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Special Interview with gabriel sayegh on Municipal Drug Strategies

gabriel sayeghThis week I interviewed gabriel sayegh, the director of the Drug Policy Alliance’s New York policy office. In this interview, we talk about municipal drug strategies in Canada and Europe and explore opportunities for New York to implement these types of municipal-drug strategies.

 

 

 


What are municipal drug strategies?

Municipal drug strategy is simply a city-based strategy for approaching the problems of drugs and that when you have a situation of opening our drug market as an example or drug-related disorder, cities are often the first jurisdictions that have to address and deal with those problems. Of course, not every element of drug use is a problem. That’s not the case at all but there are instances particularly in cities when drug use can become deeply problematic, either because of overdose fatalities or the transmission of HIV and AIDS or drug related crime or disorder related to open drug markets or public drug consumption.

A municipal drug strategy is simply a strategy that the city, any city would develop to address those problems in a more effective manner. What happens currently, particularly here in New York, is that the approaches to a drug policy are completely siloed so that the left hand almost never knows what the right hand is doing or there is a dominant approach of criminalization that minimizes or otherwise diminishes the ability of other approaches to address the problems. An example here in New York City. One of the most successful public health interventions ever in the city of New York or anywhere else has been the advent of syringe exchange programs. The multiplication of these programs and their availability in the city of New York has dramatically reduced the transmission of HIV and AIDS in the city of New York over the last 20 years. In fact, it has done so with such enormous success that no reasonable person quite even questions the value of these programs any longer. They’d become a staple part of the public health departments interventions to address drug use and the transmission of HIV and Hepatitis C and they’ve been wildly successful.

People engage with these programs not just for clean needles and the dispose of used ones but also as a point of contact, often their only point of contact, for engaging with the social service system. Many of the clients within these programs are seen within the syringe exchange program and often times nowhere else. These programs are very important part of our public health system here in the city of New York and even though we pay for those programs and that the Public Health Department has identified and tested them and clearly identified their value, meanwhile, NYPD continues to arrest people, often times, outside of these programs for possession of syringes.

NYPD’s approach in doing this fundamentally undermines the use and engagement of syringe exchange programs by their participants. If somebody is going to a program to use their facilities to see their … they may have a counselor there, they may be picking up new equipment, whatever the case, and if they’re picked up by the police on the way and charged with drug possession or charged with mostly syringe possession, they’re less likely to return to that program and they spread the word to their friends that the street is hot that if they go back to that program that the police may arrest them. When people are not engaging at the syringe exchange program, what ends up occurring is that they may be using dirty needles. They may dispose of their syringes in places that they should not otherwise do so and they’re not accessing the essential services that many of these people both need and frankly are entitled to as a simple basic human right.

Even though the Public Health Department in the city of New York has said, “Syringe exchange programs, these are valuable programs. They’re part of our public system. They’re improving the public health. They’re actually improving public safety. We need to have them. We’re going to fund them. Meanwhile, the NYPD is arresting people for possession of syringes and these things are working across purposes and a big reason for that is that New York City itself does not have a municipal drug strategy. We don’t have a coordinated plan where all of the stakeholders are at the table. They’ve all identified shared objectives and they’re pursuing those objectives in a manner where everybody understands what their role is and how success is going to be measured. There’s no evaluation mechanism here that holds NYPD to the same measurements and of success that the Public Health Department is held to but if we were to sit those players down at the table and say, “We want to protect public health and protect public safety. We want to ensure that we are enhancing both public health and public safety for New Yorkers.”

If those players sat down and had a conversation along with any other stakeholders, they may end up finding themselves developing a municipal-based drug strategy. That’s not what we have here in New York. When players do that, when they sit down with various stakeholders come together across different sectors, education, health, law enforcement, the drug users themselves, formerly incarcerated people, business leaders and so forth, they can devise a plan that seeks to reduce the harms both associated with drugs themselves and with our drug policies and that’s being done in various jurisdictions around the world, not yet here though in the state of New York.


Where did municipal drug strategies come from?

