something—don’t be afraid of being called a nerd.”

And that I can agree with. Showing people around you that you care, and helping people in non-judgemental, non-punitive ways to communicate their concerns is far healthier than to label them as “deviant” and worthy of abandonment. I know I could have benefited from a lot more of that in my life.

Photo by Jesús Rodríguez on Unsplash

The post “I Can’t Be Friends With You Anymore”—How Stigma Isolates Young Drug Users appeared first on Filter.

To give some idea of the scale of this issue, the US military employs around 1.3 million people, while 14 percent of US adults polled say they use CBD products.

In late July, the House of Representatives passed an amendment to the National Defense Authorization Act (NDAA) that would prevent the Secretary of Defense from issuing a blanket ban on the use of CBD in the military. Should this provision survive the next iteration of the bill and pass the Senate, it would work to countermand a policy enacted by the Department of Defense (DoD) in February, which prohibits the use of any hemp products by active and reserve military members.

DoD’s February memo directed that criminal provisions for use of hemp products be added to the Uniform Code of Military Justice (UCMJ). It specifically notes that this includes CBD.

Prior to this, DoD had unofficially forbidden military members from using CBD, following 2018 legislation by the US government that legalized hemp products containing less than 0.3 percent THC.

The DoD states that these products have the potential to cause a THC-positive result on a urinalysis test.

The DoD memo opens with the statement that “Substance misuse by Service members is a safety and readiness issue, and the Department must remain vigilant in addressing emerging threats, including those that come from new products and sources.”

It continues that CBD products are unregulated and unreliable, and therefore have the potential to contain more THC than the consumer might believe. It also states that these products have the potential to cause a THC-positive result on a urinalysis test, and that “since it is not possible to differentiate between THC derived from legal hemp products and illicit marijuana … the use of hemp products could effectively undermine the Department’s ability to identify illicit THC use.”

There is some truth to the Department’s statement. Besides the prescription pharmaceutical Epidiolex, approved to treat a severe seizure disorder, CBD products are generally not FDA-regulated. In fact, it is illegal to even market them as a supplement, a category that has faced criticism for its already-lax regulatory standards.

“I get why they say it. With a full spectrum product that says ‘CBD only,’ an active-duty member can go and take a bottle thinking it’s only CBD, and then it has THC,” said Joshua Littrel, an Air Force combat veteran and the founder of Veterans for Cannabis, a company that lobbies for the rights of military members to access cannabis while also selling its own line of CBD products.

“[But] for the military to say there’s no way to guarantee that no THC is in it, that’s inaccurate,” he told Filter. “We have a CBD-only product developed specifically for active-duty members and those employees in drug testing positions… it’s made from isolate. When you isolate a molecule, the only thing in the molecule is that molecule itself.”

Littrel also noted a host of health benefits he believes CBD offers, including the reduction of inflammation and anxiety, which could be particularly useful to active-duty military members and veterans. While CBD has only been approved for medical use in the US for certain seizure disorders, people who use and sell the products report health benefits ranging from pain relief to reducing anxiety and depression, treating opioid addiction, and even stopping the spread of cancerous tumors. 

While research is still relatively sparse, there are a growing number of studies backing many of these claims. Littrel specifically mentioned research out of Israel that linked CBD with faster recovery from traumatic brain injuries in mice.

“In the military, the biggest thing is, when you get an injury, it’s getting back in the fight—how quickly can you get back on your feet, get back in the fight, and take retaliation back on the enemy?” said Littrel. “If CBD can help our active-duty members return to service quicker, why in the world do we not allow that?”

Many experts sound caution, however. “The research [on the health benefits of CBD] is kind of lacking. There’s not a lot of good evidence for different conditions, but that’s not saying it doesn’t do anything,” Ryan Marino, an emergency medicine physician and toxicologist practicing in Ohio, told Filter. “The human body has CBD receptors within the nervous system, so it totally makes sense that it does something. I think high doses is where we will see effects … A few years from now, there will probably be more evidence saying CBD does things for other conditions.”

