Whiteout: How Racial Capitalism Changed the Color of Opioids in America – Reflections on Drug Policy and Health Justice

September 28, 2023

Information

September 27, 2023

Helena Hansen, MD, PhD

David Herzberg, PhD

Julie ("Jules") Netherland, PhD

Mark Jenkins

Kimberly Sue, MD, PhD (Moderator)

Sponsored by the Program for Humanities in Medicine and the Program in Addition Medicine, Yale School of Medicine

ID10750

To CiteDCA Citation Guide

00:00Hi, everybody. Hi, Helena.
00:06I'm Anna Reisman,
00:08Director of the Program for
00:09Humanities and Medicine.
00:10Very, very happy to be here
00:12with all of you near and far.
00:14I will make a couple of announcements and
00:17then I'll introduce our panelists and turn
00:20things over to my colleague Kimberly Sue,
00:22who will be moderating.
00:24So for those of you who have not
00:26been to our events before, welcome.
00:28You can find more about us past and
00:32upcoming events on our website.
00:34And if you want to be part of our listserv,
00:36you can send an e-mail to Karen Kolb,
00:39our wonderful Program Manager who
00:41is dropping things in the back.
00:46So our next event is October 18th
00:48at noon and will be a conversation
00:51between Doctor Suzanne O'Sullivan,
00:53author of Sleeping Beauties and
00:54Other Stories of Mystery Illness
00:56and a writer in residence,
00:57Randy Hutter. Epstein
01:01and I will now introduce everybody
01:04and then I will end up with I will
01:07end up by introducing Kimberly Sue
01:11Okay. So Helena Hansen,
01:13who is joining us by Zoom,
01:15is a psychiatrist and anthropologist and
01:17the interim chair of the Department of
01:20Psychiatry and Biobehavioral Sciences,
01:22interim director of the UCLA
01:23Semel Institute for Neuroscience
01:25and Human Behavior at the David
01:26Geffen School of Medicine at UCLA.
01:30I'm going to make these brief,
01:34but trust me that everybody's
01:35biography is very,
01:36very long and impressive.
01:37But Helena has published widely in
01:39clinical and social science journals,
01:40ranging from JAMA and the New England
01:43Journal of Medicine to social science
01:45and medicine and medical Anthropology.
01:46And she's written on faith healing
01:48of addiction in Puerto Rico,
01:49psychiatric disability under welfare reform,
01:52opioids and race, and the ethnic
01:55marketing of something that got cut off.
01:57In this version.
01:59I'll let she's Helena wherever you are.
02:03Mark Jenkins.
02:06Thank you, Mark. Mark
02:07Jenkins is a service connected
02:09disabled veteran of the United States Air
02:11Force and Founder Executive Director of
02:13the Connecticut Harm Reduction Alliance,
02:15formerly the Greater Hartford
02:17Harm Reduction Coalition. Mr.
02:19Jenkins has worked in the field
02:21of harm reduction of public
02:22health for the past 24 years,
02:24delivering innovative prevention to the
02:27most vulnerable members across Connecticut.
02:30He began in the field as an AIDS risk
02:32reduction outreach worker for the
02:34PERCEPTION programs in Willemantec.
02:36In a subsequent work with Community Renewal
02:38Team and the Hispanic Health Council,
02:40he further cultivated progressive strategies
02:42for reaching and delivering services to
02:44our most difficult to reach populations.
02:46Welcome, Mark.
02:50And on the opposite end of the
02:52table is Jules Netherland, PhD,
02:55who focuses on the critical study of drugs,
02:58medicine, science, and addiction.
03:00Jewels has published over a dozen
03:02peerreviewed journal articles,
03:04including White Opioids,
03:06Pharmaceutical Race,
03:06and the War on Drugs.
03:07That wasn't with Helena
03:10Hansen in Bio Societies.
03:12She's also the managing director of the
03:14Department of Research and Academic
03:16Engagement at the Drug Policy Alliance.
03:18She works on a number of issues,
03:19such as helping academics become
03:21more effective policy advocates,
03:23ensuring DPA's policy work is
03:24granted in research and evidence,
03:26and promoting a health approach
03:27to drug policy.
03:35David Hertzberg welcome Jules David Hertzberg
03:39is Professor of History
03:41at the University of Buffalo at SUNY.
03:43He researches the nature and
03:45trajectory of drug commerce,
03:46drug use and drug policy,
03:47and American racial capitalism,
03:49with a particular focus on white markets
03:52for psychoactive pharmaceuticals.
03:54His work can be seen in American Quarterly,
03:56The Bulletin of the History of Medicine,
03:58the American Journal of Public Health,
03:59The Washington Post and in three books.
04:02And of course the one we will hear
04:04a lot about today is White Out,
04:06How Racial Capitalism Changed
04:08the Color of Opioids in America,
04:11coauthored with Helena Hanson
04:13and Jules Netherland.
04:15He's also the director of the Drugs,
04:17Health and Society Program at the
04:19University of Buffalo and coeditor of
04:20The Social History of Alcohol and Drugs,
04:22the peer reviewed interdisciplinary journal
04:24of the Alcohol and Drug History Society.
04:27And our moderator holding a mic next to Mark.
04:33Next to David is Kimberly So,
04:35Doctor Kimberly So,
04:36who is assistant professor of medicine
04:38with a program in addiction medicine
04:40here at Yale School of Medicine.
04:43She's the former medical director of
04:45the National Harm Reduction Coalition
04:47and serves as an attending physician at
04:49the central Medical unit APT Foundation,
04:51which provides primary care to patients
04:53receiving methadone and other substance
04:55use treatment services and supervises
04:57fellows and trainees within the Yale
05:00Addiction Medicine Fellowship Program.
05:01She's also associated with the
05:03National Clinician Scholars Program
05:05and Program for Humanities and
05:07Medicine and has brought much to the
05:09program over the last few years,
05:11including the idea of creating this
05:13very event. So thank you, Kimberly.
05:15I will turn it over to you.
05:19Can you hear me? Thanks for coming in person.
05:22And thanks for joining us on Zoom
05:25and I'm just delighted to be able to
05:29talk about this really important
05:32book and these ideas in here with
05:35people who have been doing the work
05:38and in their own ways for decades.
05:40To be up on this panel has been
05:43is super inspiring and to bring
05:47this interdisciplinarity of
05:49boots on the ground research,
05:51you know history and social
05:54sciences and in clinical work is
05:56really I think what the heart of
05:59many of our programs hope to do.
06:01And the program in for humanities
06:02and medicine and the program
06:04in addiction medicine,
06:05we're just really pleased for to
06:07to host these tremendous people.
06:09So I'm going to I,
06:12I I read the book and I took a lot of notes.
06:16So, so I'm just going to start off
06:19with some questions that there's
06:21no softball questions here.
06:23So I think they would agree, I don't know.
06:26But they're all,
06:27they're all really bracing because
06:29what we are facing is truly
06:32is truly unprecedented.
06:34You know on the ground doing addiction
06:37medicine and harm reduction like
06:38it is it is unprecedented the the
06:41toll that we're we're facing now.
06:43So I'm going to just get right into it.
06:46So I'm going to read a brief quote
06:49from the introduction to this book.
06:52In this book we they examine how
06:56this unspoken but determinative
06:58whiteness of opioids to make the
07:01ways that whiteness works in drug
07:03policy and treatment visible.
07:04Here,
07:05whiteout refers to the use of white
07:07imagery to hide or cover the inner
07:10workings of segregation in drug
07:12policies and healthcare industries.
07:15It also refers to the need to
07:17bring whiteness out of the out of
07:19the silence and shadows of drug
07:21policy and healthcare so it can be
07:23seen so that it's harms to white
07:25people and people of color can
07:27be collectively addressed.
07:29So the question is can you unpack that
07:32for us and help us understand why why
07:35whiteout is an important theoretical
07:38frame and how we as researchers,
07:42clinicians and advocates can
07:44can utilize anti black racism
07:46strategies and a critical race theory
07:54unmute myself. Have I been
07:55volunteered to start this off
07:59So kind of you? No.
08:01I want to start by saying
08:03what a pleasure and honor I.
08:05As you may know from my introduction,
08:08I was at Yale for 10 years as an MD,
08:11PhD student in anthropology,
08:14and I have to say that this program
08:17has been such a vital part of my
08:19own career development and working
08:21with Anna Reisman as a student and
08:25beyond has been incredibly formative.
08:27So it's just a real thrill to be here
08:29tonight and to be celebrating the launch
08:32of our new book together with you.
08:35So to start with the quote that that
08:39Kimberly just read from our book,
08:42maybe to start for a moment on the
08:45meaning of white out in the title and
08:48the way that it points to an analysis of
08:52whiteness in drug policy and healthcare.
08:56So the book is challenging a master
08:59narrative that many books and articles
09:01have propagated over the past couple
09:04decades about the evil pharmaceutical
09:07companies and unsuspecting pain patients
09:09that led to this very surprising anomaly
09:13of addiction in the heartland of America.
09:16And of course,
09:17that coded language was white America.
09:19The big shocker there was,
09:20you know,
09:21white opioid addiction,
09:23which then led to white heroin addiction
09:26flying in the face of decades of imagery
09:29in American media about who is a quote,
09:32UN quote addict.
