Harm Reduction

November 01, 2021 Joe Van Wie / Jonathan Blake Season 1 Episode 2
Harm Reduction
Show Notes Transcript Chapter Markers

Jonathan Blake is currently a Licensed Social Worker in Pennsylvania. Jonathan obtained both Bachelor’s  (BSW) and Master’s (MSW) degrees in Social work from Marywood University, graduating with his MSW ins 2014. Jonathan has worked in the substance use field, as a primary counselor in both inpatient and outpatient settings, and currently works as a medical social worker, with main focus on behavioral health.

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Joe Van Wie  0:02  
All right. Well, we're here to hot mics right now. And in studio is my friend, John Blake, John, how are you? I'm good, Joe, how are you? I'm doing well. Just you're doing a podcast with you. Thanks for coming. This is John's fourth time. But this is probably the first time you're hearing him. John has been a big help with me trying to find a format that seemed relaxed, genuine for this. So we can discuss things not only in recovery about, you know, behavioral health, social work. Just kind of intro of you, John. John, tell me. How did you end up in this field, just to give a little background before we start picking some topics we'd want to talk about.

Jonathan Blake  0:57  
So yeah, I went back to school as a non traditional age college student and ended up in the Social Work major at Marywood. And got my BSW and with the plan to get my Master's in social work at the same time, and I completed that. And then, at the time, I had already been working at Mar worth. And so I naturally transition to a counseling position once I graduated with my master's.

Joe Van Wie  1:24  
In John, are you are you yourself? And recovery? Yes. So you worked in more words, and you just you just currently finished your masters?

Jonathan Blake  1:44  
Yeah, I graduated my masters 2014. Okay, yeah. And I've been working in the field as a master's level clinician, since

Joe Van Wie  1:52  
what drew you to do this work?

Jonathan Blake  1:54  
I think it was just a natural progression based on life experiences with substance use with incarceration and various problems, just the natural progression to the field of social work. And it's been a natural fit, learning about the code of ethics, and you know, the code of conduct and everything that goes into social work, the key values resonated with me, and it just wasn't natural fit.

Joe Van Wie  2:18  
What was distinct about you get to experience recovery, non professional, kind of help and support? Same as, as me? What changed in your attitude, and maybe your approaches in your beliefs about not only your own recovery, but how you help people just from the education alone?

Jonathan Blake  2:40  
Can you say that again? I'm sorry.

Joe Van Wie  2:42  
So what I'm trying to speak to is what's what's the distinct difference between being a professional and non professional help that you basically learned in undergrad? What was the distinctions

Jonathan Blake  2:55  
that you would see? Yeah, so the professionalism I think, is, was the big part of that. And that's really informed by the ethics and the, in the, in the, the ethical considerations that goes along with the profession. And to me, that kind of builds a professional body of work. And then there's certain concepts and there's certain values that are inherent in the profession, you know, whether that be maintaining relationships, or a focus on relationship and building a relationship with therapeutic alliance with somebody, it just, you know, that kind of stuff isn't built into the informal education of it.

Joe Van Wie  3:25  
Yeah. And did you find this to be helpful when helping someone therapeutically, like as an approach of things you wouldn't have considered with?

Jonathan Blake  3:36  
Oh, yeah, absolutely. Because it allows me or clinician to be more objective, right to take the, the subjectiveness, or the biases out of it, and kind of, you know, again, come from a framework of ethical considerations that person presents to you with problems, how do I solve the problem? You know, how do I, how does what informs the care? And so everything that informs the care and how we go about solving the problem is informed by the principles and the values of the profession? And that's how we go about it.

Joe Van Wie  4:03  
So you take, it's always based on this constant approach of do no harm.

Jonathan Blake  4:08  
Oh, yeah. I mean, at the very least, but it would go well beyond that. Yeah. Well,

Joe Van Wie  4:11  
you know, well, speaking to that, what was your first entry level job and speak to that experience, how it it kept you in this field?

Jonathan Blake  4:24  
So yeah, my first entry level job was as a, whether you call it a chemical dependency technician or chemical dependency specialist, but basically a paraprofessional, working in an inpatient treatment setting, you know, really the, almost like a quasi professional babysitter in a sense, but really, they're in off hours and interacting with patients and clients in a more informal setting, but while also having you know, groups and expectations, you know, professional expectations, the carry out duties as well. So there was kind of a mix of an informal approach with some formal interventions as well. And that allowed me to connect with people and you know, build relationships and learn how to build relationships, learn how to talk to people, learn how to approach people learn how to like treat people, normal and like a human. And then ultimately, you know, empathize with people.