“First of all, I don’t know why the military is drug testing people all the time; drug tests are terrible tests to begin with.”

For the Department of Defense, however, the issue seems to be less about CBD’s potential efficacy or inefficacy, and more about whether or not a member’s use of a CBD product could interfere with the department’s ability to gauge and monitor drug use.

“First of all, I don’t know why the military is drug testing people all the time; drug tests are terrible tests to begin with,” said Marino.

Urinalysis testing is particularly controversial. Observed tests—meaning that someone is watching while the sample is produced—can re-traumatize sexual assault survivors or prove impossible for people suffering from paruresis (the inability to urinate in the presence of others). Urine tests are also fairly easy to cheat, and are often unreliable. They also cannot indicate whether or not someone has a substance use disorder, nor can they measure work performance. Nonetheless, drug test results are often misused to gauge both.

When it comes to testing positive for THC due to a CBD product, toxicologists agree that it is unlikely, but not impossible.

“It could [cause a THC positive]. In most cases I think it would not, but it could, and you could test positive from taking CBD with that low amount of THC even if you weren’t getting any sort of high or intoxication or THC effect,” said Marino, adding, “It should not mess with a standard urine drug screen.” Other experts commenting for a Vice story agreed that while it was possible THC could accumulate and cause a positive drug test, most standard detection thresholds would prevent this from happening.

Marino also noted that, to his knowledge, CBD was not able to be absorbed through the skin, making it especially perplexing that topical products are included in the ban.

In addition to the general DoD ban, several branches of the military have issued their own rules governing the use of CBD products. This includes directives from the Navy that specifically target topical hemp products like shampoo, lotion and lip balm.

So what happens if a member of the military gets caught with the wrong shampoo? While the consequences of being caught using illicit substances, including marijuana, can vary for military personnel and can include court martial or service discharge, the use of CBD specifically violates Article 92 of the UCMJ, which means disobeying an order. The maximum punishment under Article 92 is dishonorable discharge and two years of confinement.

Mark Curci served in the National Guard until 2004, when he left at the rank of sergeant. He worked in security and administration, which included paperwork on service member reprimands. “If somebody had been busted for marijuana, I would have been the one to bust them,” he told Filter.

“If somebody pissed hot or whatever, they would get nonjudicial punishment … and we would have a conversation with their commander as to how to move forward. Something like pot, I don’t think anybody would have gotten kicked out,” Curci recalled, cautioning that the culture and responses could have changed since he left the military.

Curci now has a healthy relationship with marijuana, noting that since leaving the National Guard, he has experienced “positive effects of CBD for psychiatric issues and anxiety issues.”

“These people are risking their lives for us and they can’t use hemp shampoo.”

The new House measure, sponsored by veteran Rep. Tulsi Gabbard (D-HI), would not automatically grant service members the right to use CBD, but it would take away the Secretary of Defense’s power to install the blanket ban.

“There is great research being done around hemp, resulting in new products coming to market that are proven to help with ailments like insomnia, inflammation, chronic pain, epilepsy, Traumatic Brain Injury, Post-Traumatic Stress and more,” Gabbard is quoted as saying in a July press release.

“The Department of Defense could … get approved providers,” suggested Littrel as a solution to the issue of the unreliable CBD market. “But they’re not willing to have a conversation. That’s really unfortunate.” He urged those who support the use of CBD to contact their senators and urge them to support Gabbard’s amendment.

“This [CBD ban] seems very misguided,” added Marino. “If they really have [drug testing and problematic drug use] concerns, they should be working on these concerns instead of preventing military members and US service members from having the shampoo they want or taking a CBD gummy.”

“It’s kind of crazy,” he said. “These people are risking their lives for us and they can’t use hemp shampoo.”

Photograph of US soldiers in Southwest Asia by Master Sgt. Scott T. Sturkol via Wikimedia Commons/Public Domain

The post The Battle Over CBD Use Among US Military Personnel appeared first on Filter.

