Safe Injection Facilities: Out of Harm’s Way

Damien Trimingham was a bright kid. He was well-liked and a successful athlete. He came from a good family. He did not seem destined for a life of addiction— and indeed he wasn’t.

At just 22, Damien died of a heroin overdose.

The police did not notify his worried family for three days.

That was in February of 1997, and now almost two decades later, his father Tony, a psychotherapist, has become a leading voice in harm reduction.

On Sept. 30, he recounted his son’s story to a crowd of more than 200 at “Out of Harm’s Way,” a panel discussion in Manhattan.

“It was, of course, a shock even though we knew that death was a possibility with heroin use,” he said. At the time of his death, Damien was trying to stay clean. His father said, “That’s one of the ironies of heroin use, that the people who die are often the ones trying to give it up.”

He continued, “I was to find out later that no one has ever died in an injection center anywhere around the world, even though there are many overdoses.”

That’s when Tony latched onto the idea of safe injection facilities (SIFs). Although they aren’t legal in the United States (yet), there are around 100 SIFs operating around the world, in places like Canada, Spain, Germany, Holland, and Norway.

The idea is that SIFs provide a safer environment for injection drug users. Staff are available to teach safe injection practices and clean syringes are free for the taking. Crucially, there’s also naloxone available to treat overdoses immediately, without any fatalities.

Predictably, SIFs tend to face some initial resistance, but in Australia, Tony was instrumental in turning the tide of public opinion.

The year that Damien died, the Australian government proposed a heroin prescription program, but ultimately the prime minister vetoed it. But the time seemed ripe for harm reduction and so Tony took action. He wrote a letter to the local paper, describing his son’s death and explaining how unnecessary it was. The paper published his piece on the front page, and it sparked debate.

After four years of lobbying and advocating, Tony said, “We got our injection facility, thank goodness.” He added, “It was a hard road because there were opponents.”

Overall, though, he said it’s often apathy and not opposition that is the toughest obstacle. “Most of the general public don’t really care,” he said. “They’re not pro, they’re not against. It doesn’t affect them.”

Like Australia, Germany has safe injection sites, and another of the panelists—former Frankfurt drug czar Werner Schneider—documented the history of his city’s harm reduction efforts. Frankfurt began exploring harm reduction in earnest in the 1990s in response to a significant uptick in heroin use. That exploratory work quickly led to the creation of a safe injection facility.

Schneider said, “The most important result of this program was a tremendous reduction of drug-use related death cases.” Simultaneously, the city witnessed a decrease in criminality and also a decrease in public concern about drug use as a major citywide problem.

Like Frankfurt, Vancouver experienced a ballooning heroin problem in the ’90s. Canadian Senator Larry Campbell—a former law enforcement officer who was also the mayor of Vancouver—told the crowd that as overdose deaths skyrocketed, so did HIV and incarceration rates.

After a decade as a cop and two as a coroner, Campbell got tired of watching the bodies pile up, and so in 2002 he ran for mayor.

“I ran on the platform that I would open a supervised injection site in Vancouver,” he said.

He did that, but keeping open North America’s only safe injection facility, Insite for Community Safety, was a struggle. Although the federal government initially offered the program a three-year legal exemption, once that initial approval expired, Insite had to sue to keep its doors open.

Campbell said that SIFs are a crucial part of the shift from punishing addicts to treating addiction as a medical problem.

“Addiction is a medical disease. Addiction is not a criminal offense. No one starts out life saying, ‘You know what, I think I’ll be an addict,’” he said.

“You can address this as a humanitarian gesture, a humanitarian idea, that we’re all people … but I recognize that there are those who don’t move from a humanitarian end but from an economic end.” That works, too, though, because Campbell explained that safe injection facilities can save on welfare, police and prison costs.

“So whether you believe in humanitarianism or economy,” he concluded, “this is an idea that works. It’s good, and it’s time.”

Liz Evans, a nurse who works with Insite, concurred. She said that Insite is estimated to have saved $14 million in 10 years. “Over 2 million injections have taken place and not one has resulted in death,” she said.

