►
Description
From Ed Baker:
Maia Szalavitz is the author, most recently, of Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction, which is the first history of the movement aimed at focusing drug policy on minimizing harms, not highs.
Her previous New York Times bestseller, Unbroken Brain: A Revolutionary New Way of Understanding Addiction wove together neuroscience and social science with her personal experience of heroin addiction. It won the 2018 media award from the National Institute on Drug Abuse.
She writes regularly for the New York Times and has written for numerous other publications including TIME, Wired, Elle, the Nation, Vice, the Guardian and Scientific American. Her 2006 book, Help at Any Cost: How the Troubled Teen Industry Cons Parents and Hurts Kids, was the first to expose the damage caused by “tough love” youth treatment and helped spur Congressional hearings.
She has also authored or co-authored five other books, including the classic on child trauma, The Boy Who Was Raised as a Dog, with Dr. Bruce D. Perry. With Dr. Perry, she has also written Born for Love: Why Empathy Is Essential— And Endangered, which laid out why empathy is essential for social trust and how inequality can erode it. With Dr. Joseph Volpicelli, she wrote Recovery Options: The Complete Guide, the first evidence-based guide to addiction treatment.
She lives with her husband and two squeaky cats in New York City. Twitter: @maiasz
12/13/2022
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A
A
I
read
the
book.
I
I
read
the
book
fully
I
will
read
it
again:
I
I
can't
even
recommend
it
highly
enough
to
everyone.
That's
watching
the
show
you
can
be
a
seasoned
harm,
reductionist
or
a
brand
new
recovery
coach,
a
state
legislator,
a
person
who
uses
drugs.
A
person
in
recovery,
I
recommend
the
book
to
everyone.
I
think
the
book
is
being
released
at
a
pivotal
time
in
America
and
it's
going
to
change
the
way
we
see
addiction
and
the
way
we
see
people
you
know
who
need
our
help.
A
Maya's
previous
work,
a
New,
York,
Times
bestseller,
unbroken
brain
a
revolutionary
new
way
of
understanding,
addiction,
wove
together
neuroscience
and
social
science
with
Maya's
personal
experience
of
heroin
addiction.
The
book
won
the
2018
media
award
from
the
National
Institute
on
drug
abuse,
soon
to
be
renamed
the
National
Institute
on
drugs
and
addiction.
Thank
you,
Nida
for
changing
your
name
so
Maya.
You
know
just
thank
you
for
being
on
the
show.
A
A
Yeah
I
guess
I'd
like
to
I'd
like
to
begin
with
that.
Just
a
brief
like
I
get
to
know
you
with
your
personal
history
of
addiction,
I've
read
about
it,
I
understand
it.
I'm
I'm,
I
I
stood
right
next
to
you
during
that
era
and
went
through
exactly
the
same
experiences
so
identify
with
you
tell
my
my
viewing
audience
a
little
bit
about
yourself.
B
B
B
B
There
were
many
ways
of
understanding
addiction
and
many
Pathways
to
Recovery
and
we
should
never
have
a
treatment
system
that
teaches
you
that
the
only
alternative
to
this
one
is
jails.
Institutions
and
depth.
I
mean
that's
a
terrible,
hopeless
message
you
give
to
people
for
whom
it
isn't
working
for
whatever
reason-
and
we
now
know
in
the
opioid
crisis
that
you
know
the
best
treatment
for
opioid
addiction
is
staying
on
an
opioid
either
methadone
or
buprenorphine.
A
No
well
thank
you.
Thank
you
for
your
candor
and
I,
like
you
was
beat
up
by
the
War
on
Drugs.
I
came
with
you
through
that
in
that,
in
that
time
period
in
that
generation-
and
you
know
I
mean-
are
you
touching
on
a
couple
of
different
places
that
I
want
to
go
with
this
interview
today?
One
of
them
specifically
is
the
War
on
Drugs
the
punitive
approach,
the
judgmental
approach,
the
law
enforcement
approach
and
how
that
beats
people
up
and
drives
them
further
into
addiction,
now
I.
A
The
way
the
way
I
see
it
at
this
point
in
our
history
is.
This
is
the
main
problem
today
with
approaching
people
with
problems
that
results
from
from
drug
use.
