[Music]

Intro: This is Citations Needed with Nima Shirazi and Adam Johnson.

Nima Shirazi: Welcome to Citations Needed a podcast on the media, power, PR and the history of bullshit. I am Nima Shirazi.

Adam Johnson: I’m Adam Johnson.

Nima: Thanks, everyone, for listening this week. Of course, you can find the show on Twitter @CitationsPod, Facebook Citations Needed and become a supporter of the show and our work through Patreon.com/CitationsNeededPodcast with Nima Shirazi and Adam Johnson. We are completely listener-funded, so that is how we’re able to keep the show going. If you have not yet become a supporter of the show but have thought about it, please do. It really does help out.

Adam: Yeah. So any support on Patreon is helpful. Before we do this episode, I want to issue an apology. On the last episode, I made an extremely glib joke about people who buy pre-cut vegetables being lazy. This was meant to sort of lighten up what I viewed as being a scold-y conversation. As many of our listeners that pointed out to us, that people with dexterity issues and people who are disabled, the pre-cut vegetables are extremely helpful and that this exists in a broader context that the pre-cut vegetables as a, as a punchline for laziness and generally broader concepts of laziness can have extremely ableist overtones. And that’s not at all what we wanted to say or wanted to promote on the show. We really try to make an effort to consider, I mean obviously, the whole show is about how language affects marginalized people. Um, in the last thing we want to do is contribute to that. So anytime that we say things that are belittling, please let us know. We sincerely apologize.

Nima: Since the beginning of the so-called “War on Drugs,” authorities in the United States have viewed drugs not as a public health issue but one of crime, violence and vice, requiring the funding and mobilization not of medical officials but police, DEA agents and a sprawling network of paramilitary actors.

Adam: In response, corporate media and its culture of parasitic “ride-along” coverage has evolved in parallel taking this same line, reflecting the state’s approach rather than influencing or challenging it. Quote unquote “drug stories,” with rare exceptions, fall under “crime” reporting rubric rather than being seen as stories to be covered by reporters familiar with the actual science of drugs and addiction — skirting empiricism for police stenography and cartoon narratives, replete with good guys and bad guys.

Nima: The result? A feedback loop of a police and federal government determined to keep the War on Drugs in their own domain, shaping a media narrative that manufactures and manipulates the public’s and lawmakers’ perception of drugs and drug-related crime. But what if there’s another way? Increasingly, public health advocates and journalists have been pushing back, trying to demilitarize not just the public approach to drugs but how they’re covered in our media.

Adam: On this week’s episode, we’re going to explore how we got to this point — where drugs are viewed as an enemy force to be combated with violence and prisons — and highlight ways some journalists and activists are trying to fundamentally rewire the way we talk about the problems of drugs and addiction.

Nima: We’ll be joined by journalist Zachary Siegel, whose work has appeared in outlets such as The New York Times Magazine, Slate, The Atlantic and The Appeal. He is currently a Fellow at Northeastern University’s Health in Justice Action Lab.

[Begin Clip]

Zachary Siegel: We get a lot of rhetoric that says we need to arrest the dealers and the pushers invoking the image of the scary hoodlum and that we need to get users treatment. But the thing is there’s very little daylight between users and dealers. If you’re using drugs, you also have to deal them to an extent. You have to share them with friends, you have to buy them for friends. So when we go after dealers we also start going after users too, but the rhetoric is very much that these are two distinct categories.

[End Clip]

Adam: There’s a sort of general belief that we sort of turned a corner in the War on Drugs. That we’ve broken the fever and now we’re going to spend the next decade or so kind of winding down, but that’s not really the case. The War on Drugs rhetoric has simply been rebranded and there are several states by the way, where the prison population has gone up. Overall prison population has gone down, but there was an attempt to make marijuana Reefer Madness again, which is wild. Totally unexpected. Not on my bingo card on January 1st of 2019, but the fentanyl and heroin crisis or issue — we’ll discuss that verbiage later — has really ushered in a new era of moral panic around drugs. There was a 60 Minutes profile on April 28th of this year that was full of nothing but cop and prosecutors soundbites and was virtually absent. Actual independent medical professionals and neutral healthcare providers and I want you to listen to this clip and really get a sense of how cartoonishly fear-inducing it really is:

[Begin Clip]

Scott Pelley: Where did all this stuff come from? Matt Cronin: It’s from China. It’s manufactured in China. Scott Pelley: Some of this fentanyl was seized by the DEA. The rest was found in the mail by US Postal Service inspectors. Matt Cronin: This is essentially enough fentanyl and carfentanil to kill every man, woman and child in the city of Cleveland. Scott Pelley: Just this? Matt Cronin: Just this. Scott Pelley: Carfentanil is a derivative used by veterinarians to tranquilize elephants. Matt Cronin: Carfentanil is another hundred times more potent than fentanyl. Scott Pelley: So if you touch this stuff, it could kill you? Matt Cronin: Yeah. Scott Pelley: Just touch it? Matt Cronin: There’s a reason we have a medic standing by Scott.

