Blue City Blues preview: Why Drug Reform Failed In West Coast Blue Cities

[00:00:00] Hey, Seattle Nice listeners, it's David Hyde. We're gonna have a new Seattle Nice out later this week, but this is a special preview of an episode of my newish podcast with Sandeep Kaushik called Blue City Blues. And in this episode, we're speaking with former Obama drug policy advisor Keith Humphries, who has a really interesting story to tell about some of the failures that he thinks we've seen in the last few years when it comes to drug reform on the West Coast. You're gonna hear just the first few minutes, check it out.

[00:00:29] You can get a link to the full episode in our show notes, or just search for Blue City Blues wherever you get your podcast. It's the episode with Keith Humphries, Why Drug Reform Failed In West Coast Cities. Okay, here's the show.

[00:00:44] Hello and welcome to the latest edition of Blue City Blues. I'm David Hyde with Sandeep Kaushik. Sandeep, I want to remind you that we both attended Reed College in Portland, Oregon back in the 1980s, when it was known for having a sort of libertarian

[00:01:09] and some would say libertine approach to drugs. And I was going to ask if you remembered when Ronald Reagan's drug czar, William Bennett chastised Reed and actually named it with Harvard, which we were sort of proud of for rampant drug use. Famously so. It was actually the student handbook that I, my, I was a student newspaper editor that we edited at the time.

[00:01:33] Yeah, it was William Bennett was secretary of education at the time, but he waved around the Reed College student handbook, which had the infamous line in it that drug use is common and condoned at Reed College, which turned into a big national issue.

[00:01:46] I bring it up because this was part of the height of the war on drugs. And that's part of our subject for today. We're going to be talking about the response to the war on drugs in blue cities along the West Coast, especially in the Pacific Northwest, with one of the nation's leading drug policy expert, Keith Humphries, a professor at Stanford University, who also served in Obama's White House as a senior policy advisor on drug policy. Keith Humphries, thanks so much for joining us. Really happy to be on your show.

[00:02:43] I think that's the war on drugs failed, the original war on drugs, that it contributed to mass incarceration, that it disproportionately harmed black and brown people, that it led to more overdose deaths. So the thinking was, hey, we need to try something new. Are we right to see the drug reform movement that you're tracking that emerged along the West Coast in these blue cities as a reaction to the war on drugs?

[00:03:07] I definitely think that's a big piece of it. You know, people live through that and were damaged by it and are understandably bitter about it, are part of the forces that have pushed reform. I also think the rival of fentanyl and just deaths going up and up and up. It's very hard to argue that we must be doing a great job when every year the evidence is more discouraging and upsetting.

[00:03:33] And that helped, you know, set the stage for reform, including, you know, pretty radical reform, as you know. Yeah. Yeah. And just because I'm going to speak here from a bit of personal experience, David, you brought up our kind of mutual experience at Reed College. But then I went on and I told Keith this, but in my 20s and 30s or into my 30s was became a heroin addict. And so that's back in the 90s. And so I lived through sort of that era of the the peak of the war on drugs.

[00:04:02] Right. Where, you know, for much of my time as an addict, I was sort of semi-functional. I was in graduate school pursuing a Ph.D. But the last three years of it, I really fell off a cliff and I was in Southeast D.C. and haunting what was called back then the quote unquote oil joints or shooting galleries in Southeast D.C.

[00:04:20] And my life was taken over by my addiction. And so I very much remember vividly what that was like and the sort of punitive law enforcement first sort of approaches. I got rousted by the cops all the time. I learned very quickly that there was no constitution on the mean streets of the drug war back then. But but it seemed like those were the bad old days and we had to kind of try something new.

[00:04:45] But, Keith, in your paper for Brookings, one of the things that jumped out at me is you said that this movement for reform in these cities on the West Coast over the last few years was not just a reaction to the war on drugs, but it was in some sense a a a break with traditional notions of harm reduction and traditional public health responses to drug addiction. And so please elaborate on that a little bit about what you're saying there.

[00:05:10] Yeah, that that was the thing I found the most sort of disorienting as someone who's basically a public health person is harm reduction was founded. It comes out of Europe initially. And the idea is, look, people are going to use drugs, but let's try to reduce the damage that they do to themselves and also to everybody else.

[00:05:28] The total population matters. And what was striking about this movement is that it was more like vaccine resistors or gun rights advocates in saying this is really just about the person's individual autonomy and expressing that is good. It should not be constrained legally. It should not be looked down on and harm to others.

[00:05:51] It should not be looked down on and harm to others.

[00:06:12] But this with this sort of unusual combination of politics that we have out in this part of the country, which is in some ways left wing, but in some ways more libertarian getting attached to drugs that was qualitatively new and took us to some new places that we hadn't gone in American drug policy before.

