Editor’s Note: This interview first appeared in Path Finders, an email newsletter from the Daily Yonder. Each week, Path Finders features a Q&A with a rural thinker, creator, or doer. Like what you see here? You can join the mailing list at the bottom of this article and receive more conversations like this in your inbox each week.
Zachary Siegel is a journalist based in Chicago. He writes about drugs and crime for a wide range of magazines, as well as a newsletter called Substance with Tana Ganeva. His recent work has covered the ungodly strength of modern marijuana, the fallacy of overdose-by-touch, and – most relevant, maybe, to Path Finders readers – the crucial and often dangerous work of harm reduction in rural places.
Enjoy our conversation about labeling our nation’s drug problem, reductive discourse on drugs and the border, and syringe exchanges at the DG, below.
Olivia Weeks, The Daily Yonder: I was hoping that we could start with your take on where things are at with the synthetics crisis and the policy-making around it, and maybe a quick summary of your recent piece in the New Republic.
Zachary Siegel: Sure. Right now, we’re waiting on the latest data, but the mortality data that we have shows more than 100,000 people annually are dying from drug overdose deaths. This has been called a lot of different things. It’s been called the opioid epidemic and the overdose crisis. And I think the way we label this phenomenon has pretty significant influence on how we think about it, discuss it, and how policymakers are thinking about it. So, just from the start, I’ll say, we’re beyond the definition of an epidemic here. Epidemics usually don’t last for 25 or 30 years. We’re in a place in this country where the drug supply has become increasingly chaotic, unpredictable, volatile, and, in many cases, extremely potent because of profound technological shifts in drug manufacturing. And this brings us to the idea that synthetic drugs are driving this crisis. Primarily illicitly manufactured fentanyl, which accounts for about two thirds of all overdoses. But it immediately gets really complicated because when you look at the toxicological results from a lot of these deaths, rarely is there just fentanyl in somebody’s system. There could be opioids and alcohol, a very, very risky combination because it leads to respiratory depression. Same thing with opioids and benzodiazepines and other depressants – but there could be any number of substances in somebody’s system. And so that’s why I say, you know, we’re calling this thing an opioid epidemic, and it’s really much more complicated than that. It’s – to be technical, and I apologize for the kind of funky clinical sounding epidemiology lingo here – this is a poly substance overdose crisis. This is a public health emergency. Period, full stop. The drug supply is a chaotic nightmare. And the type of drug use that’s happening, it’s just way more risky than it used to be because of the introduction of synthetic drug manufacturing, kind of taking over and replacing agricultural drug manufacturing.
Long story short there, basically, for a long time, street opioids were just heroin. For that, you need to grow poppy, you need farmers, you need land, you need sunlight. There’s a lot of work to produce enough to supply the world and meet the demand. But then enter fentanyl and synthetic drugs: now all you need are chemical precursors, a chemist, a laboratory, and you can basically crank out an infinite supply of the drug without any of that complicated stuff. Thinking about climate change and ecological disaster – even then you can still produce drugs because things have changed to a synthetic production model. And to get into the policymaking world here, it seems like an incredibly difficult problem for lawmakers, policymakers, anyone in leadership trying to solve this problem has thus far failed to do it. And so that’s why all my attention is here, it’s just such a dire problem. So many people are overdosing and we’re told a lot of these overdoses are preventable. So this problem is getting worse and worse despite more investment and more attention. And so that to me meets the criteria of what sociologists or something would call a wicked problem. This thing is not going away. It keeps getting worse. And so that’s where we are right now.
I would say the usual kind of drug policy in America for the last 60 years has been a lot of focus on drug enforcement, or supply side drug interdiction, which basically means apprehending criminal organizations that manufacture and traffic illicit drugs. A lot of resources are deployed trying to disrupt this illicit economy. I think the fact that drugs are now synthetically manufactured really changes the kind of supply side enforcement. I don’t think in Washington, in terms of the highest levels of federal policymaking, that this change has been digested and appreciated and accounted for because thus far what we hear often from the right is “Fentanyl is coming through our open borders.” And that agenda is quite convenient for the Right to focus on because it kind of hits the immigration debate, they can blame the “border crisis” on the president and blame Democratic immigration commitments and agendas for contributing to the overdose crisis.