09:33Right.
09:34So that was the shocking shock and
09:36surprise in the media headlines
09:38that got so much readership.
09:42But this is a storyline
09:43that conceals a lot more than it reveals,
09:47and that's our starting point for the book.
09:49You know, we argue that it conceals so
09:51much that it might even be called false.
09:54So the quote that Kim read about white out,
09:56that white out refers to the use
09:59of white imagery to hide or cover
10:01the inner workings of segregation
10:03and drug policies and healthcare,
10:05healthcare industries.
10:05And it also refers to the
10:08need to bring whiteness,
10:10whiteness out of the silence and
10:12shadows of drug policy and healthcare
10:13so that it can be seen so that it's
10:16harm to white people and people of
10:18color can be collectively addressed.
10:21That involves making visible whiteness
10:26the role of whiteness in as in how
10:28did the opioid crisis of the past
10:30few decades come to be seen as white,
10:33at least initially.
10:35That involves a whole set of analytic
10:38tools that the three of us as a clinician,
10:41anthropologist, physician,
10:42anthropologist, historian,
10:44policy advocate and analyst,
10:47we've had to provide the tools to make that
10:50visible and really the book is about that.
10:54It's another entry point to understanding
10:57systemic racism and racial capitalism
11:00and healthcare and drug policy.
11:03So the elephant in the room about this
11:05taken for granted storyline of evil
11:07pharma aggressively marketing new opioids
11:10to unsuspecting patients using false claims.
11:13We have to back up for a moment
11:15and ask how were they able,
11:17how was pharma, for example,
11:18able to do this aggressive marketing
11:21and such a prohibitionist drug culture?
11:24In the US,
11:25we have had a century of extremely
11:28prohibitionist drug policy,
11:30so how was it that pharma was able to just
11:33swoop in and do this kind of marketing?
11:35Why would white Americans in
11:37particular be the group most affected,
11:40at least in the earliest stages,
11:42by this new group of opioids?
11:45How do we explain this?
11:47So our book does a deep dive into
11:49these questions and uncovers what
11:50we call technologies of whiteness.
11:52So this is the ways that
11:54pharmaceutical companies,
11:54biotech companies,
11:56strategically use racialized
11:58assumptions about their consumer
12:01markets and racial imagery to get around
12:04regulators and to craft beneficial
12:06policies and product protections.
12:08You know,
12:09for example,
12:10patented products that generate a
12:12lot of money for the manufacturer
12:15because they have exclusive rights to
12:17manufacture and sell those products.
12:21How are they able to craft this separate,
12:23white and largely middleclassed
12:25affluent tier of drug policy,
12:27which is what we described in the book?
12:30So in the case of opioids,
12:31this involved imagery of white middleclass
12:34people is not prone to addiction.
12:36You know, that's one big way that they
12:39got around regulators and policymakers.
12:41So white middleclass clientele where
12:44the target clientele clientele,
12:46they this image was used to generate
12:49sympathies for white middleclass
12:51patients with chronic pain.
12:53Is also very expedient to do all of
12:55this to address the chronic pain of
12:58white middleclass people through private
13:01markets using expensive new technologies.
13:03This was a way to respond to a
13:07perceived epidemic of pain without
13:09having to happen to public benefits,
13:12you know,
13:13such as Social Security disability
13:15benefits which had historically
13:17been coded as abused by black and
13:19brown quote UN quote welfare Queens.
13:21So that's a part of the story.
13:22I'm just kind of giving you tidbits
13:25of this history that we leave.
13:27Then there's the question of Oxycontin's
13:30patented sustained released capsule
13:31and all of the fantasies that there
13:34could be technological solutions to
13:36these messy problems like addiction.
13:38A messy social, you know,
13:40as in socially inflected problems
13:42like addiction.
13:43This was on the in the setting of the
13:461990s as the decade of the brain and
13:48a lot of magic bullet thinking about,
13:51you know,
13:52moving into a new era of treating
13:55addiction as a brain disease.
13:57A disease that can be treated and averted
14:00through molecular technologies that are,
14:03you know,
14:04mass manufactured and commercially
14:06sold and that would work regardless
14:08of the social conditions or their
14:10racial identity or anything
14:12about the person in question.
14:15And so this is in very brief form,
14:18this is the story that we we've to
14:20try to expose whiteness and we draw
14:23on an analytic framework of a body of
14:27scholarship called whiteness studies.
14:29So Kim in her question Doctor Sooner
14:33question brought up Critical Race
14:35Theory and Whiteness Studies is an
14:37offshoot of Critical Race Theory that
14:40really focuses on making whiteness
14:42visible as a cultural and social
14:44process and set of images and practices.
14:47So we needed the tools of whiteness
14:51Studies to pick apart analytically
14:55how the the opioid crisis largely
14:58seemed to be white.
15:00A white crisis for the past couple
15:02of decades came into being within our
15:05healthcare system and drug policies.
15:08So I'm going to take a pause because
15:09I have the feeling that my coauthors
15:11have a lot to add to that.
15:12But I was just trying to give an
15:14overview of this construct of
15:16whiteness and we can flesh that out
15:18a little bit more I think in giving
15:20examples of how we discovered in our
15:23research that whiteness is operating
15:26in pharma and in in drug policy
15:32much Helena and and this is I mean it's
15:36so relevant to our our this analysis
15:40is so relevant to the daytoday work.
15:43I remember when George Floyd was
15:46murdered and and you know I was asked
15:49to weigh in on you know his opioid
15:51use and sort of the sort of the way
15:53in which those narratives played out.
15:55I think it's it's really it,
15:59it's really relevant and and
16:00super useful for us.
16:02So thank you for for introducing
16:04the book that way.
16:05So the next question is,
16:09so the way when you read the book,
16:11there's some chapters they've
16:12written together and there's some
16:14that they've also written from
16:16their own particular expertise
16:17says you know drug policy and drug
16:21policy history or or clinician,
16:23anthropology clinician.
16:24And so each of you discuss your own
16:28whiteness and or white privilege in
16:31honest and sometimes uncomfortable
16:34ways that are challenging.
16:37And so can you give some examples
16:41of how whiteness has worked in
16:43your life and why you feel it's
16:45important to articulate this for
16:46the readers of this book and for
16:49students of drug policy?
17:00Can you hear me? Well, yes.
17:03So you know, the the thing about
17:06whiteness that Helena has said
17:08that's true is that it's hidden by
17:10design and we're not meant to see it,
17:13especially as as white people.
17:16And so there is certainly a
17:18conundrum as a white person of
17:20not wanting to recenter whiteness,
17:22which already is sort of
17:24the water that we swim in,
17:25but also feeling for me personally,
17:29an obligation to expose it.
17:31And frankly, it wasn't comfortable.
17:34And one of the things I was hoping
17:37to do in the book was to model for
17:40white people that you can and should
17:43name it in certain contexts and take
17:46risks and you might not get it right.
17:48And I don't know that I got it right.
17:50I'm. I'm learning all the time.
17:53But being willing to face those
17:54risks in that, in that criticism,
17:58you know,
17:58how I've understood whiteness in my
18:00own life is really as unnerned privilege.
18:03You know, Simply put,
18:04that I have all kinds of advantages
18:07that are unspoken and unseen just
18:10by the way that I I present and in
18:14the sort of a neoliberal bootstrap
18:17culture that centers and blames
18:19individuals for what are structural
18:21and systemic and racist systems.
18:24For me,
18:24it's really important that we understand,
18:26name and resist that impulse
18:29to blame individuals,
18:31intervene at the level of individuals
18:33for what are really systemic
18:35problems of of structural racism
18:37and other kinds of inequity.
18:39And so, reluctantly,
18:44we did include a lot of
18:46personal narrative in the book,
18:48and I hope that it's useful.
18:49I will say that one of my best friends
18:53hated it and urged me not to include it,
18:58but ultimately thought it
18:59was the right thing to do.
19:00So I hope those of you who read the book
19:02also think it's the right thing to do.
19:03But if not,
19:05I did put a caveat in there that
19:08you can skip ahead that section.
19:10Because there is like, you know, there
19:11are a lot of people that don't
19:13necessarily want and need to hear
19:15another white person talk about how
19:17they became aware of their whiteness.
19:19So there is the opportunity to skip
19:22that section if that is not for you.
19:25But personally, I did feel it was
19:27important to to try to expose some
19:31of that the way that whiteness works,
19:33which is the project of the book really.
19:35And there was no way to do that,
19:37I think sort of ethically and
19:39with a lot of integrity without
19:42examining how whiteness has worked
19:44in my own life and the kinds of
19:46unknown privilege that's given me.
19:48So I'll stop there.
19:51Yeah, Just to translate that those,
19:53those sections of the book
19:54will not be on the test.
19:58Yeah. So historians,
20:00we don't generally introduce
20:02ourselves into our scholarship.
20:04We. Talk from nowhere,
20:05which we're we're a little bit of,
20:08I guess oldfashioned in that way.
20:10And it was very this is not something
20:12that I particularly wanted to
20:14do either but was persuaded that
20:15it maybe it could be a value.
