Evan Tao
Welcome to Bear With Me, a new interview show on politics from The Brown Daily Herald newsroom. I’m your host, Evan Tao.
I’m a strong believer in the power of a conversation. My Brown education has been just as much midnight conversations in Josiah’s as it has been lectures and seminars. Conversations are where I go to test ideas out, and where I go to be challenged. So I figured, as every man who starts a podcast does, that some of those conversations were worth recording and publishing. And maybe they just might spark some new conversations of their own. That’s how “Bear With Me” was born.
This first episode is about drugs. Providence is becoming an innovator in the realm of drug policy. This past year, it opened the first overdose prevention center in the United States outside of New York. It represents something of a revolution in drug policy. Instead of aggressively policing drug use, instead of passively letting it take place on the street, what if instead the government created a safe place for people to use drugs?
On the one hand, it may be viewed by some as an admission of defeat — an admission that the War on Drugs of the past has been harmful and a failure. An admission that pushing for full sobriety from everyone is not a realistic goal. On the other hand, it’s a change in the way we see drugs and the people who use them. It is, as our guest today puts it, “stretching our moral imagination.”
Researchers at Brown are studying the methods and effectiveness of the overdose prevention center. At the same time students here at Brown have launched a club called Harm Reduction Coalition, which aims to connect students to volunteering at the OPC and advocates for the Harm reduction school of thought in drug policy. Today, I’m speaking with Kavita Doobay ’27, a junior at Brown and one of the co-founders and co-leaders of Harm Reduction Coalition.
Evan Tao
Kavita, thanks so much for joining me.
Kavita Doobay
Of course, my pleasure. Thank you for having me.
Evan Tao
So you are the co-founder of the Harm Reduction Coalition. Your group won the Best New Group award from SAO last year. Congratulations on that. What is harm reduction? What are its goals?
Kavita Doobay
Okay, so I think that harm reduction might mean something a little bit different to everyone, but to me, harm reduction is really about keeping people alive and safe. Public health often fails to address the true root of a lot of systemic disenfranchisement within so many different communities. But I really see harm reduction as an exception to this. Harm reduction came out of a place of resistance, from a lot of policies like the “war on drugs,” which were never really about drugs or about substance use, but were generally about controlling poor people, controlling Black and brown people and also controlling political dissidents. So a lot of the stigma around substance use, homelessness and sex work were never really about stigma. They were really, truly developed to dehumanize certain groups of people. There's this one quote from the book “Undoing Drugs.” And it says "harm reduction is a current manifestation of the age-old struggle for the universal recognition of the inherent dignity in all life." That is truly to me, what the core principle is of harm reduction, and it's really something that works to respect and honor the dignity and the agency of just every single person, regardless of whether you're homeless, whether you are a sex worker or whether you use drugs.
Evan Tao
Dignity and agency.
Kavita Doobay
Yeah.
Evan Tao
Let's go back in time a little bit and talk about the “war on drugs.” When did that begin? What did it look like, and why is it panned by both sides of the political aisle now?
Kavita Doobay
Yeah. My friend Kenneth, who is one of the co-founders of the harm reduction group, does this amazing thing every single year — he talks through the concept that the “war on drugs” has always been happening, and he always references this one New York Times headline from literally 1905 and it's called "NEGRO COCAINE EVIL.; Mississippi judge urges grand jury to punish druggists." And literally from 1905, you see drugs, and you see all these stigmatized behaviors as a proxy for racism and for classism. When you talk about the war on drugs, it's impossible to do this without talking about Richard Nixon. John Ehrlichman, who was on his White House Council, literally said that the Nixon campaign in 1968 had two enemies, which were the anti war left and black people. And they knew that by getting the public to associate hippies with marijuana and Blacks with heroin, and then criminalizing both of those things, they would be able to disrupt their communities. So that is the very origin of the “war on drugs.” Then you have (former President Richard) Nixon give out his whole political statement. Drugs are “public enemy number one,” and like, even at the time, there was a poll surveying Americans, and only 48% of respondents believed that drug use was a serious problem. And 4% of American adults at that time had even tried weed. So obviously this was founded with no need and with no real concerns for what was happening.
Evan Tao
What happens when the Democrats take office under (President Bill) Clinton? Do they continue it? Or do they reverse course?
Kavita Doobay
No one is really challenging this, right? Because this has become such, like a dominant societal practice, and it's like you were all taught as kids, like the "dare to say no to drugs," "just say no," drugs are bad. And drug use is something that has become so stigmatized, and not even just drug use, homelessness and sex work and all of these things where it's hard for people to even stretch their moral imagination to think about what actually like caused drug use in the first place.
Evan Tao
Let's zoom into Rhode Island now. So what did medical care for drug users look like before the harm reduction movement?
Kavita Doobay
There was just a lack of access to holistic care that really focused on addressing a lot of these systemic issues and a lot of these social determinants of health. A lot of times, this would look like people going to emergency rooms and either getting into, like forced rehab or sometimes advanced places before actually having needle exchanges or anything, or develop access to medications for opioid use disorder, and that looks like going to methadone clinics. But an issue with a lot of these interventions is that they are not always the most accessible or the most effective at treating opioid use disorder just because of how kind of topical they are.
