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April 17, 2024 - RFK Jr. The Defender

24:12

Drug Addiction and Recovery with Rene Zegerius

Rene Zegerius, a drug policy expert with the City of Amsterdam, discusses solutions and drug policy history in The Netherlands with Robert F. Kennedy Jr in this episode.

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	It's a pleasure for me today to conduct this conversation with René Zagarias, who is the leader of drug policy in Amsterdam and has had an opportunity to look at what policies work, what don't work.
	Amsterdam in the mid-1980s looked like San Francisco today.
	The Dutch government made many of the same mistakes that Many of American cities are making today.
	And there were 3,000 deaths a year, overdoses in Amsterdam alone annually, very, very similar to what we're seeing in San Francisco today.
	There were open drug markets in the street.
	There were people, drug addicts, shooting up in doorways.
	The tourism was affected.
	The businesses were affected.
	There were homeless problems that were amplified by the addiction.
	And Amsterdam today, in all of Holland today, there's only 300 overdoses a year.
	And Amsterdam is now really a model for how to solve these problems.
	And the methodologies and protocols that they've developed there Would be useful for other cities.
	In fact, London Breed, who is the mayor of Miami, went to Amsterdam.
	San Francisco.
	You said Miami is the best.
	No, no, no.
	She says she's the mayor of San Francisco.
	Okay, all right.
	Anyway, René has had the opportunity to look at a lot of American cities, has a very clear idea of what, of course, the pathway out of the current crisis that we have.
	And it all begins with first acknowledging that there's a crisis and not papering it over.
	And René, after that long introduction, welcome to this conversation.
	Thank you very much.
	You have a very good impression of what we did.
	And you know how we make a lot of mistakes in Amsterdam.
	And it would be silly if you made the same mistakes.
	That's why I'm very...
	I'm honored to have this conversation with you, just to help you, that you are able to make other mistakes than we did.
	Because the situation is very similar.
	You have some different laws, but at this moment, we have 40 deaths a year in the Netherlands.
	How many?
	40.
	Only 40?
	Yes.
	Yes.
	And that's down from thousands.
	Yes.
	So we're good at the moment.
	And what I saw in San Francisco, what I saw in New York, what I saw in Denver, And what we saw in Atlanta, it's awful to see.
	A lot of homeless people, drugs on the street, a market, a drug market on the street.
	And the police is just walking around.
	People are living in shelters on the streets and ambulances go on and off.
	For overdoses by opiates.
	It's a similar situation.
	You have no-go zones, just like we had, where the police is not welcome and ordinary people are also not welcome.
	And we had that situation.
	So it starts with the fact that everybody says, yeah, this is a problem.
	One of the things that I said to one mayor, I will not tell who it is, but he said, probably this problem is not big enough, otherwise you would have changed it.
	And that's where it starts.
	It starts with the fact that you have to acknowledge that there is a big problem.
	And you have to acknowledge that the government has to step forward, and you have to acknowledge that it's not a problem that you can solve by yourself.
	You need other parties, other participants, than just the health service.
	You need the police.
	You need the local government.
	You need housing corporations.
	You need sheltering.
	And all those parties have to work together on every particular case.
	And that's what we found out, that if you do case management from out of the government, And you make sure that every particular drug addict is having a plan where everybody sticks to.
	There are changes to make.
	I'm not going to say that it's going to solve the whole issue because there's always a rest.
	That would be a start.
	Acknowledging and the government, local government or federal, has to step forward to say enough is enough.
	And, you know, we have the problems that you describe, I've seen firsthand in San Francisco, where there's an open-air drug market with hundreds and hundreds of people selling drugs, shooting drugs, smoking drugs, and right across the street from the federal courthouse, where I... Tried, you know, the Monsanto cases in 2019, and it's right now, it's a dangerous place to go.
	It's unsanitary, as you described.
	There is a steady stream of ambulances coming in and out all day long, picking up.
	We saw it twice, two ambulances, pickups, while we, in the brief time that we were there, a fire engine came by at one point, paramedics But to describe your kind of methodology, let me make kind of an attempt at summarizing it, and then if you can fill in the interstitial spaces or errors that I make in my description.
	You get the social workers, the addiction specialists, the housing specialists, and the police all to work together.
	Every addict is picked up.
	Every homeless person is picked up.
	They're assessed.
	And some need to go to jail.
	A small part of them, some of them want to get help.
	Some of them are willing to be helped.