DY: I think it’s important to drill down on the problems with making that connection between, “open borders” and drug supply, because it’s true that the vast majority of synthetic drugs are crossing over the southwest border, but it’s more complicated than that. So what does that argument miss?
ZS: The drugs do typically come from Mexico. But what they’re missing is, we do have open borders, and Republicans support open borders, but they’re not open to migrants, they’re open for trade, for capital, and for business. Those are the open borders through which illicit drugs are trafficked. President Richard Nixon, in 1969, conducted Operation Intercept as an anti-drug measure. Operation Intercept shut down the border and shut down all trade between U.S. and Mexico, because they knew that that’s where drugs were coming from. And it is unfathomable to think of any politician doing that today, like even President Trump, who wanted to build a wall and scapegoat immigrants and Mexico for all kinds of ills plaguing American society, not even he, for a day, shut down that commerce between our two countries, which I think is in the hundreds of billions of dollars. So the Right really doesn’t want to talk about the ways our economies are so tangled up. Because if commerce between our two countries was shut down even for a day, there’d be a lot of angry people.
DY: Right, we’re so dependent on those trade routes remaining open that solving the problem through border policy doesn’t seem super feasible. But when it comes to trying to ameliorate this wicked problem, as you called it, what are the options available to us?
ZS: The overdose crisis and addiction and drugs are typically thought of in terms of economic theories and models that can also apply to other products, so when it comes to drug trends we can think about supply and demand. The supply side is what we were just talking about. It’s like, where’s the supply coming from? How does it get here? But then on the demand side of the ledger, what is really driving the mortality we’re seeing? Well, the problem is overdose. And if we really think very clearly about what an overdose is, I think it kind of presents us with a lot of ideas about how to prevent them from happening, and how to prevent them from turning fatal. So an overdose is primarily a mismatch between somebody’s tolerance for the drug and the dose of a drug that they’re taking. So that’s primarily, physiologically, what is happening here on an individual basis. Somebody takes a drug that their body cannot process and the result is typically respiratory depression to deadly levels where the person stops breathing. So from that type of thinking, if people knew what drugs they were using, which they don’t, because it’s a totally illicit economy and no bag of fentanyl bought on the street tells you its proof by volume – it’s not like alcohol where you look at the label and see this IPA from from the bar has 9% alcohol by volume and then make a decision about how many you want to have. With illegal drugs, you can’t regulate or control your consumption or your dose. People on the street right now using drugs or even high schoolers experimenting recreationally, nobody really has that agency anymore because it’s impossible to know what they’re buying. And so part of what I’m getting here is like, the drug supply is so volatile, that to me, it seems like the best way to prevent all these overdoses is to create as many exit ramps out of the illicit supply as possible. And so this is where things get really, really complicated. Because we really have to know the demographic population with drug users and really dig into who’s out at the most risk of dying from an overdose, and right now it’s primarily people around the 18 to 49 year old demographic, which is a big swath of people. And because it’s such a range there’s not like one programmatic solution to capture all of these people. There has to be extremely tailored solutions here, depending on which population you’re trying to target. And so the problem gets complicated from a policy perspective. And it’s hard to even imagine a single policy that could make a dent in the thing. So we’re talking about structural change in American society. But there’s so much stasis or gridlock and power that feels out of our grasp.
DY: Okay, well, I want to narrow this question a little bit, because one of the reasons I initially got interested in interviewing you was that you wrote this piece about harm reduction in rural spaces. So I’m curious if you could just outline, for that more specific population, what can be done to prevent overdoses?