[00:06:28] So part of what you're saying here is that there was a refocusing only on people who are dealing with addiction and not on the downstream consequences on that from a nearby store or a business or whoever who's dealing with somebody who might be having to shoplift or whatever to address their their drug addiction. Yeah, absolutely right. So in one indicator you can see of that is like it seems that it's all about the overdose death rate and overdoses are terrible.

[00:06:56] And I've spent my whole career trying to take care of people have addiction. So I grieve every one of them. And I also know that overlooks lots of other harms, like how families are affected, how marriages are affected, how, as you mentioned, shopkeepers who are just trying to make a living while they're getting robbed every day are affected. And the way neighborhoods change, particularly once use and dealing become a public activity. So, you know, the parks turn over to being a drug market, the streets turn over to being a drug market.

[00:07:26] None of that is captured in the overdose death rate. And those harms, at least initially, did not get much attention as this movement took off. It was just we just need to do things for drug users, support their rights and protect them. And I'm in favor of both those things, by the way. But that that just became the only thing was really remarkable and new. I wonder if you could talk a little bit more about kind of where that comes from, why you think it makes a lot of sense.

[00:07:55] Since we're bringing up personal stories, I will say, you know, when I started at this very libertarian, libertine college in the 1980s, I had experimented with drugs in high school. And that was it was great for me to be a place where there weren't any rules. I mean, my freshman year, there were pot brownies hanging from the trees, like literally there was there were drugs paid for by student body funds in this SU and pinatas everywhere. And I quickly lost interest in the very idea of drugs after getting there.

[00:08:23] I was much more interested in ideas and books and that sort of thing. So for me, that atmosphere where I got to make my own good or bad choices rather than having Nancy or Ronald Reagan, you know, tell me what to do was great. But I also know that my experience is kind of irrelevant when it comes to designing drug policy. And I wonder how much of this stems from people taking their own sort of personal experiences and not seeing outside of that. I mean, how much what's driving this, I guess, is my big question.

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[00:09:47] So, I mean, you know, drugs are first of all kinds of different drugs and people use them in all kinds of different ways. And a lot of the leaders of this movement were, you know, to shorthand them white kids with good teeth, you know, and they had smoked some pot and they'd been fine. And maybe they'd done a, you know, a boost of cocaine now and then, but they had a job. They had an education. So it didn't seem like a big deal to them. And if they got in trouble health-wise, well, they knew doctors and they could get help.

[00:10:14] But the people who experience most of the suffering are very different. They tend to be people, disproportionately people of color, disproportionately in poor neighborhoods, don't have the social capital, don't have a lot of nets underneath them, you know, between, you know, just making it and falling into disaster. And for them, drugs just have a really different reality. They also have a different reality about just the consequences of drug markets.

[00:10:38] So if you're living in a nice, leafy neighborhood, the idea, let's defund the police, which was very dominant at this time, and just let people deal drugs. Well, that's okay when they're not in your neighborhood. You may not, you don't notice it. But when you're in a neighborhood like the Tenderloin, which is neighborhood I volunteer in San Francisco, and there's just, you know, dozens and dozens of dealers, some of whom are armed. And you've got to walk your kids to school past them every day. It doesn't feel, you know, charming or edgy or radical.

[00:11:06] It just feels like you're being abused for the sake of other people's politics. And that's why even one of the interesting things about the Tenderloin Neighborhood Association is suing the city of San Francisco for more policing. Whereas the how it was described is they don't want police. No, actually, they'd really like to be protected. They'd like to be protected like those people in the leafy neighborhoods are protected.

[00:11:27] Yeah, and one of the things you say in the Brookings paper, Keith, that jumped out at me, is this movement, this kind of new break, and this new approach to drug reform that took root in West Coast cities over the last five years that we're now moving away from, is a kind of, I forget the exact phrase you used, but almost a head-spinning mix of libertarian ideas. And you cite the Cato Institute, as well as sort of progressive ideas.

[00:11:53] And you cite the Drug Policy Alliance, a national organization that has pushed for drug reforms. And it's a very, you know, progressively inflected, culturally progressive organization. So talk a little bit about that amalgam. What came together there? Yeah, it is unusual. And I think it's worth noting we are in the West, right? You know, this is the, you know, was the frontier. It is the place where people from Boston who were sick of hearing when you got off the Mayflower came West to invent themselves.

[00:12:20] And like, I don't want to care what the local preacher thinks. I don't want to, I don't care what the norms are. I want to be me. And in some ways that has been marvelous. That is why you think of the arts, the creativity, the culture, the startup technology geniuses, the gay and lesbian rights are all come out of that sense of be who you are, be an individual, be free. You owe nothing to anybody.

