Editor and co-founder of Drink and Drugs News discusses the difficulties of tackling smoking and how many people working in the drug harm reduction field don’t see it as a problem.
Featuring:
Claire Brown
Editor & Co-founder, Drink and Drugs News Magazine
drinkanddrugsnews.com
@DDNMagazine
Transcription:
Hi everybody, I'm Brent Stafford and welcome to another edition of RegWatch on GFN.TV.
We're here in Warsaw, Poland for the Global Forum on Nicotine, the annual conference on
safer nicotine products and tobacco harm reduction, celebrating its 10th anniversary.
Joining me today is Claire Brown, you're the co-founder and editor of Drink and Drugs
News.
Tell us about that.
That's right.
It's a magazine that I set up with my partner Ian Ralph, business partner Ian Ralph.
We set it up as a publishing company, we'd both worked in public health publishing before,
but the subject of substance use really intrigued us.
It didn't fit with public health, it's after public health has failed people really.
The more we looked at this topic, we thought, this is something we actually need to create
a publication around.
The model that we were used to was creating a free magazine funded by the advertising,
so that's where we worked in partnership, sold the advertising to produce it, we both
worked on the content for it, but the more we got to know this audience, the more we
realized there was a special reason to write about this in relation to public health and
to keep coming back to public health and thinking, what's going on here?
Even the division between alcohol and drugs, it's a false division, there's so much to
write about, and the more we got to know people working in the sector and affected by all
of these issues, the bigger the subject becomes.
So who's the audience for the magazine, at least when you started?
When we started, we were thinking of treatment professionals, so we were thinking of people
who work with treatment in rehabs, but as we began to grow this circulation for the
free magazine, it was very, very important that it went everywhere where people were
working with drug issues, so it went into hostels and prisons, and it strengthened our
determination to keep it free of charge, because it has to.
You can't put a subscription model in front of people and expect them to buy into this,
they need to have it right in front of them, landing on their desk, something that they've
got to read, and that was our ambition right from the very start.
What we weren't expecting and what has really enhanced it is that people affected by the
issues who mobilized into user groups, as they were called at the time, all over the
country were passionate about having a voice and about the advocacy side of it, and much
as we've heard about at this conference being mobilized by people who are using the vapes,
it was very much the same growth point for us with the magazine and the service user community.
And this is based in the UK?
The published version is based in the UK, but it's online around the world, so as we
began working with different audiences on harm reduction, the magazine has dipped into
all kinds of communities and been informed by them as well.
Did you find that there was a point where you had to make a choice to step into the
advocacy side of it?
No, we very much, it's our determination not to step one way or the other, and this is
something that has kept us true to our model right the way through.
We sit in the middle and we're the focus for debate coming from all sides, so when people
say what do you believe in, are you abstinence based, do you believe in methadone, we don't
set the rules, we hear from people who are affected by issues and who believe in one
model that's worked for them or that they work with and they want to find out more about,
so we're the melting pot for all of the ideas.
So we hear a lot generally around drug harm reduction, is that one of the steps, is that
a side or is it something that's just well recognised overall?
It's not recognised by everybody, but it's a baseline for us, and it's very important
for the conference that we run, for the service users and for the magazine as well.
We don't make rules and divisions, somebody's harm reduction is very different from somebody
else's, so our intention is to provide the information and to respect people's personal
decisions even down to what they call themselves, you know, you talk about stigma in the field
and different terms mean things to different people, so we try to be very non-judgmental.
So is there a lot of judgement around the issues of drug harm reduction?
Oh very much so, yes, it's not the easiest topic to work with or to write about because
some people have very entrenched views and all you can say is join the debate and as
you write about things and you accept feedback from writing about things, you might change
a person's mind, you might not, but you have the conversation, so being that forum for
conversation is I think terribly important and it enables us to feed to politicians and
policy makers and be part of changing policies in the UK.
So you're coming up almost two decades now with the magazine, walk us through how has
the embrace of drug harm reduction happened?
I think that it has changed, it's gone backwards and forwards, the arguments have become more
nuanced, I think when we started there was a case of abstinence in this corner, harm
reduction in this corner, active users somewhere over here, it's not like that now, but that's
not to say it hasn't been a really rocky road in UK politics, the UK government embraced
recovery which meant abstinence at one point and that set everybody back, it was really
really difficult to get over that and talk about it in sensible terms because recovery
means different things to different people and you step on and off that bus as you need
to, so we've had to be very determined to just keep all channels open without disenfranchising
people but we like to think that we talk to everybody.
So what is a good definition of drug harm reduction?
Drug harm reduction is making sure that there is a place to go for whatever stage you're
at, that the doors are open, that might mean a medical script, it might mean seeing a doctor
to have a methadone prescription or buprenorphine, whatever, it might mean somebody listening
to you and talking to you, talking therapies to make sure that you've got the support,
the emotional support, the strength.
