Marijuana Legalization – It’s Time For The Field To Think More Broadly

I am a huge fan of the Office of National Drug Control Policy’s (ONDCP) Director Michael Botticelli and hold both him and the transforming ONDCP agency he leads in the highest regard.  I could write endlessly on what an amazing recovery advocate and ally we have found in Director Botticelli and the ONDCP’s recovery-oriented approach to addressing the nation’s substance misuse challenges.  To that end, what follows is in no way an attack on Director Botticelli and the ONDCP but more so a challenge to the substance use disorder prevention, treatment and recovery field – this is directed at the practitioners, advocates, individuals and family members in recovery, researchers and educators who all share the common goal of making prevention, early intervention and recovery from a substance use disorder more accessible and available to all.

Currently we see a debate raging on regarding the legalization of marijuana.  This debate has been supercharged in recent weeks by Director Botticelli’s reiteration of the federal government’s stance on opposing the legalization of marijuana as some states have moved toward legalization.  Director Botticelli cited the ideas of marijuana as a “gateway drug”, young people having a low perception of risk regarding the use of marijuana and research that supports the dangers of marijuana use on the developing brain as some of the core reasons for opposing legalization.  Many experts and advocates are in agreement and see the legalization of marijuana as potentially increasing use among youth.  Many other experts and advocates disagree and see this as a step backwards in what has been forward momentum around decriminalizing substance use and substance use disorders.

While I do not pretend to know the best direction to go in, I do believe there are some aspects of this debate that are important for all of us to consider.  As a person in long-term recovery from a substance use disorder who has utilized an abstinence-based pathway to recovery for close to 11 years, I recognize that for me personally, using marijuana – whether it is illegal or legal – is not something that is in the best interest of my recovery and therefore not something I can engage in.  Just like the act of indulging in the currently legal substances of alcohol, tobacco and McDonalds cheeseburgers is not in alignment with the practices I need to maintain my health and wellness, marijuana is in the same boat.  Moreover, I can recognize that my abstinence from alcohol, tobacco and McDonalds cheeseburgers is what remains the best practice for me personally while not imposing my personal needs and choices on other people.  Millions of individuals can use these substances and eat a cheeseburger afterwards without it moving into problem use or a substance use disorder.  I just happen to not be one of them.  I do not need to oppose other people’s use of these substances just because it would not be a good idea for me and many of my friends.  I recognize that many of my friends and I, despite sometimes living in still siloed recovery systems that do not allow for us to see it, are actually in the minority when it comes to this need for abstinence only.

In addition to the idea that abstinence from marijuana is not the goal of nor necessary for more individuals than not, another point to consider is the following.  Alcohol, a legal drug and the most deadly, has seen a steady decline among youth and was actually used less than marijuana among 8th graders in 2014 according to the National Institute on Drug Abuse.  The use of tobacco, another legal and the second most deadly drug, has also steadily declined among young people. The idea that legalization increases use falls flat when we look at steady decreases in the use of these two substances.  Perhaps we ought to explore more how education and prevention efforts may have aided in this decline and how these efforts can be enhanced and more effective when substances are in fact legal.  At the very least, the data shows that marijuana use among youth is already happening at a rate higher than that of legal substances, so keeping marijuana illegal doesn’t seem to be working out too well for our nation’s young people.

To reiterate, I do not pretend to know the answer as to whether the legalization of marijuana would increase or decrease use among youth.  I believe more unbiased research is needed and there is much to consider.  What I do know however is that we have a lot of evidence showing continued decreased use among youth when it comes to legal substance use with increases in illegal substance use.  I also know that we have a lot of old thinking still pervading how we approach this issue and that some of us who subscribe to and apply the abstinence-based pathway in our own lives have difficulty seeing other possibilities outside of only abstinence. Ultimately, for those of us who practice, advocate, educate, shape policy around and aim for change in the area of substance misuse, I only propose that we step back for a moment and think more openly, critically and broadly about the idea of legalizing marijuana use.  We owe it to our young people to be doing just that.