Joe Van Wie  5:15  
Do you ever you ever miss being a tech? Yeah, yeah, I miss mixing it up. Being a tech for me, was the year COVID. Myself, and it's the best job I've ever had. I mean, in the sense of what was going on in my life, what was going on in the world, I got a chance, five nights a week to listen to people. And I haven't listened to anyone in five years. The pocket of empathy that opened up to me to know I didn't have to give advice, the person just wanted me to listen. I'm not supposed to get a therapeutic effect by working in a treatment center. But my God, to realize to a degree, I haven't been listening to anyone's real pain and and what that did for them, they knew I was sincerely listening. After a while I was interested who in their lives. That was help in itself, just observing them.

Jonathan Blake  6:12  
Yeah, I remember I remember, especially working in that role. People would ask me, you know, patients, they'd be like, oh, like, you go to meetings, and this and that. And they'd be really curious as to what you did with your own recovery. And somebody would be like, Oh, you don't go to meetings? This is your recovery here. And I'd be like, Oh, no, this is like, my job is professional. But no, like you said, at the end of the day, you definitely take something with it. And you're you're using the skills of active listening and empathizing with people. And I think that doesn't have a reverberation throughout your body. And you know, your outlook and your attitudes would be short sighted.

Joe Van Wie  6:42  
I took advice from you. Nick, some guys I knew in the field. And I took it serious. The days I was off, I went to meetings, to just even have the support knowing my recovery was not the job. You know, it sounds cliche to anyone who's in recovery works in this field. But it was a truth I want it to hold dear, dear to because I don't want to be funneled the two because I was just learning professionalism in a treatment center. I was in advertising. So I wanted to take that very seriously. So on my off days, I've made sure those days were about my recovery. Oh, John, when you first started in this field, what what I kind of just want to warm up to and at least talk about is harm reduction. Because the reason I'm asking you, I know you know a lot about it. And in my personal experience just for the audience understand. I grew up in an age like a 90s, around recovery, recovery language, drugs, the drugs, drug, methadone, or methadone clinics sounded like a plague scourge that could show up in someone's neighborhood. I remember I remember distinctly in high school battles, especially in our area over who can put a methadone clinic and I remember being upset a guy, you know, drug addicts, just drinking orange juice, drugs and running the streets, orange drink around their lips breaking into your homes. Ha, I didn't have a context of the high of heroin that this is not happening. The words sounded frightening. They were really branded bad from the start. But I grew up in an age where I thought harm reduction programs were a half measure. And of its allowing people to have a regulated way to use drugs this marginal life, I had no perspective of it. When did you first learn about harm reduction programs? And what what was your belief behind them with your your earliest belief?

Jonathan Blake  8:54  
I mean, I think, again, with my own personal experience, I think I've always kind of been into harm reduction. You know, I mean, probably the first time I've ever heard of harm reduction would have been way back in my youth of needle exchange programs, and them not being available. And, you know, locally, we didn't you went to cities, and in bigger areas. There were some grassroots things happening, but but certainly not locally. So yeah. So that would have been my first would have been nice to hearing about needle exchange programs and the methadone maintenance programs as well. They would have been the first two things, and like you identified locally, you know, there was no methadone maintenance for a long time. I think the closest was in Jersey and Allentown and that's where people drove to and then when they put one here locally, they had to put it in an industrial park away from residential away from everything, not near a bus stop, they probably had to create a bus stop for people to go there. Just to, you know, quell some of the fears, the misguided fears of people about what methadone maintenance is like, like you already articulated, just

Joe Van Wie  9:59  
to dial back a sec. again, just to introduce the idea of more, what is a harm reduction program? Like what do they consist of? What is harm reduction?

Jonathan Blake  10:06  
So I mean, if you're talking about in a broad sense, I mean, seatbelt laws would be harm reduction. Right? I mean, yeah. So yeah, harm reduction is huge. But in substance use, I mean, if we're just specifically talking about that, it would be you know, needle exchange programs. And at being more available, I mean, even information, they have crack, pipe, not exchange but give outs snorting could give out, giving out meth pipes to people, condoms, teaching people about sexual health, HIV testing, STI testing. Yeah, I mean, it can encompass a lot of a lot of services that, again, that are just anything that's meant to reduce the harm to reduce

Joe Van Wie  10:45  
the harm. That's it. And and in their past, they've been provocative and most, you know, family or conservative areas, neighborhoods, my experience, and just seeing how the media could sensationalized a story like that. I want to stay on harm reduction in specific to not only needle exchange, but the history of methadone. Suboxone and tell me why when you saw the these ideas, why did that make sense to you immediately? Like, what is the philosophy behind it?

