At @OSULawDEPC for the @DrugPolicyOrg @acluohio conference From Punishment to Public Health. I am going to tweet a lot about drug policy in the next two days. I know many people want to focus right now on the critical moment the nation is going through, feel free to mute me.

First speaker, opening keynote, is @SamuelKRoberts: “the War on Drugs has been fairly effective at what it was designed to do, which is to rationalize increasing inequality in health, education, labor, and opportunity in the post-1973 American economy.”

"This [the War on Drugs] was never about the drugs." @SamuelKRoberts drives home the point that the War on Drugs was backlash to the civil rights movement, anti-War movement, and an assault on poor people and people of color.

Super interesting: all major War on Drug legislations in the 80s were passed in election years. "Just in case you thought it wasn't political" @SamuelKRoberts #PunishmentToPublicHealth

It was clear since 1970s that white and black people use drugs at the same rate, but War on Drugs policing cracked down on communities of color. “It wasn’t just about the numbers - it was also about the character of our policing which was becoming militarized” @SamuelKRoberts

"I like to beat up on Reagan. I mean Reagan was wild he really did not care... Reagan had a lot of faults but we can't put it all on him... lest we think this is partisan issue." @SamuelKRoberts #FromPunishmentToPublicHealth

Interesting and important anecdote from @SamuelKRoberts: Dems controlled Congress during the 80s when most of the major War on Drugs legislations passed.

Can’t not talk about Nancy Reagan when we talk about the War on Drugs. “Abstinence became a mode of governance” @SamuelKRoberts critiquing Just Say No.

Abstinence only, investment in DARE/ Just Say No continued for years in spite of overwhelming evidence of ineffectiveness. @SamuelKRoberts

“How many leaders have we lost [because of the War of Drugs]?” @SamuelKRoberts #FromPunishmentToPublicHealth

Some next steps from @SamuelKRoberts:
1. Fully-loaded cost accounting of the War on Drugs -- go beyond only mass incarceration, loss of life and potential (health effect on individual and communities, family separation), denial of political efficacy (lost votes!)

More next steps from @SamuelKRoberts:
2. Addressing whiteness double standard: stigma as a double standard.
3. A harm reduction that is willing to go and address social issues. A more critical harm reduction.

"Harm reduction that moves beyond a stance that seeks to ameliorate the harms done by drug use to one which seeks to address, rectify, & repair the harms done by the state in the name of law enforcement, neoliberal responsibility schemes, & even public health." @SamuelKRoberts

A warning from @SamuelKRoberts: the war on drugs was a mode of governance. We shouldn't allow opioid use disorder treatment as a mode of governance. There are a lot of other mental health issues that need attention as well. We have to also look at the back issues.

. @SamuelKRoberts is a tough act to follow but moving to a strong panel: @alexkreit, @LeoBeletsky, William Ebben, Lindsay Lasalle, and Carter Steward.

“Doubling down on punishment: a knee jerk response to increasing death” — talking drug induced homicide.

The narrative: “since this [overdose crisis] is a white problem we are moving to a public health approach.” @LeoBeletsky says it’s problematic 1) it is not a white problem and 2) we are not using a public health approach #FromPunishmentToPublicHealth

Not only the punitive approach to drug use is "alive and well" it is actually on a surge on some aspects. Public health language is being misappropriated to make punitive responses sound as a part of the public health approach. @LeoBeletsky

The leaders of this "punishment as an antidote" approach? Prosecutors. The logic: "We are taking drug dealers off the street and that we are going to prevent overdoses down the line." But @LeoBeletsky explains that the evidence doesn't back this proposition.

. @LeoBeletsky calls “drug induced homicide charges” and large drug busts “policy theater.” There is an idea that you can “terrorize drug users” to make drug supply disappear (it won’t).

Not great shout out to PA — the state that has brought the most drug induced homicides in the country, by a lot. You can view the data here: https://www.healthinjustice.org/drug-induced-homicide #FromPunishmentToPublicHealth

. @LeoBeletsky's data shows that family members, partners, friends, and such are those charged most of the time and not king-pin drug traffickers. "Don’t take the prosecutor’s word for it, we need data to evaluate their claims."

Carter Stewart, former US attorney in Ohio and currently @DRKFoundation, talks about how the law on the books are conducive to coercing pleas by allowing prosecutors to threaten with massive penalties to drug offenses.