“I wish I could live with you, Mommy,” says my littlest.

“Me too,” says her sister. “Is that natural?”

I say nothing, wanting to gather her in my arms, and Littlest answers instead. “Yes. That’s normal, living with Mommy and visiting Grandma. That’s normal.”

“I want to be with you always, I love you both so much,” I tell them. I don’t know how to make them know, to really know and feel, that I am leaving because I have to, not because I want to.

My elder daughter pulls her little blankie—the one she’s had since she was a baby—close to her chest and pops her thumb in her mouth.

This is their home, their life, as assigned by Broward County and Florida Department of Children and Families (DCF). It’s the home of their paternal grandparents, who initiated the child welfare case against me. Their grandfather, who has since become completely paralyzed and unable to speak, requires their grandmother’s constant care.

I have written about my case for Filter and other publications in the past. About how my daughters’ paternal grandparents called a child abuse hotline to accuse me of drug use and abandonment while I was staying with them in Florida, and testified against me in family court in 2018. About the barriers the authorities placed in my way—like failing to facilitate or allow my access to evidence-based opioid use disorder treatment—before proceeding, on the basis of misconceptions about drug use and addiction, to deem me an incurable failure and place my case on an adoption track.

Now, I’m writing about the predictable outcome of that: how they permanently terminated my rights to my two little girls, who still beg to come home to me.

Sometimes, the agency arranges a final meeting, where the parent must explain to their child that this is the last time they will see each other.

Termination of parental rights is termed the “civil death penalty.” It permanently severs the legal bond between parent and child. The parents’ names are removed from the birth certificate, erasing any record of the relationship, no matter how long the family was together prior, or how bonded they are. For many, that means the sudden and total cessation of contact. Sometimes, the agency arranges a final meeting, where the parent must try to explain to their child that this is the last time they will see each other, and why. Sometimes, they don’t get even that.

“My clinic worked with a father who had been visiting his son in foster care for years,” said Chris Gottlieb, co-director of the Family Defense Clinic at the New York University School of Law. “The child knew that was his father and was very attached to him. The boy was going to be adopted by a single mother. We asked—begged, really—for the father to be able to at least stay in his son’s life through continued visits after the adoption, but the agency refused. They wouldn’t even let the father say goodbye. Who could think that’s actually good for a kid?”

For me, I am still able to have continued contact because they are with their paternal grandmother—but she could rescind that privilege at any time. Once the adoption is finalized and the case closed, she could also, if she chose, give the girls back to me. In other words, the agency has given total power over my daughters to the very woman who made the allegations that triggered this case. The allegations which were found to be untrue at the trial, but had by then entangled me in a system that judged and misjudged my substance use disorder, PTSD and lack of financial resources.

The termination means that if my daughters are seriously injured, I can be barred from visiting them in the hospital. I have no say over their medical or educational decisions. I can’t travel with them without permission; I am forced every day to choose between staying with them in Florida, isolated from all my support systems; or returning to Seattle, Washington, where their older half-brother lives.

They call me “mommy” and “mama” and “mom,” but I am no longer their mother—not legally. The decision leaves them to build their personalities, attachments and aspirations atop a constantly shifting foundation embedded in grief and confusion—the opposite of what this system purports to secure for children. It leaves me navigating a lifetime of unending trauma and loss.

Perhaps worst of all is the knowledge that this outcome was arbitrary—an automatic reaction to a timed financial incentive set at the federal level.

Perhaps worst of all is the knowledge that this outcome was arbitrary. The decision to terminate my rights was not based upon any actualized threats to my daughters’ safety; rather, it was an automatic reaction to a timed financial incentive set at the federal level by the Adoption and Safe Families Act (ASFA).

Under ASFA, if states want to receive the funding that allows them to finance child protective programs, agencies must either return children home, or move to terminate parental rights once a child has been in out-of-home care for 15 of the past 22 months.