I
want
you
to
comment
on
that.
A
little
bit
I
mean
the
statistics
are
just
mind-boggling
and
then
I
want
to
move
into
harm
reduction.
You
know
it's
kind
of
the
opposite.
Harm
reduction
to
me
is
the
actual
polar
opposite
of
the
War
on
Drugs.
So
maybe
comment
on
that
and
then
we'll
go
into
it
a
little
bit
more
deeply.
B
Sure
so
addiction
is
defined
by
like
the
diagnostic
and
statistical
manuals
of
Psychiatry
and
by
the
National
Institute
on
drug
abuse,
which
thankfully,
is
finally
changing.
It's
outdated
and
stigmatizing
name
the
so
addiction
is
defined
as
compulsive
behavior.
That
continues,
despite
negative
consequences,
so
basically,
within
the
definition
of
addiction,
is
the
fact
that
if
punishment
worked
to
fix
it,
it
wouldn't
Exist
by
definition,
because
negative
consequences
is
kind
of
another
way
of
saying
punishment,
although
it's
a
little
bit
broader.
B
So
the
idea
that
we
could
use
punishment
to
fix
a
condition
that
is
defined
by
its
resistance
to
punishment.
It
is
pretty
stupid
and
so,
but
we've
been
trying
to
do
that
for
the
last
hundred
years,
and
so
when
you
think
about
that,
you
have
to
think
about
like
well.
This
is
an
obvious
fail,
like
it
hasn't,
worked
we've
of
the
worst
rate
of
incarceration
in
the
entire
world.
We
still
have
the
worst
overdose
crisis
in
the
entire
world
and
we
still
probably
do
more
drugs
per
capita
than
everywhere
else
in
the
world.
B
B
It's
terrible
at
treating
addiction
preventing
addiction,
stopping
drugs?
It's
bad
at
everything.
It
says
it's
supposed
to
do,
but
it's
really
good
at
getting
people
elected
by
saying
they're
going
to
be
tough
on
crime
and
implying
that
that
means
an
in
fact.
It
does
end
up
mean
meaning
being
tough
on
black
people.
B
So
you
know
we
have
this
whole
sort
of
symbolic
use
of
policy,
and
the
media
is
a
horrible
player
in
this,
and
we
can
see
this
happening
again
right
now,
where
you
look
at
harm
reduction
and,
as
you
said
earlier,
harm
reduction
is
basically
the
opposite
of
the
War
on
Drugs.
It
says
like
what
we
care
about
is
not
whether
you're
getting
high
but
whether
you're
getting
hurt
or
hurting
someone
else
and,
and
so
our
policy
Focus
has
to
be
on
reducing
Global
harm.
B
And
when
you
do
that,
you
have
to
look
at
the
harm
associated
with
policy
and
when
you
look
at
the
harm
associated
with
policy,
mass
incarceration
is
a
terrible
harm.
We
know
that
locking
people
up
I
think
for
every
one
year,
you're
incarcerated.
You
have
two
years
taken
off
your
life
expectancy,
13
of
all
the
covid
in
the
United
States
would
spread
via
prisons
and
jails.
Like
it's
crazy.
B
A
So
in
America
there's
this
incredible
momentum,
that's
built
up
over
decades,
I
think
you
recite
the
Harrison
Act
in
in
your
in
your
book
kind
of
forcing
the
medical
profession
to
abandon
his
patients.
You
cannot
prescribe
drugs
to
provide
comfort.
You
have
to
let
people
suffer.
The
more
people
suffer
the
more
likely
they'll
stop
taking
drugs,
which
is.
B
B
People
had
been
used,
maintaining
their
patients
on
opioids
who
were
already
on
them,
and
they
decided
no
absence.
The
only
way
cut
them
off,
lots
of
people
died,
lots
of
doctors
went
to
jail
and,
of
course,
the
opioid
problem
was
solved
forever.
We
do
not
have
one
now
because
of
how
effective
the
Irish
and
narcotics
act
has
been
and
I'm
being
sarcastic
very.
B
A
A
You
fast
forward
to
1970
71
72
in
the
Nixon
Administration
and
that's
when,
in
my
view,
anyway,
the
War
on
Drugs
really
went
into
War
on
Drugs
2.0.