Jonathan Blake  11:20  
So all of harm reduction or like MIT or certain like, so I think there would be different nuances to different ones, but overall harm reduction. To me, it speaks to me because it's a human approach. So it's taking my values out of it, or I mean, I guess my values are bias biases, I guess, if I might have a bias, proponent for harm reduction, so that would still be there. But again, it would take out like any expectation I would have that person would need to achieve abstinence or achieve some certain measurable thing have changed that I've identified, it allows the person to tell me, what do they want to do? What do you want to do? What do you want to lower your risk for HIV? Do you want to keep using drugs? Let's figure out how we do that. Right? Are you using IV? Are you having unprotected sex? How can we mitigate some of those factors? Stopping drug use may not be feasible in that sense, in that instance, but maybe providing condoms as a step, right? Or maybe helping somebody move away from a needle into a a route of administration that where there's a less risk for overdose, not saying that it's eliminated, but it's a lower risk, and it's a lower risk for HIV transmission as well.

Joe Van Wie  12:23  
So the approach from its start, it's humane, it's humane, there's a condition that exists, addiction. It's not this, this. So I really think, like, it's hard to talk about both without mentioning stigma. Would you say that?

Jonathan Blake  12:40  
Yeah, I think to kind of go back, though, with harm reduction. I think even defining it as an addiction is already like, it kind of be in contrast, what harm reduction is because of harm reduction, we're not like drug consumption isn't the measure it that's eliminated, we're not worried about drug consumption. So whether it's an increase or reduction, that means nothing we're looking at, is there an improvement in social functioning is improvement in health functioning, and so all the different layers of where an improvement can be? Or what the person identifies that the harm? That's where we see, that's what we're looking for. Yeah,

Joe Van Wie  13:11  
so the metric isn't cure resolution? It's a it's a metric. It's just utilitarian. Can we improve? A they stay alive? And the quality of life and then you possibly don't harm other people? Exactly. Okay. So that why why do you think populations didn't understand that?

Jonathan Blake  13:32  
Again, with with with drug use, I think that the behavior, the, the manifestation of the user behaviors that people can accept, within reason, you know, there's a lot of things that go along with it. And then the dangerousness of continuing to use of overdose and, and putting your life in peril. So some I mean, it's difficult to to accept that maybe somebody is going to keep using drugs, it's illegal, they're going to keep doing it. Maybe you have a value judgment that they shouldn't be doing. And it's bad, but somebody's going to keep doing it. So I think that, I don't know, I guess, maybe liberal approaches to anything. There's pushback immediately, you know, initially, but people come around. I know, Ralph Nader had to fight Richard Nixon to put to get the EPA and seat belts in cars. You know, we're all grateful for those now.

Joe Van Wie  14:22  
Have it, to your knowledge, any harm reduction efforts in this country from needle exchanges to methadone, as they have they increased drug use?

Jonathan Blake  14:37  
So again, that wouldn't be the measure. So we wouldn't know you know, but again, have they decreased overdoses? Sure, have they decreased the transmission of HIV 100%. So, again, we have to communities defend, identify the goal. So if the goal is harm reduction, drug use going up or down isn't in consideration. So, again, some MIT like buprenorphine Feeling methadone. There is some research that shows that there might be an increased use of illicit use of buprenorphine if you're prescribed buprenorphine. But that would also seem pretty obvious as well. But again, if the risk is death, and then the other side is Now somebody might use too much buprenorphine because I've judged that that's too much buprenorphine, right. Maybe they, whatever the dosing is, you know, but again, they're not dying in their life.