“ASFA has exceptions,” Gottlieb noted. “They don’t have to file a termination of parental rights on the [15/22] time-frame if there’s one of these exceptions, which include if kids are in kinship foster homes, or if for any reason it’s not in the child’s best interest to do the termination.” Since my daughters were in kinship care, the first of those exceptions applied in our case. I would argue the second does too.

“But,” Gottlieb continued, “the only message that gets emphasized is the simplistic rule that you have to file. People are not doing the case-by-case analyses they’re supposed to do to apply these exceptions.”

In my case, when we sat down for a required mediation session in March, the guardian ad litem attorney acknowledged my daughters’ bond to me, but felt that the financial benefits of adoption, including payments to their grandmother and funding for college, were important enough to warrant severing our legal bond.

Misunderstandings of Drug Use and Addiction

Another major issue throughout the case has been the misunderstanding and mistreatment of drug use and addiction. It began with the initial investigation, when an inexperienced member of the Broward County Sheriff’s Office came by the home while I was away and did not attempt to contact me, instead choosing to file for an emergency removal because she felt my history of engaging in methadone treatment was proof enough that any allegations against me were true.

It continued at the deposition, when the judge charged me with neglect and imminent risk of harm. She cited my “skill with language,” which apparently made me a less credible witness, and a discussion about marijuana with a family member that my in-laws testified about at trial as her reasons for the decision, in lieu of any actual instances of harm or near-harm to my daughters.

“Everyone is so focused on the substance use that often they don’t see, or refuse to acknowledge, a mother’s positive behaviors.”

It continued as the agency not only failed to provide me with referrals to the trauma and addiction treatment I was mandated to complete, but also barred me for months from accessing them myself—in part by forcing me to undergo a psychological evaluation, which they repeatedly delayed, before engaging in any other state-sponsored services. Throughout the life of the case, they never referred me to evidence-based treatment.

“Everyone is so focused on the substance use as this negative behavior that often they don’t see, or refuse to acknowledge, a mother’s positive behaviors,” said Mishka Terplan, an OB/GYN and addiction medicine physician who was retained by advocacy organization Movement for Family Power to provide expert testimony during my case.

“For you, the positive behaviors were, you … sought treatment on your own and you demonstrated motivation,” Terplan described. “You understood the importance of treatment; nobody had to tell you treatment was important, you actually had to tell them you wanted this. You actively sought it and when the program was not adhering to standards of care, you sought another program that would be better for you. That seems to be completely correct.”

But at the mediation, the representative for the state attorney’s office—a worker from the drug court division who was standing in because the case was undergoing yet another of many instances of staff turnover—summarized all of that as, “too little, too late.”

Then she leaned across the table and told me that before ASFA, parents with substance use disorders had an actual chance to get their kids back, but now with the timeline, it just didn’t work.

As Jerry Milner, the associate commissioner at the Children’s Bureau, co-wrote in an article published about a month after my rights to my daughters were terminated:

“The timelines in the [ASFA] … do not reflect what we know about treatment and recovery and do not reflect the contextual factors that are directly relevant to successful reunification, such as the availability of quality services and treatment and a family’s ability to access services timely and effectively. The decades that have passed and research lessons learned have revealed the timelines as lacking alignment with what many children and families need.”

Despite acknowledgments at both the state and federal level that the ASFA timeline does not make sense in the context of substance use, and despite admonishments from the medical and legal advocacy communities, agencies across the nation continue to file for termination of parental rights at the 15/22 mark, so that they can continue to receive the millions of dollars in funding it affords them.

They continue to do this even in cases like mine where they don’t have to. And in cases like mine where everyone is in agreement—at least behind the closed doors of the mediation room, where any statements made can’t be applied as evidence at trial—that the act of termination will, in fact, cause harm to the children.

If nothing is done, the consequences will continue to echo through my life, my children’s, and generations of my family to come.

