The Ithaca Plan follows a tried history of drug strategies

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The release of The Ithaca Plan, the city's new municipal drug policy strategy, attracted national headlines for some of its "outrageous" concepts. It's garnered praise, criticism, lots of questions and even spurred some on Fox News to call for a recall election of city Mayor Svante Myrick.

Though creating a municipal drug strategy and employing some of the more controversial elements of the plan are new for the United States, municipal plans and strategies — like creating a supervised injection facility — have been tried with success for decades in other parts of the globe.

The night before The Ithaca Plan was unveiled, the back theater of Cinemapolis in Ithaca was packed with community members who came to hear about Ithaca's new strategy for a growing epidemic and also hear the context of the plan. Local leaders, members of the committee and drug policy advocates gathered to share the need for a municipal drug plan and explain how such strategies have worked across Canada, Europe and Australia.

The co-founder and co-director of the Katal Center for Health, Equity, and Justice, gabriel sayegh, painted a picture of a country dealing with a severe heroin and opioid crisis. Drug use is increasing, business owners are frustrated with people overdosing and dying in their bathrooms. He said the treatment system isn't equipped to deal with the problem and there are not enough resources to respond to it.

"The community, frustrated by what they see going on and families in particular, desperate to get help for their kids, are calling on really the only thing set up to respond to these things in any sort of force, which is the police, who by being called in, do what they know how to do, which is enforce, which seems then to only exacerbate a range of these problems, and if nothing else, it certainly doesn’t solve it," sayegh said. "Nobody knows that better than the police themselves, who then say, both to lawmakers and others, ‘Hey, we cannot be the only ones dealing with this. You’ve got to figure out a different approach.’ And over and over the cycle goes."

While that problem might sound familiar in the United States today, sayegh was referring to Germany in the late 1980s. At that time, he said, people felt like officials at the state and federal level were not doing enough, "so it fell upon the cities to take action."

"If you start to look at the history of what’s going on with municipal drug strategies around the world, you find that there’s something about creating a municipal drug strategy that’s actually not new at all," sayegh said. "Cities and countries around the world, particularly in the Western world, Europe and Canada and Australia, have been doing this for some time."

In Frankfurt, Germany, in 1988, the city took a new approach to coming up with a solution for the growing drug problem. The mayor formed the the Monday's Round, a committee that brought some traditionally adversarial groups together to work on drug policy. Out of a milieu of activity in Frankfurt and all over Europe, a four pillars approach — focusing on prevention, treatment, harm reduction and enforcement — was developed, sayegh said.

With a similar idea, for the Municipal Drug Policy Committee to create The Ithaca Plan, nearly 100 people participated in eight focus groups, including law enforcement personnel; physicians, nurses and pharmacists; people who use drugs; young people; people of color; parents; business owners; and people in recovery.

Many of the elements of The Ithaca Plan are not new, sayegh said. "They're things that have been tackled and recommended and presented before, all over the world. And in fact to great success."

National overdose deaths from heroin and opioids have been climbing. Heroin overdose deaths increased nearly six-fold between 2001 and 2014, from 1,779 to 10,574, according to the National Institute on Drug Abuse. In Tompkins County, overdose deaths have about tripled in less than 10 years. There were 14 drug-related deaths in 2014, and five reported in 2004, according to the Tompkins County Health Department.

Vancouver's plan

Ithaca revealing its municipal drug plan this week was a déjà vu moment for Donald MacPherson, director of the Canadian Drug Policy Coalition and author of Vancouver's Four Pillars Drug Strategy. Vancouver's drug strategy had many similarities to the Ithaca plan, MacPherson said, including the controversial ones — heroin-assisted treatment and supervised injection sites.

When Vancouver unveiled its plan in 2001, those controversial ideas were already about 15 years old in the European context. The first-ever supervised injection site was a café set up in Berne, Switzerland, where people could find food, beverages and information on safe sex and drug use, and condoms and syringes were provided. That was in 1986. Today, there are supervised injection sites across Europe, in Australia and Vancouver.