It's making sure that, and for our role in that, it's making sure professionals are equipped
to be switched on so that they're receptive, you know, and making sure no door is shut
and making sure that the treatment is fair and very personalised and that it isn't one
model suits all and I think we've got better at that, I like to think that it's not quite
as entrenched as it was and that there's always, and I think that the magazine has played a
part in levelling that field for the treatment providers, yeah.
So here at the Global Forum on Nicotine, tobacco harm reduction is kind of the anchor philosophy
that drives so much and for us here at RegWatch covering the issue around vaping, it's become
really an anchor for, I think, a lot of consumers of nicotine vaping products and they say,
hey, this makes sense, I am trying to reduce my harm by moving from a combustible cigarette
to cleaner nicotine.
Coming from the drug harm side and you start to look at what's happening here, are there
similarities?
There are great similarities and I also recognise the fight we've got ahead because smoking
is a difficult one to tackle, a lot of people working in the field don't really see it as
a problem and that's the first thing that astonished us first off and then it's always
just been there, you know, you always used to be able to recognise a drugs conference
by the amount of people standing outside having a cigarette, you know, there is a cultural
barrier.
I think it makes so much sense that from our public health roots we've always seen it as
just part of the issues, part of the substances that we address and the reason it's in such
heavy focus for us, why it's so important, is that a lot of the people we see who are
going into treatment have lung issues, they have COPD and this is such an enormous part
of their health story and I think the challenge we've got is to make the treatment professionals
actually look at that, recognise that and policy makers as well.
I've been trying to do a lung supplement for a long time but getting UK government
to take that seriously, it makes so much sense to us, you know, these are fundamental issues
to address and to tackle, you know, spirometry at the clinic entrance, you know, these lung
function tests, if you don't look at these issues then you're tackling something, you're
not tackling something that can be very simple, very straightforward before you get onto the
detail of what's best for somebody or what maintenance treatment, you know, what type
of rehab, whatever.
You know, it's interesting because we get a lot of, it's interesting, I think often
we get the feeling that public health is very much all about abstinence when it comes to
nicotine.
You shouldn't be smoking at all and then, oh, well, we have this vapour product that,
you know, isn't going to kill us and, oh, no, you can't have that either, you should
just quit.
It sounds like the old school drug position renewed with tobacco.
That's right and it is, going back to the pleasure principle, isn't it, and politicians'
policy is a very suspicious of enjoyment and it's something that we have written about
but there is this thing.
You can probably get a government, excuse me, from public health, somebody from public
health to write you a script or provide you with free government, you know, opioid to
try to, you know, wean you off of, you know, heroin but, you know, try to get an e-cigarette
out of them and forget it.
Yeah, yeah.
Well, it's such a simple and straightforward thing to do, isn't it, in terms of health.
Yeah, it makes no sense.
So all we can try to do is introduce the topic again and again, write about it, write about
the history and how we've been manipulated.
You know, when you start highlighting to people they've been treated like mugs, it helps,
doesn't it?
Talk to me a little bit about with inside the drug harm, harm reduction community.
Do they, do they look at tobacco harm reduction as a valid application of the harm reduction
theory?
I don't think they've embraced it or acknowledged it at all, really, wholesale.
There might be a few people, but they don't leap out at you and it's not a mainstream
acknowledged thing at all.
It's very much seen as over there and I think the industry involvement is, is problematic
for them.
Oh, you mean big tobacco being involved?
Yeah, yeah.
I think it's, it's, I've not seen it embraced on the world stage of harm reduction, let's
put it that way.
I think it's problematic.
I think sponsorship issues get very tricky.
It's difficult.
It's difficult.
At a global drug harm reduction conference, is tobacco harm reduction mentioned?
Is there a presence?
It's not invited on board as part of the mainstream program, no, because of those difficulties.
And I think it's a shame.
I think there should be that conversation and that debate and that involvement because
where do you go if you're not talking to each other?
So it, does that not, shouldn't that also apply then in the drug harm world if pharmaceutical
companies were involved in somehow part of the process?
I mean, is there something special about tobacco companies?
In the drugs world, it's very clear that they're not allowed to have face to face with their
service users.
It's a little bit different, isn't it, here, because you've got consumers talking to the
companies involved.
So I don't know.
It's to do with the money and the sponsorship and there's something problematic there about
the sponsorship side.
It's very difficult to untangle.
And you don't have, you can't put your finger on it.
Well, I do think that it's just too complicated for them to involve those companies.
It's just a suspicion and it goes with that public health tradition.
It's not straightforward and I'm not, I'm not, I don't have the solution to that.
I can understand why it's become entangled, but I don't understand why there's not more
open conversation and dialogue about it.
And I think we're in danger of rarefying what harm reduction is, you know.
What do you mean by that?
Well, in terms of traditional harm reduction, we don't take on board that because that sits
over there.
I mean, you have to embrace harm reduction as what's harmful for a person and what affects
their health, don't you?
So.
Meaning that the drug harm reduction kind of ethos is pushing out anything else that
might be trying to utilise that same approach.
Yeah.
There's definitely not that open passageway between tobacco harm reduction and the rest
of the drug harm reduction world.