[End Clip]

Adam: So, that’s not true. You cannot overdose by touching fentanyl. This is a place to start here. Our guest will talk more about this, but March 22nd, 2019, “You can’t overdose on fentanyl by touching it” headline in Vox media, “The myth that you can, however, is genuinely dangerous.”

Nima: Yeah. The Columbia Journalism Review — an article by Elizabeth Brico — also touched on this, “A dangerous fentanyl myth lives on.” Basically, there’s this story that was reported for example in 2017 where cops in Ohio responded to an opioid overdose and one of the cops like flicked a speck of white powder off his shirt and because of that was said to, you know, have gone into this, like, crazy body shutting down, he was ODing himself simply by brushing off like a speck of white powder and had to be dosed with the anti-overdose drug Naloxone. And so this one incident actually got coverage in NBC News, Washington Post, Inside Edition did a thing on it. Now we’re seeing that again in 60 Minutes the idea that just by touching this, you could go into like a drug crazed frenzy and OD and then there’s the stat, Adam, about the amount seized from China — Evil China — right?

Adam: Oh, this whole thing is full of Yellow Peril and it’s true that it comes from China, but it ties into very specific geopolitical interests, which again gets to the whole point about the militarization of drug coverage, right? Everything’s taken from this military law enforcement angle.

Nima: You see the, kind of, through lines of like Yellow Peril, opium dens into now opioid crises, but beyond the China thing, there was the stat of, you know, ‘this could kill every man, woman, child and dog in Cleveland, Ohio.’ Let’s just take a random stat if, you know, were something to happen that is not happening, it would kill a lot of people.

Adam: Yeah, and so we’re going over this to establish that we have not turned a corner. This is still very much the standard and the reason it’s standard is because places like 60 Minutes, they take their cues from the DEA, from police departments, from DEA and police department aligned institutions, organizations who really set the tone and this dates back from the beginning of the War on Drugs. The militarization of drug coverage follows U.S. militarization of drugs in general. This was motivated by the demonization of criminalization of Mexican immigrants starting in the 1920s and ‘30s and the broader control over Latin America during the Cold War. The War on Drugs was always the pretense for the U.S. to be in South America and Central America.

Nima: And then of course the demonization and criminalization of black communities and other extensively left-wing spaces, which ramped up under the Richard Nixon administration in the late 1960s, along with the kind of fear of labor and quote unquote “urban unrest.” And so you see the media’s posture toward drugs as being really militarized because they’re working so closely with the government and at that time, especially in the late ‘60s, directly with the White House after the White House has decided to treat drugs again, not as a health issue, but as a criminal one, that desperately needs the most harsh crackdown tactics led by police and government agencies. And of course never having to do with seeing this as a medical issue.

Adam: Right. And so the initial War on Drugs is a lot of people know, but we’re going to do a quick recap, was tied to this idea of the border and controlling the border and protecting whiteness from a foreign enemy. So marijuana specifically was the boogeyman du jour up until, well really up until the eighties, and it was referred to as Mexican Weed, Marijuana Mexican Weed was it’s full name. If you go to old newspaper archives or The New York Times or the AP, marijuana is very often, if not most of the time, referred to as Mexican Weed or Mexican Marijuana and it’s put in those contexts. So content warning, we’re going to use a racial slur, but we’re putting it in context here. So 1953, “Wetback Arrested On Marijuana Count.” “A wetback was in county jail today charged with possession, unlawfully acquiring, and smuggling marijuana.” This went all the way up to the seventies. “Marijuana and Wetback Cases Dominate Session.” This pejorative “wetback,” which again there was Operation Wetback, which we talked about with uh, uh, Roxanne Dunbar-Ortiz. It is worth noting how much this racist slur was actually very common up until the early ‘80s. The term “wetback” was used to refer to Mexican immigrants up until about the time I was born, unironically and not really in quotes. It fell out of favor around ‘82, ‘83. But, uh, from the 1920s to the early 1980s, this was how the media, especially in the ‘30s, ‘40s, ‘50s, ‘60s and ‘70s referred to Mexican immigrants. And so this was tied invariably to this idea of this Mexican scourge going after white people and whiteness. And that of course is the nature of the militarization of drugs, that marijuana, there’s a feedback loop where, where you have to put this militarized spin on it, this criminal spin on it because it’s about codifying the border and codifying whiteness.

Nima: Right. I mean there’s no surprise that the 1958 Orson Welles movie Touch of Evil begins in a small Mexican border town and, you know, the famous opening sequence that ends with a car bomb exploding. But the tensions that are addressed in the movie are all about drugs and drugs crossing borders and those power struggles. But there’s this critical scene where like someone is seen like whacked out like total Reefer Madness-style — on pot. So to see that in news media coupled with pop culture, I mean it is no surprise that then the kind of normalization of this idea that drugs need to be uber-criminalized, addressed through, you know, military action. That is how that all works together.

