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Despite the tremendous representation of traditional harm reduction topics at the 13th National Harm Reduction Conference held in San Juan, Puerto Rico the lack of tobacco harm reduction knowledge was astounding. Why the disconnect? Find out in this RegWatch on GFN.TV interview.

Kevin Garcia
Tobacco Harm Reduction Fellow, Filter
Graduate Research Asst., Colorado State University


Brent: Hi, I'm Brent Stafford and welcome to another edition of Reg Watch on GFN.TV. Well, here we are in 2023 and we have joining us today Kevin Garcia. Kevin, how are you?

Kevin: Hey, I'm doing great. Thanks for having me.

Brent: One of the reasons why you're are here really cut our eye was an article that you wrote in Filter magazine last November, all about the National Harm Reduction conference, which we're going to talk about in depth that and its relationship or lack of to tobacco harm reduction. You're a graduate student and graduate research assistant at Colorado State University. Why don't you tell us about that first?

Kevin: Yeah. So I'm currently in a MSWMP program at Colorado State University. So getting to do a degree in social work and public health. And for me, I think the values and ethics of social work align very closely with those of harm reduction. And before I knew that harm reduction was considered a public health initiative, I was practicing public health with the harm reduction philosophy in my position at the TriCounty Health Department. And I've had little exposure to harm reduction as part of my official coursework. But the philosophy of Harm reduction acts as a guide to the way I approach my work inside and outside of the classroom. So every opportunity I have in the classroom, I speak about harm reduction to my professors and my colleagues. During classroom discussions, every time I hear something incorrect or misrepresented, such as vaping causes, popcorn lung I call the person into a conversation and I attempt to facilitate a discussion about it so we can all learn from each other. Let's talk about some literature, let's share some information. What do I know? What do you know? What can we learn from each other? A lot of the assignments I write, I focus them on harm reduction. And one of the things I've done is I volunteered to help facilitate a harm reduction training for my graduate social worker course peers. And I also helped my professor revamp the Substance Use and Harm Reduction course module because I felt like I could use a little bit of work. And as far as the conference, I thought overall it was a wonderful conference as always. I think it was my second or third one. But the one main thing that really set out to me was there is only one tobacco Harm Reduction panel and it included myself, Helen Redmond and Pat Danning. And I felt like overall in the conference, I mean, despite so much knowledge surrounding the more traditional harm reduction topics particularly associated with opioids and Stimulants, the lack of tobacco harm reduction knowledge was astounding to me, especially since individuals at these harm reduction conferences are can often consider experts.

Brent: And you yourself actually are an expert, correct me if I'm wrong, with a lot of street level experience running activations. Tell us about that.

Kevin: Yeah, so part of one of my other positions I work as a harm reduction content expert for Next Distro. And they're a male based harm reduction organization that mails supplies to individuals living in rural communities that can't access harm reduction services. And my first harm reduction job that I got when I moved to Colorado was street based. So I was doing a lot of harm reduction work on the street, providing lock zone sterile syringes. I was giving people trainings, meeting people where they're at. And I feel like that experience really helped me get to where I am today. Many people that I met were, for example, injecting heroin. So we suggest other routes of administration. If they couldn't find a vein, if they wanted to continue injecting despite their complications. We treated them as humans with dignity, respect, support, and we helped them have their autonomy, but also stay as safe as possible. And that made me think today, why is that so difficult for people to craft when it comes to tobacco? Why is tobacco not considered something that we could practice harm reduction with?

Brent: Yeah, it does seem strange that the very public health professionals who seem to support harm reduction strategies when it comes to, say, drug use and HIV AIDS are the very same who simply refused to accept tobacco harm reduction as a legitimate content.

Kevin: Very much so. I've seen such a disconnect. I feel like even the huge disconnect, I guess I could start with the misinformation surrounding vaping. I feel like it particularly started after the whole EVALI, where the popcorn lung was coming up and people believed that vaping was leading to these lung illnesses. I've seen medical doctors facilitating training about HIV, saying that vaping is worse than smoking. I spoke at a Stanford conference about vaping where every panel, except for mine, essentially every panel, was basically saying, vaping is very harmful and addictive, we need to ban it. Mine was the only one kind of like talking about harm reduction. I always see such a focus on saving the children when it comes to vaping, but also undermining the fact that adults need harm reduction. And importantly, I've seen a lot of undermining the fact that smoking kills. Like we shouldn't be banning drugs in the first place. But why are we banning vapes and flavors and not cigarettes? To me, that's so ridiculous and so contrary to harm reduction. I remember working at the health department, for example. I was doing harm reduction work and people knew I vaped. But instead of having a conversation with me, somebody posted a study on my office door stating how harmful vaping was for your house. And so a lot of these things I see are astounding to me, and it's particularly prominent in the United States.

