Q&A: "The Media Loves Itself Some Drug War"

A conversation with New York Times Opinion writer Maia Szalavitz about covering harm reduction and drug policy at this peculiar moment.

Police officers rushed to the hospital after accidentally “inhaling” fentanyl. Public officials claim “fentanyl-laced marijuana” is behind a massive surge in overdose deaths. Florida hopes to curb drug dealing by allowing prosecutors to charge dealers with first-degree murder. Leaders in supposedly liberal cities are waging toxic campaigns to shutdown local syringe programs. Other liberal cities hope to enforce coercive, tough love treatment for addiction. Opioid medications are now so stigmatized that even terminal cancer patients are being denied pain relief and left to suffer. Over 100,000 people now die from totally preventable overdose deaths.

What gives?

During America’s worst overdose crisis in recorded history, panic, stigma, backlash, and junk science lurks around everywhere corner. Seemingly everyday there’s some news story about cops “overdosing” on fentanyl or a small-time “dealer” being charged with murder. The media’s obsession with covering a dire public health emergency through a hyperbolic lens of crime reporting has serious consequences.

Why can’t America seem to shake this punitive impulse when it comes to substance use?

That’s the main theme of this (lightly edited) conversation with journalist, author, and now New York Times contributing opinion writer Maia Szalavitz. Time for me to gush: I probably wouldn’t have the career I do had it not been for Szalavitz’s decades of dedication to covering drug policy and harm reduction. Her painstaking years of covering drug use as a matter of health and human dignity blazed a trail for writers and journalists like me to come up in a media ecosystem beset by sensationalism and cop-a-ganda. While her work changed the game, and she feels hopeful about the future, there’s still a long way to go.

The first one-third of our conversation will be free for all to read, and the rest will only be available to paid subscribers, who will also have access to a video recording of the conversation. Tana and I are incredibly grateful for everyone signing up to read our work. In order for us to dedicate more time to writing Substance, we’ll need to start asking for more of you to become paying subscribers.

I hope you enjoy our conversation, and if you feel so inclined, become a paying a member to support us.

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Zach Siegel: First off, congrats on your new gig at New York Times Opinion. A lot of us are really excited about what that signals.

Maia Szalavitz: Thanks. Yes, I’m very psyched. I have wanted to be a COW for a very long time: contributing opinion writer. Moo. I have a piece that I’m working on right now about the pain situation, which also makes me happy because that just gets ignored. 

ZS: I definitely want to hear more about that. But to set the stage for this conversation, I want to start off by saying that it feels like strange to be covering harm reduction and drug policy. Ideas that were once fringe and taboo in the US are suddenly mainstream: Decriminalization in Oregon and supervised consumption in New York; The Bureau of Prisons is now offering all three forms of medication treatment for opioid use disorder. At the same time, very old ideas that maybe once felt settled are suddenly subjected to debate, yet again, from coercive treatment to syringe programs. What do you make of this uneven patchwork, where there's signs of progress and backlash? If you could try to take the temperature, where do things feel like they stand?

MS: So it is a very, very weird moment and harm reduction has gone from, as you were saying, being really on the fringe to being close to mainstream at this point. We actually have the endorsement of the Biden administration; harm reduction is one of its key areas of drug policy. So that is definitely a very good sign and very hopeful. At the same time, you have Republicans saying [adopts Republican voice], “Oh, yeah, they're giving out free crack pipes. Haha.” 

What is so frustrating about that is that drug policy has always been used as a political football. It's never about: Does this actually help people with addiction? It's always about: Will this help me win re-election. And typically, that has been around race and around racism. It has historically been used to send a message to white racists that we will crack down hard on those people. 

So we've had this policy apparatus that is really not about dealing with the actual questions that it pretends to be about. Michelle Alexander and The New Jim Crow really made this clear for a lot of people for the first time. But it is an enormous problem because when you're trying to have the debate on the level of rationality, the data is overwhelmingly in favor of harm reduction. Giving people free heroin doesn't enable them in the sense that it doesn't make their addictions last longer. And if that doesn't enable people then the whole concept [of enabling] is ridiculous, which it is. 

That kind of illogic of the whole discourse makes doing journalism pretty hard. Because we have to deal on a level of surfaces, to an extent. He said this. She said that. Obviously, there's creative ways around that kind of a rigid form of journalism. But in covering drugs, it's easy to be accused of bias when we try to puncture that surface, and question assumptions, motives, etc.

Right, and that has been a career long struggle for me because if I say the truth about certain facts, that is considered biased. If I say, this data shows overwhelmingly that needle exchange doesn't send the wrong message, it doesn't encourage young children to take up injecting, it doesn't keep people out of treatment because they're just having so much fun with their clean needles, then I’m biased. Those are religious objections. Whatever you want to call it, they're not based on actual empirical evidence. 

My whole thing has been, for a long time, I'm gonna see this like a science journalist. If the studies overwhelmingly say one thing, I'm not going to be like, “Oh, 99% of climate scientists say the climate is changing and it's human caused, and 1% say, “No, Exon Mobil is fabulous.” I'm not going to give those equal weight because that is actually bias. That is a bias itself and it’s really frustrating in this area. 

I am glad to be writing straightforwardly opinion. I obviously have to engage in all the arguments, but I don't have to quote some ridiculous person saying, “Oh no, but needle exchange will kill the children” with no empirical data. If you want to argue the data with me, that's cool, you just have to show up with some.

To specify some of the things we're talking about: One instance of this, I guess we can call it false equivalency, that stuck with me is when NPR's Hidden Brain framed an entire episode around a working paper, which was not peer-reviewed, claiming a moral hazard to naloxone expansion laws. The entire episode was framed around: Is reversing overdoses actually making things worse? 

Risk compensation occurs. The thing is, it is not plausible to argue that high levels of naloxone availability cause fentanyl availability. How would that happen? Like, give me a mechanism by which that could happen? Nobody goes to their dealer and says: I have more naloxone, so you can give me carfentanil instead. That's just not how drug markets work. 

What makes covering this stuff so maddening is that the basics of Journalism 101 fail to apply on the surface of the debate. The discourse is already fakakta and rife with a tone of panic. All of which has serious real world consequences. Like with fentanyl, all the coverage feeds right into the idea that we need harsh crackdowns to punish more people. 

What I feel like people don't realize is they don't know what they don't know. A lot of journalists think everything they need to know about drugs they learned in DARE in eighth grade. They don't realize, for instance, that it’s ridiculous to say that dealers are putting fentanyl in cocaine in order to hook people. Now, how does this work? I am a person who's buying cocaine. I want to go out dancing all night. Or maybe I want to study. Now I've just taken fentanyl, something that puts me to sleep! And I'll be lucky to wake up from it because I don't have a tolerance. Why would I go back to that dealer? It is just stupid to think that’s what’s happening. 

You mentioned the Biden administration's funding of harm reduction and support for harm reduction. But you also mentioned the racist crack pipe smear. That incident really made me pause and think hard about the damage media can do. Groups have been distributing crack pipes for years without anybody really noticing or caring. The article that whipped up the whole news cycle from the Washington Free Beacon, a right wing tabloid, came out the day that of the deadline for grant applicants. So I really stopped and thought: Is bringing attention to harm reduction well, causing harm? Should we even be covering some of these stories?