Adam: Yeah. And then if you go through the archives and you look at all the stories of marijuana, you realize how many stories there are of white people being arrested on the border, or even not necessarily always on the border, and then blaming like the Mexican Weed as if it told them to commit this crime. So here’s a headline from The Boston Globe March 15th, 1934 the headline is “Safe-Cracker” — as in not a white person, but one who cracks safes — “Cafe-Cracker Blames Weed” sub headline is “Says Mexican Marijuana Dreams Inspired Crime. Confesses $440 Lunchroom Robbery — Girl Tips Police.” So the article had gone to say: “Dreams induced by smoking marijuana, Mexican narcotic weed, gave Joseph Gormey, 26, of Berkeley St., South End, the idea that he would make a safe-cracker and lots of money, he confessed to police yesterday after his arrest.” So there’s various stories about about marijuana leading to this panic, which of course the Reefer Madness sort of punchline that we all know and the perception around this isn’t just about hyping the War on Drugs and keeping people away from drugs, it’s about blaming crime that was happening on Mexicans. It’s about racial sort of parasites.

Nima: ‘The outsiders made us do this by their crazy weed that they gave us.’

Adam: Yeah, that was, that was always the subtext.

Nima: ‘So it’s beyond us. It’s really about them.’

Adam: That it’s, it’s driving your white men and your white women to criminality and lesbianism and all sorts of badness.

Nima: Yeah. Exactly. Homosexuality and, yeah, yeah, yeah.

Adam: That they otherwise wouldn’t do.

Nima: Totally. But there’s another layer of political expediency and a kind of purely calculated propaganda that goes along with this as well, which is that the War on Drugs was also seen as a way to explicitly and deliberately put down a lot of the civil rights movement in the sixties. In a Harper’s article by Dan Baum from a few years ago revealed a quote from Nixon aid, John Ehrlichman. This is a statement that Ehrlichman made in 1994 in which he reveals the impetus behind the Nixon administration’s War on Drugs. And here’s the quote:

“You want to know what this was really all about. The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying. We knew we couldn’t make it illegal to be either against the war or black, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings, and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”

Adam: Some have disputed the veracity of this quote. It was reported 22 years after it was said because there was, I think there was some embargo he had agreed to like have for this particular quote.

Nima: It’s remarkably clear.

Adam: It’s probably accurate. I mean I would venture to say it’s accurate. I think it’s probably something that was generally understood in the Nixon White House, especially for a domestic policy advisor that there was, and this has been documented, you know, about a million different other means about how the War on Drugs served the political ends at the time, which was the criminalization of black communities, which were threatening and to a lesser extent the criminalization of left-wing spaces, which were also threatening, which again, the coverage would follow suit. So this really reached its nadir or it’s zenith depending how you look at it in September of 1986 when the Reagan White House really took that Nixon framework and ran with it. We touched on this in Episode 39: From Cradle to Courtroom, the live show we did about this time last year, in which the White House was effectively controlling the media’s narrative around drugs and drug coverage and they described the use of crack cocaine as a quote “new epidemic” and a quote “uncontrollable fire.”

Nima: So, Reagan, in a speech delivered in September ‘86, spoke directly at one point to people in the media and you know, he addressed himself to quote “newsrooms and production rooms of our media centers.” Reagan added, “you have a special opportunity with your enormous influence to send alarm signals across the nation.” End quote. Subsequently, the White House then worked with and instructed DEA officials to allow reporters from ABC News to do these ride-alongs, right? To accompany them on crack house raids, which then the head of the New York office of the DEA reported back to his own superiors this, quote, “Crack is the hottest combat-reporting story to come along since the end of the Vietnam War.” End quote. This crack coverage was actually so ubiquitous that a University of Texas study by scholar Jason Glenn found that, in 1986 alone, there were more than a thousand different cracks stories that appeared in the American media, 400 of which aired on NBC News. NBC News. This is the the mid-‘80s, there is not, you know, rampant Internet, rampant cable news. NBC News at that time had a singular nightly news broadcast, which means that for it to have 400 stories in that year, it basically did more than one crack cocaine story per day.

Adam: Yeah, that’s, wow. So this legacy lives on today, which is to say the, the, the general assumption that drugs fall in the crime framework and need to be framed as crime still lives on today. We’re going to read some, this is just over the last year, some very banal everyday local news stories where we’re going to read them and they’re going to, they’re framed as if they just found the Lindbergh baby or killed John Dillinger. But in an otherwise moral society, they would be viewed as being either non stories or stories about public health and mental health or fall in the domain of a writer or reporter who’s from intimate with notions of addiction or intimate with notions of homelessness. But here in our contemporary setting, because the media is so militarized and has had this framework for 70, 80 years, it can’t shake it. So we get really goofy stories that are, that are otherwise totally benign. This is from April of 2019 in my hometown of San Antonio, it has two mugshots, one black and one Latino man looking really sinister and scary and the headline is quote, “Two drugged, drunk men arrested after being found asleep in car.” So there was no crime committed other than being on drugs and having drugs. This gets the whole mugshot treatment.

Nima: Uh, and in my hometown of New York, the outlet DNAinfo in April of 2017 reported on “2 Men Arrested for Heroin at Troubled 30th St. Homeless Shelter, NYPD Says.” So, here’s a story about a couple homeless people, people who do not have homes, arrested for heroin possession after the police conducted a routine locker sweep in this homeless shelter. So that means that in homeless shelters where people are already pretty desperate, don’t have basic needs, the NYPD does these sweeps looking into people’s stuff and then arresting them. So this speaks directly to the criminalization of homelessness. People’s utter lack of privacy. I mean, we’ve touched on this recently in the Florida Man episode, the idea that someone who is addicted to drugs or doing drugs or has purchased drugs to do normally would be able to keep those drugs somewhere in a drawer in their home. But because homelessness precludes that from happening, there’s this added level of, uh, being criminalized simply because what you would do normally and maybe not get caught for in the privacy of your own home, happens in public and you can get arrested for it.