Brent: I've noticed at this major international harm reduction conference, there was, what, about 2800 harm reductionists there, but very few focus on tobacco harm reduction.

Kevin: Yes. I would say it was basically just the one panel of tobacco harm reduction where it's me had an impact. Yeah, nobody really talked about it, although I did see people I saw more people smoking, but I did see a few people vaping. But yeah, it was just not a conversation that was had like the more societally accepted drugs like nicotine or alcohol, they weren't talked about at all, which was kind of interesting to me because the use of these substances is so high as well as the harms associated with them.

Brent: Isn't the public health propaganda and the moralizing and the hysterical kind of aspects and notes and tones of it, isn't that actually what you're fighting when you're fighting for harm reduction? And should those people then not recognize the level of propaganda from public health when it comes to safer nicotine products?

Kevin: Yeah, and I completely agree. When harm reduction first started, it wasn't evidence based, it wasn't publicly funded. It was largely considered to be something ineffective and harmful, but some people believed in it. And here we are with strong support for many types of harm reduction throughout the country. But one thing that I've noticed that acts as a barrier, I think, to tobacco harm reduction is that, for example, in many harm reduction organizations, such as the National Harm Reduction Coalition, they're considered one of the biggest harm reduction organizations in the United States. They have little to no information, to my knowledge, about tobacco, nicotine, vaping, tobacco harm reduction, and they're one of the most prominent organs in the country. And a lot of folks follow what they do. And I feel like there needs to be conversations that open up the avenue to talking about tobacco harm reduction as part of harm reduction. And something I've been thinking of too, that might help is just doing away with the name tobacco harm reduction because it's still harm reduction. We're simply just focusing on tobacco instead of a heroin, for example. And we don't call heroin harm reduction, we just call it harm reduction. And I feel like by shifting the name, just treating it as part of harm reduction, then maybe we could get more of these larger harm reduction organizations to adopt tobacco harm reduction so that these folks often facilitate trainings for like the public health agencies you mentioned, for example. And if the head individuals doing training, facilitating training, don't believe in tobacco harm reduction, then it's just going to funnel down to the people on the ground. And I definitely saw that when I was at the conference.

Brent: Let's talk a little bit more about the article that you wrote on the conference. Now, first of all, we're big fans of Filter here at Reg Watch. Yeah. What does it mean to be a fellow at Filter and I guess where does that scholarship come from and so forth?

Kevin: A fellowship is similar to a scholarship, pretty much. A fellowship provides financial support with no repayment requirement. And as part of the fellowship, I applied for funding through the independently administered Tobacco Harm Reduction Scholarship for Knowledge Action Change. So I'm essentially getting funding from Knowledge, Action Change to work for Filter as a fellow as a tobacco harm reduction writer. So I'm basically like a part time writer, and I feel like I was already doing this type of work before the fellowship, so it seemed like a great opportunity. And I've worked with Filter previously, really enjoyed working with them. I truly feel that they're an organization that upholds the principles of harm reduction in their work and the material they produce, and the work life balance is fair. And the editors are phenomenal, helping writers synthesize their ideas into something captivating. I'm a big fan of Filter, and they've been very supportive with the fellowship.

Brent: That's excellent. Let's dive into a couple of the quotes that you share from some of your conversations and experiences at that conference. First one being, would you say a majority this is my question to you would you say a majority of your colleagues at the conference shares your views regarding THR? Now, you've already basically said no, it's just not on the radar, is what I understand. That's the case. Right? But here's the quote “vapes, those things are horrible for you”, said one conference attendee who was smoking a cigarette and asked to remain anonymous.

Kevin: Yes, that to me was astounding. I feel like that was the most extreme example of the misinformation. As a result of EVALI and all of this, I feel like most of my colleagues at the conference, they really just weren't aware of THR. I saw people practicing THR, using their vapes, and they'd say, like, yeah, I used it to stop smoking, but I'm not really sure if it helps or not. I don't know if there's evidence about it. Other folks I talked to are like, since I started vaping, I feel so much better. I like, I could breathe better, and when I exercise, my lung capacity is better. But yet they're telling me I hear all these things about heavy metals and popcorn lung and like, I don't know, is it worse for me? Is it not? So it seems like there was a lot of people scratching their heads. They weren't aware of what the truth associated with the pocket harm reduction was.