There’s a very interesting history here. I’ll give a very generalized overview. Back in the 80s in Europe, there were a great number of cities that were facing very serious problems with respect to open air drug use particularly with heroin and in Europe where different countries, different languages, different cultures, the federal governments in many places where as slow to address some of the local problem as our federal government is. Many cities across Europe were faced with people using drugs, injecting drugs in public parks or in train stations and they were dealing with overdose fatalities and they were dealing with associated crime and what have you associated disorder and with many of these jurisdictions Frankfurt, Germany for instance, Amsterdam and other cities, they would go to their provincial government, their federal government and they would say, “Hey, we need help here. We’ve a got a problem.”

They were not getting a sufficient answer to their pleas for assistance and eventually, they decided that as municipalities, as cities, they would pursue a solution on their own and this is a very interesting development. Now in 1990 or ’91, I believe it was ’90, many of the representatives from these cities met in Frankfurt, Germany and they issued what was called the Frankfurt Resolution and the resolution essentially outlined the position of many of these city stakeholders. These were various officials from these cities that came together and they basically came to the conclusion that the approach to drug policy in these various jurisdictions was not working, that the enforcement-only approach or what we would call here in the US the drug war approach where we’re going to criminalize people, we’re going to use the criminal justice system to solve this problem or at least it’s going to be the primary mechanism by which we seek to solve this problem that that had failed in this jurisdictions in Europe and they called for a new approach.

Now they knew that they could not simply draft new federal laws in each of their countries, that was impossible at the time and even the provincial governments or what we would call a state government were not necessarily going to move swiftly to change the local laws that that could be changed. The cities were thus faced with a scenario where their provincial or their federal governments had decided on this particular criminalization-based approach that the cities were now saying, “Hey, this no longer works for us.” The city said, “What can we do? Even if we can’t change all of those laws at these higher levels, what can we do here locally that we can approach these problems in a different way even if we’re approaching those problems within the old context?”

That was a very, very important development because it meant that the cities were going to be proactive in dealing with some of these local problems. They were not going to let the fact that their provincial or federal governments were not moving swiftly enough to come to a realization of certain failures. They instead were going to just move forward and do what they could at the local level and it turns out there was a lot that they could do even given that their larger regional or federal government had decided on maintaining the status quo.

Frankfurt is a particularly interesting example as a city which is what the resolution was named after. They begun to look at what was being done in other places, in other countries particularly in Switzerland and they said, “Okay, the first thing that we need to do is to have everybody sitting down together. We need to have all of the stakeholders who care about this issue, sit down together and identify what the problems are that we all understand the problems in the same way and then identify what solutions we can pursue.” They’ve started to do that and they did what … every Monday they held what was called the Monday round and it was all of these stakeholders every single Monday would sit down including the police and over time, what they did in Frankfurt was fairly remarkable. It was not a fairytale story by any means and there was no silver bullet but they were able to convene various stakeholders many of whom are often times at odds with each other or had previously been in adversarial positions. They got together and said, “Look, let’s work together on this.” They started to identify what things they could change locally and a lot of that had to do with how they were policing, how they were addressing the problem locally, how they were thinking about what possible solutions were available and how they were coordinating to various social service apparatuses that were there to provide the central services that were needed.

In Switzerland, when they did this, they developed this concept called the four pillars. There’s, generally speaking, 4 areas where we have got to make sure that the stakeholders are coming together under 1 is prevention, 1 is treatment, 1 is enforcement or public safety and 1 is harm reduction. Frankfurt implemented those 4 pillars so to speak and then the other cities did as well. This was done in many cities across Europe through the 90s.

If you fast forward in the early 2000s and you look at Canada, our neighbor, yet something very similar happened particularly in Vancouver, the nation’s second largest city has the highest rates of concentrated poverty there in their downtown area and they were dealing with a lot of the same problem. There was drug-related disorder on the street. There was drug-related crime. There were many people using or consuming drugs in public. There were overdose fatalities. Of course, there’s a great amount of poverty as well and joblessness and an overall sense of hopelessness amongst many people but there was a very pioneering and innovative mayor at the time in Vancouver who decided that he was going to take this on and he and his team begun to convene a lot of the stakeholders and very similar to what happened in Frankfurt and other parts of Europe, they had to bring together stakeholders and key leaders who often times were not on the same page and were even adversarial often times. The drug user union in Vancouver which still exists and do, was sitting down with the police force.