Adam: So there’s, there’s KHOU in Texas from earlier this year, quote, “That’s not meth, it’s ‘healing crystals,’ suspect told Dickinson police.” Of course, it’s in the weird section. The cop is portrayed as clever for not buying the arrested woman’s meth, which was healing crystals. They were doing a sting operation. So this is really funny. This is from a Louisville newspaper in Kentucky “CRIME REPORT: Louisville woman arrested on drug charges.” Again, petty oxycodone charges.

Nima: April of this year from Rochester, Minnesota. “Rochester Homeless Man Turns Himself In For Meth Possession.” That was reported by KIMT.

Adam: Really important news right there. Very important you know that.

Nima: And that his mugshot was then plastered all over.

Adam: All of these have the obligatory plastered mugshot. Uh, February of 2018, “Texas woman defecated to conceal drug evidence, police say.” This of course, is also has the mugshot, its played for laughs. June, uh, 2018, “Utah woman drunk on mouthwash asks to smoke weed before going to jail.” This was a small town in Utah that inexplicably had a write up in the New York Daily News probably because it ‘lol, very funny.’

Nima: From March, 2019, Birmingham, Alabama, “Naked man found with baggy of crack cocaine in ear; now jailed in Jeffco [Jefferson County].”

Adam: This one’s really the kicker card here. This is from KWCH in Kentucky, quote, “Man walking alone accepts ride from deputy, arrested on warrant.” The story will go on to detail how the man was walking by the side of the highway by himself, the police officer offered him a ride, on the way there he asked his name and then he looked him up and he had a warrant for possession of meth and then arrested him. First off, what an asshole.

Nima: Right. It’s like picking up someone ostensibly to help them and then, like, running their name through your fucking system and then they end up in jail. Like just drive past.

Adam: None of these people are, these aren’t stories. Like there’s nothing happened here. All of the stories we just listed are about possession. They’re about possession of drugs. No second, third order crime, no drug kingpin, no other, you know, they didn’t steal, they’re just stories about people being arrested for drugs or being on drugs. But they’re all given this very specific cop speak narrative about how “police say” “the 1300 block of Perrin Beitel,” the, you know, “according to officials” and it’s, it’s, it’s sort of, it reads like a police blotter, but none of these stories are really even stories at all and if they were reported, again in a moral society, in a rational society, they would be reported as epidemic of heroin use, the local shelter has health officials asking what they can do for recovery. You know there, there would be a frame that would frame it as a health issue, not a crime issue, but again, article after article after article, and this is just scratching the surface over the last couple of years, article after article after article that frames, and again we hear these a million times a day, local news, local newspaper, you don’t even think about it for years, for decades. It conditions your mind to view these otherwise completely 100 percent medical stories as stories about “police say” “officers say” “officials believe.”

Nima: Similarly, the AIDS epidemic was openly mocked for years as hundreds of people were dying. Stand-up comics and TV sitcoms even used AIDS as a punchline. While the White House Press Corps would snicker and laugh when less mainstream reporters dared to ask Reagan Press Secretaries about the growing number of AIDS deaths. In 1981, The New York Times published just three stories on AIDS and just three stories the following year. The disease was basically perceived as only affecting gay men. Before it was known as “AIDS,” it was called “gay-related immune deficiency” or “gay cancer” or even “the gay plague” and was thereby dismissed as particularly newsworthy in a haze of early ‘80s ignorance, extreme homophobia and just, like, basic cruelty to the victims. But after this relative silence came sheer panic, once it became a more mainstream story. Reagan didn’t mention aids publicly until 1985, after more than 5,000 people had died. But the same year, a New York Daily News poll found that 42% of respondents wanted people with AIDS to be quarantined. While stories of nurses quitting their jobs rather than treating AIDS patients, prison guards demanding to wear special hazmat suits and morticians refusing to embalm people who had died from AIDS were rampant in the press. So finally, by the late ‘80s, due to the tireless efforts of activists and advocates, harm reduction narratives started being used in public health strategies in positive ways: the distribution of condoms to talk about safe sex to at-risk populations. This idea became really important in terms of syringe exchange programs. When we’re talking about ways that this can be done, we have evidence, we’ve seen it. There are ways to employ this harm reduction narrative in political ways and also through the media that does not necessarily view public health issues as being purely criminal in nature. And so there are ways to really use certain strategies to push for far better policies. But when it comes to the War on Drugs, that’s just not done.