Carter Stewart says he disagrees with @LeoBeletsky that the message of federal prosecutors during the Obama-era was about stopping drug trafficking, not about public health. Agrees with Leo that deterrence doesn't work and that too often those charged are not king-pins.

Lindsay LaSalle @DrugPolicyOrg asks Stewart: often families of overdose victims want "justice" (which often means more penalties). Did he see that as US attorney?
Stewart: often victim's families wanted a change from punitive approaches.

William Ebbeen, lost his son Tim to an od, "I don't blame the dealer. The dealer was pushed into the black market just like Tim was pushed into the black market... that dealer went to the black market for a job... criminalization of drugs is 100% incompatible with any treatment."

"As soon as you put someone in the criminal justice system you extinguish their hope." William Ebbeen says that treatment doesn't work because people don't have opportunities in recovery because of a "black mark" on their record.

I am really glad that Ebbeen took the conversation there: the "disease model of addiction" is important but incomplete. Addiction is also a social disease. The disease of despair model is very important to complete the physiological understanding of addiction.

. @LeoBeletsky, which I can listen to *all day*, talks about disparity in how we regulate black market for drugs vs. how little we regulate treatment programs.

"It is easier to get street drugs than to get treatment... something is backward in the way we approach this problem."

Lindsay LaSalle: "one of the problems with drug induced homicide prosecutions is that they only deter the behavior that we want people to engage in -- calling 911." If you are afraid that by calling 911 when a friend ODs you could be slapped with murder charges you won't call.

. @LeoBeletsky: "there is a lot of research to suggest that the number one reason that people don't call 911 in a case of an overdose is legal repercussions." Could mean drug induced homicide charges but also child welfare services, losing public housing, or being evicted, etc.

Public health messaging: if you use drugs, don't use alone.

Drug induced homicide message: if you use drugs, run away as far as you can from anyone else that is using so that you don't get charged with murdering them. @LeoBeletsky

William Ebben: why would a bright guy like @PreetBharara think that more punishment will solve this crisis when more punishment never solved any drug problem ever.

Carter Stewart: you will need to ask him!

Mr. Bharara? Wanna chime in. Happy to read your response to the room.

. @alexkreit: why is it the rise in drug induced homicide charges, this surge in punitiveness, comes at a time of a growing recognition that addiction is a disease?

Lindsay LaSalle: about a narrative of white users vs. black and brown dealers who "push" drugs.

Lindsay LaSalle: myth that "the end seller, the person doing a hand-to-hand sale, actually has any control or any knowledge to what is in their product and even if they do you would want them to disclose that." Another behavior that drug induced homicide prosecutions discourages.

. @LeoBeletsky:"The advent of fentanyl is a byproduct of our failed responses. Just like during the alcohol prohibition American who drink alcohol had to move to vodka.. in the same way we moved from a market of heroin and a market of fentanyl which is more compact and profitable"

. @terrellPNNY asks from the audience asks how do you deal with the stigma of judges against people who use drugs or angry judges because of impact of drugs on their life?

crickets

Point from the crowd: when you incarcerate a rapist there is one less rapist out there. When you incarcerate a drug dealer, you create a job in the black market.

"We are not regulating drugs well in the medical space and our regulation of the black market is abysmal... there needs to be a political movement to demand a change." @LeoBeletsky

That's a wrap! I missed a lot of good points. @rs_mcneil also live tweeting some of the discussion.

Next up: "Treatment instead of incarceration: a wolf in sheep's clothing." A discussion about drug courts with: @jazzyjtyler, @DMTJoshi, @mjsmilloy, @christinemehta. It is going to be good!

If you determine that someone has a health condition then treat them in the health space. Don’t treat them in the criminal justice space.... Compulsory treatment works about half the time — you never know if you will get the outcome that you want. @jazzyjtyler

"I do not believe that drug courts should exist. They are a continuation of a flawed system." There are success stories but they didn’t need to be in the court system to get recovery." @jazzyjtyler brings truth and

"Poor black folks don’t get drug courts, they get jails" @jazzyjtyler

“Not one drug court in the United States takes violent offenders” @jazzyjtyler also reminds that there are many categories of crime that are deemed violent even though no violence actually occurred.