Joe Van Wie  15:25  
How many dead people? Do you know that? How many of them gets sober? Oh, that's easy, quick. Sober jokes of growth. Now. I think this was one thing, you know, that I had to confront. Why do I believe the six? I didn't think methadone allowed someone to feel that they were sober or stable. And I don't know where wasn't, it wasn't an idea I created by myself for a decision. It seems like it was there waiting to be dug up because of how I experienced the pushback the opposition to methadone clinics when I was in high school or grade school, the way it was described in the 80s for drug classes, that were zombie walking around drinking orange juice. And I think that stayed with me and it added to my own stigma. So why stigma and this is why I wanted to talk to you today about it. I'm just so curious. Sometimes I have beliefs. I don't even know how I decided they're mine. And this was one of them, where I feel I've made a critical error in judgment, that harm reduction keeps people alive. It's humane, harm reduction when it comes to drug use IV drug use, especially. And that's what I want to really zero in on because I was in a position myself with having to decide when I agreed on some of these things. And can you explain to me how a little short kind of history of methadone and how it evolved into Suboxone? Or to the idea of what what is Suboxone?

Jonathan Blake  17:14  
So yeah, suboxone buprenorphine is the medication and there's different preparations for it. So you know, there's buprenorphine by itself, and there's buprenorphine combined with naloxone. So buprenorphine combined with Naloxone, which is Narcan, it's the the opioid antagonist. And so if it's crushed up and injected, that's when the Naloxone will be activated. And so buprenorphine can't be abused that way couldn't be abused by snorting or injecting it, so you can't inject Suboxone, you can if it's just buprenorphine, but if it's a preparation that's mixed with Naloxone, you can't but you can abuse it orally. I mean, you could take you know, you can keep taking them, you know, as much as you want. But the difference between buprenorphine and methadone, which, you know, when I'm sure, between the two of them, so methadone is a full agonist for opioid agonists and buprenorphine will be a partial agonist. So methadone is going to fully activate those opioid receptors and give you that full effect that you know whether they want to call it a high or whatever, the full the full effects. So what's there from the from the drug, certainly not like heroin or fentanyl, and it's powerful, but then buprenorphine is going to not not excite that receptor site as much as a partial agonist,

Joe Van Wie  18:20  
would it be limited, but like descriptive to call it the euphoria of of the drug?

Jonathan Blake  18:25  
Ultimately, I mean, that's what it's trying to limit and get away from, but again, honestly, the research around buprenorphine suggests that higher doses of buprenorphine are the most effective and longer time taking it. So So dose is typically 60 milligrams and higher daily, really show positive results versus like 50 milligrams results to what goal so people staying alive and people staying abstinent from other opioids, so they're still maintaining with the buprenorphine but abstinent from other opioids, and all in you know, the other markers of whatever the research has identified in that study

Joe Van Wie  18:59  
with suboxone and methadone. What do you know what the original idea was for them? Like the use was at a taper down? Yeah. So

Jonathan Blake  19:10  
I mean, substitution therapy has like really been a part of the drug story from inception. Right? So if you think about, morphine was used to get people off alcohol, alcohol was used to get people off morphine, heroin was used to get people off morphine, beggar made heroin, so really to get, you know, get people off morphine. And so all these things have been there. We've always been using ma T and agonist treatments and kind of cycling through these things. So methadone was a pharmaceutical concoction, you know, it was meant to be a substitute and it was meant to, at the time, really specific populations and really specific people. And to be honest, the research around methadone, like even I mean, they've tried methadone in the 60s before the Rockefeller drug laws in New York. He was, Rockefeller was a liberal, leaning Republican or so they say but You know, they tried funding, methadone maintenance programs, even people, you know, fought it, and they tried it, and they didn't see what metrics they were using didn't see reduction in drug use. But again, if we're talking harm reduction, the goal isn't reducing drug use, the goal is keeping people alive and reducing some, you know, the health costs and the social cost surrounding it.

Joe Van Wie  20:20  
So can you speak to on average, when a person's you know, hypothetical, they're suffering from heroin addiction, and crossed over to fat and all this mix of whatever they could be taking into ingesting, shooting up? I don't hear methadone a lot anymore. It's just it seems like everyone has Suboxone. So how would that work? I want to get sober and I have I'm having terrible time stabilizing, it's excruciating. Is there a metric that shows I have a better chance of success? If I'm willing to do a maintenance program for three months to a year as a suboxone rather than go cold turkey? Cold Turkey being just like, going to an abstinence based program? Like is there any kind of studies out there to?

Jonathan Blake  21:15  
Yeah, again, what the research suggests is that with buprenorphine maintenance programs, that again, he'd say, the higher the dose, and the longer the duration of time, have more positive outcomes with abstinence from the drug than abstinence based program.

Joe Van Wie  21:29  
And how long do you know how long these studies have been following people? Like a year five years? Kind of?

Jonathan Blake  21:34  
Yeah, I'm not exactly sure. Yeah.