Adam: Yeah, and we, we have other examples from other countries. It’s not always in media criticism that you have kind of A/B test right? You have a thing to compare to, but other countries like the Netherlands and Uruguay, which have relatively very liberal drug laws, their media reflects that. They don’t do the police blotters largely because they’re not arresting people in the first place. When they do address drugs, for example, in the Netherlands, if you look at NL Times, they tend to focus on drug dealers and traffickers, which again is not the clearest line, but just as an example, when it mentions drugs at all in the crime section. So in Uruguay, drug stories, they focus on drug dealers intercepting drugs and transportation and shipments, but you can look at these websites and there’s basically zero stories about drug users or drug usage and when there is, it’s done in the context of health policy and how to help people. And so it’s not as if we don’t know how to do this, that the media’s militarization and this mindless police blotter mentality works in a feedback loop with the state to reinforce the law and order framework of drugs when every single independent scientist and observer will tell you is not the right frame for drugs and drug coverage in the media.

Nima: To talk more about this, we’re going to be joined by journalist Zach Siegel, he is a Fellow at Northeastern University’s Health in Justice Action Lab and he’ll join us in just a moment. Stay with us.

[Music]

Nima: We are joined now by journalist Zach Siegel. Zach, it’s great to have you on Citations Needed. Thanks for joining us.

Zachary Siegel: Yeah, happy to be here.

Adam: So this episode is about the militarization of drug coverage, which logically follows from the militarization of drugs in general and how to kind of rewire people’s brains to think about drugs, not as a “police say” “officials say” crime story, but as something closer to care, public health coverage. This is something you’ve been covering a while, namely at um, Slate and Columbia Journalism Review. In your opinion, to what extent has the so-called opioid epidemic, which is something that has affected quite a few people’s lives, is real as far as it goes, although we can debate the name, to what extent do you think that that has given a much needed boost to this kind of militarization of drug, vis-à-vis the War on Drugs?

Zachary Siegel

Zachary Siegel: Yeah. Everyone is calling what we’re in right now an opioid epidemic and it’s really like an overdose emergency. So like 70,000 people die every year due to overdoses. And about two-thirds of those are because of opioids. And so I think back in October 2017 Trump called this a national public health emergency and I mean for the last few years this has been sort of coded as a public health crisis. And a lot of people when they think back to the ‘80s and ‘90s when there was a quote unquote “crack epidemic” the response was like militant enforcement, right? And followed by incarceration of so many young black men, mostly for like simple possession of crack. And what’s happening now is the drug war has mutated in new ways and the progressive response from police to prosecutors, they say things like, ‘we can’t arrest our way out of this epidemic’ and that ‘we need a public health approach.’ But I mean if we look at what’s really happening on the ground, the War on Drugs is still very much alive and well and also in our sort of Washington parlance people say that the opioid epidemic is the only bipartisan issue left, which is, I mean like there’s no bipartisan consensus on what kind of approach to take though rhetorically both parties agree that there’s a big issue here. But again, we get a lot of rhetoric that says we need to arrest the dealers and the pushers invoking the image of the scary hoodlum and that we need to get users treatment. But the thing is there’s very little daylight between users and dealers. If you’re using drugs, you also have to deal them to an extent. You have to share them with friends, you have to buy them for friends. So when we go after dealers, we also start going after users too. But the rhetoric is very much that these are two distinct categories.

Adam: Can you expand on that a little bit? Can you explain why that is? Because I do think that part of this militarization reform that we’re in bifurcates between dealers and users. But your argument that this delineation as far as it applies in the law in most places is that it doesn’t, this distinction is not very clear at all.

Zachary Siegel: Yeah. I mean the way that all of this works is if you are addicted to heroin, you need to hustle and come up with about like fifty bucks every day. Otherwise you’re going to get sick. Like you need to have a way to fund your own habit. And so what happens is people accumulate money through friends and they buy for friends. And what happens in these cases where people are hooking each other up, say somebody overdoses and dies, well then all of a sudden there is a homicide investigation and that overdose death is treated as a potential homicide. And in some states like Florida, it’s first-degree murder punishable by the death penalty or life in prison. And so though we don’t hang people here the punishment for drug crimes are still very severe. And so these are like so-called drug induced homicide laws or death by distribution laws. And a lot of states have been either reinvigorating old drug induced homicide laws sort of lingering from the ‘80s or passing totally new laws in the last year or so.

Nima: On the show we talk about language a lot and how words do a lot of heavy-lifting a lot of the time. And when you translate policy into media coverage that has done exponentially. Now, Zach, you have started a project to try and help reporters move away from some of the carceral, cop-speak, copaganda framework when reporting on drugs. Can you tell us what you find to be the most egregious terms or labels that you have identified in drug coverage in the media and maybe what some possible alternatives might be?

Zachary Siegel: The project you’re referring to it’s called Changing the Narrative and basically it’s a website and it’s a functioning toolkit for reporters to use to help them avoid a lot of these bad ideas and tropes that are very much not grounded in any evidence whatsoever. And there’s a lot of stigmatizing language. And so what we want to do is help them avoid this. It’ll be a source directory and journalists can get a good quote from doctors and researchers and people who have lived experience. And so we hope what this will do is move journalists away from a lot of the cringe-worthy stuff that’s out there.

Adam: So let’s talk about what that is. Could you give us some examples?