Really,
let's
get
them.
Somebody
in
the
Nixon
administrations,
I
think
I.
Think
you
cited
in
your
book.
The
quote:
is
we
couldn't
make
black
and
being
against
the
war
illegal,
so
we
made
drugs
illegal.
A
B
I
mean
yeah,
it's
it's,
it's
completely.
Nuts
and
what's
I
mean
it's
just
infuriating
on
so
many
levels,
because
it
it
replicates
racism,
I
mean
I,
don't
understand
how
anybody
could
say,
there's
no
systemic
racism.
When
you
look
at
the
disparities
in
drug
enforcement
and
you
look
at
the
way
black
people
have
been
incarcerated
at
rates,
you
know
triple
or
more
compared
to
white
people.
B
When
AIDS
is
hitting
very
clear
people
in
Europe
very
rapidly
realized
that
AIDS
was
a
greater
threat
to
their
population
than
drugs,
because
you
know
you
can
spread
it
to
other
people,
and
at
that
time
it
was
almost
universally
deadly
and
so
people
in
the
UK
and
the
Netherlands
thought.
Well.
You
know
we
gotta,
like
just
we
gotta
just
focus
on
fighting
AIDS
and
they
knew
that
people
actually
prefer
clean
needles
to
dirty
ones,
like
people
prefer.
B
B
They
they
realize
that,
like
this
works
so
much
better
than
trying
to
stomp
people
into
the
ground
in
hopes
that
they
will
hit
bottom
and
get
better.
You
know,
I
mean
this.
Whole
concept
of
bottom
is
really
you
know
even
AA.
In
the
very
early
days,
they
recognized
that
there
was
a
problem
with
this
concept
because
they
suddenly
had
high
bottom
and
Low
Bottom.
A
B
But
if
we're
nice
to
you,
you
will
you
will,
you
know,
continue
to
be
addicted
and
what's
really
especially
ridiculous
about
this
is,
if
you
think
about
who's
more
likely
to
recover
somebody
who's
homeless
and
jobless,
and
has
no
education
and
is
not
connected
with
their
friends
or
family.
And
really
has
you
know
a
horrible
situation
or
somebody
who's
like
a
CEO
who
has
their
family
who's,
got
tons
of
money
and
tons
of
friends
and
resources.
Now
I'm
gonna
put
my
money
on
the
CEO
right.
B
A
This
very,
very
good.
Thank
you.
Thank
you.
Thank
you.
You
know,
I
think
one
of
the
concepts
that
you're
capturing
is
this
idea
of.
What's
really
the
driving
value,
the
in
the
way
I
see
it
and
it's
from
my
reading,
the
driving
value
and
harm
reduction
is.
We
would
rather
keep
you
alive
than
try
to
force
you
to
stop
taking
drugs.
The
driving
value
with
the
War
on
Drugs.
Is
we
don't
care
whether
you
die
or
not,
we're
just
going
to
make
you
stop
taking
drugs?
A
So
if
the
question
becomes,
would
you
rather
have
a
dead
person
or
a
person
alive
taking
drugs
and
the
obvious
to
us
I
mean
the
answer
to
us
is:
is
obvious:
that's
the
the
harm
reduction
approach.
In
my
view,
and
in
your
view,
I
believe
the
primary
purpose
is
to
keep
people
alive
while
we're
engaging
them
and
we're
seeing
this
more.
B
And
more
and
I
mean
there
is
no
conflict
between
that
and
and
the
original
12
steps
and
the
whole
on.
You
know
the
whole
idea
like
thing
in.
If
you
read
the
literature,
it's
all
about,
how
do
you
attract
people
into
recovery?
Not
how
do
you
stomp
on
their
face
until
they
get
better?
You
know
it's
all
about
this
part
for
me.
Maybe
you
want
to
try
it,
which
is
the
fundamental.
B
A
B
We're
gonna
put
we're
going
to
keep
you
alive
first,
because
we
care
about
you
and
one
of
the
things
that
is
sad
about
this
is
that
when
we
care
about
people,
if
we
think,
for
example,
that
they're
white
people
we're
open
to
harm
reduction,
if
we
don't
care
about
people,
we
want
them
to
die
as
an
example
to
our
kids.