Joe Van Wie  21:40  
I see it, as you mean, I've seen a lot of success rates just as personal Well, that's I'm not saying that's a study, but I really, I've, I've changed my mind. I did not always believe that. And it wasn't from any evidence, it was just what I was told, you know, drugs or drugs, a drug kind of ideal. But that same logic, I didn't apply to other things. I think stigma really damaged the idea of media and the stigma that was created in my head. Once I started reading about these programs, it could it fell apart, like like, this is not even. There's no question here. It's humane. Or tickets, a really strong tool to help someone get to long term sobriety, whatever that would look like for them. That gives them a chance to get their life back at least as some kind of transition.

Jonathan Blake  22:36  
Yeah, I mean, we can really call them life saving medications, you know, like life maintaining medications at the end of the day. But, you know,

Joe Van Wie  22:45  
this suboxone work for fentanyl withdrawal.

Jonathan Blake  22:49  
So fentanyl is a much more powerful opioids. So the dosing might be, again, I'm not exactly sure what like the dosing would equate to that to somebody coming off but again, methadone, methadone dosing, and and can be can be more appropriate for people that have higher tolerances and where the, the withdrawal symptoms aren't being touched by the buprenorphine. So the craving still there, like there's ways that they can measure whether or not it's an effective dose, and it's if it needs to be increased, or again, try something else.

Joe Van Wie  23:19  
Do you think we need more of these programs? Do you think there's enough?

Jonathan Blake  23:23  
No, I mean, even even if you look at and it could have changed, but the last I know, like, past couple years, is that doctors in their first year of having a license for buprenorphine can prescribe to 30 people after the first year if they maintain credentialing, then go up to 100. And after that, then go up to 275. Again, if they maintain credentialing one doctor, one doctor, but you know, you look at like other countries like France, France, they have no I think since the 90s they've been any doctor can prescribe buprenorphine. So it's probably a lot more people using buprenorphine. But I don't know, are there overdose rates lower? Or, you know, are people able to work or people, you know,

Joe Van Wie  23:58  
ours climbed up to 80,000. And within the last decade, and there might surpass six figures this

Jonathan Blake  24:06  
year, we had 99,000 in the 12 month period from March to March. Oh my god. Yeah.

Joe Van Wie  24:11  
4000 people died in the World Trade Center from a terrorist attack. And we've we spend a trillion dollars or less 20 years. I mean, 100,000 Americans have a, you know, a disorder, a substance use disorder, cognitive problem, physical addiction that, you know, it's growing, it's spiking up, it's not going down. What do you think of where do you think the fight is for you? Do you do besides the work you do? What what legislation do you support? What initiatives to combat stigma would help soften the blow that people can use medication to get off drugs? Yeah,

Jonathan Blake  24:56  
so I think so the MIT is a good point and how people change their minds, right? And how people kind of maybe have, you know, a come to Jesus moment or a paradigm shift within themselves like, oh, wow, like this works, people can stay alive. I would say that the same could happen if people read about needle exchange programs that people read about. Giving out people, meth pipes, right to go into go into cities where there's like methamphetamine encampments, and people are using IV methamphetamine, like, Hey, guys, why don't you try smoking meth? That's a great harm reduction technique. And that's something like countries like Portugal that have legalized drugs. Now, when you look at the youth population, the demographics of the drug users, the majority of them smoke, they don't inject. They don't shoot drugs, I think they said, like they give out 100,000 needles, or the hundreds of 1000s of needles per year versus cities in the United States that are giving out millions of needles a year. So I think that's like, the MIT is a good example of how people can change their mind if they open up to it. And really, the opioid epidemic probably opened the door for a lot of people, or what we're calling this recent opioid epidemic, opened the door for a lot of people to be willing to change their minds, because again, most people were touched by all everybody dying. When this fentanyl and all these other stuff popped up. A lot of people were touched by it. And so it became much more personal. And I think people were probably more willing to examine things that they hadn't examined before. And in those moments, you would hope there could be like a real big paradigm shift or like a change in things. But you know, we didn't really see that all we again, we saw buprenorphine and MA T becoming much more accepted, I think in mainstream treatment. And again, the research has been supporting that. But again, all these other harm reduction techniques that are shown to be very much effective are still you know, they're not utilized there. I mean, needle exchange programs would be illegal in Scranton, you mean you literally could be arrested for it or giving out methamphetamine.