"The national association of drug courts professionals started to acknowledge the issue [of standards of care]" and made recommendations to what *should* treatment look like. "Most drug courts aren't listening to them." @christinemehta

"All drug courts are abstinence based model and that is not supported" by the evidence. "If your marker of success is that you seized to use drugs... that does not hold up in the scientific community." @christinemehta

Drug courts like natlrexone/vivitrol because it is "controlled." Treatment providers that are contracted by drug courts are skeptical of buprenorphine and methadone. @christinemehta

. @christinemehta: "drug courts often talk about moving away from incarceration but we really need to talk about moving away from the criminal justice system." To do that we need to fix the healthcare system and ensure access to treatment.

. @mjsmilloy gets into the medicine, "relapse.. is a part of that natural disease progression for people who live with opioid use disorder... periods of drug use after a person didn't use drugs for some time" are especially dangerous. Abstinence increases OD risk.

. @mjsmilloy: @InsiteVan has seen many people overdose in the 15 years that it is open.. not one have died.

Yes! Yes! Yes! @DMTJoshi: recovery can come in many forms -- without help, 12-step, medication, etc. -- but there is a difference between what works for individuals and what is good public policy.

For me, it is all about increasing choice for treatment options.

. @mjsmilloy shares evidence on abstinence. Cites NJEM study that shows that immediately after periods of incarceration are at risk that is 12 times higher to die of overdose.

If you need proof that the War of Drugs doesn't work: "in the most controlled setting in our country [prisons] there are drugs." @jazzyjtyler

. @DMTJoshi: not only drug court do not offer evidence based medications (methadone/ buprenophine) but judges mandate that you stop taking those medication -- against your physician's recommendation. Take that in.

Speaking about making people stop using buprenorphine and use of drugs in prisons, check out my latest piece on that exact issue: https://twitter.com/abgutman/status/1043091410210185221

"At the end of the day, the buck stops with the judge... the person who has the final call around that table is the judge" not the treatment provider. Drug court *is* court, not treatment. @christinemehta

If you are treated through drug courts, you sign away all of your confidentially. So the treatment provider can share with the judge *everything*. They can report anything that is said in counseling or in group session. So much for a safe space between doctor and patient?

Shoutout to @johannhari101 -- a good book about drug courts and treatment is Dying to be Free: https://www.theguardian.com/books/2016/apr/12/johann-hari-chasing-the-scream-war-on-drugs

For @mjsmilloy treatment must include "confidentiality, consent, and compassion." Drug courts don't include any of these elements.

An evidence based approach that we don't have in the United States or Canada because public safety always trumps public health: prison based syringe exchange programs. One of many examples of course. @mjsmilloy

What I hear from this panel is more of what @LeoBeletsky was talking about: another instance of the criminal justice system using language of public health (treatment) to re-package a punitive approach.

. @DMTJoshi: "One of the big selling points is that they say that they reduce incarceration... does that hold true?"

@jazzyjtyler: "drug courts are not alternatives to incarceration... they fuel incarceration."

Talking about the choice to take prison time or do drug court, @jazzyjtyler says that when you tally the length of program plus the number of jail days due to sanctions, it makes more sense to choose taking the time.

Before Vancouver had a safe-injection site, they already had wet-housing.

THANK YOU FOR MAKING THIS POINT @jazzyjtyler !!!!! I'm going to hammer on this point tomorrow in the panel that I'm speaking at but YES -- we need to provide healthcare (!), housing (!), and jobs (!).

"Ohio can join Portugal and Vancouver in becoming the promise land!!! Somebody tweet that @jazzyjtyler." Done.

She is talking about #OhioIssue1 which would change drug possession from felony to misdemeanor. @johnlegend supports it so get with the program. https://www.daytondailynews.com/news/local/issue-john-legend-lends-support-criminal-justice-reform-measure/ie8YfIXkdKHs1Pg6ZMuOkI/

How do we change the system?

"Get yourself a drug user union like @VOCALNewYork" @jazzyjtyler

"BOOM" @terrellPNNY from the crowd

Someone from the crowd tells a story of an amazing drug court that "does work." I always appreciate people who have the courage to thoughtfully push against the panel. It is not easy in a room with 200 people.

Very thoughtful response from @christinemehta -- takes a step back and looks at the entire system "there aren't good options. There is a crisis of social service provisions. There is a crisis of providing a net for the people who need it."