Brent: So there was no evidence that they had that it was safer than smoking. It was one of the comments and then, as you said, that they didn't know whether or not popcorn lung was a reality or not. There is still some thinking that popcorn lung might be a thing, right?

Kevin: And it makes total sense. For example, you go ahead and go on Google and you type in a vaping in the United States, and most of the information you get is misinformation. And most of the information it will talk about vaping causes it's due to Evali, the popcorn lung, concerns of heavy metals, black market issues. And personally, I've had to find that you have to go outside of US. Sources to be able to find, in my opinion, more honest information about tobacco harm reduction. And I feel like being in the United States, many harm reductionists, many public health agencies, they consider the CDC to be the end off, and the CDC isn't particularly keen on tobacco harm reduction. But there are other public health agencies around the world that have conducted their own research and have found different findings. And I feel like there's too much focus on the US centric information. Kind of like as a movement in the THR movement and the HR movement, we need to emphasize a little less just the United States, like information and evidence. We need to branch out, maybe check out what the UK is doing, check out what Australia is doing. We're still siloed here, and it feels like it's going to lead to something, lead to harm.

Brent: There's obviously got to be some reasons why there is this disconnect, and we've certainly come across some of them while covering this issue. You have a pretty good summation in the article, and one of them being is that many within HR forget that nicotine is a drug.

Kevin: Yes, and I feel like that is definitely in part due to our culture in the United States, at least, nicotine, caffeine, alcohol, these typically, they aren't considered drugs. When we talk about drugs, we always say drugs and alcohol. We never just say drugs. We never just say drugs that include alcohol. It's always separate. And I feel like, yes, that's one of the issues that many within harm reduction forget that nicotine is a drug. That was in the article. When I interviewed somebody, that's actually what they told me. And they were working a harm reduction organization, and they came to the panel and they were like, yeah. It made me think, like, oh yeah, nicotine is a drug, and harm reduction is about reducing the harms associated with drugs. And the conversation we had basically with that person and other folks was, we need to be under one wing. We're offering the same thing, and that's reducing harms due to drugs. And, you know, there shouldn't be so much separation. And, you know, that disconnect too. And the fact that people don't consider nicotine a drug, it's a I feel like that also has to do with stigma. You know, like, because people don't consider nicotine a drug, the stigma associated it with it is lower. You know, you can vape, you could smoke in most places, and you likely won't be stigmatized, but you can't inject heroin anywhere without stigmatization. And I understand where both sides are coming from, but my concern is that if the laws change and vapes are prohibited, this may look different in a few years. People who vape, people who smoke may have the same supply issues as people who use other drugs today. And as harm reductionists, I feel like we need to look at the past and the present and analyze what could occur in the future with the work we're doing today. As we know, restrictions today often always lead to harms in the future.

Brent: It's interesting because public health has made such a big deal about nicotine being a drug. It's a drug totally addictive. It gives you brain damage if you use it before 25. It's a drug. But yet those who, you know, spend their entire lives fighting the war on drugs don't consider nicotine a drug.

Kevin: It's interesting because they consider it harmful. You know, and when I say, maybe, you know, these public health agencies in the US. They consider it harmful in this form of smoking. But when it comes to nicotine replacement, therapies, like pouches or gums, it's still the same drug. But suddenly now it's safe. Suddenly now it's the medicine. And when you vape nicotine, according to many sources, such as public health in England, it's 95% safer than smoking. So, I mean, it just it just doesn't make sense to me. It's very contradictory. You see so many things on so many sides. Like, it doesn't make sense to me.

Brent: What about the disconnect? Could it also be coming from the fact that there is a delayed kind of response when it comes to the negative impacts from smoking, whereas an overdose is anything but delayed?

Kevin: Yes, that was one of the big conversations I had at the conference with few folks prominent in harm reduction. So I was trying to have a conversation on how could we address this disconnect? When I was at the recent harm reduction conference, it was full of harm reductionist. When I went to the Global Forum on Nicotine, the conference last year, it was full of tobacco harm reductionists and there is almost no overlap. And so, as you were saying yes, I think part of the issue is the delayed consequences of smoking versus the very immediate consequences from overdose. When I was talking to the folks at the harm reduction conference, that was one of the main concerns. I remember them saying people in the tobacco harm reduction spaces don't care about safe supply or they don't care about people overdosing one day to the next. And I disagree with that particular part. I feel like we just need to come to a consensus. There needs to be a conversation and there needs to be stakeholders in the room. Like we need to realize that we have the same overarching goal, then why aren't we working together?