Joe Van Wie  26:47  
I like to give credit to the Scranton mayor, we do have a very progressive Mayor friend of recovery and treatment in the degree. She now proposed legalizing fentanyl strips to test drugs, that they're not criminal to have. I mean, what did you think of that? When you saw it? Did it give you hope that I mean, changes can be slow, but it did give remember anyone else proposing hell? Yeah,

Jonathan Blake  27:16  
it gave me hope. But I think if you look in the cities that have done it, they did it through executive action of their mayor. And that's not what happened in Scranton, so Oh, okay. Yeah, I don't think they're still I don't think they've been the I don't think that's been resolved as of yet.

Joe Van Wie  27:29  
Okay. I couldn't speak to that. Well, hopefully it will. But I've gotten to speak to her a couple times. And she gets it. She gets recovery. She gets what works. What's humane. So maybe she just needs more some voices of support, like us.

Jonathan Blake  27:53  
Yeah. And I think that's what I think it's education. For most people. I think most people don't want people to suffer. They don't want people to like, you know, use dirty needles or expose themselves to HIV and AIDS and hepatitis C and all these things. But again, the fear and like you said, the stigma that's been beaten into us from Forever, right. Yeah, I mean, it's, yeah, it's unconscious bodies.

Joe Van Wie  28:18  
It's just always Yeah.

So I wanted to talk to you about that, because we've talked ourselves and I thought it would just be interesting to make this discussion public. Because I have a lot of friends. I don't know what they believe about these things. And I think it's worth starting to discuss because of just the sheer numbers of people loved ones people are losing. And without China sensation, I like the dread and the fear of fentanyl. How would you describe fentanyl versus heroin? What how is fentanyl change the the response local and county government should have for this the opioid crisis.

Jonathan Blake  29:11  
Again, I think it kind of brought it much more to the forefront and you know, people I think people are much more willing to to address it. But yeah, I mean, I guess to me hearing about fentanyl if I was in that position in that world, you know, they talk about it not to be offensive, but a junkie pride, you know, and even you know, felt that, you know, when you're using it's like this kind of like nothing can hurt me and what I'm doing is better than anybody else. And I think that that would put a crack in the facade of it, at least for me, you know, thinking that something I'm buying could have fentanyl could be fentanyl. It could be packaged as something else, you know. So to me on the outside looking in now, it's terrifying, but in the world I'm sure I don't you know, I don't know what it's like.

Joe Van Wie  29:56  
Yeah, I'm getting to see it. It's scary. It's scary. to see someone that could be in their first week of addiction second week, but opioid addiction and get something that they didn't buy, buying heroin, and it's not heroin, it's fentanyl. So can you can you describe the distinct difference between heroin and fentanyl? Like that makes it more potent and more dangerous, more likely to OD? How would you describe that

Jonathan Blake  30:24  
more of it's getting across the blood brain barrier, ultimately. So whatever it is, it's more lipid soluble. And it's getting into the brain more of it's getting there. I mean, it's the chemical reaction in the brain ultimately. So you know, whatever it was, I mean, heroin added two methyl atoms to it, or methyl molecules that again, made it more able to cross the blood brain barrier than morphine, which is what heroin. Morphine is the written to

Unknown Speaker  30:46  
organic compound. It's just its most powerful.

Jonathan Blake  30:49  
I think car fentanyl is the most powerful, which is another synthetic

Joe Van Wie  30:54  
fentanyl distinctly can be produced cheaply, all of it. Yeah,

Jonathan Blake  30:58  
I mean, carpet to Haley. Yeah, anything that's synthetic. I mean, yeah, once once you know how to do it or have the recipe? Yeah.

Joe Van Wie  31:06  
Yeah, it was tragic. There was just a story of a kid. You know, long, he was in a transitional living facility. terrible anxiety. You know, it was still out of control, maybe had 40 days of stable stabilization. So over, taken anxiety attacks, goes down to Kensington wants to get just Xanax. He just wants to he doesn't have a prescription to Xanax. He just wants a benzodiazepine to calm his nerves. He buys a st compress pill. It was a knockoff Xanax. It was fentanyl. It killed him. That's terrifying. Yeah. So I mean to pivot from harm reduction, just wanting the metrics of keeping people alive. I always get frustrated because the kid to me I'm not concerned. Yeah, he Oh deed. But anxiety is an uncontrolled cognitive disorder, kill them. Like that he would take the risk to buy a prescription drug on the streets of Kensington. My heart broke, he just needed a time. He needed tools. So what really like what, what physically killed and we know is an odd but what what is the precursor of that? What's going on? That's, that's where I think that's where I make most sense in where I fit in to the field of addiction. I want to I want to talk to people already talk about that. Yeah,