And it has. It has caused my children harm. Not a day goes by that I don’t hear my daughters ask to come home to me, tell me they love me and miss me, muse about how much they miss Seattle, their brother, and their other friends and family back home. Their questions about the situation, their acknowledgment that it’s not normal and doesn’t feel good, are accumulating urgency with each passing day.

If nothing is done, the consequences of this travesty will continue to echo through my life, my children’s, and generations of my family to come. I started a petition requesting the immediate return of my daughters and/or an independent third-party review of my case and appropriate remedial action. It’s a small hope, one that rests upon the world taking notice and deciding to care, but it’s what I have left.

For all the families impacted by such systems, we can listen to the experts, and stop applying this irrational timeline. Our federal government can reform or repeal ASFA, and in the meantime, states have the choice to take a stand and say no—to take the hit instead of forcing their families to.

As Gottlieb explained, “Just as some states opt out of certain aspects of Obamacare, they could opt out of ASFA. They could turn down federal money rather than buying into a system that incentivizes severing parent-child relationships.” But so far, none have.

It’s millions of dollars, and it would cripple their child welfare system, but the other choice is continuing to tear apart hundreds of thousands of families each year for no real reason.

Yesterday I hung on my walls in Hollywood, Florida the sequined monsters and Dr. Seuss landscapes the girls and I crafted together over the holiday weekend. I was reminded of the conversation we had while we glued down those pom-poms and plastic gems, one about the strangeness of memory, and how we forget the memories we don’t use.

“Will I forget you, Mama?” asked my elder girl.

“Do you think about me?” I asked.

“I think about you sometimes,” she replied.

Then my littlest one chimed in. “I think about you. I think about you all the time. I think about you all the time because I’m always missing you so much.”

Photograph courtesy of Elizabeth Brico.

The post “The Civil Death Penalty”—My Motherhood Is Legally Terminated appeared first on Filter.

One powerful voice in the outcry will come as no surprise to people familiar with harm reduction and drug policy reform. Kassandra Frederique of the Drug Policy Alliance* has been speaking out compellingly on these issues for years. Currently DPA’s managing director of Policy, Advocacy and Campaigns, Frederique will, in September, take over as that preeminent organization’s executive director—a prospect that energizes the whole field.

On May 28, Frederique issued a statement in response to Floyd’s death: “With George Floyd most recently, Breonna Taylor earlier this month, and countless others before them, perceived drug possession and drug use served as a justification by law enforcement to dehumanize, strip dignity from, and ultimately kill people of color,” she wrote.

While Frederique had previously said she wanted to hold off on media interviews until taking up her new position, circumstances are exceptional, and she agreed to elaborate on her statement to Filter. Our interview has been lightly edited for length and clarity.  

Elizabeth Brico: At the beginning of your press release, you discussed the fact that Officer Thao, who prevented bystanders from interfering in George Floyd’s murder, used anti-drug rhetoric to defend what was happening. “Don’t do drugs, kids,” he said. What are the wider implications of those words?

Kassandra Frederique: I think it’s important for folks to realize that it is not an innate thing that Black people get killed by law enforcement. Some people might struggle with that because of the history of people of color and law enforcement and slavery and child slavery and different institutions that have criminalized and killed and maimed people, but the fact that people of color—Black people and Indigenous folks—are getting killed is based on a set of decisions and policies. It’s a culture that we have built.

So it’s important, when people are killed by law enforcement, that we point to the reasons that create the circumstances of the issue at hand. There are countless decisions that were made that led to the killing of George Floyd. There were countless decisions made that led to the situation of Breonna Taylor being killed in her bed. If we are not situating these killings in that way, then one can feel completely overwhelmed, and have no sense of direction about how to get to the answer.

Is there not another potential actor who can fill in this role?

What are the surrounding circumstances that create the confluence of factors that lead to an extrajudicial killing? Why do they have so many officers responding? Why is it we are calling law enforcement to deal with something like potential forgery? Is there not another potential actor who can fill in this role? Why is it that law enforcement feels the need to restrain someone, and be on camera and feel like the camera is not a deterrent to the abusive acts that were happening? 