Evan Tao
So what changes with the harm reduction movement?
Kavita Doobay
The difference with harm reduction is the focus on a person as a whole within society. Harm reduction sees a person as an individual who's not just acting with their own agency and making all of these decisions of their own free will, but also as somebody who has been heavily influenced by society, by the political environment, by the economic environment, and by social conditions that have been created to encourage engagement in these behaviors, including drug use and sex work, that are very heavily stigmatized. So harm reduction is not just focused on, like, "Okay, here's this intervention, and this is what we're going to do,” right? It's focused on building relationships. It's focused on being consistent and building trust in systems that have betrayed people in the past. To build back that trust is more than just, “here's a doctor, here's what you're going to do.” It's about having people who have been in the same spot as you before, having people with lived experience that are working to not only run these interventions, but to design them as well.
Evan Tao
I find that so interesting, that first thing you said about how harm reduction sees people as not having 100% free will, right?
Kavita Doobay
Yeah, that's maybe not the best wording, but the concept.
Evan Tao
That is philosophically, what's behind it, right? The choices we make are so shaped by the contexts that we live in. I sound like Kamala Harris now, you think you just fell out of a coconut tree? But there's something to that, right? Some of the language that I sometimes hear is that addiction is a disease, right, not a choice, and you don't choose to have diseases. Your diseases come from your environment. Yeah, that's fascinating. So tell me a little bit more about what effective rehab does look like.
Kavita Doobay
I don't have lived experience as a person who's using drugs, and also, I'm not a social worker. I think that if somebody is going into rehab, the first thing is that they decide what recovery looks like for them, right? I think that a lot of traditional rehab programs, it's just the idea that you're only in recovery if you are not using any substance at all, and you can get there by following this exact process. I think that that's something that is not centered in the values that we talk a lot about in harm reduction, right? Centered in respecting people's agency, respecting people's dignity and empowering them to make their own decisions. And it's voluntary, it's long term, it's holistic. It addresses housing, mental health and social support, and not just substance use in isolation.
Evan Tao
So there's been some policy arguments, especially on the conservative side, but increasingly on the liberal side, too, for compulsory rehab. And although we can really want to respect people's agency, If somebody tells you I don't want to get clean, should we respect their wishes?
Kavita Doobay
Yes. And I think that the push for compulsory rehab comes out of this very confused perception of what drug use looks like, right? I think a lot of people think, okay, if you're using drugs and you go to rehab, you come out clean, and then you're clean forever. But that's not how that works, right? The chances of people relapsing are so high, and also people are more susceptible to overdose and fatal overdose when they are in recovery.
It’s this perception that recovery is where we need people to be. Recovery is the only way that people can function when there are so many systems that have developed against this idea, right? In the U.K., there is this practice where physicians are allowed to prescribe a sustenance level of, for example, heroin to people where people can become functional addicts, right? You can live your life while using in manageable amounts, because you don't have that stress of, “where am I going to get my next dose?” Where you don't have to worry about your supply being super contaminated, right? There are all of these other things that people should be thinking about when thinking about what recovery looks like, or what it looks like to not have chaotic substance use issues, right?
Evan Tao
I do want to push you a little bit on compulsory rehab, though. I mean, we can agree that addiction is not a choice, and that because of the way that addiction manipulates people's thinking, that the choices they make are also not fully their own. They don't really have full agency. When they're under the throes of addiction, when they're suffering withdrawal, they might not be able to make good choices for themselves. How do you think about that?
Kavita Doobay
Think about it this way, I could not get up today without drinking my tea that has a whole bunch of sugar in it, even though I know that it's not great for my health, right? I get so grumpy and tired. I had a midterm today. Would have fallen asleep during it. Would not have been able to write my midterm. I know that I'm not the only person who's like this. My dad will get jitters and will get headaches until he has like three to four cups of tea a day. And my mom gets migraines when she doesn't have coffee twice a day. And this type of obsessive behavior despite harm is viewed with other addictions. So addiction is defined by the National Institute on Drug Abuse as "compulsive behavior that recurs despite negative outcomes, regardless of whether substances or compelling activities like gambling are involved," right?
Once you start looking into the history of the drug war, you will learn that substances like caffeine, alcohol and nicotine are different only in the fact that they are legal … bans and harsh policy aimed at particular drugs have always been related at least as much to the kind of people who are using them than to the actual harm associated with the drug itself.
Evan Tao
So you're envisioning a world where marijuana, heroin, cocaine — using those things is as normal as alcohol or caffeine.
Kavita Doobay
Yeah. I mean, the comparison that we made at our first harm reduction general body meeting was that in the Ottoman Empire of the 17th century, drinking coffee in public would get you beheaded, right? Like, this is because there is a stigma associated with it. You're drinking coffee. And coffee is this big evil, just as much as when you think of somebody using heroin, it's this big evil. And it's like, drugs that are legal — "drugs," in quotations — that are legal do not have that status because they're any less harmful than these illegal drugs, right? Their users and their sellers just had the power to influence the people who are making these decisions, right, about what is legal, what is illegal, what is good and what is harmful to society, right?