Zachary Siegel: Yes, there is a lot, but I think one of the more relevant ones is when it comes to overdose prevention sites or otherwise known as supervised injection facilities. These are all over Europe and now there’s a bunch in Canada. And these are spaces where people can inject drugs under medical supervision to prevent fatal overdoses. And like it sounds really radical, but it’s just a syringe exchange program that’s brought inside and it prevents hazardous litter and overdoses and the spread of Hepatitis C and HIV. But these headlines, they will call them “drug dens” and “shooting galleries” and like “havens for junkies.”

Adam: (Laughs.) Sorry, I don’t mean to laugh, but “shooting galleries” is pretty, uh, pretty over the top.

Zachary Siegel: Yeah. And it’s so absurd because if you, if you like look at the photos of these places, there’s one in Vancouver called Insight. It’s like the Cadillac of supervised injection sites. They have all kinds of services. It’s very well lit. It’s very sterile. There’s also clinics like these in Switzerland and they are pristine, very clinical looking medical facilities, but calling them “shooting galleries” like invokes images of used syringes and blood everywhere. It’s just really disingenuous, very lazy and myopic. So that’s definitely one.

Adam: You write a lot about people-first language, which is something we’ve talked a lot about on this show or we talked specifically with Sharlyn Grace. And when we talked about, um, local news reports being glorified police blotters how terms like “convict,” “felon” are very stigmatizing and this isn’t just sort of liberal busy-bodyism it actually has a tremendous effect with how people read these things. So can we talk about the importance of people-first language when we talk about the issue of drugs and it’s something we’re all, I mean we’re guilty of, we’ve used the word addict, we’re certainly not scolding anyone, which is usually what we say right before we scold someone. But to you, why is that important and can we talk about how that, how that affects coverage of drugs?

Zachary Siegel: Yeah. So obviously “addict” is very popular, culturally it’s everywhere, like “junky” and “drug abuser” to me are much worse. Like abuser sort of like invokes violence. Like no one is beating their drugs against the wall or whatever. But addict is to me I think quite insidious. And so there’s this, there’s research by this guy named Robert Ashford and he shows, I mean empirically that when people, and even doctors, when they come across these words in case notes and reports that they’re more likely to prescribe a more punitive kind of treatment than the more clinical or therapeutic one, so person-first language like it, you’re right, like it may sound like snow flakey PC stuff, but it really makes a world of difference. And simply calling someone an addict, it really strips away so much complexity to what’s going on here. I mean, like people say gambling addict or they’re addicted to TV shows, like the word is everywhere, but it’s still very, I think, loaded with to me like this image of someone who is manipulative and selfish and just like not someone who’s fun to be around. And plenty of people who use drugs are not like that. And so I think rehumanizing people can go a long way, especially in just regular news articles. And it only takes a couple of extra words to avoid “addict.” And I think in 2017 the Associated Press, they 86’ed words like “addict” and “drug abuser” from the style guide, but in 2019 I still see it everywhere, so not many people have caught onto it.

Adam: It also implies that it’s static, that once you’re an addict, you’re always an addict and once you’re an abuser you’re always an abuser.

Zachary Siegel: Right.

Adam: It’s not something you do. It’s something you are.

Zachary Siegel: Yeah, and, and I think on that point, what people really don’t understand, and this is shown in a lot of epidemiological surveys with sample sizes of 40,000 people, is that the vast majority of people who at one point meet criteria for addiction or substance use disorder, they either grow out of it or phase out of it or somehow stop the addiction without any treatment. Almost a majority of people have an addiction at some point in their lives and overcome it in some way without really any formal help. I think that goes to show just, (a) how many people this really affects, but (b) how, yeah, it isn’t static and that people do change and that this could be a very temporary condition for someone.

Nima: So to that point, I want to address a particular news article that was in The New York Times in April of 2018 and the article is headlined “Injecting Drugs Can Ruin a Heart. How Many Second Chances Should a User Get?” It’s written by Abby Goodnough. And it talks about people who inject opioids or meth and how they can develop endocarditis, which is an infection of the heart valves and how like surgeons are somehow in a bind when treating these people because they are seen by these surgeons as hopeless addicts who are just going to do it again. So how many times are you going to fix their fucking heart before they just do it again. And the article says this:

“With meth resurgent and the opioid crisis showing no sign of abating, a growing number of people are getting endocarditis from injecting the drugs — sometimes repeatedly if they continue shooting up. Many are uninsured, and the care they need is expensive, intensive and often lasts months. All of this has doctors grappling with an ethically fraught question: Is a heart ever not worth fixing?”

Now —

Zachary Siegel: That’s fucked up.

Adam: They’re both sides-ing life. You don’t get a lot of both sides-ing of life usually. Uh, this is literally the death panel that Sarah Palin warned us about.

Nima: Right. And so to me, I think something, when we’re talking about militarization of drug coverage and articles like this, there’s like a really stark parallel with the way that war-weary imperialists handwring about, ‘Well you know what, maybe spreading democracy isn’t really worth it because people over there aren’t really equipped to handle it.’ It’s like deciding that the ‘do no harm’ code, you know, the Hippocratic Oath doctors take, like, ‘Well I guess, you know, if the patient is just going to keep doing the thing then like why bother?’ And the ‘why bother’ then speaks to maybe getting away from addressing this as a public health crisis putting the onus back on the user and away from the system by having these decisions made by surgeons just being like, ‘it’s not worth saving lives anymore.’