20:18And I and you know how do how would
20:20I pick one of the infinite ways
20:23that my whiteness has shaped my
20:26life trajectory from my educational
20:28opportunities to to home ownership
20:31to a million different things and
20:33I guess 11 relevant place that I
20:36could give an example of This is
20:38at a certain moment in my life
20:40when I began Graduate School,
20:43I was a single parent.
20:44I was a former heroin user and a
20:49former methadone patient and I was
20:51receiving assistance from the county
20:54for to be able to sustain the family
20:58and continue to to pursue my education.
21:01This was right on the
21:03heels of the Clinton era,
21:04when many people in my situation
21:07were receiving a lot of brutal
21:10cultural stigmatization and and and
21:15a lot of destructive policies that
21:18created obstacles to their thriving.
21:20And yet,
21:21my experience in this moment was
21:25receiving nothing but support in every
21:28institution that I interacted with.
21:30People,
21:31I could tell they were rooting for me.
21:35They saw me as a unique case,
21:37whether I was in the county welfare office,
21:40at at the clinic,
21:42if I was just at the grocery
21:44store with my children.
21:46And
21:49I could tell this had a lot to do with
21:52being a man or with being a white man.
21:55And if I'm going to be completely honest,
21:57I I'm sure I consciously leaned into that.
22:01I needed the things that these white
22:03people had to offer me and anything I
22:05could use to connect with them and to
22:07have them see me as a person and to care
22:10about my wellbeing and where I was going
22:12was something I was going to seize on.
22:18So this isn't this isn't something
22:23that I would usually speak about in
22:26fact it's the the first time it's I
22:29where it was to reveal it publicly
22:31is in the book and this is the first
22:33time I've spoken about it out loud.
22:34So I'm just going to let it
22:37lie there and feel nervous
22:41for doing that and and
22:42don't feel nervous at all.
22:44I I really appreciate your honesty
22:46and and I think we'll go to Helena but
22:49I I just want to say that I I really
22:51think the the I I disagree with your
22:53best friend because I think that I
22:56read I read your story of of white
22:59privilege and whiteness and and and
23:01also your story very authentically
23:03and and I I felt they were they were
23:07critical to to the book and and really
23:09made me feel like I knew both of you
23:12and your projects that you work on.
23:14So I'll go to Helena about the whiteness
23:17question. The whiteness question.
23:19Oh, sure. So this book
23:22was also a first for me and that it was
23:26the first time I've written about and
23:29probably this is the first time I've
23:31publicly spoken about my own whiteness.
23:33So I did not grow up with a white identity.
23:36You know, this is a a country that has long
23:38had a one drop rule where if you have,
23:41you know, one drop or 132nd African
23:43ancestry for example, you count as black,
23:47which was you know at state law
23:49level true up until I believe the
23:51mid 70s which was after I was born.
23:54So. So I certainly did not grow up
23:57thinking of myself as a white person.
23:59However, I do have a white parent,
24:01my father, who's who was born and
24:04lived almost his whole life in Norway.
24:07I didn't grow up with him,
24:09but I'm certainly in appearance
24:13not someone who looks to have
24:16exclusively African ancestry.
24:17And what that has meant is
24:21that I've been personally,
24:23I've been observing throughout
24:26my life gradations and the ways
24:29that racial identity is relative.
24:32So if I'm in a room with a lot
24:34of white people,
24:36I am the black person in the room.
24:39If I am in a room with many
24:40dark skinned black people,
24:42I'm not necessarily the black
24:44person in the room.
24:45One thing that even though I very
24:48much feel embraced by African
24:50Americans and that is my identity,
24:54one thing that studying the
24:57evolution of the quote UN quote,
24:59white opioid crisis has brought into
25:01relief is the degree to which you know,
25:03whiteness is a relative thing.
25:05And I'll give you one example that there,
25:09in the beginning of the quote,
25:10UN quote, opioid crisis,
25:12there was a discussion of
25:13Oxycontin as hillbilly heroin.
25:15And parallel to a whole discourse
25:19about suburban middleclass housewives,
25:22grandparents who had gotten
25:26addicted to Oxycontin and sister
25:29products by unscrupulous, you know,
25:32prescribing unscrupulous doctors,
25:34there was a discourse in tandem
25:37around poor white people in
25:40Appalachia and other parts of rural
25:43America that was less flattering,
25:46I would say less humanizing.
25:49And my colleagues who study drug use
25:52and drug policy in that part of the
25:55country point out that if you do,
25:57if you look at public policies there
26:00and media coverage of people who use
26:03opioids and other substances there,
26:05the way that they're described is
26:08poor white people is very similar
26:09in many ways to the ways that black
26:12and brown people are described
26:13in areas of the country that have
26:15more black and brown people.
26:17And so it,
26:18you know,
26:19what it did was it this forced me to to look
26:23with a little bit more complexity into race,
26:27whiteness and drug policy because
26:30there are people who can be blackened,
26:33so to speak,
26:34in drug policy based on their
26:37relative position as the other.
26:39That's just one example.
26:41But in the book,
26:43I was forced to meditate a
26:45little bit on how I in,
26:47you know,
26:48everyday encounters,
26:52can have benefited from my own whiteness.
26:54You know, and the way I'm married to
26:56a black man who's darker than me.
26:57And I will be sent in before him to
27:00buy things at the store, reserve,
27:03a motel room because he gets a
27:06different reaction than I do.
27:07And so that also made me think
27:10about within the opioid crisis,
27:12what race actually means that, you know,
27:15part of our work here is to unpack
27:17race as really a power relationship.
27:20It's within a hierarchical society.
27:23It is not an absolute.
27:24You know, it's not biological and it's
27:26not even a fixed entity when it comes
27:29to functioning as a social category.
27:31It's something that is created
27:33in relation to something else.
27:35Whiteness in this society is
27:37created in relation to another.
27:39And so that's a dynamic that plays out in
27:42drug policy and in healthcare all the time.
27:44And it's a part of really excavating
27:47and making visible what whiteness
27:48is and how it works as a system.
27:51It's not a static thing.
27:52You know,
27:53no one can claim to just be white
27:55with without having a context
27:57in which they're white.
27:58And certainly the power relationship in it
28:01is that no one can just claim to be white.
28:03You know,
28:04being white is something that you
28:06have or don't have depending on
28:08where you fall in the hierarchical
28:10system that you're in.
28:11So it it just added for me a lot
28:14of complexity to think about.
28:16It just helped me to think about my
28:19own whiteness in thinking about how
28:21whiteness functions as a system,
28:26which is not something that
28:27someone who identifies as African
28:29American talks about very often.
28:32Thank you. Thank you so much for talking
28:34about it and and all of you and and
28:37now I'm going to go to Mark because
28:40Mark is is is a powerhouse if you don't
28:45know if Mark he he's one of the most
28:49OG harm reductionists that we have.
28:54And so the question that I have for
28:56Mark and we're lucky to have him in
28:59Connecticut and but he's a national and
29:01internationally sort of like famous guy.
29:04I mean I just you know I'm so lucky to
29:07he's saying I'm like fangirling over Mark.
29:10So Mark and and I want you to give
29:15us the truth because I think I think
29:17we've gotten a lot of truth from
29:20everyone as much truth as you think
29:22I think they can handle it.
29:25And so can you discuss what it means
29:27to be black and working in the harm
29:30reduction and drug policy space and
29:32how your experiences of being a black
29:35man in America inform your work and
29:37in what ways and forums you know
29:40you choose to talk about your story.
29:41And and knowing that the the history
29:44of what Mark has created in this state
29:46and in and and around the country.
29:48I mean the the syringe service apparatus
29:51and that he's created and the the
29:54changes he's managed to to make on a
29:57micro to macro level are are incredible.
29:59So I would love to you know hear you know
30:04all of your you know your wisdom on that.
30:08Thank you Kim and thank you for
30:13having me in this forum and in this
30:16space and similar to Helena. Hello,
30:22I also have a white father, you know,
30:29I don't, you know, and again being born
30:32in the 60s and coming up and you know
30:36like hating Cher forever singing the
30:38song **** ***** you know my experience
30:42was quite a bit different, you know.
30:44And having a white father, I never
30:45acknowledged him as my father publicly.
30:47He was my Big Brother because my older
30:50brothers had Big Brothers through the
30:52Big Brother and big sister programs,
30:54the Big Brothers, Big Sisters.
30:56So again, a whole different dynamic and
31:00how I grew up in that relationship. And
31:07to answer your question and
31:09and when Kim asked me that,
31:11I'm like, well, it's I, I I'm,
31:16it's always challenging for
31:18me to stay politically correct
31:20and and speak the truth.
31:24And then what my truth is may be offensive
31:28to others in the room, you know.
31:31And I was just recently given an award
31:35by the state for the work that has
31:39been accomplished in harm reduction and
31:44but yet and still the state
31:46does such backward ****.
31:47It makes me question, you know,
31:51why would you give me the award?
31:52And when I received the award,
31:54it's like, well, how can I allow you
31:57to sit in your seat comfortably?
32:00And this **** bothers me every waking day.
32:02It wakes me up out of my bed at 4:00
32:04in the morning with the thoughts and
32:07everything's of how are we going to
32:10continue to move this work forward.