And then, why does Officer Thao think that saying, “Don’t do drugs, kids,” is an effective line of reasoning to try to quell down the crowd that has now surrounded them? 

There are multiple decisions, multiple strategies creating the confluence of factors that killed George Floyd that day. Leading them all is that he was a Black man, and society’s decision about Black men in public space, in private space, is that they must be watched, must be surveilled, must be met with aggression, and that killing is a justifiable outcome in navigating situations with them. And obviously that can be said about anyone who is not a cis white man. 

How is the drug war used as a tool for racism, particularly against the Black community?

Audre Lorde says we are not single-issue people. She has that beautiful quote, “There is no such thing as a single-issue struggle because we do not live single-issue lives.” It’s important for folks that do drug policy reform work to acknowledge that.

While the drug war might be the most present factor that is criminalizing, harming and killing our folks, there are multiple other issues that are happening in the lives of our people that are exacerbating the fact that the drug war is present in their lives. It can be housing, it can be unemployment, it can be mental health, it can be food insecurity, it can be so many different issues. The drug war, though most present in some of our lives, is not acting alone.

When it comes to racism, the drug war is most certainly not acting alone. The drug war is acting as a force multiplier in the everyday lives of people, and our strategies and our campaigns and our messaging have to take that into account. Ending the drug war will not end racism, just like legalizing marijuana did not legalize Black people. So we can’t say it will, and we have to build out the capacity to understand what else is going to be necessary to care about the people we care about.

Just like naloxone isn’t going to be the thing that ends the overdose crisis, [ending] the drug war is not the thing that is going to end racism.

It’s not just that I care about people who use drugs, right? I care about people who are struggling with homelessness, people without active healthcare, and those people might be the same people. In order to end the drug war, we might need to pay attention to: How are we making sure people are housed? How are we making sure people have access to healthcare? How are we making sure people have access to food? All these things matter.

I think one of the biggest examples of this is if you look at syringe exchanges and you see all the additional services that they offer in addition to giving people access to unused equipment. We can’t just care about people’s drug use; we have to care about how they are operating in the world. If you give someone naloxone and you revive them, and then they leave and they walk down the block and get killed by law enforcement, did you really save a life? You saved it for that moment, but if we’re not really working to end state violence, all you did was delay their death.

There is no naloxone for racism. Just like naloxone isn’t going to be the thing that ends the overdose crisis, [ending] the drug war is not the thing that is going to end racism. We have to work on multiple issues to deal with the overdose crisis, just like we have to deal with multiple issues to end racism. We can pick our piece of the puzzle as the drug war, but we can’t pretend like it’s the whole thing, and we can’t pretend that our work is going to be as helpful … if we are not talking about race as well.

What you think about the use of curfews in response to the protests and the pandemic, especially in the context of people who use drugs?

It’s so interesting to watch people engage with the curfew, because it’s the curfew in wide use. But I think for people who are of color, and people who are trans or non-binary, there’s always been a curfew. It seems like the curfew is about controlling where you can move and how long you can stay in certain places. You see this with Christian Cooper and Amy Cooper in Central Park in New York, where she’s telling this person to leave and move along, and she’s enforcing her own version of the curfew. She was done with this person and wanted this person to be out of her sight.

There are so many marginalized groups that are already living under a curfew.

People who use drugs and people who are drug-involved are consistently challenged in public space. It’s as if people don’t want to see them. What was incredible about the curfew is that [other] people experienced a modicum of that⁠—to not have the agency to be in different parts of your neighborhood or other places because the state said so. That happens all the time to people who use drugs, people that are homeless, people that are broke, people that are trans.

There are so many marginalized groups that are already living under a curfew, that watching society rise up to push back on the curfew was incredibly inspiring. It gave me this incredible desire to stand up for other people who are living under a curfew every single day, in a pandemic or not.