"Every 25 seconds someone is arrested for drug possession" @jazzyjtyler

During this panel (75 minutes) 180 people throughout America were arrested for drug possession. Take that in.

On Vancouver: in terms of Insite we got it right but we still have too many people dying of overdose in our city -- not enough safe injection sites and not enough treatment options. "In so many ways prohibition has its hand all over this public health crisis" @mjsmilloy

. @DMTJoshi: A part of the solutions to the overdose crisis has "nothing to do with money but has a lot to do with political will... housing is one of the best harm reduction measures out there... but we have a lot of NIMBY responses."

Break! Stretching the fingers.

Dr. Susan Sherman of @JohnsHopkinsSPH starting her talk about the impacts of incarceration and racism on the overdose crisis.

“20% of incarcerations are drug related, mostly possession.”

Some of the collateral consequences of concentrated policing: arrest => trauma and stress => predisposition to problematic substance use => arrest => trauma...

And in the center of it all is racial discrimination.

Collateral consequences of concentrated policing on communities: community members arrested/ incarcerated => disrupted family structures => trauma and stress => loss of family income => engagement in drug economy => community members arrested/ incarcerated....

HIV is a collateral consequence of incarceration -- on the individual and community level.

Consequences of prohibition of drugs: unregulated drug market and legislative barriers to implementing measures for those using to protect against contaminants or overdose (or infection).

Dr. Susan Sherman's conclusion: 1) Prohibition of drug use and associated criminalization of people who use drugs indirectly and directly fuels endemic drug use epidemics and their impact on communities.

2) The criminal justice situation creates social isolation, stigma, lack of opportunities, that are risk factors for substance abuse.
3) Drug policy reform will not reduce burden of incarceration low-level offenders but likely broader rates of drug use.

4) Individuals and broader communities of color (largely) are traumatized by both over-incarceration and the morbidity/mortality associate with current day opioid drug use.

Up next: the cops! @NeillFranklin, Ronald Martin, Jerome Sanchez, Baxter Worth Paschal, @TomTsynan11, all current or former law enforcement, discussing the role of police and prosecutors in harm reduction.

All law enforcement talk about embracing harm reduction principals after seeing the crisis first hand -- but all also mention not having tools and have tremendous pressure from communities to address crime.

"What I need you to think about: as long as drugs are illegal there is going to be a response." For Ron Martin, given that prohibition exists, harm reduction is how do we do the most to help people within this system.

. @NeillFranklin: how can Law Enforcement Assisted Diversion helps move people away from the criminal justice system?

Worth Paschal: gives cops an option to move low level offenders with addiction to avoid the cj system all together and be refereed to social services & treatment.

Ron Martin talks about the culture change that occurs in law enforcement in recent years from only enforcers of law to counselors, first responders, etc -- police officers "are the ultimate triage unit."

Ron Martin asks the harm reduction community to embrace the policing community -- he says that it is a reality that as long as drugs are illegal people who use drugs will be in touch with police all the time so the most should be made of it.

. @NeillFranklin: "why is it important for law enforcement to support harm reduction programs?"

Jerome Sanchez: there are a lot of cops that have no clue what harm reduction is. Police departments do what communities ask them to do and communities oppose harm reduction measures.

"Law enforcement is at a crossroads right now -- are we law enforcement or first responders?" @TomTsynan11 says it starts by understanding that addiction is a mental health medical conditions, "if it impacts the brain how can it be a crime?"

"How do we get to a place of legal access for people who are using drugs? Ending prohibition policies means legal access in some form and somewhere down the road we need to get to that." @NeillFranklin

"We need community controlled policing" @NeillFranklin

"Why wouldn't you want the person responding to have naloxone?" Ron Martin asks me in response to my question about whether instead of training police officers to be first responders we just need less police. I want the person to have naloxone, but why have a gun?!

Civil commitment is a "carceral solutions to a public health problem" @SamuelKRoberts

Last panel for the day: Ohio state issue 1! @jrosnick @SLandP @ShakyraDiaz @stephenJG discuss the Ohio state constitutional amendment that is on the ballot and proposes to turn some drug felonies to misdemeanors among other changes to reduce the prison population.

What is Issue 1?