Jonathan Blake  32:39  
yeah. When I hear something like that, it's stigma to me, right? Stigma all of it, right? So if somebody you have anxiety, and so the thought is I'm gonna go buy something off the street, because I'm a drug, like, I'm a drug addict, and I buy drugs off the street, that's what I do. So imagine if there was no stigma, one around anxiety and having mental health problems, but to around being an addict as well. Or if somebody has an urge to want to do opiates. So when I hear stuff like that, and really like even the solution to fentanyl, being out, there would be legalizing heroin and having safe injection sites. Right? And how are you having the ability to control the the if somebody wants the drug? Like you can have it and be safe with it?

Joe Van Wie  33:16  
Yeah, that's a whole nother approach to understanding why didn't he have it? Why didn't he have that aid? What I mean, is it still stigma to, to speak to something wanting to achieve a homeostasis without external medication? Like how do you parse that? Am I speaking with a stigma about treating addiction as there can be a homeostasis through a method a conscious approach to life? That's a practice of meditation that you would find in a 12 step abstinence based program? Is there a stigma I'm not noticing in myself, I don't want to make a judgment on someone taking drugs, but to take the risk to buy it from the street. That's addiction. That is just risk versus reward is off your it's a cognitive problem, right?

Jonathan Blake  34:14  
But to me, this thing of fueled all of it right, and again, yeah, the Act would be the addiction and the risk reward. But why is somebody in that position? Why can't somebody go to their doctor and say, I'm a heroin addict and anxiety? I'm a heroin addict, I'm struggling. And they can theoretically and your sponsor be like, Oh, you could do that? Yeah. Like, can I do it? Like, is it really feasible? No, not is it feasible for like people to go talk to their doctor about HIV and high risk behaviors? It's not and so to think like these, these safety nets are there and people could get some of these services? They can. But again, it's not feasible, and if they're not accessing them, is that a failure on them? No, it's a failure on society. Right? Because the services are there the money is there. Like, you know, just one little thing with that Recovery Act last year in COVID. They authorized I think $4 billion for treatment there. $2 million for needle exchange programs. Most states have paraphernalia laws where needle exchange programs are illegal, you can't do it. So there's money there that isn't going to be used. It's just sitting there.

Joe Van Wie  35:12  
Why isn't there more vote voices, it's times are changing, and a lot of cultural things just in the last decade. I mean, I feel like we're at lightspeed of things. I've changed my ideas and plenty of things. Why isn't this changing fast enough? Is it's just I guess you'd need to really target on a map where, where the changes are crucial. Where are you losing the most amount of victims to? Not not having access to clean needles, the stigma of feeling like seedy? Yeah.

Jonathan Blake  35:53  
Yeah, I mean, to me, you know, it's, I guess it's the cynical side. And it's really not based in anything other than cynicism, but it would be money, money, money in forms everything. And, you know, we can talk about opioid epidemic and wanting to treat people and like all this more money for treatment, but the prison population is still over 2 million people, right? There's over 500,000 people in prisons for long sentences with nonviolent drug offenses still there, you know, so we're talking not just talk about like cannabis, but it could be heroin or crack, but any any nonviolent drug offense. So again, there's a lot of money involved or invested in not changing and not change, and not having a paradigm shift, not having these things available, not not making an addict, a criminal, right? The addict is a criminal. Unfortunately, it's a revenue stream, and it's maybe seen less in big cities, but in smaller municipalities and smaller areas, that 100% They're gonna get fines and probation and all this stuff, it's gonna support jobs, a lot of things. So again, to me, it's just it comes down to money, and there is still an investment in having people sick out there. And, you know, and that's the Yeah, I think there's still an investment in that.

Joe Van Wie  37:03  
That's a whole paradigm, a lot of really well meaning people in recovery. I don't think share, like, like, or have that shift, have just seen it that clearly. Because there's a more like, believe it or not, I mean, like, it's, it's just an old antiquated disease model, if you're only like, at a 12 step based program. This is where you have 30 days of treatment. Now, you know, since you are suffering from an addiction, you know a lot about it, right. But they they don't, where and how, outside? Like, how did that become sensible to you? Like, was it a revelation? Or did you just always feel this way yourself? Or did your metrics and education support this? What do you mean, it's specifically this idea that, you know, like, more of a French attitude of harm reduction? Stigma? Why does it?