32:12When the powers that be that are now
32:17awarding me also keep us from getting the,
32:22you know, the the meaningful work
32:26done and how I still have to work
32:32twice as hard for half as much.
32:37How I have to continue to bid
32:43on 100 and $200,000 grants,
32:46hopefully to win them when organizations,
32:50white led organizations who
32:53seek to do the work,
32:55not actually do the work,
32:57can get $5,000,000 contracts over
33:01five years and take a year to figure
33:03out how they're going to do the work
33:05before anything ever gets done.
33:09These are so and at the same time,
33:12as I said to you, still remaining
33:14politically correct because as I've
33:17said at the national level and before,
33:22the angry black man does not get funded.
33:26Passionate black man will get funded.
33:28No, no, let me take that back.
33:31The passionate black man is tolerated.
33:38They still seek the system.
33:40Society, Systemic racism still does
33:44not accept my experience, my expertise,
33:51and will look to other ways.
33:54To me, for instance, that term Bipoc.
33:58Bipoc is another way society is found
34:00to get around dealing with black people.
34:04They would prefer to deal with anybody
34:07else of color than that traditional
34:11African American black population.
34:14So do I see things improving?
34:24Yes and no. You know my experience,
34:28I have been, I've been blessed that
34:32as a result of the relationships I've
34:36built over the years and the work
34:38that I've done and managing now,
34:41even just to stay alive,
34:43has lessened the field of other
34:47experts to where they don't have
34:49much choice than to deal with
34:51the fat black guy, you know?
34:53Now maybe that's my opinion,
34:56because I feel like this a lot of times
34:59if I'm the smartest guy in the room,
35:01we're in the wrong ******* room.
35:06Excuse my language.
35:09I have been blessed with a vocabulary,
35:11but I tend to, you know, to skip
35:14around and I get lazy if you will.
35:20And that's not just in the state,
35:23you know, I feel that's even,
35:25you know, here at Yale,
35:27I've said for years, you know,
35:28there's New Haven and there's Yale.
35:31The two probably never get together.
35:38Things have progressed.
35:41But we have a long way to go.
35:44I mean, I I when I, when I read
35:46this book and I read the preface,
35:48I'm like, you know, wow.
35:51And and I'm glad to see Helena as a
35:54as a person of color also write in
35:57this book because I would have said
35:58this **** wouldn't went anywhere by
36:00a black person and I don't mean it to
36:03refer to it as please forgive me for
36:05using that word but then it's project.
36:08And I say this project if it
36:11were been someone from per se my
36:13neighborhood that wrote this and
36:15put it out it probably would still
36:17be sitting on a publisher's desk.
36:19You know.
36:20So but I'm grateful that this kind
36:23of information gets out and what I
36:25say even more I'm glad you said it.
36:27I'm glad you said it and not me
36:30because then we have a chance that the
36:33information doesn't fall on deaf ears.
36:35And this is what happens often
36:37times in the world.
36:38Rick is my experience out
36:39here like it from Yale.
36:41You know me and doctor Heimer can
36:42be in the same room and he'll say
36:44something and they'll look at me
36:46and I'll say look at me he said it,
36:48you know.
36:48And I'm glad he said it because
36:50it was the truth.
36:51But it's the truth that they could
36:53hear it from because he'll drop
36:55some bombs that make them want to,
36:57like, shoot him.
36:58But they won't say that to him,
37:02you know, because he, he has that
37:06privilege to say those things.
37:09And he has the privilege that I do
37:12not have and not sure I want it.
37:17So, you know. Yeah, that
37:21that's that's that's, yeah,
37:23that's a that's really,
37:25that's a really interesting and
37:26nuanced way to think about it.
37:27And I mean what you're kind of
37:31referring to that'll pick up the
37:32threat of is just like the building
37:35community and like triangulation of
37:38like that's a strategy to build power,
37:41you know is to like every person can,
37:44you know kind of kind of utilize
37:47it's sort of Doctor Heimer. I don't,
37:49I don't know you know how you guys work,
37:51but but you recognizing sort of that
37:55whiteness I think and using it strategically.
37:58So yeah, I think we'll come back to
38:02some of some of that, but I want to,
38:03I want to talk to you more about
38:05some of those things, Mark.
38:06But the next I'm going to
38:08go back to the history,
38:10which you know,
38:11it's so it's so fascinating and
38:14important that we understand that this
38:17is not our first rodeo so to speak in
38:20our in our racialized war on drugs.
38:23And and that's what the historians task.
38:26Sisyphean Tasker,
38:27I don't know the historians task is
38:31so David's chapter on on history.
38:34He writes of the relentless massive
38:38project of forgetting as a historian
38:41of drugs task bringing us to previous
38:44opioid use peaks after the Civil War
38:47as well as the 1960s and the 70s,
38:49benzodiazepines mother's little helper.
38:51And I would love for David to talk
38:56about drug regulation and drug policies
38:59in the US as racialized projects and
39:02how we can use the case studies to
39:05inform the calls for regulation and
39:07consumer protections of current substances.
39:10And in David's written a whole another
39:13book about sort of about the white,
39:16the whiteness of some of these
39:17in more detail as well.
39:18So you can refer to his other book,
39:21but I'm going to hand it to the historian.
39:28I think maybe this one's better.
39:31Yeah. So one of the central stories that
39:35circulated around the opioid crisis,
39:37as it's called in the early
39:3920th century was its novelty.
39:40Like, this is this new, unprecedented thing.
39:42And excuse me for quoting
39:45some pretty gross language,
39:47but there were headlines and,
39:49you know, in my local newspaper,
39:50a new breed of addict,
39:53a new breed of dealer.
39:55And the stories were about addiction
39:57cropping up in people and in
40:00places where it didn't belong.
40:02And they meant the white suburbs or
40:05the white exurbs or rural areas.
40:07And, you know,
40:08I'm a historian of pharmaceuticals.
40:10I'd written.
40:11A book on the history of
40:13psychiatric medicines,
40:14and one of the chapters was on
40:15a cultural panic over Valium
40:17addiction in the 1970s.
40:19So this was in living memory.
40:21I was alive at that time,
40:23and it seemed curious to me that
40:25there was this massive recent
40:26precedent that was all over the news.
40:28Like if you go in the late 70s,
40:29it was everywhere, right?
40:31And yet and and and it was taking
40:34place in the same people in the same places,
40:37but it seemed to have just been kind
40:38of dropped down the memory hole.
40:40And this was now the first time that
40:42anyone these areas had had been using drugs.
40:44And so,
40:44you know,
40:45when I went and decided to look
40:47into that question,
40:48I,
40:48I found very soon that there always
40:52seemed to be a pharmaceutical
40:55addiction crisis in white suburbs,
40:58white small towns, white areas,
40:59as far back as I could go,
41:00which was, you know,
41:01I went back to the 1870s,
41:02which is when the industrial and
41:06market revolutions first started
41:07to make these kind of products
41:10more widely available.
41:11And it always seemed to be there.
41:12And the weirdest part was if you
41:14went and you read those newspaper and
41:16magazine articles for all those years,
41:18which being a history nerd I did,
41:21they
41:21were the same. You know, you could
41:23have just, you could have just
41:25substituted out, you know,
41:26the year and the author and
41:28they were the same things.
41:29And they all traded on the shock,
41:31the shock value of this distressing
41:33behavior popping up in a place
41:35where it didn't belong.
41:36And I was like, well,
41:37how is that possible that this can be
41:40going on so continuously for so long
41:44and yet every time,
41:46every year, year after year,
41:47it's presented as something new.
41:49You know, this,
41:50this kind of massive forgetting
41:51doesn't happen by accident.
41:52It's a sign something
41:54purposeful is happening.
41:55It takes a lot of resources
41:59to manage memory in this way,
42:02to treat each instance as this aberration.
42:04Okay, something weird happened
42:06because these folks are now using drugs.
42:08We need to tweak something because
42:10something went a little wrong,
42:11something out of the ordinary is happening
42:14and to try to not speak a whole book
42:17and keep this under control time wise.
42:20So just say that the that this
42:23project of forgetting in my,
42:25in my understanding has been to
42:28try to to make sense of a situation
42:31that shouldn't make sense,
42:32to make it seem logical and that
42:34is the structure of the way that
42:37the US governs the circulation
42:38of psychoactive substances.
42:41Now this the the,
42:42the overall architecture is a
42:44division between medicines and drugs
42:46and that is so omnipresent that it
42:49just seems to make sense to us.
42:51But in fact, that that legal architecture,
42:53that cultural architecture was put
42:55together at a particular time in U.S.
42:57history in response to one of these
42:59drug crises as the turn of the 20th century.
43:02And it was put together by the reformer,
43:05good government people of that
43:07era who were also building racial
43:10segregation in all its forms,
43:12Jim Crow in the South,
43:13but also segregated consumer
43:15markets for all kinds of products,
43:18leisure products and entertainment,
43:20housing all across the country.
43:24This was,
43:24they understood this as a
43:26good government reform.
43:27And if you look at it from
43:28this point of view,
43:29and I love to dive into the details,
43:31but they're very detailed.
43:33You can see that they that they
43:36constructed drug markets in a way
43:37that looked an awful lot like the way
43:40they thought markets ought to look,
43:42which is a kind of a high class market.