We
don't
care,
and
so
I'm,
just
hoping
that,
as
we
sort
of
start
to
recognize
that
this
is
a
much
more
Humane
Kinder,
more
effective
approach.
A
I
pulled
a
quote
out
of
your
book:
I
pulled
too
close
out
of
your
book.
One
was
from
1993
the
1993
harm
reduction
working
group
and
then
the
second
one
is
from
the
harm
reduction.
Coalition
I'll,
just
read
the
second
one.
It's
very
concise.
This
is
Dave
purchase,
you're,
quoting
Dave
Burgess
quote:
harm
reduction
is
against
harm
neutral
on
the
use
of
drugs
per
se
and
in
favor
of
any
positive
change,
as
defined
by
the
person
making.
The
change
close
to
quote
that
to
me
is
sheer
Beauty.
That's.
B
It's
supposed
to
be
about
unconditional
love
and
about
serving
people,
and
this
is
exactly
what
harm
reduction
is,
and
this
is
why,
like
a
lot
of
people,
really
sort
of
find
a
spiritual
thing
in
it,
because
what
you're
doing
when
you
are
working
in
harm
reduction,
is
you
are
saying
I
value
you
exactly
as
you
are,
you
don't
have
to
change
to
deserve
to
live?
You
just
have
to
be
you
and
we
want
to
help
you
and
we're
not
asking
for
anything
in
return.
B
Maybe
you
want
to
try
this
if
you
feel
like
it,
and
what's
so
interesting
to
me
about
this,
is
that
like
for
every
other
group
of
people,
we
understand
that
nobody
likes
to
be
told
what
to
do
and
that,
in
fact,
if
you
tell
somebody
to
do
something
that
they
already
want
to
do,
they're
less
likely
to
want
to
do
it.
On
the
other
hand,
if
you
help
them
see,
why
doing
the
thing
that
you
want
them
to
do
will
also
help
them.
B
B
A
I
had
the
Good
Fortune
of
speaking
within
Livingston,
and
you
know
you
know
what
she
does
full-time
is
organize
drug
users.
That's
what
she
does
and
she
told
me
this
story.
She
said
you
know
if
you,
when
you
get
a
group
of
drug
users
in
a
room
and
you
are
there
with
them
and
you
ask
them.
How
can
I
help
you?
What
do
you
need?
She
said
they
weep.
A
That's
their
first
response.
They
weep
because
no
one
has
ever
asked
them
that
they're,
so
beaten,
they're,
so
accustomed
to
being
judged
and
looked
at
in
certain
ways
that
are
just
harmful
that
when
somebody
sees
them
and
cares
enough
to
ask
them
what
they
need,
they
weep
I
just
thought
that
was
a
beautiful
beautiful
story
and.
B
That
I
mean
that
is
just
very
true.
Throughout
harm
reduction,
I
mean
from
the
very
earliest
days
like
when
John
Parker
would
go
out
illegally,
giving
out
needles.
You
know
people
were
originally
like.
Why
are
you
doing
this?
What's
your
angle,
you
know
what
do
you
want,
but
when
they
realize
that
hey
here's,
this
guy
he's
risking
himself
his
own
freedom
in
order
to
just
try
to
help
me
stay
alive,
they
were
weeping
or
just
deeply
moved
because
it
was
like
yeah.
B
B
B
But
I
really
did
want
to
draw
attention
to
the
enormous
courage
that
the
early
and
still
many
harm
reduction
activists
now,
especially
in
the
South,
where
there's
still
a
lot
of
opposition.
But
what
was
also
especially
moving
to
me
was
to
see
how
you
know
back.
Then
there
were,
like
you
know,
20
of
us
in
the
world
who
knew
what
this
thing
was
and
were
trying
to
like
get
the
message
out,
and
then
you
know
now:
it's
like
the
White
House
says.
Harm
reduction
is
part
of
their
policy.
B
A
A
B
A
B
B
A
B
A
A
Now,
when
you
look
globally,
I
want
to
change
our
Focus
over
those
prevention
centers.