Zachary Siegel: Yeah. I think this gets into really creepy eugenics and kind of social Darwinism stuff where even with drugs like Naloxone that reverse overdoses, people are like, ‘well, why should we keep reversing overdoses? Like if they die off, doesn’t that kind of solve the problem?’ It’s horrifying, but since I write a lot of these articles, I’ll get the occasional weird email or comment from like tin foil hat person owning me with the logic of eugenics and I’m just, yeah, it, it’s very gross, but these kinds of things are totally relevant and prominent, especially when we get into things like healthcare resources where these drugs are expensive and saving lives is expensive, but we’re putting a value on a life and yeah. How many chances should someone get to replace her heart valve? Two, three, four or one? Like how do we put a number on this?

Adam: We should be replacing heart valves and then when we run out of money, we’ll take some yachts and then we’ll go from there.

Nima: Well, right, because these articles also are clear about that most of the people in this position are uninsured, live in poverty, are unemployed. And yet it says, well that’s just a given in these communities. And so basically they just have to figure out how to also not be addicted to opioids and then, you know, dust off your hands, problem solved. Like, it’s this bizarre thing where then yeah, we’re determining who is worth saving. And it really comes down to how much money they cost.

Zachary Siegel: And also about endocarditis. So that condition, it’s an infection. It isn’t inherent to injection drug use, like injection drug use does not cause it. So every time a doctor gives you a shot, they put alcohol swabs on the spot where they’re going to inject you. They do that to prevent endocarditis and other infections from entering your bloodstream. And so if people have a safe space to inject or they are provided with sterile, unused syringes or they’re not in a back alley in the dark scrounging for a vein and rushing it, if we make the conditions in which people use drugs, they won’t get endocarditis. Right? That’s the whole point here is that this infection is totally preventable.

Nima: And yet then the, the ways to prevent it are further stigmatized, you’re saying?

Zachary Siegel: Yeah.

Nima: Because it’s like, ‘Oh well, if you want to avoid getting endocarditis, you have to go to a shooting gallery’ and it’s this trope where it’s turn-of-the-century New York opium den in The Knick as opposed to, like, an actually safe, sterile environment where people can maybe, you know, not die.

Zachary Siegel: Right. And also there’s tons of lobbying against syringe exchange programs. So these cropped up in the eighties during the HIV epidemic when injection drug users were falling out from AIDS left and right. People started to realize when they looked to the research in Europe that if you simply distribute sterile syringes, you will prevent a huge number of cases of HIV. And so again, another policy that can prevent the spread of disease and infection is the same policy that people just can’t wrap their heads around. Or, like in West Virginia for example, a community had a syringe exchange and then a bunch of people got mad that there were syringes everywhere. These become like NIMBY issues to a large extent. And so yeah, it’s infuriating when like The Times will sort of do both sides of a heart valve and not mention that if we just hand people sterile equipment we’ll prevent these expensive surgeries in the first place.

Adam: So we wanted to talk about this militarization and fear-mongering of drugs and what an alternative can be. There was another article in The New York Times from September of 2017 with the headline, “Opioids Aren’t the Only Pain Drugs to Fear.” And this article talks not only about the issues facing many communities regarding opioids, but how the opioid crisis is then implicating other painkillers and basically spreading the idea that now everything needs to be looked at as a sort of sinister gateway into serious addiction. Uh, can you kind of unpack this article for us?

Zachary Siegel: Yeah. So it says “With 100 million Americans living with chronic pain, according to a 2011 report by the Institute of Medicine, there is a vast market available for people, [quote] ‘legitimately’ prescribed an opioid to become hooked on even larger doses of these drugs.” So like I don’t know why there’s scare quoting “legitimately” there because there are plenty of legitimate reasons for people to be prescribed opioids. And I think one of the things that gets lost in the fervor of the overdose crisis kind of rhetoric, is that opioids play like a critical role in western medicine. And almost everyone has taken an opioid at least for acute pain at some point in their life. And the vast majority of us don’t come down with addiction and don’t start injecting heroin months later. So that trajectory is a very extreme and actually rare occurrence among people who try opioids. But because there’s 70,000 people dying from drug overdoses every year, it takes center stage and as though it is the sort of right in the center of the bell curve when really we’re talking about a minority of people who probably have experienced childhood trauma, have anxiety or depression or some other kind of co-occurring mental health problem or maybe they’re poor and they lost their job and a robot took their job and their dignity in life has been totally evaporated. Like, these are the human social complex drivers of addiction that unfortunately are happening to many Americans in this moment. And we don’t ask like why is there a population so vulnerable to addiction? Like, why are so many people so miserable that they feel the need to escape or find some kind of oblivion with prescription medicine that they probably need for some real pain issue. And so I think right off the bat we just get into this idea that opioids are bad and that they’re all addictive and if you get prescribed them, you better watch out because you’re going to get addicted and start shooting fentanyl. Like, that’s the trajectory, but it’s not what is happening.