Over time, the community has come to accept the program. Evans said that the last poll taken showed that 76% of Vancouver residents supported the safe injection site.

By bringing users off the streets, it has created a better environment with less public injection around the facility but also, she said, the presence of a safe injection facility seems to encourage people to get help. “If you’ve just come to Insite once, you’re 33% more likely to come to detox or treatment,” she said.

Evans pleaded for “peace” in the War on Drugs and said, “The controversy today should not be around where … a safe injection facility makes sense. The controversy today should be over how we have allowed the status quo to persist for such a long time.”

She added, “In Vancouver, drug users will tell you that Insite is a symbol of care. This is a humane space where we are able to reverse a pattern of exclusion.”

The panelists—and moderator Amy Goodman of Democracy Now!—drew an enthusiastic crowd, and the evening was punctuated regularly by bursts of applause. (One comment that drew particularly raucous support was a question Tony posed to the crowd: “Who in here supports safe injection facilities?”)

Although many audience members came from in and around New York City, some traveled much farther, with four- and five-hour drives from Binghamton and points north.

One of those longer commuters was John Barry, the executive director of an upstate New York syringe exchange called the Southern Tier Aids Program (STAP).

“We need one of these,” he said.

He acknowledged that growing political will and legal support for SIFs could be difficult, but he didn’t see it as impossible: “I think the dominoes have to fall in the right order.”

This story was originally published on The Fix.


How Medical Marijuana Users Are Treated Like Criminals

Steve Green has epilepsy. His wife, Maria, has multiple sclerosis. Since 2011, they’ve been growing cannabis for medical use.

Everything they do is perfectly legal under state law in Michigan, where the couple resides. Maria is a registered caregiver—meaning that she’s allowed to grow 12 plants per patient—and both are qualifying patients.

Nonetheless, in 2013 Children’s Protective Services came in and removed the couple’s six-month-old unweaned infant, Bree. According to Steve, “Bree was ordered removed from our home because the judge said it was an inherently dangerous situation, that people could break in to steal the marijuana and steal the baby.”

The removal came despite the fact that the Michigan Medical Marijuana Act notes, “A person shall not be denied custody or visitation of a minor for acting in accordance with this act, unless the person’s behavior is such that it creates an unreasonable danger to the minor that can be clearly articulated and substantiated.”

Sara Arnold, the director and co-founder of the Massachusetts-based Family Law and Cannabis Alliance (FLCA), a national nonprofit organization founded in 2013 and dedicated to advocating for medical marijuana parents, said that the Greens’ story is not unique. “It is extremely common,” she said.

She knows a thing or two about it because in addition to being an advocate and policy expert, Arnold is a medical marijuana parent herself.

“I was investigated by CPS for neglect three times for my medical marijuana use,” Arnold said. “My story is common; I was investigated after the birth of my first child after self-disclosure to my prenatal care provider and twice more from mandated reporters.” By law, people in certain professions—or in some states, all citizens—are mandated to report potential or actual neglect and abuse, which specifically includes drug use. She continued, “One of the mandated reporters had never met my child nor seen me parent her and had only read ‘medical marijuana’ in my medical records mentioned by a (supportive) physician; and the other did not want to make the report but believed they were mandated to do so.

“The outcome of these investigations resulted in the allegations not being substantiated and no further action taken by CPS, but investigation by CPS is still an intrusive, traumatic experience for any family—much less three times for the same thing. It is also a huge waste of limited CPS resources that is taking case workers away from real child neglect and abuse.”

Like Arnold, the Greens eventually got their daughter back—but only after six weeks of expensive legal wrangling.

Although the above cases were in Massachusetts and Michigan, those states aren’t cherry-picked examples. Arnold explained that similar situations happen everywhere: “This is a problem throughout the country. Obviously some states are worse than others (like Texas and Florida) but you might find it surprising that even states with mature medical marijuana programs still investigate their patients who are also parents. Even CPS in medical and legal Colorado still regularly and consistently investigate medical marijuana patients.”