When
you
look
globally
to
overdose
prevention,
centers
the
you
know,
people
will
keep
attacking
the
data.
The
data
is
unequivocal:
they
work
nobody
dies
in
them.
People
within
the
certain
circumference
around
them
are
dying
less
of
drug
overdose.
They
connect
people
to
Services.
They
establish
relationships
with
people
that
are
caring,
probably
many
of
them.
A
For
the
first
time
they
they
work
now
you're
saying
that
the
Biden
Administration
yes,
Rahul,
Gupta
people
have
embraced
this
concept
of
harm
reduction,
and
we
have
in
Vermont
too,
but
in
America
harm
reduction
seems
to
stop
just
screeches
to
a
halt
right
before
overdose
prevention,
centers
I'd,
like
your
view
on
that,
why
do
you
think
this
is
when,
when,
when
worldwide
I
think
there's
over
over
a
hundred
centers
there's
never
been
a
have?
These
places
are
successful
wherever
they're
established,
why
Canada
has
overdose
prevention
centers?
A
B
We
still
have
that
they
enable
people
and
that,
if
you,
unless
you
make
people
inject
on
the
street
or
at
home,
if
they
have
a
home,
you
know
you're
sending
the
wrong
message.
We're
still
stuck
on
that
same
old
idea,
and
so
we
think
you
know.
Oh
yeah,
like
you,
know,
you're
going
to
make
a
safe
injection
Center
and
nobody's
ever
going
to
quit
because
now
they're
happy
because
they
can,
you
know
inject
and
not
die.
The
reality
is
if
you've
ever
visited.
B
One
of
these
places,
people
who
are
injecting
drugs
and
who
visit
these
sites
are
often
extremely
traumatized,
extremely
poor
on
extremely
marginalized.
You
would
start
crying
before
you
heard
half
of
the
story
of
their
childhood.
If
he
sat
and
listened
to
them,
you
know
the
idea
that
they're,
not
stopping
injecting
because
they
don't
have
a
safe
place
to
inject
is
just
ludicrous
and
so
yeah.
B
You
know
the
we
still
have
this
very
puritanical
idea
that,
like
you
know,
punishment
is
going
to
stop
people
from
doing
things
that
we
don't
want
them
to
do,
and
we
don't
care
if
we
allow
ourselves
to
do
equally
dangerous
things.
Those
people
that
do
those
things
should
die,
and
it's
just
yeah
now,
I
think
the
thing
with
safe
injection
or
overdose
prevention
sites
is.
B
They
are
difficult
to
scale
in
rural
regions
you're,
just
not
going
to
be
able
to
have
them
as
close
together
as
you
would
need,
because
simply
geography,
so
you
know
like
in
places
like
San,
Francisco
and
New
York,
where
there's
very
and
and
a
lot
of
places
in
Canada,
where
there's
very
defined
areas.
A
lot
of
people
who
use
drugs
are
those
places
are
perfect
for
overhaus
prevention.
A
B
A
Let
me
just
let
me
just
clarify
something,
because
we
had
norovalkov
on
the
show
and
and
Dr
volkov
mentioned
the
same
thing.
This
idea
of
rurality
and
what
I
pointed
out
was
that
that
all
of
Vermont
is
sometimes
considered
a
you
know
like
a
rural
State.
Burlington
is
a
city
where
I
live.
There's
45
000
people
it
shouldn't
encounter
is
the
biggest
County
in
Vermont.
We
had
51
deaths
one
a
week
in
2021.
we
have
a
heat
map
showing
the
concentration
of
those
that
vets.
A
B
So
I
mean
I'm,
not
saying
like
in
a
situation
like
Burlington,
where
you
have
exactly
shown
that
that
they
shouldn't
be
I'm,
just
saying
that,
if
we're
talking
about
dealing
with
reducing
over
a
hundred
thousand
deaths
a
year
on,
we
have
to
do
things
that
you
know,
because
the
other
problem,
of
course,
with
overdose
prevention,
centers
and
one
of
the
reasons
there's
so
much
opposition
to
them
is
the
mimby
thing.
Oh.
B
A
I
heard
you
mentioned
safe
Supply,
let's
go
into
safe
Supply,
because
I
think
safer.