Jonathan Blake  38:00  
Yeah, I mean, I think coming from my personal experience being, you know, part of, at times, you know, in putting myself in these positions, not, you know, they weren't, I volunteered to be part of these populations, but be part of like marginalized and vulnerable populations and being there, and being on the end of stigma and dealing with all the issues that go along with it. And, you know, I think I'm alright, you know, like, like, well, you know, so if, and I'm dealing with this, and I'm like, on a very small level, and, you know, I have a lot of, I had a lot of opportunity that a lot of people don't have, and I'll continue to have, but, but again, just kind of feeling that and seeing me seeing how I was going through it, and knowing that it was a lot worse for other people. And then again, the education just kind of followed right after that. So the personal experience, and then the education, and I just latched on to it. And you know, I love research, I love reading research, I like new things. I like contrarian opinions. So if there's somebody disagreeing with something, you know, I might listen to it, you know, and I'm not just gonna believe it, but I'll investigate it and look into it. And again, you know, some of the work in training positions come into the mainstream now, you know, so

Joe Van Wie  39:18  
John, where do you just a step off base, you've been a social worker now? What are you looking forward to in the next five years? Where do you think you're gonna make the most impact in the idea? I knew you were thinking of

Jonathan Blake  39:36  
my hope would be that at some level, you know, not that, that I can participate in some way in some sort of policy change or some sort of legislative movement, some sort of action that has like a real, a real change in practice in the drug and alcohol setting. So, you know, when the opioid epidemic became an epidemic and became a thing you know, I think mentioned, like the MIT, you know, what's MIT, just medication assisted treatment, like that became much more accessible to people. And, you know, could have potentially been a big paradigm shift. But there was it kind of maintained a treatment as usual approach with people being a little bit more open to this thing that they weren't open before, to before. And really, I mean, fentanyl, you know, accelerated it. But people have been overdosing on heroin and opioids the whole time, you know, so with this treatment as usual approach, so it's kind of sad that things didn't change, you know, much more quicker than time.

Joe Van Wie  40:32  
Well, you also get a chance to educate the next generation of young social workers and professionals in this field. And you find that these ideas are resisted as, as this kind of a standard fact of people in this field of human services, behavioral health,

Jonathan Blake  40:53  
I'll say social workers as a group and as a profession, typically, at least present as you know, being very open minded to concepts. I know, you know, in I teach a course at Mary wood on chemical dependency, or have taught in the past on chemical dependency. And, you know, I, this is what I talked about, I talked about harm reduction, and legalization and decriminalization, and the things that, you know, that, again, that not only I think are important, but again, that research and time have shown to be effective and important. And, you know, a lot of people it seems to resonate with people, people are more into a humanistic approach, rather than, you know, you know, a value judgment, subjective approach, you know, me imposing things on you, when you talk about social work, informed consent and self determination are going to be like, here, you know, the first thing that we're considering, so, you know, if somebody is really going to, you know, have self determination, they're going to what would you call self determination, you know, a person determining what they want to be or who they want to be and how they're going to get there. You know, all I am is a conduit for change in that instance. So if somebody comes to me and said, they want to achieve abstinence, that's where I got abstinent men come to me and say, I just don't want to shoot heroin anymore. Let's work on that.

Joe Van Wie  42:07  
I want a job. I want to help out. Yeah, I want to get back to school. Right? Yeah. And they could be a mix of all of what about if, what do you mean, it's I, I'm really glad you came on to talk about this. John's my friend. He's an educator. He's a social worker, and he's a professional. I've had a lot of great chats. And he's been very patient with my madness over the years. But I like discussing these things. Because I don't know I've just found the last two years with COVID a very exciting thing that I've been terrified in my adult life of is being wrong. And it's it's been really exciting to be wrong, or at least know I'm wrong. So I could hear new ideas. And I'm grateful to have a friend like John to talk about these things, because I don't know some people carry this as a duty to at least put new ideas in a thick head like mine. So I thank you. I'm really glad to came on to talk about this. And if you're interested, I'll leave some links to some of the definitions of the stuff we were talking about today. John, thanks for coming on.

Jonathan Blake  43:23  
Thanks a lot for having me. Joe.

Transcribed by

Forth time is a Charm
Personal Recovery
Career Begins
Harm Reduction
Meeting you where you are
Needed Policy Changes