From 60 days to Purple Sash

As a 24-year-old with about 60 days drug-free and in the very infancy of my recovery journey, I looked around and studied the crowd gathering at Memorial Hall in Philly’s Fairmount Park.  The recovery house I was residing in mandated that all residents come to this thing called a “recovery walk” before going on our home passes.  To be brutally honest, many of us were just eager to get this mandatory event over with so we could move onto the main attraction of the day – our hard earned and highly coveted weekend passes that allowed us to get away from one another and the recovery house.

As I took the whole scene in, I was surprised by the large number of people gathered there.  I was most amazed by the individuals and families who did not appear to be in a mandated recovery house wolf-pack formation but instead present on their own accord.  I was astonished that these folks actually chose to spend their Saturday morning at this event.  Some people even brought their dogs with them, these adorable little puppies and big golden retrievers with recovery-oriented t-shirts wrapped around their four-legged frames.  As more and more people descended upon the area, I began to get the chills.  I didn’t realize that there were so many people in recovery!  As a man named Vincent Faust led the walkers in a “2005 PRO-ACT Recovery Walks! warmup”, we all hunkered in closer to one another and moved toward the stage.  I recall the electrifying energy being something unlike anything I’d ever felt.  To be part of a crowd of hundreds of people gathered in the name of recovery was indescribable.  To go on to walk side by side people just like me gave me unimaginable hope.  It gave me hope that this thing called recovery works.  It gave me hope that I could live the rest of my life without using alcohol and other drugs because these people were doing it.  It gave me hope that I was not alone.  Ultimately, this hope changed my life.

I returned to the Recovery Walks! the very next year, this time not as a recovery house resident but, instead, as an employee of that recovery house.  I explained to the residents who now griped about having to go to the event that they would be so glad they did.  I stood among them with tears in my eyes as I saw the look on many of their faces – that same look of awe I had the year before.  I also observed that the crowd had grown even larger than the year before, and again I felt that swelling of hope in my heart.  Lastly, I noticed that some people were walking around wearing purple sashes with numbers pinned to them, and I asked somebody what that was about.  “Oh, that’s for the Honor Gaurd.  Those purple sashes mean they have 10 or more years in recovery.”  I smiled and immediately thought to my 25-year-old self,with just over a year in recovery at this point, “Wow, 10 years?  That’s pretty cool.  I’m going to get one of those sashes one day.”

I returned to Recovery Walks! the next year, this time with a job so far beyond my wildest dreams.  I had gone on to work for PRO-ACT, and now I was at the walk as an employee of the very organization responsible for organizing the event.  The walk was, again, even bigger than the year before, and I got to be part of all the hard work that goes on behind the scenes to make it happen.  I now played a part in creating the very same event that had so impacted my own recovery and my own life a few years before.

Year after year I’ve returned to Recovery Walks!, and year after year it has continued to grow and surpass the year before.  The walk has now grown from a few hundred people walking in the shadows of Fairmount Park to over 23,000 people clogging the streets of my city’s center.  I’ve gotten to watch though gratitude tear-filled eyes as that magnificent mass of people gathers in solidarity to show that recovery is possible. I have continued to be blown away by the magnitude of the recovery community and its allies.  And yes, year after year, I’ve continued to eye up those purple sashes rocked by the Honor Guard and whisper to myself  “I’m going to get one of those sashes one day.”

That ‘one day’ has come.

This year, my 10th year of long-term sustained recovery, I will be walking with the Honor Guard in the PRO-ACT Recovery Walks! for the first time.  I will be walking evidence that long-term recovery is possible.  I will be graced with experiencing what it is like to be part of the group leading over 23,000 people through the streets of Philadelphia as we aim to reduce stigma, end discrimination, increase awareness and expand access to prevention, treatment and recovery support services.

As I anticipate lifting that long desired purple sash up over my head and across my chest, I can still see that 24-year-old version of myself.  I can still see that young person with 60 days drug-free who didn’t know if recovery worked, who didn’t know if life was going to be worth living, who didn’t know that there were millions and millions of people just like her.  I still see that 24-year-old version of myself in my mind’s eye and I smile as I think, “Wow.  We got that purple sash after-all.  Now let’s make sure other’s have an opportunity to get their sash too.”