Evan Tao
Yeah, when you're thinking about, like, alcohol, that's objectively a very harmful drug, in terms of health outcomes, in terms of being dangerous to others, and that's why we have DUI laws, for example. But possession itself is not illegal, right? So maybe the role of policy isn't to criminalize or decriminalize, but to kind of create boundaries around which safe use can take place.
Evan Tao
Let's talk a little bit about housing policy next.
Kavita Doobay
Yes.
Evan Tao
There's a well-documented link between addiction and homelessness and something of a debate over which one causes the other. What's your opinion? What is it your experience has shown you about the link between these two crises?
Kavita Doobay
Yeah. So there's this school of thought called Housing First. And this was started by Sam Tsemberis, not sure if I'm saying his last name correctly, but a mental health professional who worked in New York City, right? And I'm sure that these ideas long predate our buddy Sam. I'm very interested in this idea, and I fully agree that for so many people, addiction is a side effect of this larger instability that people are experiencing when they are unhoused. Even on outreach, I have heard stories from people expressing that they use, not only to cope with the instabilities of being unhoused, of not knowing where you're going to sleep that night, but also because you're laid bare for the whole world to see, right? Somebody once put it that it's like when you are unhoused, you're not even afforded the basic privacy that we get when we can just, I can just go into a closed room and not be judged by people, but you're living your whole life out there for people to see. And people will walk away from you, they won't make eye contact when they're talking to you. And you can feel less than human, right? It can get to somebody, and it's very hard to deal with this if you don't have an outlet. And for so many people, that outlet becomes substance use, right?
I do fully understand why this approach has gained so much popularity and has been expanded across the US and works really well. But both of these issues are products of very large systemic inequities. And I think it's really hard to say that Housing First is the only way that anything will ever work. There are people who are able to get into recovery, or who are able to manage their substance use in whichever way that looks for them, while still being unhoused. I think it's really hard to say materially, this one works and this one doesn't.
Evan Tao
It also strikes me that the converse is also true, right? People who have stable housing and are still addicted. West Virginia, for example, very low homelessness, very high addiction.
Kavita Doobay
Yes, that is exactly a very valid point.
Let's talk a little bit about what it's like being a student in some of these spaces and what it was like founding Brown Harm Reduction Coalition.
Kavita Doobay
So I started the coalition with two of my friends, David and Kenneth, and we were just talking so much about things that we were seeing on outreach with HOPE (or Housing Opportunities for People Everywhere), or just getting out into the community in Providence, and we started the coalition with this idea of students who go to school in Providence need to be more involved in these efforts within our own community. And we need to get people out there. We need to get people making injection kits for intravenous drug users, or just doing outreach with people who are unhoused and use drugs, right?
But we eventually realized that not only is this work important and it's something that we continue to do, we have this very unique positionality as students on College Hill, where we also need harm reduction. Harm reduction is not (only) for people who are using intravenously. People who are using in clubs, in bars, people who are using Adderall and go to Brown. Everybody needs harm reduction. Your supply could be contaminated with (fentanyl) or you could be thinking that you're taking Adderall and you could be taking meth. Like, there are so many things that students on campus need to be aware of. We've realized that there is this pushback, and we were there at the start too, right? Do we even need harm reduction? Is this our job? Is this where we are best using all of these resources, but everybody needs to be a harm reductionist. Everybody needs to carry naloxone, so no matter who you are, or no matter where you are, no matter whether you live on like College Hill, or if you live downtown, these are things that people need to be aware of, and these are things that people need to be talking about in a different culture that needs to be developed.
Evan Tao
Yeah, that's interesting, isn't it? Because people of different social classes all use drugs, right?
What's it like being a student in those spaces, in the overdose prevention center, as someone who's learning and studying?
Kavita Doobay
I think that people there are so welcoming and so kind, but sometimes I really do stick out like a sore thumb. Especially in places like Weber that are so special, they're almost entirely staffed by people with lived experience in either using drugs, engaging in sex work or just living on the streets, and entering into these spaces is so special for me as well, because it's like a different world — people there are so comfortable with each other. There's this element of trust and vulnerability in literally every single interaction. And getting to witness this and getting to be part of a community that is really taking care of each other means so much to me. This work is something that flips everything that you've ever known right onto its head, and you're rebuilding. And it just gives me a different perspective in a lot of the work that I do.
Evan Tao
Last question, what do you wish more Brown students knew about addiction and homelessness?
Kavita Doobay
I think primarily, addiction is not a moral failure, and homelessness is not a choice. Reexamining what we know about drug use, reexamining what we know about all of these stigmatized behaviors and why they were constructed that way, how we learned about them, and realizing that the stigma that surrounds these things are the results of systems that have decided that some people are less deserving of safety and care, and realizing that we can do our part to counter this by literally just not buying in. We can believe that we all have a role to play in creating this community and in challenging these inequities, literally just by caring about each other.
Evan Tao
Kavita Doobay, thank you so much for joining us on Bear With Me.
Kavita Doobay
Thank you for having me.