Could it be that just the seriousness of, you know, you know, being addicted to street
level, you know, drugs, you know, you could overdose and die like right now.
It's like much more important to be dealing with harm reduction.
These are serious issues.
They're trying to quit smoking.
That's not really a serious issue.
They might be thinking like that, but when you look at the death rate around the world,
that's just not a valid argument, is it?
Just because it's more catastrophic within a short timescale doesn't mean to say it's
not going to kill you.
So I don't think that's a relevant argument at all.
I think it's about the sponsorship and the money and the direct contact with tobacco
companies.
But I'm not the person to ask about that, really.
Well, that's just so interesting because, of course, this group of people here get it
on all ends.
So we don't get any respect from drug users because we're talking with big tobacco.
We can't, you know, get at the table with WHO or public health in the U.S. or Canada
or whatever because we're somehow linked to the tobacco industry.
It's really, it's crazy.
It is crazy and it's a great shame.
And that's where we're determined not to follow that route and to bring it into our mainstream
readership and our audience because people should be thinking about these issues.
Now I should say, I mean, I've certainly experienced my share of use of many different things over
the years.
I'm 10 years sober, so I can certainly say I've gone through some of the issues.
And nobody ever made me have a drink or use a drug.
And I always thought that that was similar for around most drug users.
It strikes me that public health seems to think that smokers or us vapers were useful
idiots of the tobacco industry.
And I'd like to remind them that no tobacco industry made me a smoker.
I'm not a victim of the tobacco industry.
And to hear that drug users have got their, you know, nose out of the joint because tobacco
industries involved in safer nicotine business, it just, you know, I'm a bit flabbergasted
on that.
I don't think I'm talking about the people who are using drugs themselves.
I'm talking about the people who are organizing to discuss the people who use drugs, which
is very different, isn't it?
I think you'd find people who are using drugs and smoking, vaping, very open to vaping,
very open to the conversation, which is, you know, our start point for it.
We mobilize by popular opinion, people reading the magazine saying we need this, we want
to know more.
I'm talking really about the people who organize the discussions, you know.
The public health people, the people that are involved in that, OK, well, that makes
more sense.
When you look at, you know, the Global Forum on Nicotine and what's going on here, what's
your sense in terms of what's happening and how it might help move the ball forward?
Well, I was really impressed to listen to the debate and to realize 10 years of progress
here.
There's been a lot happening.
The wheels have been moving very fast underneath, there's been a lot of mobilization.
I mean, in terms of politics, it's gone back and forth in different countries in a way
that's hard to understand, really.
Politicians seem so reactive.
But in terms of progress, I think that we're all talking and there's such a parallel with
what's happened in the drugs world.
I can see that if we pull in the public health arguments and we look at what people need
to do now, I mean, that's my priority, to try and look at what we can do on the ground
to actually save people's lives, make their health better.
If you start from that point, it fits in entirely with what we try to do every issue of the
magazine.
So that's my very small-scale take on it.
But everything I've heard has been impressive and exciting and the energy generated, something
like this.
And the fact you've got doctors standing up and people who work with these issues, they've
bothered to come here to actually say the progress that they've made, the strides they've
taken and what they've learned off other people and what they've found, different websites
and networks and social media, it encourages you a lot.
I wasn't sure what we'd expect when we got here, but the fact that there is such a representative
forum of public health and health and research, it's really grounded in research and good
sense.
And that's very, very encouraging.
So that was surprising, then, the level of science, the level of public health participation
to some extent.
Yes, yeah.
And that's very important because that's the golden nugget you need to just grow that
part of the coverage.
It really is.
It's got to be based on that.
When you talk to consumers here of nicotine vaping products, they're consumers.
That's a different label than, say, a user.
And not only that, but the goal is to not, for most, to not get off of using your vaping
products.
It's like, I'm a vaper, I'm going to be a vaper for the rest of my life.
Chances are I would have been a smoker for the rest of my life.
It just would have been shorter.
I'm going to be a vaper for the rest of my life.
So it's harm reduction, but it's not like...
It's different, isn't it?
You're presented as a consumer with choice and you're faced with a market.
It's very, very different from being somebody who's labeled as somebody in treatment who's
looking for somebody to listen to you and give you the option that you're hoping for.
It is very different.
But at the end of the day, we're looking at substances and the substances that affect
your body.
And you should have that level of choice to be healthier, whatever you are involved with,
whether it's drugs, tobacco, alcohol, whatever.
You need to have informed choices.
You need to know where to go to be healthier.
So do you think that THR tobacco harm reduction has got a future?
One that you'll be writing about a lot more?
Definitely.
I think it's part of our responsibility to mainstream this and not have it as this thing
that sits over there.
Even though it's a conference in another country from ours, we can bring it closer and we can
write about these things.
We can have a questioning approach to it.
And I think we do that through the Public Health Channel.
That's exactly where we need to be.
It's rooted in public health and it's not an irrelevance at all.
It's bang mainstream to what we're writing about.