Why is Issue 1 needed? Something needs to change. For the past 8-years straight drug overdose deaths have been increasing. @ShakyraDiaz

"Because Issue 1 is on the ballot, people are talking about the issue [drug prohibition and enforcement]" @SLandP says. "In this process judges showed that they want to be a part of the law enforcement community."

B-A-N-A-N-A-S the chief justice of the Ohio supreme court is a leading voice against Issue 1 (the OH ballot initiative to not put some people who are caught with drugs in state prison)! The justice is doing radio shows about it. So much for an independent judiciary.

"What Issue 1 is about is getting more resources to the things that work that we have on the ground right now." @stephenJG

"What we see through the entire criminal justice system is a system that is not designed to help these people [people in addiction]" @SLandP "a public health trained person should be the one on the front line" not the police.

Everyone follow @SLandP -- hero status here -- I've been following his academic work in the past couple of years but hearing him to speak in person... I'm an immediate fan. This is me right now hear him talk about having *not* armed police responding to 911 calls about overdoses:

One of the message of @SLandP is that even when campaigns fail, they are opportunity to raise an issue.

The budget of Ohio state prisons is $1.8 billions, says @ShakyraDiaz. That's a lot of housing vouchers...... just saying

"Any time that you put someone in a position that they can't find work, you put public safety at risk" @ShakyraDiaz

Wow. I did not know this. In Ohio, if a person that has a felony charge on their record gets murdered, their next to kin won't get any benefit under the Victims of Violent Crime Act. Is that true in every state? This is horrible.

Ok -- it's a wrap. What a truly incredible day (though I do miss baby Mara). I am going to eat some cheese and chat and learn from the awesome people here! I'll return to this thread tomorrow.

Welcome back! It is the second day of the @DrugPolicyOrg @OSULawDEPC @acluohio #FromPunishmentToPublicHealth conference.

Starting the day off is @RickAHodges with the stories of people who used a variety of different drugs and fatally overdosed on carfentanil.

“Most drug users are just people, not all of them struggle... what is in our drug supply is most important.”

@RickAHodges explains that people don’t use drugs more now, the drugs are just stronger. Carfentanil is stronger than fentanyl and fentanyl is stronger than heroin.

Talking about what is in drugs in Ohio is economist Dan Rosenblum. Prohibition creates a big problem for researchers: “we don’t know demand, we don’t know supply.”

Heroin used to be heroin. Cocaine used to be cocaine. Sometimes the two mixed — rarely. Now, everything might be a synthetic opioids.

“This is why people are dying.”

“All the change [in overdose death] is driven by synthetic opioids.”

Why is the strong correlation between synthetic opioids in the supply and overdose death so important? Because "There's a real possibility of an early warning system to alert drug consumers, first responders, and efficiently mobilize harm reduction services."

No @RickAHodges (it's really him this time!) talking about the Ohio Population Health Alliance. Working on surrounding women who are incarcerated with services.

Now @RickAHodges (it's really him this time!) talking about the Ohio Population Health Alliance. Working on surrounding women who are incarcerated with services (health and social). Also work on research -- what are the years of lives lost due to opioids in Ohio?

I have to say, I am becoming a bit frustrated. So much of the programs that are praised intrench the criminal justice system as a treatment provider. Prison, jails, cages, are traumatizing and not a the right place for recovery.

How can you tell a patient that you understand that they have a disease and at the same breath tell them that their disease is a crime? Providing services in prison should not be the goal -- it is the bare minimum. The goal must be to not cage people. Not to make the cage better.

It is kind of wild to hear a presentation that starts with someone saying that their "BIG IDEA" is providing services in a women's prison and then to move on to explain the importance of considering the social determinants that lead to addiction. Why incarcerate then!?

Up next: @Kassandra_Fred of @DrugPolicyOrg talks about race and the overdose crisis.

“I’m Professor Frederique and this class is The War on Drugs is a Master Class on Whiteness and Policy Making, so take notes.”

"I am telling you that most drug laws that we have passed in the United States have always had a boogieman... every time we talk about drugs we talk about a group of people that we want to be scared of [who are not white]." @Kassandra_Fred

"We are consistently talking about white drug use, we are talking about white pain... honestly, what it comes down to is understanding that so much of what we are working towards is uplifting and upholding the pillars of white supremacy and patriarchy." @Kassandra_Fred

. @Kassandra_Fred says that the faces that we put forward as the faces of the victims are white faces. Talk about them as being accidentally addicted because of someone else’s fault.