The social service agencies were sitting down with the police force and people from the corrections agencies. These were not easy meetings and they were certainly not easy dynamics. The business council was sitting down, the doctors, the nurses, neighborhood representatives, homeowner groups and so forth but they did it. They sat down and they worked through some of the difficult meetings and they developed in Vancouver a 4-pillars drug strategy, a municipal-based drug strategy for the city of Vancouver that outlined very clearly what the shared objectives were, who was going to be involved, what were the philosophies underpinning those objectives and how are they going to evaluate whether or not they were achieving those objectives, what was going to be considered a success and how would they know that they had achieved it.

In Toronto, Canada, something very similar happened although it was more bottom up as opposed to top down as in Vancouver. In Vancouver, it was the mayor who said, “Hey, let’s pull everyone together and do this.” In Toronto, it was a lot of the local groups and drug user union, people in recovery. It was a very bottom up movement and they said, “Hey, we need to come together and be smarter about how we’re addressing these issues here in Toronto.” Eventually, Toronto developed and launched its own drug strategy and, in fact, just recently in May when we did our conference in Buffalo, we had the Toronto drug policy secretariat. The city of Toronto has a drug policy secretariat. It sounds like a very cool thing, that name. She’s the person at the health department whose responsibility is to help coordinate that city’s 4 pillar drug strategy.

Now, these are not, again, these are not silver bullets. These coordinated drug strategies don’t solve every single problem. They’re not designed for that and shouldn’t be viewed that way, however, there are a number of very interesting things that occur in these jurisdictions that have these coordinated strategies. You often times see a reduction in drug-related crime and drug-related disorder. It doesn’t disappear but there are reductions that can be shown in many of these jurisdictions. In Frankfurt, when they did this, there were dramatic reductions. In Vancouver, there were some reductions. In Toronto, you see reductions in the transmissions of communicable diseases like HIV and Hepatitis C. It’s a major development and an important 1 that we have to maintain a very steady commitment to.

You see reductions in overdose fatalities. This is huge. In Vancouver, through the process of their development of a coordinated drug strategy, they decided to do what’s now very common in Europe which is to open up a drug consumption site. They call it their supervised injection facility. This may be startling to many people in New York or in the US but this is a common public health practice in many parts of Europe and now, in Vancouver. It’s a room where people can go in and consume their drugs under the watchful eye of medical personnel.

In Vancouver, people using this facility, there’s not been 1 overdose fatality since the facility opened up. This is an incredible development considering that overdose, accidental overdose fatalities, had become a leading cause of death here in New York City and around the state. For many of the people who walk into that facility, they’re gaining access to services many of them for the very first time and some of them who had not ever planned on going into treatment or recovery decide to do so as a result of coming into that facility.

In these jurisdictions so much has happened that yield much better outcomes both with respect to public health and public safety that it’s become something that other municipalities particularly in Canada are seeking to replicate. In the province of Ontario, there’s over 30 cities now that are moving forward to develop their own municipal-based drug strategy. Some, they call the 4 pillars approach. Others, they call it something else. Whatever it is that they’re calling it, the purpose of these strategies is to ensure that stakeholders from many different areas come together, identify shared objectives and seek to achieve much better outcomes in both public health and public safety.

Again, this is fairly common at this point in Europe. It’s becoming increasingly common in Canada and these are situations where the local city has decided that it’s not going to wait around for its regional government rather or its federal government to move forward. Now in Canada and in many parts of Europe, what’s particularly interesting and probably worthy of note for those of us here in the United States is that often, these municipal drug strategies survive even though the federal government changes hands between more liberal leaning governments or more conservative governments. In Canada when Toronto and Vancouver started their municipal-based drug strategies, the country had a far more liberal government.

Then, some years ago, that changed and it’s a got a very conservative government now but both of those city municipalities maintain their drug strategies. Of course, this does not mean that they don’t have problems. It doesn’t mean that there’s not ongoing issues that have be dealt with. Those are things are true too. As I said, this is not meant to be and it’s not a silver bullet but it does allow for the cities to have a much greater degree of control over what it is that they’re doing to manage costs much more effectively, to ensure that the left hand and the right hand are working in concert with each other as opposed to working in a contradictory fashion and, of course, as I noted, it’s leading to these better outcomes in both public health and public safety which is the 1 of the reasons why I believe they continue to exists even if the governments themselves shift from 1 perspective to another and potentially back again and that’s also been true in Europe where in many these places, the government have shifted but the city strategies have remained the same in terms of making sure that there is a coordinated effort to address many of these problems.