Heather Thompson, a molecular biology PhD who works as the deputy director of a nonprofit known as The Elephant Circle, said that often CPS might get involved before the child is even born. Because the Denver-based organization advocates for new mothers, Thompson has become acquainted with the surprising ways in which legalization has played out in Colorado. Instead of creating a more permissive environment, Thompson said that legalization has created among medical professionals a heightened awareness of cannabis and thus some hospitals are now more likely to drug test newborn babies. She said, “That’s where federal law trumps state law—because it is Schedule 1 it is legal for someone at the hospital to test a baby for THC without the parents’ consent or knowledge. Then if they test positive, because it’s for a Schedule 1, then they have to involve CPS.”

She continued, “If a baby tests positive, it’s automatically a charge of neglect and abuse. There is no evidence to say that drug use equals abuse, but because of the climate in Colorado there’s a very punitive attitude toward parents in general who use marijuana.”

Thompson is not the only advocate quick to note the problems caused by conflicting federal and state laws; it’s something Jennifer Ani is very familiar with, too. Ani is a California-based attorney and child welfare specialist who handles cases where legal medical marijuana users and growers find themselves running afoul of CPS.

To some extent, funding is the source of the problem. The Child Abuse Prevention and Treatment Act (CAPTA), was originally enacted in 1974 as a federal law to allocate CPS funding to states that meet certain federal standards. Ani said, “That’s where marijuana comes in. How do you reconcile that with medical marijuana laws?”

After a 2003 revision, CAPTA now requires states to have policies in place to report and address situations in which infants are born “affected” by illegal substance abuse. That can be problematic both because cannabis is still an illegal substance on the federal level and because the line between use and abuse can be unclear.

Ani said that, once the child is born, “Just the fact that a parent is breaking a federal law is not enough to remove a child [in California]. Regardless of the substance, in California, a parent can use any substance they want to as long as they’re not abusing it and that abuse does not affect the child.” Of course, whatever the law says, Ani said that the children of medical marijuana users are still being removed on a regular basis.

“It’s a problem,” Ani said, “because there’s so much ignorance as to the fact that it’s not harmful. Not only is it not harmful but it does not cause serious physical harm, as the law requires.”

In fact, according to Thompson, existing literature doesn’t even support the idea that marijuana use is harmful during pregnancy: “There has been research on pregnancy and marijuana since 1982 and Canada has been doing it since 1978, and there are very few clinical effects of marijuana. It does not seem to affect growth. If you take the literature as a whole, it does not seem to affect babies negatively in a way that can be documented.”

In a sense, Thompson said, it’s like the crack-baby myths of the 1980s and 1990s. The crack-baby myth—the belief that crack cocaine use during pregnancy would cause major damage to the fetus—grew out of a lack of well-designed studies and thus a lack of understanding. Now, medical marijuana users are facing a similar lack of understanding.

As Ani put it, “Families are being separated because of idiocy and incompetence and a failure to understand cannabis.”

As of now, some states—like Michigan—have language that should theoretically protect medical marijuana parents. Unfortunately, it doesn’t quite work out that way. As cited above, the law says that medical marijuana should only affect custody if “the person’s behavior is such that it creates an unreasonable danger to the minor that can be clearly articulated and substantiated.” However, Arnold explained, “There is no definition of ‘unreasonable danger’ or ‘clearly articulated and substantiated.’ What this has often been interpreted to mean (including in Michigan) is that a) investigation is required of any parent found to use marijuana to ensure that there is no reasonable danger and b) that it can be widely subjective, to the point where the marijuana use itself…can simply be a sign of ‘unreasonable danger.’”

Despite the struggles medical marijuana parents are facing, Arnold remains optimistic. She explained that FLCA offers model language for parent-protective initiatives, such as one that has already been proposed in Massachusetts.

“Marijuana reformers,” she said, “are waking up to the fact that parental rights for patients matter, and social workers are waking up to the fact that it shouldn’t be their job to continue the war on marijuana to the detriment of children and families.”

This story originally appeared on The Fix.