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Learn more about Recovery Walks!, register, start a team and begin fundraising today by visiting http://www.recoverywalks.org

In Sadness, The Solution

The line between living and dying as a result of a substance use disorder is as thin as one generation in my family.

I used to wonder why my mother, who died at the young age of 32, was unable to sustain recovery from her illness while I have been able to do so and in turn have lived. I spent years going through the gauntlet of thinking maybe it’s luck, God, good fortune, motivation, her lack of motivation, her not “wanting” it bad enough, karma, me working harder, etc.

What I have learned in my journey is this:

Recovery is not about any single one of those things. Recovery is instead something that can absolutely be manufactured by making the right ingredients available for people who need them at the right time.  It is about having what it is we need, when we need it.  I was fortunate enough to have had access and continued access to what it was I needed, when I needed it.

It’s time to get rid of the myths and look at what we know.

People do not need to hit “rock bottom” in order to recover.  There isn’t just one way to recover. There isn’t one approach that should work for everybody.  People need access to treatment and support 24 hours a day, 7 days a week because substance use disorder and recovery is not a 9-to-5 operation.  Medicated assisted treatment works for many people.  Families should be included in the recovery process.  Naloxone saves lives.  We know these things.

The tricky part for me is no longer trying to figure out why some recover while others do not.  The tricky part for me lies in the ingredients and the timing – how do we begin to ensure that everybody who needs it gets their own individualized mixture of ingredients at precisely whenever the right time is for them?

For me, this is where I see hope.  Not the sort of hope we find in blind faith or in wishful thinking.  Not the sort of hope we hold onto when we don’t know where to turn.  It’s the kind of hope we have when we see a solution on the horizon.  If we know that recovery is possible, and if we know many of the ingredients that help people recover, and if we know that we need to make them readily available – well, then we know the solution.

Now all we have to do is make it happen.

I don’t know what specific ingredients my mother needed, all I know is that she didn’t have them when she needed them. Now, instead of thinking about why she died while I lived, I think about how our combined experience can be used to help make recovery available to all.

On this International Overdose Awareness Day, I think of my mother.  As we march into Recovery Month, I also think about the solutions that we have, and how the time is now to allow everybody access to them.

Medication Management Treatment and Narcotics Anonymous (NA): Time for an Open Mind

Imagine if people living with HIV had been shunned, shamed, alienated and stigmatized for utilizing Antiretroviral therapy (ART) medications.  Imagine if people living with cancer were told that using chemotherapy or radiation treatment was “taking the easy way out” and that they weren’t really in recovery, or if people using blood pressure management medications were told they should be able to lower high blood pressure all on their own. Imagine if individuals living with serious mental health challenges were told that they should be able to manage symptoms without the use of medication, or else they weren’t really healthy and well.  It all sounds so absurd, right?  Then why do many of us convey this message to people living with the deadly illness of substance use disorder?  Why is this all too often the approach to individuals considering or utilizing evidence-based medication maintenance treatments such as methadone or buprenorphine (Suboxone)?  As would be the outcome in these other cases mentioned,  in doing so we are killing individuals, shattering families, devastating communities and failing as a society wherever and whenever we allow such an absurd mindset to pervade.

I recently met with a group of individuals who are using methadone maintenance treatment as a tool in their overall toolkit for recovery from substance use disorder.  When the topic of stigma and shame came up regarding their use of this tool, many of the comments and sentiments were heartbreaking.  Here was a room full of beautiful people struggling to overcome a deadly disorder that kills more people than car accidents in our state – people who were once somebody’s cute little baby that other people cooed over, people who are an older sister or little brother, people who are somebody’s BFF or favorite cousin – and what they had to say was saddening.  For me, I was more frustrated by the discrimination and stigma they face within segments of the recovery community, in places such as Narcotics Anonymous (NA), than the discrimination and stigma they face outside of it. My experience with this goup last week served as a stark reminder of the need for change in this area.