Are there opportunities for New York to implement these types of municipal-drug strategies?

Yeah, there are, especially now with the recent elections both in New York City and elsewhere. To take New York as a whole, you know, we’ve been around the state quite a bit over the last number of years from Buffalo over into Rochester and Syracuse down into this southern tier. We’ve been up into the North Country. We’ve been into the Hudson Valley and the capital region. We’ve spent time out in Long Island and, of course, all over here in New York City. A lot of that, of course, is done as part of our project within New York Academy of Medicine working on the blueprint report that we published earlier this year where we talked to over 500 New Yorkers all over the state asking them, “What do you think New York’s drug policies should look like? What do you think we should do?”

In addition to that, we’ve spent quite of bit of time in many of these places working on issues around overdose prevention and fixing our marijuana policies and sentencing reform and so forth and I think it’s fair to say that New Yorkers that we’ve talked with whether they’re in Buffalo or they’re in Brighton Beach, whether they’re in Rochester or out in Suffolk County are very frustrated with the lack of action in Albany. The dysfunction that we’ve seen in Albany has been enormously damaging to the people of New York let alone frustrating.

Most recently, our efforts to try to fix the states marijuana possession law, here’s a proposal that is supported by law enforcement. The governor took this on to his credit. He took this on and said he was going to work on getting this thing fixed, had the backing of many prominent officials around the state and we couldn’t get it through the state senate. Many good ideas go to die in the state senate right now. There’s a great deal of frustration that very common sense solutions are stuck as a result of the political infighting in Albany and often times the backwardness that we see in that place.

Therefore, there’s a great deal of hunger to be able to do something locally because if Albany won’t act, then, what can we do here locally and energy, we’ve seen all over. In New York City getting a mayor for the … we’re getting a new mayor for the first time in 12 years. There’s a great deal of energy and enthusiasm about this and we think it’s a new opportunity for us to engage with these questions. Now, the blueprint that we published with the Academy of Medicine has very specific recommendations for the city of New York on how the city could move forward to develop a coordinated drug strategy or a municipal-based drug strategy and we’re working now with folks around the city to try to advance some of those ideas and we’re optimistic that the de Blasio administration will take a look at this issue around drugs and drug policy and take into account that there’s much better ways that we can address it that don’t require us to go through Albany or through Congress. We’re optimistic there.

In other jurisdictions across the state, there’s a great deal of enthusiasm and I think a lot of opportunity to engage with this issue. I was recently at a meeting about different approaches to law enforcement and drug law enforcement, the local level, and the top law enforcement officials from the county and city of Albany were all there; the sheriff, the police chief, the district attorney. They’re ready for new approaches. They want new ideas. They’re hungry for a new paradigm and to the extent that we are ready to advance 1, I think there’s a going be a great deal of receptivity. Most of the cities that are the major cities I should say and the state of New York don’t have anything close to what could be called the drug strategy. Rochester, Syracuse, Buffalo, Albany, New York City, Yonkers, we could go on and on. Binghamton, Newburgh, nobody appears to have a coordinated drug strategy. What that means is that for the most part we’re operating in most of these municipalities in paradigm that is now increasingly viewed as old and ineffective. The paradigm of the 1 drugs. Even the Attorney General Eric Holder and President Obama have acknowledged that the 1 drugs has failed and that it’s led to mass incarceration and racial disparities and it’s not the right way to deal with these problems and that we need a health-based approach. Even though they recognize that we have not yet seen the full shift towards that direction and certainly in Albany, we may not see that shift for some time.

It’s going to probably fall upon the cities themselves to address these problems in a way and to be fair, the cities are far more capable of doing so because they can move more swiftly and with greater dexterity than Canada state government and as we’re seeing with issues not just here in New York but around the world, cities are increasingly taking on some of the most pressing problems that we’re facing on the 21st Century from climate change to issues related to economic development, the education, to law enforcement issues. Cities are really leading the way here and not just here in the United States but around the world.

We’re deeply optimistic about the opportunities here and we have a lot. We can learn from our neighbors in the north, in Toronto and Vancouver and folks out in Europe. There’s been an outpouring of support when we’ve reached out to many of those stakeholders in those jurisdictions and said, “Hey, we’re thinking through potentially a municipal-based drug strategy here in New York and we can really use some help and we’ve gotten a really, really warm response by folks in Canada and Europe saying, “We can help. We’ve learned a lot. We’ve been doing this for a long time.” You don’t have to repeat our mistakes.