Interview with David Dastmalchian, Former Heroin Addict and Current Film Star

Now, he’s a big-time actor, but in 2002, David Dastmalchian was living out of his car, shooting heroin. Though his best-known role is as the Joker’s henchman in The Dark Knight, recently he starred in and wrote something more of interest to readers of The Fix. Animals, a tale of two heroin addicts in love, is partially based on Dastmalchian’s own experience. The struggling characters, Jude and Bobbie, spend their days pulling off scams for drug money and their nights sleeping in their car parked near the Lincoln Park Zoo. The film debuted on May 15, and The Fix ran a review of it the same day. This week, Dastmalchian made the time to talk about his film, his recovery, and his life. (Note: This interview has been condensed in places.)

So first, let’s start with the easy stuff—how do you say your name? 

The trick is to imagine that you have a small chin and you’re saying “this small chin.”

You may have seen it, but we just reviewed Animals. 

Yeah, today we posted Richard Roeper’s big review and that was exciting. I think we’re going to put up The Fix one this afternoon. It meant a lot to me, in particular, just because I know I read The Fix and I think it’s just, it’s been tough, to be quite honest, and terrifying to figure out where I feel comfortable talking about my history and at what points I feel comfortable breaking my anonymity or my family’s anonymity while at the same time wanting to be as open as I can about the film because I’m 13 years into my recovery. I think people can spend their whole lives fiercely guarding their anonymity. Because it’s such a personal nature connected to the film itself, it has been 90% of the time, really rewarding for me to be as open as I’ve been able to be about the fact that I was an addict.

What has come down as criticism … was one radio host who felt like certain details were “embellished.” I didn’t want to get into it but I wanted to pick up the phone and call up the station and be like, “That literally happened to me!” I’d say 98% of the response from the recovery community has been so positive. There’s been a couple of painful things to read. That’s the danger of things like social media … it’s a subject matter that is so fundamental to who I am as a human being, my recovery as an addict. As an actor, I’ve been doing this for a long time and I don’t even read what people say about me. They can attack my acting but it’s not so deep to the bone as the other stuff. It’s been an incredible ride, not without its bumps, but it’s been an incredible ride.

If anybody in recovery watches this film and feels that I’ve exploited something for some reason, they’re entitled to their opinion. There’s nothing that I can do other than feel really sad about it. I didn’t make the film to make it a “recovery film.” I didn’t want to make a message film because I still don’t even know what the message is. I feel like addiction is such a complicated and complex issue that the only message I’ve got is that we’ve got to stop giving up on people.

How much is the male lead actually based on you? 

Both of the main characters are based on, inspired by—god, every character that I ever write is somehow based on me. What I was trying to convey with Jude was somebody who probably could really be an amazing lawyer or doctor … I think I wrote him a lot smarter than I am. And Bobbie is a lot like me in that her journey in addiction ultimately led [to] the same trajectory that mine did.

I was homeless because of the heroin. I didn’t pull off as intricate of scams as Jude and Bobbie—like the date scam was actually some friends of mine that I shot up with sometimes. That was absolutely something that I used to watch this couple do. I lived in a car on and off for almost two years. And then a lot of my journey as an addict, for me, Chicago was the backdrop for my journey.

As we tell the story, people who watch it see how much pain people go through even at their worst. I never knew an addict that was giggling when they were preparing to pull off a robbery or a scam. I never knew an addict that was enjoying a single moment of that. I hope you see that with Jude and Bobbie and I hope people feel their humanity and don’t look at them as criminals, they look at them as their kids, their siblings, their neighbors.

You ended up in a hospital like Jude, right?

In real life, it happened to me twice. That’s another thing about the movie, an addict’s journey can be difficult to portray in cinema because it took me so many tries to get clean. I was never taken directly to a detox or rehab, I was taken directly to a psych ward. I’m also a dual diagnosis—I deal with depression too, and other psych issues. I had made an attempt on my life which had landed me in a hospital but because I didn’t have insurance I was transferred to a psych facility where I spent a month, month and a half. That was a necessary experience for me. It was hell at the time. I was quite literally strapped to a bed and given Motrin.