In mutual aid societies such as NA, “truth consists of knowledge drawn from firsthand experience (inside looking out) and the transmitted wisdom of recovery elders who serve as the repository of the stories of earlier generations of NA members” (White, 2011).  Although I concede that there is great value to the oral tradition and transformative knowledge passed down within the NA fellowship, I think the time is now for all human beings – in recovery themselves or not, members of mutual aid societies or not – to become more educated about the truth of the matter when it comes to substance use disorder and the many pathways to recovery.  More than 350 people die every single day from the treatable illness of substance use disorder, and the reality is that the “truth” transmitted from one individual to another in NA and other mutual aid societies is at great odds with the scientific evidence and hard facts about effective, life-saving treatment strategies such as methadone and buprenorphine.  While the time is now for all of society to know the fact, I suppose I do expect a little more from those of us who are in recovery.

If ignorance can be seen as coming from a lack of information and knowledge, then it is fair to conclude that the ignorance found in the NA stance on medication management treatment can be reversed with education.  Language in official NA World literature that refers to people utilizing methadone or other medication management treatments as “under the influence of a drug” or “members who are not clean” (Bulletin # 29) is ignorant in nature and in turn discriminatory, stigmatizing and harmful.

Harmful, in this case, means people are shut out and dying.

While no studies exist to adequately capture the impact of restricted NA participation for an individual who discloses utilizing medication management treatment, I have personally witnessed its deadly consequences.  I have met people who were shunned by NA while using methadone as part of their recovery journey and went on to later die as a result of an overdose.  The collective restrictions placed on individuals using methadone or buprenorphine in NA are alienating and actually rob those individuals of access to some of the very ingredients that makes mutual aid societies like NA so successful.  Ingredients such as transformation through storytelling (i.e. sharing), inclusion in a “recovery-supportive social network”, participation in “rewarding, recovery-focused social activities” and the “therapeutic effects of helping” found in service and sponsorship are the four ingredients that often are withheld from members openly using methadone or buprenorphine (White, 2011).  By withholding these key ingredients and their recovery enhancing benefits from individuals using methadone or buprenorphine, people using medication management treatments are in turn not permitted to utilize some of the very things that make programs like NA work.  I think the time is now to change that.

During my time as an active member of a mutual aid society, I learned a lot about what is deemed the “spiritual principle” of open-mindedness.  I was taught what it means to be open-minded and how to practically apply this principle in my life.  I can earnestly say that learning how to go beyond my own limited lived experience, beyond my own opinions and beliefs, and beyond what appears threatening to my ego has been a gift that has served me well in my recovery journey and my travels as human being on the path to self-actualization.  It has always struck me as an unfortunate dichotomy that the very places that taught me how to be open-minded have proven to be close-minded in the area of medication management treatments.  As I stood among the group of brave, heroic individuals last week who are fighting against the deadly but treatable illness that I too am in recovery from, I couldn’t help but think about open-mindedness.  I couldn’t help but think that the time is now for mutual aid societies like NA to become open-minded to a new way of thinking about and approaching members who utilize medication management treatments.  The time is now for individuals and the fellowship as a whole to become open to learning the real truth about treatments such as methadone and buprenorphine, and in turn, become more open to offering its benefits to all those who seek recovery from substance use disorder.

If you would like to become more open-minded today, here are some great resources to start:

Narcotics Anonymous and the Pharmacotherapeutic Treatment of Opioid Addiction in the United States

William L. White

http://atforum.com/documents/2011NAandMedication-assistedTreatment.pdf

Trends in the Use of Methadone and Buprenorphine at Substance Abuse Treatment Facilities: 2003 to 2011

SAMHSA

http://www.samhsa.gov/data/sites/default/files/N-SSATS%20Rprt%20Trnds%20Use%20Methadone%20&%20Buprenorphine%20at%20SA%20Trmt%20Facs%20%2003-11/N-SSATS%20Rprt%20Trnds%20Use%20Methadone%20&%20Buprenorphine%20at%20SA%20Trmt%20Facs%20%2003-11/sr107-NSSATS-Buprenorph.pdf

METHADONE MAINTENANCE TREATMENT

CDC

http://www.cdc.gov/idu/facts/MethadoneFin.pdf