43:45This was for quality control products
43:47with honest labels sold by people whose
43:49job it was to care for the consumers.
43:51They gave the consumers a
43:53special name called patients.
43:54And these consumers were overwhelmingly
43:57ones with social privilege,
43:58the most important of which was
44:00racial categorization is white.
44:01And then there were these other
44:04markets where other people bought
44:05pretty much the same substances,
44:06but with no quality controls, no labels.
44:08And authorities not only didn't
44:10give a **** about these people,
44:12but actively saw them as
44:14threatening criminals.
44:15And the goal was not to protect them,
44:16but to punish them.
44:18And this this logic undergirded that
44:20way of governing the circulation
44:22of this kind of substances.
44:24And we've we,
44:26I think we know for people who care to know,
44:29know what happened on the
44:30prohibition market side of that.
44:32So there's white markets and
44:33there's prohibition markets.
44:34We know that that's been an ongoing
44:37unfolding human rights and public
44:38health disaster for 150 years.
44:40One of the things that we dive into in,
44:42in the book is let's look at that other side,
44:44What happened on the other side.
44:45These legal markets that were
44:47intended at least on their face to
44:49provide the benefits of psychoactive
44:51substances to this privileged
44:52kind of consumer called a patient.
44:54And there we found out what Helena
44:56was talking about in in the opening
44:58that the that the mask of whiteness,
45:00that the technologies of whiteness
45:02that made those markets possible also
45:04became a tool that enabled drug sellers,
45:06particularly the kind of large
45:08companies that get involved in there to,
45:12to evade and surpass kind of
45:15weak consumer protections.
45:16Because the assumption was, well,
45:17everybody in this situation is white.
45:19So they're all well-intentioned
45:20and all pursuing health.
45:21The companies want to make lifesaving drugs.
45:23The doctors just want to help people.
45:24The pharmacists who just found the doctors
45:26and the people just want to get healthy.
45:27So there's not really any risk there.
45:30And if you were paying attention
45:32during the opioid crisis,
45:33you can hear that whiteness flowing
45:35through all of the marketing buildup
45:38to selling opioids in in mass
45:41quantitative refronities with with
45:43insufficient consumer protections.
45:45That whiteness became a tool for
45:47doing that and that helps explain
45:49this kind of boom bust economy.
45:51Things have always been awful
45:52in the prohibition markets.
45:53They go boom bust in the white markets and
45:57we need to pay attention to the booms.
45:59We also need to pay attention to the
46:01busts because those were laboratories
46:03for exploring different ways of
46:06governing these substances with
46:07the idea of protecting rather than
46:10protecting consumers rather than
46:12trying to police and punish them.
46:15So much to be said about it,
46:16but I'm, I better,
46:17I better stop myself there.
46:19And I mean I I don't know
46:21if we have the capacity,
46:22but David and I were talking earlier
46:26about how and in the in the book
46:29there's many examples of the the
46:31pharmaceutical marketing of of
46:35white whether it's buprenorphine
46:37whether it's Mother's little helper.
46:40You know, just that the,
46:41the iconic you know person on the
46:44ad is a a white woman of what it you
46:47know like between 20 and 60 years.
46:49I don't I'm not totally sure but
46:52I've looked at so many of them
46:54but you could replace the drug
46:55with the with the almost through
46:57the ages it sounds like
46:59yeah I have thousands of them on this
47:01computer right here if you want to see some
47:02so so I I
47:03think you know we should we should
47:04definitely you know if we can you
47:06know I would love to look at some of
47:09those and then the the drug policy
47:12question that Jules Jules wrote a
47:15really I said it was a a gram chapter
47:18on on on drug policy and and I'll
47:22highlight a couple things that Jules
47:24Jules talks about which was the
47:27passage of a medical marijuana act
47:29where they were you know really hoping
47:31to you know have it benefit all of
47:33these different conditions a ton of
47:36different conditions that different.
47:37You know people had were were
47:40experiencing that they hoped could
47:42could get covered under under medical
47:44marijuana or cannabis but really it
47:47got carved out to benefit white young
47:50people who were having seizures white
47:53kids and and so that was and and and
47:57the how to make those concessions
47:59and and and should we pass something
48:01that's incremental but but but
48:03hopefully we can build on and and and
48:06those tensions and as well as the
48:09passage of medication for opioid use
48:11disorder coverage for people with
48:13private insurance like I remember I
48:15was in New York when that happened
48:17but not for patients on Medicaid or
48:19you know black people are people of
48:22color you know and and and I want
48:26jewels to weigh in and maybe Mark
48:28can also weigh in on on this being
48:29being in the drug policy space but
48:33you know what what can we what can
48:35we learn from in our our ongoing drug
48:38policy that's that's informed by by
48:40this theoretical tools that that you
48:41guys have laid out of whiteness.
48:45Thanks. And I'm probably not the first
48:48person to portray the policy making
48:51process is grim normally be the last
48:54but but that that is my perspective.
48:56You know, one of the thing the opioid
48:58crisis sort of laid bare I think
49:00is this sort of policy paradox.
49:03And I was working in New York at the
49:05time and I I've been doing drug policy
49:07for a while and I remember working on
49:09the reform of the Rockefeller drug laws,
49:11right, with these draconian,
49:12very punitive carceral responses
49:14to drug use mostly aimed at black
49:17and brown communities.
49:18And that was those were reforms
49:20led by coalition of of black and
49:24brown people and families and and
49:26we fought tooth and nail to get
49:28what were very incremental reforms.
49:30And I remember being in Albany and
49:35all of a sudden these conservative
49:37Republican legislators were talking
49:39using talking points from the
49:41Drug Policy Alliance about the
49:44importance of harm reduction.
49:45And this was early days and
49:47I was like what the ****?
49:49You know, like what?
49:50Pardon my friend, Like what the actual ****.
49:52Like this guy.
49:53You know last last session was all about
49:57thank you, you know
49:59and of course what
50:00was that play was whiteness right.
50:02That white constituents were suddenly dying,
50:05you know tragically But if there
50:07have been tragic deaths of black
50:09and brown people for for decades
50:11and and and also the harms of
50:14criminalization that were you know,
50:16not just ignored but applauded. Right.
50:18Like we we couldn't build enough
50:21policing or law enforcement apparatus
50:23to lock people up for for drug use.
50:27And now right there's this kind of kindler
50:29gentler so-called you know war on drugs
50:33and and so yeah, in the book I,
50:35I talk a lot about how whiteness
50:37operates in a policy space.
50:38And honestly, like in in this
50:41medical marijuana campaign,
50:42my complicity in that based on a lot of
50:47factors but really wrestling with these
50:50moral questions of incremental policy
50:52reform and do when in should you ever
50:56leverage whiteness to promote policy.
50:58And I want just to spoiler alert,
51:01my answer is no, you shouldn't.
51:04And and So what I would say to people
51:06that care about policy and advocacy,
51:08and I hope you all do because
51:09it is more important than ever.
51:11And despite my cynicism,
51:13I have seen very important policy
51:15changes get made by people like
51:18those sitting in this room and
51:21certainly by people like Mark,
51:23is you.
51:24You do need a deep racial analysis
51:26of the kinds of policies that
51:29you're passing and including
51:32unintended consequences.
51:33And I think the the best way and
51:36maybe the only way to do that is by
51:39for people like me frankly taking
51:41a back seat and making sure that
51:44people who are directly impacted
51:46and people of color are the ones at
51:49the tables deciding what the policy
51:51should be and what the strategy
51:54should be to advance those policies.
51:58You know,
51:58which we have a little critique
52:00of race neutral policies in the
52:01book that I won't go into.
52:03But what I would say is we need
52:05policies that are explicitly anti racist
52:07versus anything that is race neutral.
52:10And as it relates to the the war on
52:14drugs and and drug policy reform we
52:17also need policies that don't just
52:20promote harm reduction and decriminalization.
52:22All things that I are hugely important,
52:25but also that redress the harms
52:28that the war on drugs has done by
52:31really devastating communities
52:33of color across this country.
52:36And let me tell you,
52:37policymakers don't want to look at that,
52:39but we need to, to make them do that.
52:42And then I would say to, you know,
52:44white folks that are in the policy space,
52:48you have privilege whether you
52:49like it or not,
52:50you know,
52:50like and I mean Mark was alluding to this.
52:53And so how can you spend that privilege
52:56in ways that are going to be most
52:58beneficial and open doors to people
53:01who don't have the same kind of access.
53:03And this is not a I'm not
53:06trying to plug my department,
53:08but we have a whole like long day,
53:11long day and a half long training on policy
53:13advocacy for researchers and clinicians.
53:15And so if if you want more sort of
53:17specifics on how do you get involved and
53:19where can you plug in and all of that,
53:21I would be happy to share that.
53:23But my,
53:24my call to all of you,
53:26if you're not already sort of politically
53:29engaged and in the policy space,
53:31you you should be a need to be.
53:34Not just because there's so much at stake,
53:36especially with the opioid crisis,
53:39but because a lot of the
53:41solutions that are going to help
53:42the people that you care about,
53:44the people that you serve,
53:47are going to be solved by individual
53:49level interventions, right?
53:50Are going to be solved by
53:51structural change that,
53:52for better or worse,
53:54and very slowly happens at the policy level.