Supply
is
really
an
important
concept.
We're
not
talking
about
it
yet
in
this
state,
but
some
people
are
looking
at
it.
Certainly
we're
reading
about
it,
I'm
looking
into
Canada
I'm
speaking
with
people
in
Canada.
What
let's
talk
about
it
because
I
think
it's
a
very
important
concept,
especially
in
a
rural
state
where
people
can't
get
to
an
overdose
prevention
center.
What
do
we
do
with
these
people?
How
do
we
keep
them
alive?.
B
Well
and
that's
why
and
that's
why
I
think
that
actually
can
be
a
nationally
scalable
idea.
The
problem,
which
is
a
massive
one,
is
our
Controlled
Substances
Act
and
the
Harrison
narcotics
act
in
fact,
because
the
history
of
allowing
prescription
drugs
for
people
who
are
addicted
is
one
of
no.
We
can't
do
that
like.
If
you
are
not
addicted,
you
could
have
them,
and
if
you
have
pain,
you
could
have
them.
B
Maybe,
but
if
you
are
addicted,
oh
no,
we
can't
come
for
you,
so
you
know
in
Canada
they
do
not
have
the
Harrison
narcotics
act,
and
nor
do
they
have
it
in
the
UK
and
the
UK.
Now
they've
gone
very
backwards,
but
for
the
most
for
most
of
the
history
they
instead
of
creating
the
Harrison
narcotics
act,
they
explicitly
legalized
maintenance
prescribing
by
doctors
and
so
from
the
19
teens
to
the
70s.
B
You
could
be
prescribed,
cocaine
or
heroin
or
other
opioids
if
you
were
addicted,
and
so
basically
like
one
of
the
people
in
my
book
would
go
to
doctors
to
get
opioids
and
one
of
the
times
they
basically
said,
look
I,
know
you're
faking.
Here
you
can
have
the
prescription
anyway,
because
that's
legal
there
and
they
recognize
that
making
that
legal
for
people
who
are
already
addicted-
and
he
was
very
clearly
so
you
are
protecting
them
from
the
street
market
and
you're.
B
You
reduce
that
pool
of
people
you're
going
to
reduce
new
users,
and
so
you
know
so
the
you
know
we
had
this
whole
panic
over.
You
know
opioid
over
prescribing,
and
there
certainly
was
over
prescribing
in
in
some
cases,
but
a
lot
of
what
happened
was
the
opioids
that
were
prescribed
to
one
person
went
to
someone
else,
both
80
percent
of
the
people
who
became
addicted
during
the
prescription,
phase
of
the
opioid
crisis,
we're
already
using
other
drugs
and
the
prescription
that
they
were
using
the
first
time
they
tried.
B
Opioids
was
not
theirs,
they
were
not
legitimately
prescribed
it,
they
got
it
from
somebody's
medicine
cabinet
or
a
family
member
or
friend,
or
something
like
this.
So
you
know
we
just
have
this
misconceived
idea
that
the
people
who
became
addicted
are
all
innocent
white
pain
patients
whose
doctor
addicted
them
when,
in
the
vast
majority
of
cases
well,
first
of
all,
there's
no
innocence
or
guilt
when
it
comes
to
addiction.
But
in
the
vast
majority
of
cases
these
were
people
who
already
had
a
history
of
serious
drug
use.
B
80
of
them
had
used
cocaine
or
Methamphetamine,
who
got
introduced
to
opioids.
Diverted
from
the
medical
system-
and
then
you
know,
and
then
this
happened
so
now
we
crack
down
on
the
medical
supply
and
what
happens.
Well.
We
developed
this
massive
fentanyl
Market
because
we
cut
everybody
off.
We
didn't
help
the
pain
patients.
We
didn't
help
the
people
with
addiction
we
just
cut,
and
then
we
were
surprised
that
we
developed
this
massive
cartel-led.
You
know
Market.
A
With
addiction
I'm
not
talking
about
the
the
solution,
but
but
I
mean
this
idea
of
the
way
that
opioid
opioids
became
less
available,
heroin
became
more
available
and
then
heroin
and
Fentanyl
became
even
more
available.
We
haven't
really
touched
on
fentanyl
as
yet,
but
fentanyl
is
I.