[00:12:46] But when you attach that to addiction, the problem is that people really aren't free. Yes, if you're the occasional pot smoker is, you know, still pretty autonomous. But someone who is, say, using a drug like fentanyl or meth multiple times a day is not an expression of that, you know, beautiful freedom. And it's not just some, you know, bourgeois disapproval, you know, that makes you concerned about them.

[00:13:13] It's that they're not in control of their own life all day long. They have to think about when do I get my next hit? But then they use, then they, you know, with fentanyl, you pass out, fall asleep, wake up and withdraw. You've got to use again. You're really trapped. And so that rhetoric that this is we need to respect people's bodily autonomy and their freedom is just being, you know, really naive about what it's actually like to be addicted to fentanyl. It doesn't feel free to the people in that space at all.

[00:13:43] Yeah, this is something that really this point you make about this sort of fixation on autonomy. Right. The autonomy of people who use drugs. Right. There was a Seattle Times article from September of 2023 where it was about a hearing at the Seattle City Council where one of the city council members was asking,

[00:14:04] hey, do all of these sort of interventions we're making, you know, harm reduction interventions we're making, are they producing any results in terms of getting people into treatment? And the response that she got from someone from the Hepatitis Education Project, a local organization, was this is a direct quote. There are folks who don't want to stop using drugs. There are folks for whom abstinence is not something by which they measure success in life. Ultimately, bodily autonomy is the key. Right.

[00:14:33] And so we shouldn't be pressuring people. The person who's smoking fentanyl in the bus shelter, maybe they're just making a lifestyle choice there or it's what works for them. And who are we to tell them different? That's right. So this was really a qualitative shift. So typically in public health, what people used to say is, you know, we're going to give people naloxone when they overdose.

[00:14:55] We're going to give them fentanyl test strips and we will give them clean syringes to keep them alive in the hopes that in the long term we'll get them into an even better state, not just living the next 24 hours, but they will get into recovery. They'll be able to function better and all that sort of thing. And the shift happened here in this region was, no, no, that that second stuff is irrelevant. It's as long as you're honoring their right to keep using this stuff is good in itself.

[00:15:22] Even if the person is overdosing twice a day, as long as they're, you know, getting the overdose medication and keeping alive, that is that is sufficient and good enough. And I quote in the Brookings piece of a friend of mine, a journalist who came out here and was really stunned. He asked a harm reduction worker, what would you say if someone said, you know, I think I want to stop using drugs and get into treatment. And the harm reduction worker said, I think I'd discourage him from that. She'd set different goals.

[00:15:47] Yeah, that's very different than how what most people, when they think practice harm reduction, you know, think of as the purpose. They would say, well, that's great. Let's go ahead and do that. You're going to be even better off than you are now. And that still exists. I mean, you know, certainly some people are chastened by the various failures. But I was really struck by the governor of Oregon's proposal for the opioid settlement dollars. These are the money gotten from companies like Purdue Pharma, you know, for what they did in the opioid crisis.

[00:16:14] But her proposal of what to do with the money was 0% for law enforcement, 0% for treatment, 0% for recovery, 0% for primary prevention, 100% for harm reduction. And not willing to spend even one penny on something that might reduce the amount of drugs people use. You know, instead of saying, you know, drug use will just go. We'll try to reduce the harm. But that is all that is the limit of our aspiration.

[00:16:40] That is really different than we've usually thought about this problem in America. Can I follow up on that just by asking? So stigmatization of drug use and drug users is bad. But what you're describing is not really de-stigmatization exactly, right? It's something different. No, it's actually kind of a celebration, you know, to say this is a right and we should not stigmatize a right. Right. And, you know, and it's just an example of that.

[00:17:09] You know, this is going to surprise people, but it really did happen. So the San Francisco Public Health Department, you know, as overdoses got higher and higher, put up billboards of people using fentanyl. And they looked a lot like beer ads. They were young, attractive, successful people. They said, fentanyl, do it with friends. And the idea was, let's de-stigmatize. Let's stop getting so hung up about fentanyl, right? Now, of course, if a tobacco company had done that about tobacco, the health department would have gone ballistic. They would have said, what are you doing?

[00:17:37] You're making it look like tobacco is harmless. You're enticing kids. You're making it look like this great thing, you know, because public health normally is, in fact, does stigmatize tobacco use. It's constantly saying, don't smoke, don't smoke, don't smoke. But with this, they flipped the other way around and said, you know, no, we need to de-stigmatize this. The only problem with this is that we think that we have negative ideas about it. If we just accepted it and tried to make it a bit safer and kind of celebrated it, we would be better off.

[00:18:06] And I think that's a mistake. I think we should have complete compassion for people who are addicted. We should never shame anyone for being addicted. We should definitely do everything we have to help them get on a different path. But I do not think we should be putting up billboards celebrating fentanyl use. I also think it's a perfectly appropriate thing to tell kids, you know, that fentanyl use is really dangerous and not to do it. And it's a really bad idea. And it's not just a lifestyle choice. It's actually super, super risky behavior.