54:03Okay, okay, great,
54:08okay. The next question is for Helena.
54:11Are you there? Okay, Great, great, okay. So
54:17I'd like you to talk a little bit
54:19more about your critique of the age
54:22of addiction medicine or neuroscience
54:25and the erasure of the social
54:27conditions in which people live.
54:30So as an anthropologist
54:33at A at a researcher I I wonder
54:36how we can work towards funding
54:39alternative epistemologies and
54:40methods that have direct application
54:44to impact the overdose death crisis.
54:47We've had 111,000 people die of of
54:52overdoses in the past 12 months with
54:57you know black Lenex and indigenous
55:00folks disproportionately the
55:02rates have been disproportionate.
55:05Those are very clear.
55:07And so how can we,
55:10how can we shift those to
55:14how can how do those epistemologies
55:16and those and those funding streams
55:18and and and addiction, neuroscience,
55:19rethinking, addiction, neuroscience,
55:20how can that help us in our current moment?
55:26It's a softball.
55:29Well, the softball is,
55:31you know, can they help us?
55:33And I just want to say Amen to
55:35what Jules was just saying,
55:37the need to have laser focus on
55:40systemic and structural intervention
55:41because we're in a society
55:44that's not only individualist,
55:46but that relies on that.
55:48For it's it's racial capitalism,
55:51you know, as its economic engine.
55:54It's much easier to make money
55:57by individualizing a problem and
55:59developing very expensive patented
56:01solutions to that problem that
56:04are sold to individuals that,
56:07by the way,
56:08don't help and may even accelerate
56:10the problem when it comes to overdose.
56:12There's another builtin piece there
56:15around the demographic shift and
56:18who is dying of overdose right now.
56:21The fact that this may have
56:23started off as a quote UN quote
56:25white problem mainly meaning that
56:27white people as Jewel as David was
56:29outlining before the kind of the
56:32unexpected people using opioids,
56:34the the people that the the people with
56:38a problem that doesn't belong there,
56:40quote UN quote.
56:41Even though it was perceived as
56:43a white problem in the beginning
56:45and the attention was to white
56:48deaths from these opioids,
56:49we now are entering as of 2020
56:53into an era where the percentage of
56:57people who are overdosing is higher
57:00among black Americans and Native
57:02Americans than among white Americans.
57:04It's long been the highest among
57:06Native Americans.
57:07That's something that the
57:09headlines ignored 2030 years ago.
57:11It's always been higher among Native
57:13Americans. They've been totally in.
57:15In visualized through this,
57:17But now we can also count African
57:20black Americans as those who among
57:23whom overdose rates are even
57:25higher than among white Americans.
57:27Really,
57:27the bottom line is the overdose
57:29rates have gone up dramatically in
57:32all virtually all racial ethnic groups.
57:33It's really astounding.
57:35And they've gone up despite enormous
57:39expenditures, public monies,
57:40many of those dollars going to
57:43publicprivate partnerships with
57:44pharma to develop new technologies,
57:46individual level commercially
57:48sellable technologies to combat
57:50the very problem that the pharma
57:53industry helped to create.
57:54So not to take anything away from
57:58technologies, they can be very helpful,
57:59but we've had the majority of our tax
58:02dollars go to these publicprivate
58:04partnerships and to commercially
58:06saleable products on an individual level.
58:09Those tax monies have not gone to
58:12address structural institutional root causes.
58:15They certainly haven't focused on
58:18racial capitalism, systemic racism.
58:20And I thought that Mark gave a really
58:24brilliant example of how systemic
58:26racism and racial capitalism are working,
58:29even in the field of harm reduction and
58:34community interventions for addiction.
58:37The fact that we haven't attended
58:40to privilege privileging grassroots
58:41organizations that are founded
58:43and run by the very people who are
58:45dying off at the highest numbers
58:47and have lived experience.
58:48We have not done that that we have to have.
58:51We have to have a very,
58:52we can't have a quote,
58:53UN quote colorblind approach here.
58:55Colorblind approaches are just going
58:57to reproduce the very hierarchies.
58:58We have to have a reparative
59:01restorative justice approach where
59:02we actually privilege people from the
59:04affected communities and make sure
59:06that they're getting the investments,
59:08make sure that they are deciding
59:10how the investments are spent.
59:12So we desperately need that with regard to,
59:16well, how do we move forward
59:18with this kind of approach,
59:19I'm not sure I have the answer,
59:20but I think the progress we've seen
59:22in the US, which is a really tough
59:24US drug policy and healthcare,
59:26those are really hard nuts to crack.
59:28Here we are in 2023, we've had many,
59:32many waves of lobbying for universal
59:35healthcare as a bare minimum.
59:37I mean, here we are holding up
59:39buprenorphine as our major tool now to
59:41intervene on overdose rates when that
59:43depends on someone having a private doctor,
59:46you know,
59:46or at least an individual Doctor
59:48Who will prescribe it.
59:50And most people are left out of the
59:52healthcare system that aren't the
59:53most at risk for overdose at this point.
59:55So it makes no sense.
59:58We have to invest in systems.
01:00:00We have to invest in the social determinants
01:00:03that we've documented over and over and
01:00:05over again are pivotal to making a dent
01:00:08in overdose rates and bad health outcomes.
01:00:10Housing, healthcare,
01:00:11childcare, employment.
01:00:12There's a little bit of a discourse in
01:00:16this country around deaths of despair.
01:00:18How did the phrase deaths of
01:00:20despair even get on the map as a
01:00:22way of explaining overdose deaths?
01:00:24Because white Americans were suddenly
01:00:26subject to these deaths of despair.
01:00:29White Americans, many of them low income,
01:00:31stuck in deindustrializing areas,
01:00:33Rust Belt America,
01:00:35where jobs were being shipped
01:00:37out and where they were at.
01:00:38They were subject to the same things
01:00:41that black and brown Americans have
01:00:42been subject to for many decades
01:00:45before that as deindustrialization
01:00:46hit those groups first.
01:00:48You know,
01:00:49black and brown Americans not
01:00:50being welcomed into trade unions,
01:00:52not having the protections,
01:00:53being the first hat fired, last hired.
01:00:56They experienced those layoffs
01:00:58that unemployment much earlier and
01:01:00now white working class America
01:01:02is really experiencing it.
01:01:04And so Deaths of Despair got on the map.
01:01:06And we have long been arguing
01:01:08that Deaths of Despair is again,
01:01:10kind of a whitewashed concept and
01:01:12we have to expose that and privilege
01:01:16explicit racial reparations.
01:01:18So in this country,
01:01:19the progress that we've made
01:01:21really has always stemmed from
01:01:24grassroots political movements.
01:01:25It that that, as far as I can tell,
01:01:27it's always come from that.
01:01:29And the most recent really,
01:01:30really robust example that I
01:01:32can hold up is AIDS activism.
01:01:34You know,
01:01:35I came of age in the late Early's late 80s,
01:01:39early 90s,
01:01:40and was exposed to ACT UP and
01:01:43other AIDS activist organizations.
01:01:44That made really big inroads because
01:01:48they pressured through a very wide
01:01:52and creative variety of of techniques,
01:01:56through street theater,
01:01:57many different kinds of demonstrations,
01:01:59behind the scenes,
01:02:00political pressure and alliances
01:02:02between different marginalized groups,
01:02:04racial and also through sexual orientation,
01:02:08gender identity.
01:02:09There was a broad based movement
01:02:11around AIDS
01:02:12that actually led to a significant
01:02:15infusion of federal funds to
01:02:17aid services and research.
01:02:19It changed the way that the
01:02:20NIH made its decisions.
01:02:21They began including people from
01:02:24directly affected communities and
01:02:26people who are HIV positive in
01:02:28their scientific review sections
01:02:30and scientific priority setting.
01:02:32Ryan White Care Act was passed and
01:02:35it required community councils to
01:02:37make decisions about how the AIDS
01:02:39service money was going to be spent.
01:02:41And those councils had to have
01:02:43members that were HIV positive and
01:02:45from heavily affected communities.
01:02:47And all of a sudden we had
01:02:49funding going for housing,
01:02:50funding going for what then
01:02:51was called buddy programs,
01:02:52Now we call it peer programs,
01:02:54peer navigation,
01:02:55community health workers.
01:02:57So you know,
01:02:58really I I I think we have to
01:03:00have allies working from the top
01:03:02and we do have some of those.
01:03:05I think that within the Biden cabinet
01:03:07and the Drug Policy Administration,
01:03:09we have some allies there
01:03:10and that's really helpful.
01:03:12We must have interracial and intergroup
01:03:16alliances on the grassroots level.
01:03:19And I see hope in organizations
01:03:23like National Survivors Union,
01:03:25formerly known as Urban Survivors Union,
01:03:27of people who use drugs and other
01:03:29groups like that who are doing that
01:03:31really hard work of organizing so that
01:03:33there is a a base at the grassroots.
01:03:37I'm trying to do what I can through
01:03:41academic medicine and academia,
01:03:42and that's not an easy place to get any
01:03:45kind of policy or institutional change.
01:03:48But my tiny contribution,
01:03:49along with my coauthors and
01:03:51everyone you know who's here,
01:03:53gathered here tonight,
01:03:54is to circulate ideas,
01:03:56concepts that help people to direct
01:03:58their action in the right place.