Think
one
of
the
main
just
reasons
for
this
idea
of
a
safe
Supply
or
a
safer
supply
of
becoming
you
know
kind
of
like
the
an
obvious
solution
to
the
rate
of
death
in
America.
Let
me
just
read
something
from
this
is
from
the
Canadian
government's
website.
A
It
says
about
safer
Supply
services,
safer
Supply,
Services,
provide
prescribed
medications
to
people
who
use
drugs
overseen
by
a
health
care
practitioner
with
the
goal
of
preventing
overdoses
and
saving
lives.
They
are
provided
in
a
less
clinical
and
more
flexible
way
compared
to
other
care
options
for
substance
use.
How
beautiful
is
that,
then?
A
They
go
on
to
say
these
services
are
intended
to
reach
people
at
risk
of
overdose,
for
whom
currently
available
care
options
have
been
ineffective
or
inappropriate,
and
this
is
I
mean
correct
me
if
I'm
wrong
Maya,
but
isn't
this,
who
we
see
dying
in
America
people
who,
for
some
reason
or
other,
are
not
able
to
really
kind
of
engage
with
established,
Health
Care
Facilities.
One
of
the
reasons
why
that
may
be
keeping
them
from
engaging
could
be
stigma.
A
We
went
in
like
in
Vermont,
we
have
a
hub
and
spoke
system
that
has
worked
really
well
here.
We
have
over
10
000
people
on
medication
for
opioid
use
disorder.
Through
this
Hub
and
spoke
system.
We
have
no
waiting
list
for
the
hope
and
spoke
system.
At
the
same
time
as
we
have
no
waiting
list,
we
have
another
estimated
10
000
people
with
opioid
use
disorder
who
are
not
seeking
treatment.
The
question
becomes:
why
are
they
not
seeking
treatment?
A
B
B
They
know
it's
just
that
for
them,
the
drugs
seem
like
the
solution
to
their
problems,
and
so,
if
you're
not
providing
something
that
seems
like
a
solution
to
what
is
happening
for
them,
they're
going
to
be
like
well
you're,
going
to
take
away
my
only
coping
mechanism
and
you're
going
to
give
me
what,
like
you
know
so
on
the
other
thing,
is
that
historically,
we've
had
very
lousy
treatment.
A
lot
of
it
has
been
humiliating.
B
The
idea
has
been
to
force
people
to
hit
bottom.
It
has
been
crushing
it
has
actually
caused
PTSD
in
a
lot
of
people.
It's
been
sexually
abusive,
there's
all
kinds
of
issues,
because
so
much
treatment
was
serving
the
criminalization
system
and
it
was
the
alternative.
So,
basically,
you
had
no
choice
like
yeah,
male
or
treatment,
so
a
lot
of
people
would
pick
treatment
and
then
they'd
find
out
in
some
cases
that
the
treatment
was
worse
than
jail
and
that
the
treatment
was
more
psychologically
damaging.
B
And
so
a
lot
of
people
who
use
drugs
now
are
just
like
I,
don't
want
to
sit
in
a
room
and
get
yelled
at
and
that's
what
treatment
historically
has
been
for
a
really
long
time.
Alternatively,
they're,
like
I,
don't
want
to
have
to
show
up
a
clinic
every
day
and
pee
in
a
jar
in
front
of
people
which
historically
has
been
how
medication
for
opioid
use
disorder
has
been
so
trying
to.
B
That
is
actually
helpful,
which
is
hard
to
find
they're
just
going
to
get
worse
so
helping
those
people
again
involves
this
harm
reduction.
Idea
of
we
want
to
help
you
the
way
you
want
to
be
helped.
We
don't
want
to
hurt
you
more
and
we
want
to
provide
things
for
you
and
so
what's
really
interesting
about
the
heroin
prescribing
programs
in
other
countries.
B
Is
that
you
know
if
the
idea
of
enabling
was
true,
then
providing
free
heroin
would
be
a
pretty
darn
strong
form
of
enabling
right
like
how
more
enabling
do
you
get
than
actually
giving
the
people
free
drugs
right.
So
you
would
think
that
people
in
heroin
treatment
would
just
stay
there
forever
and
never
stop.