“Am I making this up?”

No. She is not.

"We have not created the conversation about how we can disrupt the issue about race and drugs... we are building whole structures, even in this conversations about this overdose, we are talking about opioids and not all drugs." @Kassandra_Fred

"If we are having a conversation about ending the overdose crisis without having a conversation about ending criminalization of all drugs we are not having a conversation about saving people's lives" @Kassandra_Fred

"In order for us to end the overdose crisis we need a reckoning [where are we complicit to white supremacy and what is commitment to dismantle it]... white supremacy is about white people and it is not about white people. It is about power. It is about access." @Kassandra_Fred

Reducing harm is not just giving a syringe, is not just giving methadone, is not just giving a syringe -- it is about disrupting structures that make it ok for us to cry for Philip Hoffman and laugh at Whitney Houston @Kassandra_Fred

If you ever have an opportunity to hear @Kassandra_Fred speak -- don't miss it.

Next up: @DanielBRaymond of @HarmReduction talks about harm reduction holistically as a social justice movement to respect and protect the rights of people who use drugs.

"Celebrating any positive change seem like a commonsense thing" so why is it that when we talk about any positive change in the context of drugs use and people who use drugs it becomes a radical proposition?

A critical point for advocates to think about from @DanielBRaymond

We hear the term "meeting people where they're at" a lot. @DanielBRaymond explains it through the inverse -- come to us to get a service. Meeting people where they're at means that the comfort of the service provider is less important than the person the service is for.

"When we talk about harms that we are concerned about it is not just he harms of the substances themselves but the systems and environments" that are related to drug use. Example: not calling 911 at overdose because of fear of police. @DanielBRaymond

"These impossible choices that people have to make are not only about the pharmaceutical properties of drugs but of the structures around them" @DanielBRaymond

"Too often we think of harm reduction as optional... not necessarily institutionalized"

How do we make the case for harm reduction?

@DanielBRaymond: if we can identify harm, there is probably a need for harm reduction.

If we want to commit to prevention and treatment, do we still need harm reduction? If they will prevent 100% of drugs use, maybe not. "But we are never going to get to that 100% effectiveness.. so we are going to need harm reduction to keep people safe and alive." @DanielBRaymond

"At the individual level harm reduction prioritizes safety, stability, and support... at the program and community level harm reduction can provide a sense of place, purpose, and participation." @DanielBRaymond

"At the systems level harm reduction problematizes the social, cultural, environmental, policy context of drugs use to explain why vulnerability and resiliency to harms are unevenly experienced and distributed" @DanielBRaymond

Wow this day is SO GOOD!

“Nothing about us without us” we hear that a lot but what does it mean?

@terrellPNNY, Dylan Stanley, Laura Cash, and Taylor Bennett break it down.

Dylan Stanley: I am currently in a methadone program, while it is not ideal it gave me life back. Also talks about the importance of syringe exchange programs. Says she used to use the same needle for 30 days.

"We are the experts.. no one can sit hear and tell me how to address problems in my life... you cannot sit there and tell me how it feels to wake up in the morning sick and use heroin to get better." @terrellPNNY

"You can understand what I went threw, but if you haven't walked in my shoes, you can't tell me how it feels." @terrellPNNY

"When we talk about the overdose crisis, about people dying, we need to look at where things started -- the systems that are in place, we need to look at the white supremacy." @terrellPNNY @VOCALNewYork

"For a long time people told us where we need to go and how we are going to get there without asking us where we want to go" Taylor Bennett

"As soon as you admit to someone that you are a drug user you are automatically less" Stanley

"Heroin is seen as a white drug and probably that is the reason that people are paying attention, because white people are dying" Stanley

Laura Cash talks about her son, who died of overdose, "I saw him fight with everything he had for two years [always in some kind of treatment]." Says she started searching for an answer: why did he die?

The first thing that she learned: not only drugs are stigmatized. People who use drugs are stigmatized, treatment is stigmatized, recovery is stigmatized, families are stigmatized, and the death is stigmatized.

30-day treatment program told Laura that if her son would do everything they tell him, after 30 days he will be cured. When he came home he relapsed. Talks about how awful and guilty her son felt for relapsing. "We need to start supporting people."

"I wish I have known the gold standard of treatment -- we were told that they shouldn't use any medication." Laura Cash talks about the importance of methadone.