In addition to racism, your release mentioned discrimination based on “one’s perceived gender—as our trans siblings know all too well—or one’s socio-economic status.” Can you recommend trans leaders who can teach us more? And what would you add about socio-economic status?

Tamika Spellman. Another person who is not a trans woman but does work on this directly and has done a lot of work on this is Andrea Richie. I’m a part of collective called In Our Name Network, and it’s a collective of Black women working against police violence, and it’s cis and trans women together.

We can’t pretend classism is not a defining factor in the way that people experience the drug war. Poor communities are more over-policed than other places. They have less access to supports, and are also not given the benefit of the doubt in the same ways as people with more resources, and there is a way that our criminal legal system looks down on poor people, and society does too.

The likelihood of people caring whether or not you live and breathe is based on this redacted version of dignity that people have ascribed to your life.

So when you have a situation where you’re seen as less-than, the punishment and the way that the system interacts with your life is seen as less-than. When you have a situation of people struggling with drugs, which is already an identity that is less-than, and then you are also of a lower socioeconomic status, that confluence is one that can’t be ignored.

Then, when you add race on top of it and potentially citizenship, you are literally a walking target. And the likelihood of people caring whether or not you live and breathe is based on this redacted version of dignity that people have ascribed to your life.

Some areas that saw an overall decline in overdose fatalities in 2018 still saw an increase in overdose fatalities among Black people. How are efforts to mitigate the harms of drug use failing Black communities and how can we do better?

I think the thing we are navigating is the same thing that we see with these police deaths. It’s this recognition that we don’t actually give a damn about whether Black people live or die. That the death of Black people is not a rallying cry, it is not enough to marshal resources or attention. They are not deserving of dignity and sanctity of life.

The perception is that Latinx, Indigenous and Black people are always going to struggle with drug use and addiction because there is something culturally inept with them.

That’s why movements like Black Lives Matter are so central, because Black drug users’ lives matter. They do, even if the doctors and the researchers and the agencies don’t think they do, they do.

The perception around the drug war and race is that Latinx, Indigenous and Black people are always going to struggle with drug use and addiction because there is something culturally inept with them. What we saw with the overdose crisis is the perception that this being a middle-class, white issue is not normal, and therefore we need to motivate and push forward together, so we can save those lives—white lives.

You’re asking about Black lives, but we don’t even hear the mention of Indigenous lives, whose rates [of overdose] are rival if not higher. We are also not always tracking the lives of Latinx folks, and so while we are ignoring Black lives, we are also not having full conversations about people who are struggling.

So it just reinforces the need for us to elevate that Black Lives Matter is a movement for drug policy and harm reduction. It’s not just the extrajudicial killing by law enforcement that is killing Black people⁠—it’s the extrajudicial killings of the healthcare system that are killing Black people; the extrajudicial killings of the housing industry that are killing Black people; the extrajudicial killings of employment that are killing Black people; and it’s the extrajudicial killings of the drug war that are killing Black people, and Indigenous people and Latinx people.

That goes back to the point that I made in the beginning, which is that we are not navigating single issues. All the reasons why Officer Chauvin felt he could put his knee on George Floyd’s neck for nine minutes without fear of accountability are the same reasons why people can take victory laps on declining overdose numbers and not see that it’s still a major issue that overdose is rising among Black folks. It’s the same fruit from the poisonous tree.

The issue of breath seems to keep coming up: police chokeholds and “I can’t breathe” protests, COVID, opioid overdose deaths… I don’t really have a fully formed question, but I would love to hear your thoughts.

Breathing is what reminds you that you are alive. If you don’t have breath, you don’t have life. Breathing also, when you illustrate it, you know, they do the cartoon and when breath comes out, it’s the essence of your being. It can be a physical explanation of your soul.

I think COVID, the fact that people are being choked out, and overdose are all running into each other right now, and what we see on the streets and what we are witnessing as a society is potentially the last breath, the last dregs of this version of white supremacy.

We can’t keep doing CPR forever. We can’t keep reviving people to have to revive them again.