Now, we’re looking for is local leadership who will take this on and we’ve seen some of that leadership emerged in Albany. We’re pleased to see of some of it begin to emerge in places like Buffalo and we’re hopeful that we’ll see it emerge here in the city of New York. People like council member Melissa Mark-Viverito has been a real leader on these types of issues and we believe it could help lead us into a new area on drug policy at the city level.


Can you share a little bit about criminalization and mass incarceration and the affect that it has on the people that you worked with?

Yeah. This is probably one of the most pressing reasons why a municipal-based strategy is so essential right now. The last 40 years in the state of New York have been operated under the context of the failed war on drugs and most explicitly the Rockefeller drug laws. Now, while those laws reformed back in 2009, the paradigm of those laws remains unfortunately and by paradigm, I simply mean a way of thinking and a context for approaching the kinds of problems that are merged. When you consider that the number one arrest in the city of New York is for marijuana possession and then there’s hundreds of thousands of people who have been arrested for marijuana possession in the city of New York in the last 20 years, hundreds of thousands of people. the vast majority of them are young black and Latino men, this is despite the fact that evidence is very clear that young white men are far more likely to be using marijuana than our young men of color but that evidence, you wouldn’t have any idea that that was case by looking at who it is that is arrested and even though many of these cases end up being dismissed, that doesn’t change the fact that these young men are saddled with a lifelong arrest record that follows them around for the rest of their life especially in the information age.

That’s just a small sliver of what’s happening with this broad context of criminalization and we have chosen in the war on drugs over the last 40 years to use the criminal justice system to respond to these questions of drugs and drug policy. As a result, you’ve got hundreds of thousands of people who have been arrested or incarcerated for drug offenses or drug-related offenses and as Michelle Alexander has noted in her book, “Once you’re marked with the mark of criminalization, once you’ve been tagged that way as a human being, you are now a second class person in our society.” It becomes much harder to get a job, to get a loan, to go to school. We’re doing court observation right now. We’re seeing people who are arrested for marijuana possessions, they’re being stripped searched and they’re having their licenses revoked for 6 months.

The impact of criminalization in the last 40 years is so profound that I dare say that we don’t fully understand how severe the impacts are and we won’t understand it for sometime but we’re dealing with right now with problem of this mass criminalization and we’ve got to stop for a moment and reflect on what it is that we’re doing so that we can change our approach and account for the harm that has been done because I can’t tell you how many people we’ve talked to on a daily basis when we’re doing our interviews in the courts, in the Bronx, in Manhattan, in Brooklyn, when we’re travelling and visiting with folks in Rochester or in Buffalo, when we’re attending meetings in Syracuse or in Albany we’re going out to different events out in Long Island like in Hempstead or Mineola. We’re at constantly talking with people who have been arrested or gone to jail or they lost a loved one from overdose because people didn’t call for help. Why didn’t people call for help? Because they were afraid that if they called for help then instead of an ambulance coming that a police car would come and that is a very real fear.
People are dying needlessly. People are being criminalized in ways that are both racially disproportionate and unnecessary based on even current law. We don’t even have to get into what laws need to be reformed if the police simply followed existing laws. We would dramatically reduce the number of people who are arrested for some of these things but the police aren’t following the laws in many of these instances. They’re breaking the law and we’re holding them accountable.

We’ve got a very serious problem on our hands and our hope is that with some of the recent changes here in New York City with the new administration that that will be a starting point to advance some smart reforms and to stop some of these egregious practices and to bring some degree of accountability to the police force as a starting point but in a longer term, we’ve got a lot of work to do to both change policies and practices so that we reduce criminalization and reduce the role of the criminal justice system in our drug policies overall but also to account for legacies of racism, the legacies of unequal treatment under law and the legacies of these policies that have been too long in place that have decimated entire communities here. We can’t just change law and walk away and assume that everything is okay. We’ve got to really account for the harm that’s been done and do our best to rectify it so that we can be responsible both as a community and as a society.

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This post is part of the Monthly Social Justice Topic Series on From Punishment To Public Health (P2PH). If you have any questions, research that you would like to share related to P2PH or are interested in being interviewed for the series, please contact Morgane Richardson at justpublics365@gmail.com with the subject line, “P2PH Series.”