"I wish that we listened to him. We didn't know about drugs, but he did.... we really needed to listen to him." Talks about how big it is to have someone to say "I'll be here no matter what."

"If tomorrow we found that heroin is a treatment for cancer" our society would start using it immediately. "My son's death certificate says he died of an overdose but he died of society's stigma."

"No one wants to be called a junkie, no one wants to be called an addict, no one wants to be called a prostitute.... language plays a key part when you are addressing people that use drugs" @terrellPNNY

The way to move the needle on addiction: "science and storytelling" @lipiroy

"As a patient in a methadone program you wake up every day at 6am to go to a methadone clinic.. it is massively inconvenient.. you are supposed to go out and get a job.. how are you supposed to do that when you need to wake up every morning get on a bus to a clinic?"Dylan Stanley

Dylan Stanley says that methadone is working for her -- "I don't wake up sick"-- but that the regime of going to a clinic every morning is "like being chained to a heroin dealer."

Next panel: what does “evidence based treatment” actually mean?

Speakers: @lipiroy, Shawn Ryan, Richard Massati, Josiah Rich, and John Brooklyn. Real powerhouse panel.

Dr. Ryan of @BrightView_LLC: addiction is a disease that is treatable and can be fatal if you don't treat it.

"People expect perfection when people [in addiction] enter treatment but that is not reality -- not a reality in asthma, in diabetes."

“There is not a whole lot of choice here”

Addiction is about interaction of genetics and environment.

"If you do not offer medication assisted treatment to your patients with opioid use disorder that's malpractice."

The causes of addiction are traumatizing events that cause complex emotions and isolation @lipiroy

The 4 C's of addiction: Impaired control over drug use, compulsive use, continued use despite harm, cravings.

"in addiction the cravings are so intense -- think about it as the primary symptom of addiction" @lipiroy

Methadone and buprenorphine are life saving medications. @lipiroy

Addiction does not equal dependence. @lipiroy

What can you do? Change your language. #LanguageMatters #ChangingTheNarrative #FromPunishmentToPublicHealth @lipiroy

"Withdrawal is your opioid receptors telling your brain that you are dying." Dr. Josiah Rich

Dr. John Brooklyn talking about the Hub and Spoke model in Vermont -- make addiction treatment just like the treatment of any other disease -- make treatment universal in offices and create a referral system and network of care.

1.5% of Vermont's population is currently on a medication to treat an opioid use disorder. For every person in treatment there is a person in addiction to opioids that isn't.

I love the term "highly" illegal. "Heroin is 'highly illegal'." -- what makes it "highly" illegal? What is lowly illegal?

In 2015 Ohio passed a law authorizing syringe exchange programs. Ohio now has 14 programs. Pennsylvania, which saw more overdose death than Ohio in 2016, has only 2!

Fentanyl testing strips change behaviors and save lives.

It is the right thing to do.
It saves money.
The science supports it.

Call it supervised consumption facility, safe consumption site, comprehensive user engagement site, overdose prevention center, or drug consumption room it really doesn’t matter — let’s open it!

Peter Bruun speaking in front of a self portrait of his daughter, Elisif, which she drew 3 weeks before she fatally overdosed. A friend sent her heroin in the mail - he didn’t know she was in recovery. Prosecutors charged the friend w/ homicide. Peter testified for the defense.

Sorry I have been slower to tweet today. Panels have beeb amazing. It is only because I'm getting anxious about my upcoming panel. Hopefully someone else will tweet a bit!

I can't live tweet my own panel, because, you know. But here is a teaser: it is not random that that the overdose crisis is at a time of a national housing affordability crisis. Addiction is a disease but it is also a symptom of social disease called capitalism induced despair.

Thank you so much @OSULawDEPC @DrugPolicyOrg @HarmReduction @acluohio for having me! It was such an honor to sit among such terrific panelists. Thank you for moderating, @rs_mcneil.

My main points:
1. No new resources into law enforcement and prisons. Divert existing criminal justice budgets to treatment and harm reduction in prisons — no new money.
2. America is a welfare state, it’s just that the rich get the benefit — no strings attached unlike the poor.

That’s it! Heading to the airport. Now all that’s left to say is that I MISS MY BABY!!!! Will she even remember me?! She struggles with object permanence and all that.