Brent: I wonder also too, whether or not nicotine smoking specifically is seen as a tool to be used in some recovery and so forth. Like, if you look at AA, without coffee and cigarettes, there wouldn't be AA. So maybe it's just not taken seriously by HR because it's just not seen to be something that is serious.

Kevin: I hear it. Yes. In the circles, in the twelve step circles, nicotine and caffeine aren't considered drugs. And you're right, it's a tool used for many as a form of harm reduction. Sure, smoking cigarettes has its harms, but if somebody is smoking a cigarette and that helps them avoid other drugs that may be more risky for them, then that's harm reduction. As somebody who's been in the rooms, that distinction that caffeine and nicotine aren't treated like drugs, I feel like adds a lot of to a lot of these notions of I didn't even consider nicotine a drug. And if you don't consider nicotine a drug, then why would you need to practice harm reduction with it? So I feel like it's even more of like it's a societal issue too. But I've also just met people in the rooms who use Vapes for harm reduction purposes. Like, I connected the recovery community out here pretty often, and there's a lot that utilize Vapes for this purpose. And I was surprised to know that more people in the, I guess, absent recovery community utilize Vapes than those in the harm reduction communities, which is quite interesting to me.

Brent: You know, what's funny is that I think Vaping is a tool for harm reduction, not just for nicotine, but for all of the harm government does to you. If you're a smoker, there are thousands and thousands and thousands of dollars in tax you have to spend every single year. And it keeps going up and over and over again the mental anguish that you experience by being told you're a loser and worthless as a smoker. And so the harm reduction part of it of Vaping is reducing that public health stigma and tax harm that comes from public health and government.

Kevin: Yeah, because you type in smoking on, you go to the doctor, you say you're a smoker, and suddenly you have to pay a lot more money. And so I feel like that's an issue too. I mean, it's not talked about at all in the harm reduction in circles like the impacts of smoking. It's a fact, too, that people who use drugs often smoke at very high rates. Their prevalence of smoking is quite high. And it doesn't mean that that's the most immediate concern for these individuals. But it's just another thing that we could reduce the harm of. The point of harm reduction through traditional harm reduction, for the lack of a better word, is to keep somebody alive. And if somebody is alive a long time using drugs, including smoking, I mean, cancer, for example, could eventually catch up with them. Eventually. It's in the long term. And that's why I feel like we should be focusing on all the drugs when it comes to harm reduction and behaviors and stuff too. But that's a whole it's a whole thing, definitely.

Brent: So, Kevin, you mentioned the Global Forum on Nicotine in Warsaw, Poland, that you were there last year. So were we. And of course, it's coming up again this june, I believe it's actually June 21 to the 24th. Why is an event like GFN important?

Kevin: So, for me, it's important because, you know, right now we're in a world where India, they banned vapes in the whole country. So many disastrous public health impacts throughout the world. There's just been an emphasis on just banning nicotine products. And I feel like what I like the most about GFN was the international presence. As a person who lives in the United States, studies at a United States university, despite being in the global health and health disparities concentration, everything is so US. Centric. So it was so refreshing for me to hear and listen from an international perspective. It was definitely the most international conference I've been to. And hearing perspectives from different countries is important. We have our own experts and we have different cultures and ideologies. And sometimes you need to pick pieces from certain thoughts and ideologies to come to a place where we can reduce the most harm. Tobacco harm reduction is a global issue. People around the world smoke cigarettes. They vape, they chew, and many people are harmed either by the actual drug or, as you mentioned, by the government, this is often the issue with the war on drugs. A lot of the harms associated with drugs come from the laws. And at GFN, I was very surprised with how strong and tight knit the tobacco harm reduction community was. But at the same time, I was also disappointed by the lack of people from the harm reduction world. When we're comparing the National Harm Reduction Conference and the Global Forum on Nicotine conference, it's like there's the same overarching goals, but the two communities are completely separate. There's almost no overlap. And I feel like there is quite a few overlap with some topics as far as overall public health initiatives or, like, talking about equity issues, access issues. But overall, it was minimal. And I feel like both conferences really GFN and NHRC would benefit from trying to bring in those other crowds like GFN, bringing in more of the traditional HR folks, the HR conferences, bringing in more of the THR crowd. And like that, we could work together as a movement to reduce harms from all these strokes and the laws that affect us too.