01:04:01Let's educate people as much as we can
01:04:04about how institutional racism works,
01:04:06Systemic racism works.
01:04:08Educate them about how it's
01:04:09prevented us from having a universal
01:04:12healthcare system and any kind of
01:04:14rationality about public resources.
01:04:15Let's educate them about racial
01:04:18capitalism and the way that racist
01:04:20ideology has really bolstered
01:04:22and held up the disproportionate
01:04:25power of companies and industry
01:04:27and healthcare and other sectors,
01:04:29you know,
01:04:30And so that's my tiny little contribution,
01:04:32our little tiny contribution speaking
01:04:34with each other and hopefully
01:04:36beyond in academic medical centers
01:04:38and and in that's where social
01:04:41scientists and social scholars can
01:04:43be helpful to providing concepts like
01:04:45whiteness and systems of whiteness.
01:04:48And what is the underlying mechanism for
01:04:51systemic racism and racial capitalism?
01:04:53So there is an area where we can
01:04:56contribute just with the concepts.
01:04:57Where do we even begin to make a difference?
01:05:00Well,
01:05:00we have to understand how these systems work.
01:05:03So I'll stop there.
01:05:04But there's so much more work to be done.
01:05:08I don't know how you're
01:05:10going to go after Helena Mark
01:05:15but I I think that that's a really.
01:05:16Yeah. Thank you Helena for for you
01:05:18know all that you do and and Helen is
01:05:21like meeting with the mayor soon of of
01:05:23Los Angeles like right after this or
01:05:25tomorrow and and so you know really
01:05:29really just doing incredible work and
01:05:32and it's interesting that you talk
01:05:34about AIDS activism because who was
01:05:36Ryan White I mean Ryan White was a good
01:05:39point a young white you know child who
01:05:42had got gotten HIV from hemophilia.
01:05:46If I'm not, you know,
01:05:47it wasn't this Keith Siler,
01:05:49you know Gay Black.
01:05:50You know it's not the Keith Siler you
01:05:53know funding but but again that you
01:05:57know that he was the face of that.
01:05:58So the whiteness is is even there
01:06:01in in that history.
01:06:03So Mark,
01:06:05can you can you talk a little bit
01:06:07about the history of racialized drug
01:06:09policy and harm reduction here in
01:06:12Connecticut and how you've managed to
01:06:14build your powerhouse organization
01:06:17CT Harm reduction Alliance.
01:06:20I
01:06:22know you've been also and he's also been
01:06:24taking a lot of notes on on Doctor Hansen.
01:06:26So if you want to weigh in on anything
01:06:28she had to say, please feel free to do
01:06:30that. Well, you know, well,
01:06:33I'll say there were a few key points made.
01:06:37But also understanding that you know
01:06:40harm reduction was born out of the
01:06:44HIV movement and that also harm,
01:06:48harm reduction, like still the
01:06:51HIV movement is still controlled
01:06:53and led by gay white, gay, white,
01:06:57male led organizations and
01:07:04still eat the the systemic.
01:07:07When you talk about how HIV,
01:07:13similar now to the opioid epidemic,
01:07:17directly and disproportionately
01:07:19affects communities of color,
01:07:22and you know, my mom,
01:07:24I don't know who she got the quote from,
01:07:26She always said history repeats
01:07:28itself because people don't
01:07:30listen the first time around.
01:07:33And and my mind was you know I
01:07:36believe ahead of her time you know
01:07:46similarly to when you know I I
01:07:50founded greater Hartford harm
01:07:52reduction coalition really out of
01:07:55frustration and out of resentment.
01:07:57You know so when people say
01:07:59resentments can be harmful.
01:08:01You know contrary resentments
01:08:03actually forced the growth of 12
01:08:05step fellowships worldwide because
01:08:07people would get mad at somebody at
01:08:101A a you're in a meeting and go over
01:08:12here and start another one and as a
01:08:15such we now have you know worldwide
01:08:17you know groups and and I will tell
01:08:21you so that same frustration and
01:08:24resentment with having done this work
01:08:28for so many years for a gay white
01:08:32male led organization and Hartford
01:08:35and trying to find ways to expand
01:08:38those services in my neighborhood.
01:08:41You know having done that work
01:08:44and was met with resistance,
01:08:46you know and then when that
01:08:49organization changed hands and and
01:08:52merged with another gay white male
01:08:55led organization to form a statewide
01:08:58coal it was a statewide coalition.
01:09:01So we found ourselves on the outside
01:09:04and and I'll tell you now I also
01:09:07had another business that I could
01:09:09have gone on to and continued in
01:09:11which even now today is one of the
01:09:13larger sound companies in the state.
01:09:14However,
01:09:15this work has always been near and
01:09:18dear to me and I felt that my role
01:09:21being also a person in recovery.
01:09:23I may as well you know.
01:09:24Let me state that for the record,
01:09:28my treatment history reads like Greg CV.
01:09:35You know
01:09:39not to put you on the front St.
01:09:41it's long but and so if you
01:09:43don't know Greg CV all right
01:09:50and and so is my treatment
01:09:52history you know but for
01:09:59and as a result of that and and and
01:10:03how the two and I know I'm I'm I'm
01:10:05going way around the block because
01:10:07so when I tell you I'm sitting here
01:10:10bouncing when Helena was speaking
01:10:12because some of the same same things
01:10:15when I started this organization
01:10:17as also when you know is that I I
01:10:21was met with opposition I was met
01:10:24with opposition I was closed out of
01:10:26certain circles just to and because
01:10:30of the power of white privilege
01:10:36and how it was like don't engage
01:10:40don't promote this let this stay
01:10:44to the outside until it dies off.
01:10:47But it was just my stubbornness,
01:10:52my knowledge that I just felt I was
01:10:58the best person to do that work in
01:11:02my community that I was invested in,
01:11:05came from, lived in and knew the
01:11:07ins and outs of what happened,
01:11:09why, the history and all of that.
01:11:12And I did not recognize that
01:11:16privilege that was blocking me.
01:11:21It did not happen overnight.
01:11:23But persistence and that passion
01:11:29and then developing, you know,
01:11:33some really simple things,
01:11:35branding the whole 9 yards and stuff
01:11:37that that has enabled me, you know,
01:11:41that I'd already built the relationships,
01:11:44you know, here within the state
01:11:46and then nationally as a result
01:11:48of being part of a larger harm
01:11:50reduction collective that we were
01:11:53able to I guess overcome a lot of the
01:11:57opposition that was put in our way.
01:12:00And then I will tell you,
01:12:01they were quite a few turning points
01:12:06where publicly I did not acknowledge
01:12:09the privilege of certain individuals
01:12:12and it came back to haunt me.
01:12:14You know, when I was told,
01:12:15hey, listen,
01:12:16you got to make some apologies here there,
01:12:18wherever when I thought it was feasible,
01:12:21I did.
01:12:22I lost members of my board because
01:12:25there were times I chose to make an
01:12:29apology publicly for the sake of the
01:12:32organization to grow or to you know,
01:12:35but we still now and in a different
01:12:38way face things because here we are
01:12:41we know what the what the opioid with
01:12:44you know the backside of this and
01:12:47the money that's about to cascade
01:12:50into community based organizations
01:12:52and who I call the usual suspects.
01:12:55These are those organizations that
01:12:58already have those relationships
01:13:00with the state and they just like
01:13:03they don't have to provide evidence
01:13:05of doing the work.
01:13:07Their word is evidence that
01:13:10they're capable of,
01:13:11and so therefore they will
01:13:13get the lion's share.
01:13:15You know, and I'll, I'll even blast this,
01:13:18this institution right here,
01:13:20which, you know I don't have a,
01:13:22you know, I pull no favorites.
01:13:24I'll sit in Sampson space and
01:13:27blast Sampson because they have
01:13:30singlehandedly coopted harm reduction
01:13:32and try to reduce it and have
01:13:35reduced harm reduction to to syringe,
01:13:37I mean to fentanyl test strips and
01:13:41Narcan completely bypassing some of
01:13:44the core principles and everything
01:13:46that harm reduction stands for.
01:13:48But also you know I met and spoke
01:13:50to a couple of members of of
01:13:52teams here at Yale that have been
01:13:58I I will say requested to provide a report
01:14:01to talk about some of their findings
01:14:04who they think how funding should be
01:14:07played out or how funding should be led.
01:14:09And we had deliberate conversations
01:14:13about funding black communities and
01:14:15and and organizations and yet when
01:14:18that report came out it didn't say
01:14:21**** about funding black communities
01:14:23but it was it was pretty deliberate
01:14:25about talking about funding research.
01:14:29You know what I'm saying?
01:14:30And and you know if you know Mark Jenkins,
01:14:33I was pretty quick to not blast
01:14:36the people publicly.
01:14:38If it would have been here at this campus,
01:14:39I would have, you know,
01:14:41but yeah I called up Robert and and you
01:14:46know I'll say that and I called up a
01:14:47couple other people and said, listen,
01:14:49you will actually I I texted them hope
01:14:52that hope that's not them calling me
01:15:00and said listen,
01:15:02no I'm not I'm not well.