In the late 1980s and into the 1990s, it was a "public policy disaster" in Vancouver, MacPherson said. Seventeen overdoses in Vancouver in 1987 grew to 400 overdoses by 1994. Because nothing was happening and people were dying, drug users actually opened up their own supervised injection site in 1995, which MacPherson described as a "little, terrible dump of a back alley" that police just turned a blind eye to.

Today at one of Vancouver's supervised injection sites, a long-term drug user can walk into Insite, get a clean needle and inject heroin in a booth with a mirror. "It's all very visible," said Anna Marie D'Angelo, senior media relations officer for Vancouver Coastal Health. The drug users are supervised by a nurse, and if they overdose, a nurse can provide naloxone. Above the injection site is a detox facility, and a range of resources are also available at Insite, like connections to counseling or wound care.

MacPherson told the roomful of community members at Cinemapolis that Ithaca was at the beginning of a journey. On Wednesday at the news conference, he had a similar message.

"This strategy ... is within the context of a global shift that’s taking place, slowly but surely, within the U.N. system and within other countries, moving from a criminalization paradigm to a paradigm of public health," MacPherson said Wednesday. "The rubber hits the road at the local level, and in Canada, there’s 20 cities that have local drug strategies, not all of them exactly the same. They have nuances depending on where they are and what the issues are."

A moment of clarity

"I think we need to have a moment of truth and clarity," said Travis Brooks, of the Greater Ithaca Activities Center, Wednesday at the news conference.

While Brooks has worked at GIAC for the past 17 years serving youths in the community, he came to the area 25 years ago as a member of the drug trade.

The moment of truth and clarity, Brooks said Wednesday, was that "more than 20 years ago, we should have been sitting in this room when we had the crack epidemic of the '80s and '90s, and the city missed an opportunity to do something many, many years ago because of the people it affected."

But within that missed opportunity is a silver lining, Brooks said, because many people involved in the new drug strategy were a product of what happened then. "Whether you sold drugs, whether your mother or father was addicted, whether your father was in prison, your grandfather was in prison, your uncles, your brothers," Brooks said. "The silver lining is the folks that were involved in this process were affected by it. So they had a unique perspective. They had a desire to do something different and bring some change to this new epidemic."

Brooks, a member of the Municipal Drug Policy Committee, joined the law enforcement pillar because of the life he used to live and the life he lives now, he said.

"I was tired of watching young black men get locked up over and over and families destroyed," Brooks said. "And that still goes on. Let’s be very clear about that. I have kids in my program, we have people in the community who are in third generations of fatherless families. I don’t want to see that for another community."

New York has had a long history around drugs and drug policy, said Kassandra Frederique, director of the New York state policy office at the Drug Policy Alliance, on Wednesday. The Drug Policy Alliance served as a consultant and adviser during The Ithaca Plan's creation.

Frederique said New York was the first to "actually actualize" the war on drugs by introducing mandatory minimums for drug possession, and New York was also one of the first states to decriminalize marijuana in the 1970s.

Frederique, who has frequented Ithaca during the crafting of The Ithaca Plan, said the focus groups have included many tears, hugs and people willing to try something different.

"What is amazing about the process your town has just gone through is that it is the first in the United States to have a jurisdiction to say, ‘This is what we want to do about drugs and drug policies, and all the things associated with them,'" Frederique said.

In the seven years she has worked on drug policy reform, Frederique said, the thing she knows most is that sometimes, the conversation about drugs is not about drugs at all.

"It is about how we decide to treat people we don’t like. It is about how we think who should have certain resources and when. And what are the rules associated with the resources that I’m going to give you," she said. "This plan has the potential to change the conversation about what it is people need, as opposed to what it is we think people need. In that schism, is the possibility to do something different, is the possibility for a new approach, is the possibility that centers compassion instead of stigma, that centers evidence instead of propaganda. There are a lot of things that we work on at Drug Policy Alliance that people in this room may not agree with, but the thing that I can tell you that we agree with you on is that the priority is saving lives, and the priority is to affirm peoples’ humanity."

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