ZS: Sure, so last winter around this time I was in West Virginia and I actually went to Pittsburgh and drove across the border to Morgantown and then from there to Charleston, and I was just blown away at how vast the space was, between those cities. But what brought me there was the fact that West Virginia has one of the highest overdose death rates in the country, and it seemed like an example of how we need to customize this need for deep structural changes in our society. I think places like West Virginia — from my experience visiting there — there’s suffering from incredible amounts of neglect from the state. And when it comes to the overdose crisis, people are truly on their own to figure this out. In more rural areas, demand-side responses and harm reduction are incredibly difficult to execute.
So what I saw people doing to try to prevent overdoses was mostly mobile harm reduction. It was like there was a whole system all underground because a lot of West Virginia prevents syringe programs from being implemented without jumping through these really prohibitive hoops and a lot of onerous restrictions. So the way that this underground Harm Reduction program was operating and doing outreach was incredible. Basically they were getting a lot of people’s phone numbers who are using drugs, mostly injection drug users, people using methamphetamine and fentanyl, and they would send out these texts in a dispatch-style system, saying “We’re going to be at this Dollar General on Friday night at 7:30.” Or, “We’re gonna be in this Lowe’s parking lot Friday night at 8:30.” They were just sending different messages to different people, giving them the time and place to pick up injection supplies and distributing Naloxone, and all this was being done below the radar of police officials and operating on a completely threadbare budget. It was just really something incredible to witness. And so this made me wonder what if these activities were not criminalized? What if the state’s obligations to its people are such that they want to prevent as many overdoses as possible, prevent as much HIV as possible, prevent as much hepatitis C as possible? All of these are symptomatic of illicit drug use, but I will emphasize the illicit part, because using drugs does not have to result in any of these things. But it does when it is criminalized so harshly. And that goes back to the idea that in these regulated and controlled markets, people can make decisions, people have agency, they can choose how much to use, where they use, how they use it. And in these illicit underground markets, there’s not a lot of agency and people are left with a series of bad choices. In places that are criminalizing harm reduction responses, people are reusing the same needle over and over and over and they’re getting infections. It’s absolutely heartbreaking to see the deprivation that people were facing the way that they were forced to navigate through all these conditions alone. But there was also so much hope in seeing how much people are doing for each other in these conditions, and how much care people are offering to one another. I think it really lights the way for what could be happening all over the country. It really does come down to caring about your neighbor, worrying about people, and being able to show up for people. That was what this whole underground harm reduction program was about.
DY: This is such a dark and heartbreaking topic, but I think hope is the note that I’d like to end on. So I’m wondering if, in your time reporting that story, you got any sense of how people who want to get involved in harm reduction efforts – or advocacy for even just decriminalizing those efforts – can do that.
ZS: Some of the people in that story, without naming names, just won seats on city council. They realized straight up, “The only way this is gonna change is if we do it.” And they ran campaigns, worked ungodly hours of unpaid work and labor. These are people who committed their lives to this. And so I think for individuals out there it’s about finding your role, finding where your commitment is, and trying to line up with it. Not everyone could run for office or wants to run for office, but maybe they can find some place where their skills and their knowledge and their experience work. Just to speak for myself, I’m not the person who is driving around distributing syringes, or I’m not the academic who’s writing the scientific papers to support this work. But I can be there, I can just see what’s happening and try to communicate it to as many people as I can. And I find that to be nowhere near enough but at least in this whole mess I think I found a place for myself.
[Editor’s note: Zachary also sent along these resources for people interested in getting involved in local harm reduction. The National Harm Reduction Coalition, The National Harm Reduction Technical Assistance Center, the NASEN harm reduction program locator, and the National Overdose Prevention Hotline.]
This interview first appeared in Path Finders, a weekly email newsletter from the Daily Yonder. Each Monday, Path Finders features a Q&A with a rural thinker, creator, or doer. Join the mailing list today, to have these illuminating conversations delivered straight to your inbox.