It was a state-run facility so their resources were pretty scant but they were wonderful. From there, I was able to reconnect with my family. I went to treatment, got out, tried sober living, started to think I could drink again … and it was weeks before I was making eight-hour drives to score dope again. Then it took me another six to eight months of being back out again, maybe over a year of just going really hardcore. Then I got really sick from both infection and dirty using practices and I knew I was going to die. I had that desire to live and I wound up back in the mental hospital again, but this time things changed for me. I can only describe it as a miracle that my family was still there to love and support me when I was ready to ask for help.

I personally utilized, with the doctor’s care, a very specific and well-planned maintenance program with methadone to come down off of dope. I know that’s such a hot-button issue and it’s tricky for me when addicts ask me if I used methadone. I feel like it’s such an abused medication. I mean, I’m not ashamed of the fact that I used methadone, because, you know, there’s a lot of shaming of methadone. It was part of my replacement therapy—meetings, medication, exercise.



So that’s sort of how it ended, but how did you get into drugs in the first place? 

Addiction runs in my family for sure. I totally believe in the fact that there are genetic factors involved. I was in like the sixth grade [the] first time I got intoxicated and I just felt completely at ease for the first time. I felt completely confident. I felt completely in control. So it started with the alcohol which in high school turned into pot, inhalants. I really abused cough syrup in an intense way in high school.

When I was 18, I went to Chicago to study acting and at this point I [was] a daily practicing addict of some form of substance abuse or another. I wasn’t on opiates yet. I was definitely a partier, too—I liked the social aspect of using. When I almost 20, 19 turning 20, I was friends with some guys who were shooting and I was with one in particular … he was trying to kick dope and had just bought eight bags and we were going to go on a roadtrip together and he was like, “Can you please keep these out of my hands?” and I was like, “Oh sure.” And I just started doing it. I started as a weekly—a Saturday—user for a very long time and then there was one week in particular when I was 21 and I said, “Oh I can try on a Wednesday, just once.” It was just a matter of weeks before I turned into a daily user.

I went from being a sniffer to using needles pretty soon. At this point, I was not a partier anymore, I was just a very successful student. I was working on really intense material as an actor in school. I was high-functioning. I wasn’t shooting to get high anymore, I was just keeping well. That went on for a long time and I really truly believed that was going to be the rest of my life. Eventually, one day, the bottom just dropped out.

How do you even get from Point A—homeless heroin addict to Point B—movie star? 

[Laughs.] Well, you take five years—I took five years when I got clean. The point at which I reached the bottom that I reached was so low when I finally had my miracle—that I all wanted in life was the ability to have a little apartment with a futon and a TV where I could just watch movies and make pizza in the oven. I just wanted to be alive. I thought acting was off the table for good. I didn’t know if that was a trigger for me. How much was acting or my career a part of my disease? It took me a long time to realize that it wasn’t. It was about getting psychologically healthy, about going to meetings all the time, submitting to the greater will. I just reached that point of willingness that I was going to do it no matter what.

I worked in a movie theatre as an usher, then I got a job as a telemarketer and the clean years just started to build up and I started to find each year I was getting more happy, psychologically. I started to realize that I was building the tools for how to navigate those waters without getting high. I ultimately went through some very trying times, I went through a horrible breakup with someone whom I’d spent a lot of time in recovery who relapsed. My sobriety has been tested many times, I’ve lost people that I cared deeply for. Then I had a friend, when I was five years clean, who’s a theatre director—actually, two friends, two theatre directors in Chicago. They both said when you’re ready to, we’d like you to get back up on the boards. That was a big test for me and it was a-fucking-mazing man. It was the greatest feeling in the world.

I need to cut this short now—I’m with my wife and son and this is kind of an amazing thing that I’m talking to you right now. We are literally standing across the street from the Lincoln Park Zoo in Chicago and right now I’m walking into the zoo with them. I’m literally in the same place where, 13 and a half years ago I was using the bathrooms here to get high in and now I can eat an apple and carry my son around and introduce him to the gorillas. It’s pretty amazing.

This interview, by Keri Blakinger, first appeared on The Fix.