01:15:05I'm not well with this because it
01:15:08leaves out this very same thing.
01:15:10And if we, you know, listen,
01:15:13if we don't have assistance,
01:15:16if we need help with this,
01:15:19we can talk in forums like this
01:15:21right here all day long about how
01:15:24things should and could take place.
01:15:26But let's be quite honest,
01:15:30the people in this room are
01:15:31not going to be heard in those
01:15:33circles where it means the most.
01:15:36And some of the same things
01:15:38that I get mad with Yale for,
01:15:41some of the same things that I
01:15:43love Yale being here because I
01:15:45don't think we have any other
01:15:47institution that will raise more
01:15:49hell when they believe in something,
01:15:51you know,
01:15:52so how do we get that energy
01:15:55behind these particular topics?
01:15:59Because we need you,
01:16:00we need you to talk about these things.
01:16:02And we've had some really,
01:16:03really great young leaders come
01:16:05out of this institution that have
01:16:08been really helpful and pivotal
01:16:10in this work to date, you know,
01:16:12So I look for the next one,
01:16:13you know who's coming along so we
01:16:15can so we can grab a hold of them
01:16:17and team up early and then drive,
01:16:19you know, some of this work.
01:16:22Thank you, Mark.
01:16:23And so let's just open it up to questions
01:16:27from Are there any questions on Zoom?
01:16:29Feel free to type them into the
01:16:31Zoom question or chat.
01:16:33And if any of you have questions,
01:16:35I can run the mic around.
01:16:37And please introduce yourself
01:16:40and direct your question to your
01:16:43panelists or panelists of choice.
01:16:46I'm coming over you.
01:16:48You have a question.
01:16:50OK, yeah, I'm OK.
01:16:50I'm coming over,
01:16:54OKOK.
01:16:59Hello. Hello. I'm Anthony.
01:17:00I am a first year here at Yale.
01:17:05Thank you so much. I studied history
01:17:12and my question is,
01:17:14is has to do with like the comfort
01:17:18in using the term community.
01:17:20I grew up in a predominantly
01:17:23black community.
01:17:23I my parents are Indian and
01:17:26and African American and
01:17:31class distinctions within racialized
01:17:32community is something that
01:17:33often time is not talked about,
01:17:35is not talked about and community,
01:17:37especially when you're talking
01:17:39about funding to a socalled
01:17:41abstract community can become
01:17:43very problematic very quickly.
01:17:44And I've seen it many,
01:17:45many times in my life,
01:17:46especially with I was a teacher
01:17:48before I came here and I saw it
01:17:51with the charter school movement
01:17:53and how the charter school movement
01:17:55eviscerated public schools.
01:17:58And if we're talking about
01:18:00like black people in unions,
01:18:03teacher unions,
01:18:04especially black teachers in
01:18:05teachers unions was very important
01:18:07in many communities of color.
01:18:09And now charter schools have basically
01:18:13eviscerated them and so much of
01:18:16like notoriously constructed notions
01:18:17of middleclass black identity.
01:18:20So yeah,
01:18:20I just this comfort of the term
01:18:23community and describing like
01:18:24we're funding is going who the
01:18:26leaders are coming from, etc.
01:18:28Do you want any of them to in particular
01:18:31or anybody who feels so moved
01:18:38navigate
01:18:42community.
01:18:45You know
01:18:49I speak of being deliberate and in a lot
01:18:53of instances only because I think if
01:18:58we can get focused into the community,
01:19:03you know, there there,
01:19:05there's there caveats also where
01:19:08even communities silo, you know.
01:19:12So I think when we have,
01:19:15when we have movements that capture
01:19:18thought and and really beat down
01:19:20those silos to address issues,
01:19:23that's where we see the most benefit.
01:19:25What I do, what I don't see quite often,
01:19:29is that because we're so often put
01:19:35in in positions where we have to
01:19:37fight for the same pots of money,
01:19:39it segregates, you know,
01:19:43organization versus bringing them
01:19:46together for collaborations.
01:19:47And what you have, you know,
01:19:49I just heard a politician say this recently,
01:19:52is collaborations.
01:19:54You know, they're supposed to be,
01:19:57they're supposed to be collaborations.
01:19:59But, you know,
01:20:01beneath the surface where,
01:20:02you know,
01:20:03we're still crabs in a bucket
01:20:08and. And do you want to weigh in as a
01:20:11historian on that question, David, or or?
01:20:16I mean
01:20:20one of the, I mean if we're going to
01:20:21put in a context of a place where
01:20:23that appears in the book, you know,
01:20:25one of the things we we wrestled
01:20:27with is is whiteness is this is a
01:20:29is a category that you know is is
01:20:32invisible with wields all this power.
01:20:34But there are a lot of different
01:20:35kinds of white people.
01:20:36Like there's a lot of white people.
01:20:37There are poor white people,
01:20:38rich white people, urban white people,
01:20:41rural white people.
01:20:42And one of the one of the delicate
01:20:45parts of the book and one one I think,
01:20:48which is received appropriate
01:20:50scrutiny in some,
01:20:51in some degree of skepticism,
01:20:52is how do you talk about gradations
01:20:55of difference in terms of
01:20:57political power and whiteness.
01:20:58And I know Helena talked about this
01:21:01in one part of the book about how she
01:21:03could surprisingly be more white than
01:21:06someone who is in some like scientific
01:21:08way white depending on context.
01:21:11And I guess that that's the mirror,
01:21:12the mirror image of what you're
01:21:14talking about is when you that that
01:21:15it's important not to see these,
01:21:16not to reify these categories
01:21:18as if they they actually define
01:21:21us in some essential way.
01:21:23Of course they are political
01:21:24categories that are used to support
01:21:27social hierarchies and you have to
01:21:29be careful with how you use them,
01:21:31just in the way that you don't
01:21:33want to use whiteness,
01:21:34leverage whiteness to accomplish
01:21:36political goals because it comes with
01:21:38a cost and the costs are borne by the
01:21:40people who don't get categorized as white.
01:21:42I think that kind of essentializing
01:21:45or homogenizing a black community
01:21:47can make it harder,
01:21:49it seems like,
01:21:49to navigate some of those some of those
01:21:51challenges that you're talking about.
01:21:53But that's as far as I can
01:21:54speak because I'm too ignorant.
01:21:59Okay. Other questions, any questions on Zoom?
01:22:09Can I just say 1 little thing?
01:22:11About to follow up on what
01:22:13David said and Mark said,
01:22:16I think we have gotten a lot out
01:22:21of a certain kind of identity
01:22:23politics of the past few decades.
01:22:26And what would be good to do is to
01:22:28move into this phase of structural
01:22:32and systemic analysis because
01:22:34by definition getting stuck.
01:22:37It's really important to understand
01:22:39how people are defined by others
01:22:41and how they define themselves.
01:22:43That's really important.
01:22:44But we also have to get beyond that.
01:22:47That's not the whole picture.
01:22:48We have to understand these systems.
01:22:51And so to the extent that we
01:22:54can understand these systems
01:22:56and understand who to work with
01:22:59within a particular community,
01:23:02hopefully selfdefined that needs to be at
01:23:05the table and needs to have investments.
01:23:07If we have a systemic lens who to
01:23:09work with and how to work with them so
01:23:12that we can leverage systems change.
01:23:14I think that determines a lot of the rest.
01:23:18Because what I hear implicit in
01:23:20this the the question we got just
01:23:22got from the floor was it was about
01:23:25identity politics and who gets
01:23:26counted as in a particular group.
01:23:30So I think it the more we can bring a
01:23:33systemic and structural lens rather
01:23:35than individual identities to bear,
01:23:37the better individual identities
01:23:39are really important but they're
01:23:41the starting point.
01:23:45Thank you so much, Helena.
01:23:47I I'm I'm cognizant of time and I'm
01:23:49sorry I did I didn't leave enough time
01:23:52for a ton of questions but I think
01:23:55I'm just so I'm just so grateful to
01:23:58to have these folks and hopefully
01:24:00if you're in the room or online you
01:24:02can e-mail us or please continue to
01:24:05keep engaging and we'll stay hang
01:24:07around and and answer any questions
01:24:09you have in person and and yeah and
01:24:12and of and of course the plug is
01:24:14the plug is that if you want to be
01:24:17involved in in any local movements
01:24:19to to build power with Mark Jenkins
01:24:22and harm reduction or drug policy.
01:24:25We are here for you.
01:24:26I'm here for you barks here for you
01:24:29and and and and if you're in New
01:24:32York or nationally please reach out
01:24:33to to Jules and and David and and
01:24:35we'd love to keep engaging with and
01:24:37Helena and and Helena who was our
01:24:39powerhouse on the West Coast and and
01:24:42so it's it's an honor to to have you
01:24:44all here and to and if you haven't
01:24:46please please get the book and and
01:24:48you know if you haven't been so moved
01:24:51by this tremendous conversation.
01:24:53I think you'll really enjoy we we barely,
01:24:57we barely skimmed through many of
01:24:59the important chapters on Oxycontin,
01:25:01buprenorphine, heroin, fentanyl history.
01:25:04So. So please read the book.
01:25:06So thank you so much for joining us.
01:25:09Thanks, Doctor Reisman.
01:25:11Thank you.