One of the things we know about overdose is that we have to teach each other CPR. We pump the chest and then we breathe into each other. But, you know, you can’t do that with COVID. [Chauvin] literally could have just lifted his knee. I think the thing is, we can’t keep doing CPR forever. We can’t keep reviving people to have to revive them again.

This moment is really about asking: How do we create new breath in a way that is more sustainable and is not based on someone giving a damn? How do we make sure that our movement is sustainable, that we are building sustainability, not based on whether people are paying attention to us or not? People paying attention [or not] is based on [their] assumptions. We want it to be as natural as your everyday breath. 

What is DPA doing to continue the fight to remove drug involvement as what you described as a “cover for disregarding the dignity and sanctity of human life?”

What we are doing in this moment is really elevating the work that we have done in the past and what we will continue to do. We are reinvigorating our work on defunding the DEA, which is super-important considering that the DEA is one of the main agencies that funds and enforces the drug war. It’s wild that in this moment, the federal government gave the DEA more power to surveil protests and communities, using the same technologies that they use to surveil our community; these are now being used on everybody, which really reinvigorates our fight that the DEA should be abolished.

We know that our piece of the puzzle is to help starve the beast⁠—so as everyone is talking about defunding police, DPA’s part in that fight is making sure to end the funding that leads to the militarization of law enforcement, which is largely funded because of the drug war.

Police departments got really suited up based on drug war money. Practices like no-knock and quick-knock raids are the things that kill people, like Breonna Taylor in her own bed. We gotta take that out. So DPA is joining the fight to defund the police by really focusing on what is the funding, how can we disrupt and end the funding streams of the drug war, and then how do we capture that money and actually put that into harm reduction services, housing, evidence-based substance use treatment?

We need to identify the “police” in all the systems.

And then also, how do we call out drug-war policing in people’s everyday lives? People are having a conversation about policing that’s focused on law enforcement, but we gotta talk about these social workers; we gotta talk about teachers; we gotta talk about hospital administrators that are creating the circumstances for people to be killed, and that are creating the circumstances for people to be harmed, and criminalized and destabilized. People aren’t doing cop-watch on that, but they need to. 

We need to identify the “police” in all the systems. Where is the policing happening of people who use drugs that are applying to a job at Walmart? Why are we drug testing everyone? One in five people are food-insecure. Why do we have federal bans on SNAP or TANF benefits for people who have drug felonies? Why? I think, for us, it’s about elevating the role of: What does drug war policing look like, and how do we abolish it?

What are your recommendations for people who want to learn more about the relationship between racism and the drug war?

I think folks should follow DPA. I think they should follow Harm Reduction Coalition. I think they should follow the various drug user unions. There are a bunch of harm reduction coalitions in your state, and you should follow them all. I think people should watch films like The House I Live In, and Grass Is Greener. I think people should watch 13th. I think people should read Michelle Alexander’s book, I think people should read Carl Hart’s book. They should read Maia Szalavitz’s book. They should look at the work that Movement For Family Power is doing on child welfare and the drug war. 

DPA has webinars every month with drug researchers highlighting different issues. I think people should look into groups like the In Our Name network. I think folks should look into Latino Justice, the Immigrant Legal Research Center, and Immigrant Defense Project. TruthPharm in Upstate New York is doing amazing work around child welfare reform, the drug war and justice; Alexis Pleus is doing amazing anti-racist organizing in Binghamton, New York. There’s so many people doing amazing things.

It’s just an honor and a privilege to be under the tutelage and leadership of people who are really putting their lives on the line every single day to fight for the dignity and sanctity of others, and it is an honor to fight.

Photograph of Kassandra Frederique by Daniel Shapiro, whose website is here.

*DPA has previously provided a restricted grant to The Influence Foundation, which operates Filter, to support a Drug War Journalism Diversity Fellowship.

The post “There Is No Naloxone for Racism”—Kassandra Frederique Speaks Out appeared first on Filter.