A small triumph

Getting your fix of thought-provoking ideas about addiction recovery and drug policy is hard in a media that saturates us with stigma-laden messages. Will Godfrey reflects on the triumph of publications talking about sensible solutions to addiction.

I first ran a publication about drugs without quite realising. It was inside Pentonville, a large Victorian-built prison in inner London. Inspired by a prisoner’s suggestion, one of my education department colleagues and I founded a small newsletter, written entirely by prisoners and read by prisoners and their families. Pentonville’s governors, wary of inciting either the volatile prison population or the British tabloid press, ruthlessly censored the content of each issue, including most drug references.

But of course drugs were everywhere. I’d smell cannabis as I walked through the wings every day. Swathes of the population were using heroin. (In a futile prevention effort, staff were banned from bringing in lunchtime sandwiches wrapped in foil.) And in late Autumn, when the heating pipes were turned on, the pungent aroma of hooch – brewed from bread, sugar and orange juice left in a warm place – would be added to the mix.

And as you’d expect, substances (alcohol very much included) were a big factor in people being there in the first place. Battered faces, cracked voices, tales of desperation, suicides and violence were facts of life inside. So was a persistent sense, throughout my four years there, that I was witnessing the perpetration of a mass injustice.

I vividly remember one distraught 22-year-old first-timer who couldn’t understand why he’d received a lengthy sentence for dealing ecstasy: “Just selling a few little things to my friends that they wanted!” I didn’t have an answer for him. Other men would come to prison, get released, and then return, often several times in a year, without receiving any treatment for their palpable substance problems. And as you’d expect, hardly any of them were from a middle class background like me – although many people I’d known at school or university used or sometimes sold illegal drugs, no one was ever locked up.

I brought along these memories as I moved to New York and joined the editorial team at TheFix.com, which launched in March 2011. As a journalistic enterprise, covering everything related to addiction and recovery, drug policy and treatment, we were occupying a niche that we considered was growing in importance. As an online magazine, we had the power to reach unlimited numbers of people – and to allow them to reach us in privacy. Happily for us, the traffic numbers have since shown just how much people care about this field.

While I was already familiar with various kinds of substance use, I knew far less about ‘recovery’. One big difference between the US and the rest of the world is the extent of the dominance here of AA and 12-step, abstinence-based recovery. People I’d known back in the UK who were using substances would sometimes talk about cutting down or quitting. Sometimes they’d do it. In the US, that very specific idea of being ‘in recovery’ was just one of many phrases and concepts that were unfamiliar to me. That’s changed fast. Many of our readers, contributors and staffers are members of AA, NA and the rest, and much of our content is about 12-step life.

Passions run high about interpretations of this form of recovery – and why wouldn’t they, about something that you credit with saving your life? Opinion pieces that we have published that criticise tenets of ‘the programme’ – such as total abstinence or anonymity at a media level – have seen the comments fields erupt with arguments against or in favour of the writers’ opinions. We’ve also run numerous pieces affirming the values of a traditional 12-step approach, and the same applies; while 12-step fellowships are by far the largest single element of the US ‘recovery community’, other groups and individuals attack this model – some even call AA an abusive ‘cult’.

I certainly don’t believe that. Neither do I share the core beliefs of AA. But it’s been a privilege for me to get to know many within this community, to attend some meetings and to hear about how people have transformed lives that once seemed hopeless because of addiction. I have nothing but respect for that.

What’s sometimes frustrating is the insistence of some AA members – and only some – that the 12 steps and total abstinence are the only road to recovery. The evidence doesn’t support that. There are many people for whom AA doesn’t work or who choose other paths. One survey last year indicated that 23.5 million Americans would answer ‘yes’ to the question, “Did you once have a problem with drugs or alcohol, but no longer do?” AA’s estimated US membership is 1.3 million (the other 12-step fellowships are much smaller), so it’s interesting to consider what everyone else is doing.

Many find ways to deal with substance problems on their own. But another important answer is harm reduction programmes, which we also cover widely on The Fix. ‘Harm reduction’ makes many people think immediately of needle exchange – a vital element, and I was recently pleased to publish an on-the ground report on one programme – but of course, there’s much more to it.

An uplifting story here in the UShas been the advance of so-called ‘Good Samaritan’ laws, which grant immunity from prosecution for drug offences to those who call 911 to report an overdose. Fear of Police involvement is the most commonly cited reason that overdose witnesses fail to call for help. This summer, thanks to tireless campaigning from various groups, Vermont and Delaware became the 13th and 14th US states to enact Good Samaritan laws since New Mexico got the ball rolling in 2007.

These laws save lives. They also show that attitudes to drugs are changing. The wider distribution of naloxone, the lifesaving drug that reverses opioid overdoses – fatal overdose deaths attributed to prescription opioids quadrupled here between 1999 and 2010 to over 16,000 – is another case in point. Some initially opposed naloxone distribution, on the basis that it would ‘encourage’ more opioid use.

But the US still has a very long way to go. The Obama administration passed legislation in 2009 to overturn a longstanding ban on federal funding for needle exchange programmes; Congress reinstated the ban in 2011, and it still stands. And supervised injection sites remain illegal here – despite the success of North America’s only legal supervised injection site in Vancouver, recently confirmed by a long-term study demonstrating its benefits.

A bigger scar on America’s conscience is the appalling inhumanity of its incarceration policies. The US has the highest incarceration rate on Earth, with about 2.2 million people currently behind bars, about half of whom are there for non-violent drug offences. Savage mandatory minimum sentencing laws see many languish for decades. One of our regular contributors at The Fix is a writer who is in federal prison. He has been there for 20 years, having received a 25-year mandatory minimum sentence for his first-time offence: selling drugs at the age of 22.

A growing clamour of opinion in the US and around the world – notably including some Latin American leaders – agrees that the War on Drugs has failed, that the human rights violations must end and that legalising or decriminalising drugs is the way to make this happen. As someone who believes that government has no business penalising us for what we put into our own bodies and having seen the damage prison does, I’m with those who see the end of drug prohibition as the greatest harm reduction of all.

Political reality might be slow to change, but happily, the process has begun in the US. Historically, Washington and Colorado voted to legalise cannabis last November, and with majority support for cannabis legalisation now regularly showing up in national opinion polls, more states should soon follow.

The hope should be that we achieve – at the very least – a drug policy model resembling that of Portugal, which, in 2001, stopped applying criminal sanctions for any drug possession for personal use. Overall drug use in that country has not significantly increased since then, but HIV and hep C infections have fallen, and more people with addiction problems are now receiving treatment; the harms of both drug use and drug prohibition have been mitigated.

With attitudes changing fast, there has never been a more exciting time to run a publication in this field. The complexities, entrenched prejudices and personal passions that you encounter mean there are plenty of pitfalls and stresses. Still, given the amount of stigma that has surrounded this subject, it’s a small triumph that such publications exist at all.

Will Godfrey is the now-former Editor-in-Chief of TheFix.com. He was right to appreciate his publication while it lasted; just before Matters of Substance went to print, costs and complications arising from a board-level lawsuit forced The Fix to fold. 2013 was its best traffic year, and it remains online for now.