A
B
B
You
know
supportive
care,
our
fear
that
this
will
mean
they
will
live
in
this
horrible
limbo
instead
of
getting
into
glorious,
happy
abstinence.
That's
what
happens
like
you
know,
it's
possible
that
there's
some
edge
cases
where
that
is
true.
But
if
you
look
at
the
data
it
just
doesn't
show
up
and
basically
also
like
when
what
you
see
with
people
in
heroin
maintenance
in
particular,
is
often
that
like
when
they
don't
have
to
spend
their
entire
life
chasing
the
drug.
B
A
And
and
perhaps
people
in
that
situation
can
begin
begin
to
feel
a
sense
of
confidence
and
build
a
base
and
then
that
that
idea
of
positive
movement
defined
by
the
person
from
that
base
decide
I
want
to
move
a
little
bit
more
into
a
healthier
place.
Can
you
help
me
and
then
the
response
is
yes,
we
we
were
very
fortunate
to
have
klnc
the
program
director
at
on
point
in
New
York
City,
on
the
show
and
when
she
I
haven't
visited
on
point
yet
I
will
but.
A
But
when
you
talk
to
her
and
hear
about
the
services,
they
have
a
barber,
they
have
a
showers,
they
have
a
laundry,
you
know
they
will
sit.
She
has
social
workers
coming
in.
That
will
actually
sit
with
a
person
while
they're,
self-administering,
a
drug
and
and
and
just
be
with
them,
engage
them
in
in
relationships.
B
B
A
B
That
is
really,
you
know,
that's
how
all
Health
Services
should
be.
It
is,
you
know,
I
mean
obviously
like
we
don't
live
in
an
Ideal,
World
or
whatever,
but
being
welcoming
and
and
trying
to
make
people
feel
like
they
matter.
It
matters
an
enormous
amount
and
that's
what
you
do
see.
I
I
visited
there
and
and
yeah
I
got
exactly
that
same
feeling
of
like
these
people
are
really
here
just
trying
to
serve,
and
they
are,
you
know,
for
lack
of
a
better
word
doing
God's
work.
A
A
You
know
you
can
hit
bottom
a
hundred
times
and
be
met
with
a
punitive
response
and
it
just
drives
you
deeper
into
the
darkness
when,
when
I,
when
I
listened
to
Karen
in
the
way
and
I
know
you
know
it
because
you
were
there,
it's
it's
more
of
a
a
hitting
safety.
You
know
you
walk
into
that
place
and
you
hit
safety
and
you
know
you're
safe,
and
you
want
to
go
back.
It's
so
engaging
There's
Hope
in
that
slow
moving.
A
A
Left
I
want
to
thank
you
for
being
on
the
show.
I
wanted
to
I
wanted
to
give
you
the
opportunity-
and
this
is
a
little
bit
of
a
surprise,
but
you
know
I
wanted
to
give
you
two
opportunities.
One
would
be
to
say
to
to
say
to
to
people
who
are
using
drugs.
What
would
be
your
message
to
people
who
are
using
drugs
and
then
the
other
thing
I
would
love
to
hear
from?
You
is.
B
And
please,
please
know
that
there
is
hope
and
that
you
can.
You
can
do
amazing
things
whether
you
continue
using
or
not,
but
you
are
valuable
and
you
have
stuff
to
give
and-
and
that
is
just
you
know-
I
mean
I.
Really
when
I
was,
you
know
at
the
worst
of
my
addiction,
I
just
thought:
I
was
hopeless
and
I
didn't
know
any
other
way
of
coping
and
I
just
thought.
Well,
I'm
gonna
go
somewhere,
they're,
gonna
yell
at
me.
B
It's
not
going
to
help
me
figure
out
how
to
you
know,
and
it
took
me
a
long
time
to
figure
out
what
was
going
on,
but
for
me
actually
being
on
antidepressants,
has
been
enormously
helpful
and
finding
people
that
will
support
me
and
that
have
been
through.
You
know
what
I've
been
through
in
many
cases,
and
so
you
know
I
just
do
I
always
want
to
say
There's,
Hope
and,
and
you
can
do
it,
you
can
like
most
people
do
get
better.