[00:18:36] This is such an important point because, you know, those billboards in San Francisco were amazing. And obviously you have an image of one in the Brookings paper, but I'd seen them before. And it really does glamorize. You know, these are very shiny, happy, pretty people, you know, hanging out, apparently doing fentanyl together. The message of the billboards is don't use alone because it's an overdose prevention message. But it really does make it look like it's fun and cool. Like all the cool kids are hanging out, like doing fentanyl. Right.

[00:19:03] So when I first moved to Seattle 22 years ago, I had just relapsed. And so I was I went back on to methadone, you know, and every morning would go down to this place, the airport way in Seattle. The Evergreen Treatment Services are a major methadone provider in Seattle. And so it's 22 years later. And last year they found out I had been a client of theirs and they asked me to speak to keynote their annual fundraising lunch. And so I went and I told them the story of my addiction and kind of my trajectory.

[00:19:30] And but I also said to them, you know, there are some things I hear in Seattle about addiction and what it is that give me a lot of pause. Right. Because I'm on board with traditional notions of harm reduction. I do believe that we did the war on drugs. We really stigmatized addiction and also the treatments for addiction. Methadone. I had to get over a real stigma myself.

[00:19:57] It took me years to go and seek help and seek methadone, which saved my life. So I get that part. But I said to them, I worry, though, about normalizing addiction or glamorizing it. And that's where I said to them, I do wonder if Washington, D.C. in the 1990s had the same approach to, you know, use of hard drugs that we do here in Seattle now.

[00:20:23] I'm not sure I would be here today talking to you about this. I'm not sure I would have survived that. Right. And so, Keith, you've said this before and in other conversations and interviews and stuff that there does need to be some friction somewhere, some pressure that moves addicts.

[00:20:45] To get the help that they need, that you can't just sort of sit around and sort of say, hey, we're just going to make life comfortable for you until the day you're on your of your own volition going to stop. Yeah, I mean, that was the theory in Oregon, particularly when they did their Measure 110, that if we removed all legal pressure and all social pressure, people would come running into treatment. And they really didn't.

[00:21:11] And, you know, the reason for that is just addiction is different than health problems that are just consistently lousy all the time. If, you know, if you have chronic pain, it's just awful all day long and you will do anything to get rid of chronic pain. But if you're addicted to fentanyl or methamphetamine, yes, your life could be falling to pieces. But, of course, the immediate experience of using the drug feels good. If it didn't feel good, you wouldn't do it. Right.

[00:21:38] And so as a result, people usually need some press on the other side to counter that, that you don't need to give up pain, to give up their drug use. And I bring up as an example of how potent this is, is the study from the alcohol field because alcohol is legal. Right. And it's broadly accepted. So of people who come in to alcohol treatment, it's slightly more than nine and ten. And they say, why are you here?

[00:22:04] They say, well, because my husband said he was moving out with the kids if I didn't start. Or my boss said, you know, you showed up at work drunk again. I'm going to fire you if you do it. Or my lawyer said, you know, this is your third drink driving arrest. Get a treatment because this judge might just throw you in the penitentiary. It's being pushed. And that makes a lot of left wing people uncomfortable. That sounds like now we're not just accepting everybody the way they are.

[00:22:30] But the reason we don't accept everybody the way they are, one, in the long term, they might, you know, do great harm to themselves. And two, very often they're doing great harm to other people as as this is going on. And those people matter, too. And that's, in fact, why a lot of that pressure comes from. It comes from people who love that person but are also suffering because there's no money for groceries. Because the kids miss their dad or they miss their mom.

[00:22:56] Or the employer is like has been stolen from and is going out of business and going to have to fire other people. It always has those ripple effects. And so it's really wrong to think of it as, well, it's just an individual autonomous decision. It really isn't. It's something that affects many people and therefore is legitimate in most typical understandings of liberty. When it starts to impinge other people's well-being and liberty, then some constraint, it becomes ethical.

[00:23:24] But Keith, our progressive listeners who disagree with you are thinking to themselves, for the addicts themselves, this doesn't work. Coercion does not work. The evidence is clear. What's your response to that? The data shows that coercion does not work. Yeah. What data? I'm not aware of such data. I mean, you know, for example, you know, randomized trials, which is, you know, kind of the creme de la creme for doing causal inference.

[00:23:53] That's it for the Blue City Blues preview. To hear the whole thing, you can find a link in our show notes or just search for Blue City Blues wherever you get your podcasts. It's the episode with Keith Humphries on drug reform. We're going to have a new episode of Seattle Nice Out later this week. Thanks, everybody, so much for listening. We're going to have a new episode of Seattle Nice Out later this week.