Maia Szalavitz is the author of the New York Times bestseller, Unbroken Brain: A Revolutionary New Way of Understanding Addiction. For nearly 3 decades, she has written widely on addiction and drug policy for publications like TIME, the New York Times, VICE, the Guardian, Scientific American and many others.
transcriptAARON MATE: It's The Real News. I'm Aaron Mate. President Trump says he will declare a national emergency over the opioid epidemic. President Trump: We're going to draw it up and we're going to make it a national emergency. It is a serious problem the likes of which we have never had. When I was growing up they had the LSD and they had certain generations of drugs. There's never been anything like what's happened to this country over the last four or five years.AARON MATE: Drug overdoses are the leading killer of Americans under 50, about two-thirds of them from opioids. A national emergency declaration would marshal federal resources to address it. But this comes amid news some are taking bold action on their own. According the American Journal of Preventive Medicine, a US social services agency is secretly running a supervised injection site at an undisclosed location. The underground facility has over seen more than 2,500 injections by around 100 people. Joining me is Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction. Her new piece for VICE is called "There's been a secret safe injection site in the US for three years." Maia, welcome.MAIA SZALAVITZ: Hi. Thank you so much for having me.AARON MATE: Let's talk first about this site that you've written about. Shocking news that somebody here in the US, we don't know where, has been running a safe injection site on their own.MAIA SZALAVITZ: Yeah, I mean I think there's probably more than one. There certainly was a bathroom in the Bronx that was sort of unofficially serving as such a place. When people see people at risk, they have to, people feel moved to do something to help.AARON MATE: What is going on at this facility? MAIA SZALAVITZ: Basically what happens is people who inject drugs can go there. They have clean equipment, a nice mellow place to just do their thing. They don't have to rush. They can properly find a vein and not just sort of stab at themselves. That allows people to practice safe injection technique and be safer about what they do.AARON MATE: This is a practice that is legal in many other countries. Can you talk a bit about what happens there and what the research has shown about its efficacy?MAIA SZALAVITZ: Sure. There about 66 such facilities in at least nine countries. The most important statistic is that there has never been an overdose death, even though they have had thousands of injections and at least hundreds, perhaps thousands of people through these places.AARON MATE: Looking at this news now of this secret site in the context of Trump appearing to be poised to declare the opioid crisis a national emergency, your thoughts on the conversation around addiction right now and this potential federal response to it. MAIA SZALAVITZ: Well there's a good thing that could happen from declaring an emergency and there's bad things that could happen. The good thing would be that when you have a state of emergency for health, you can cut through a lot of red tape. One of the things that has really been hampering the response to this epidemic is we have two treatments that we know of that cut the death rate 50% or more. We are not, only about 10% of treatment programs offer these treatments and we create all these barriers because we have just too much regulation on this. Ironically, the sort of Republican let's cut red tape and let's get rid of bureaucracy and let's stop overregulation, that is a really important aspect of this because basically methadone and buprenorphine, we know that if you use them long term, they cut the death rate 50% or more. Yet we have limited access to those substances only to people who are willing to show up at a certain time and go through counseling and get urine tested and all these kinds of things, when really we should be giving those substances to anybody who wants a dose as long as we know that they haven't gotten another dose from another site the same day. Because even if they're going to use illegal drugs on top, if they maintain their tolerance and at least have some access to something of known dose and purity, they will be at far less risk of dying. The research shows that if you, regardless of whether you provide counseling or other things, these medications save lives.AARON MATE: I'm sure you've gotten this question though before. How can you give people a dose of something that is bad for their health?MAIA SZALAVITZ: Well it's not necessarily bad for their health and if the alternative is taking poison, it certainly is appropriate to do. I think what we have to do is we have to think about drug related harm, not about is somebody taking a substance I believe to be immoral or the law has decided is immoral? We have laws that were made because of racism. Our drug laws, nobody sat down and said, "Yeah tobacco and alcohol should be legal and marijuana and all these other substances shouldn't be legal based on clear science." The way we got our drug laws was a series of racist panics. If we're going to be rational about substance use, what we need to realize particularly about opioids is that most of the danger associated with them is associated with illicit use. This is not to say that you can't overdose on pain pills. It's more to say if you want to avoid overdose, and you know the dose and purity of something, you are much more likely to be able to do so than if you are taking something that you have no idea what it is.AARON MATE: What do you make right now of the efforts to hold big pharmaceutical companies accountable. There have been lawsuits against some ...MAIA SZALAVITZ: I think that actually, I think ... The drug companies did serious wrong here. They should be fined. They did terrible marketing things, but the crime here is what's legal for them to do. It's not that ... I mean they, like I said, I'm not justifying anything they did, but one cannot become a person with addiction without taking drugs not as prescribed. You have to repeatedly use drugs despite negative consequences in order to meet criteria for addiction. You can become physically dependent on a substance if you just take it every day, but that's not addiction. Addiction is compulsive behavior despite negative consequences. If the consequences of taking a substance every day are I get out of bed and function really well, I'm not addicted to that substance. With opioids what we have done is basically chased people from having a supply that they know the dose of and they know the purity of, to fentanyl which is thousands of times stronger often, depending on the variant, and it's, what we have done is simply increased harm. AARON MATE: Finally Maia, if you were on the president's commission, what would have been your top recommendations for how we should address the epidemic on a federal level?MAIA SZALAVITZ: Sure, so I mean immediately lift all the regulations that prevent prescribing of buprenorphine and methadone to whoever wants it in a controlled fashion. Do not say that you may only get methadone for addiction in X clinic. Allow all doctors who want to prescribe to prescribe and the only requirement for participation in maintenance programs should simply be we know your name. You show up. You get your dose. You can do your thing. Now there are certainly people who want to stabilize their lives and want to move on and who could benefit from counseling and psychiatric care and all kinds of other good services that we can give them. We should triage those services to people who actually want them rather than forcing people into them who don't want them. If we do this, we will get access to a far greater number of people and we know that if people have access to these drugs, people who stay on them have a 50% less risk of dying or overdose. If we get this to as many people as possible, we can cut this thing in half.AARON MATE: Maia Szalavitz, author of Unbroken Brain: A Revolutionary New Way of Understanding Addiction. Her new piece for VICE is called, "There's Been a Secret Safe Injection Site in the US for Three Years." Maia, thank you.MAIA SZALAVITZ: Ah, thanks so much for having me.AARON MATE: And thank you for joining us on The Real News.