Nima: It goes really hand-in-hand with what you, Zach, have written about in terms of how addiction is basically known or called a disease a lot of the time, not all the time, but that is simultaneously medicalized and also criminalized. And so the kind of duality of that, that it’s something that needs to be addressed medically, but also funneling people into jails and prisons expanding mass incarceration and then on the other side of that, you have this remarkable stat from the Massachusetts Department of Health that the opioid overdose death rate is 120 times higher for those recently released from incarceration compared to the rest of the adult population. Can you maybe just talk about how deeply confusing in many ways this narrative is of addiction being something that needs to be treated with care while also simultaneously by locking people up?

Zachary Siegel: Yeah, so that’s, that is horrific. And it came from the Massachusetts Department of Health and basically what happens is jail, even a short stint or a few days, for someone addicted to heroin or fentanyl, it could be a death sentence. What happens is you lose your tolerance to the drug and after a few days you’re probably in withdrawal. They’re probably not giving you methadone or buprenorphine drugs that treat withdrawal symptoms by replacing the opioid with a far safer one. So jails rarely do that. Prisons rarely do it. And so what happens is when people are released from jail or prison, they’re craving, they’re sick and they’re about to go do a dose that they think is safe and this is probably the first thing they’re doing mind you when they get out, and so they take the train, they get off at the stop and they use and they die probably alone in some foreclosed building somewhere. Like it’s so sad that this is the case. But really jailing people with addiction, especially when it’s opioids, is just utterly counterproductive. And if we’re talking about public health measures, if we’re talking about policies and laws that can reduce the overdose stats, jailing people is probably the first I would pick to do the opposite. It raises death rates and that’s been known for a long time. And because the heroin market is sort of, it’s been taken over by very potent drugs like illicit fentanyl, it’s even worse now. So this problem is not going away and it seems to be getting worse. And the status quo, the modus operandi is to arrest drug users and we know that this kills them. But again, like you’re saying, people do not understand that this is a public health problem, it’s a medical problem and jails are no place for people with addiction.

Nima: We will leave it there. Thank you so much journalist Zach Siegel, uh, your work has appeared in The New York Times Magazine, Slate, The Atlantic, The Appeal. You are a current Fellow at Northeastern University’s Health in Justice Action Lab. Zach, thank you so much for joining us today on Citations Needed.

Zachary Siegel: You’re very welcome. Thanks for having me.

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Adam: Uh, so yeah, another light beach read from Citations.

Nima: Yeah, you’re welcome, everybody.

Adam: Yeah, it’s, you know, there’s a carceral of mentality that’s buried deep into the DNA of this country, specifically amongst its white constituents. And I think it’s interesting to the extent to which the media reinforces that and how they play along with it. And if we can just kind of pry that open a little bit, just a little bit I think it’s a, it’s a useful thing to do to have those conversations about, about why, again, we list off these stories, we shared some of these stories with Zach, you know, all these kinds of ‘Man Found in Car High On Drugs,’ ‘People Arrested For Drugs’ and we were sort of talking about what are the ways you can kind of make these stories into public health issues? And the reality is that for 90 percent of them, they just shouldn’t, they’re not stories at all. They’re not, they’re not news that they’re not news. It’s like some guy having, you know, a drug episode in a car is not news. It doesn’t, it doesn’t affect anyone. It’s not, you know, there’s no victim. There’s no, there’s no stakes. There’s no harm. But again, it’s just police blotter reciting, which we’ve, you know, we’ve talked a lot about on the show and, and, uh, you know, you got to get those mugshots up there, got to make sure that you, uh, you indelibly plaster their grill on, on the Internet forever. So it’s important important work they’re doing.

Nima: And as we know, uh, you know, as hokey as it may be, words, words really do matter when it comes to the framing of news articles, whether they’re opinion pieces or what is known as quote unquote “straight news” which may or may not exist. But, uh, you know, that’s why we really do like digging in to these types of topics when we can,because even little shifts in language using, as we discussed with Zach, people-first language really does start to shift things. It can’t do 100 percent of the work by far. But criminalizing people through language is very common in the media. And so whenever that can be picked at altered and challenged, that will be for the best. So those journalists that are working to do that, um, should be commended. And I can only hope that more and more people do that.

Adam: You can check out the Changing the Narrative website that Zach built on our show notes and other articles he’s written on the topic. Tons of good information there for people who are kind of trying to get their head around the overdose crisis, which is again ripe with all kinds of political, politically difficult issues and he does a good job, among some of the other writers we feature in kind of breaking that down.

Nima: So, that will do it for this episode of Citations Needed. Thank you everyone for listening. You can follow the show on Twitter @CitationsPod, Facebook Citations Needed and become a supporter of our work through Patreon.com/CitationsNeededPodcast with Nima Shirazi and Adam Johnson. And, as always, an extra special shout out goes to our Critic-level supporters through Patreon. I am Nima Shirazi.

Adam: I’m Adam Johnson.

Nima: Citations Needed is produced by Florence Barrau-Adams. Production consultant is Josh Kross. Production assistant is Trendel Lightburn. Additional research by Marco Cartolano. Transcriptions are by Morgan McAslan. The music, as always, is by Grandaddy. Thanks so much for listening again. We’ll catch you next week.

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