	Some of them should be routed to rehab.
	And then after the rehab, long-term treatment, Or housing where they can stabilize and detox and get their lives back on their feet again.
	And the social workers have to work with police so that the police aren't trained to deal with this kind of problem.
	And I saw in San Francisco what you described as the police standing across the corner doing nothing.
	And they don't know what to do.
	And they're not trained what to do.
	And the social workers have to come in occasionally and say to the police, okay, we'll handle this.
	You need to back off on this.
	And then make the assessment and make a determination for each drug addict As to what happens to them.
	And then we need long-term treatment available that is cheap or free.
	So is that pretty much how it works?
	Yeah, pretty much.
	Pretty much.
	Yeah, pretty much.
	One of the things that you do not have and what we use is what you call tough love.
	I didn't know what it was, but it's a carrot in the stick.
	You have to give someone something, but in return you can ask something.
	It's very useful to let the police be the stick.
	If you act on what we are saying to you and you make steps, even if they are small, you cooperate with us and you are willing to change it a bit, even though that we provide heroin in Amsterdam.
	For people who are not able to stop using opiates.
	That's also part of treatment.
	It's one step too far for you, but the tough last thing.
	The colleagues of police are my best colleagues.
	They are responsible and reliable.
	And if they know what to do with someone, they do that.
	If they know that someone is cooperating with the system, they will help him.
	And if they know that someone is doing the opposite, they will also help him, but the other way.
	But everybody knows that.
	Also, the people who are involved know that if I do this, that will be the next step, whether or not it's jail, temporarily, or anything else.
	So it's very clear what we're doing.
	And one of the things that we do is that we examine people by doctors, by psychiatrists.
	To see whether or not someone is mentally disabled, psychotic or whatever, or just using opioids.
	That's what we do.
	That's one of the bricks that we make to build that plan.
	Because if you make a plan and after two years you find out that someone is mentally disabled, you can't see that from the outside.
	It doesn't work for the particular addict, but it's also not working for the system.
	So you have to find out whether or not someone is a patient and what kind of patient and you have to make a program, a plan for those patients.
	But it's also tough love because the fact that someone is living on the street in a tent is front page in Amsterdam.
	It's not allowed to use drugs on the street.
	And we started, one of the things that we do, we made shelters where they were allowed to use, provided by the government.
	It worked for us, just to make sure that they didn't overdose, just to make sure they were not on the street when they used, they had a shower, and we had lots of them.
	At this moment, we have one of them, because of the fact there is no use for that.
	So all those particular things, you are, yeah, the fact that you know 80% of what I'm going to say means that it's not, I don't want to be unpolite, but it's not that difficult.
	The fact that you understand it and that 80% of what I say is in your mind and you can say whatever you, that it's, whether or not it's good.
	What do these shelters look like, Rene?
	Because that's all kinds of shelters.
	Country is the price of housing, the cost of housing.
	Yes.
	I had an argument also with the mayor because I'm not a very polite person.
	So if you talk, how should I put it nicely?
	If it doesn't make any sense what you're saying, I will mention it.
	So we had all kinds of sheltering because there is no...
	Such thing as one solution, because all those clients are different and also different in what they need.
	So one of the mayors said to me, I'm going to start with housing first for all of them.
	Then you make three problems out of one, because not everybody is able to live in a house.
	If you are housing someone who's very addicted, and you give someone a house, there will be neighborhood disturbance.
	He or she will take a dealer inside, and at some point, he or she will get an overdose, and he or she is not on the street, so you will find him or her dad in that department.
	So that's not the solution for...
	It's one of the solutions, but there are a lot of...
	The solutions that you have to make because all those plans that you have of particular patients, you have to make sure there are groups in that and for those particular groups, you make that.
	And it's a sort of stepping.
	If you do well, you go to the next step.
	And if you do, if it goes wrong, we're not going to stop helping you, but we do it differently on a different place.
	That's the way it works.
	Some of the American mayors are operating under a judicial decision.
	In the Western states that I think would make some of this difficult, which is supposedly a constitutional interpretation that says you can't remove these people from the street unwillingly.
	But the thing is that...
	Mayors talked to you about that issue?
	Yes, yes, yes, yes.
	They were very interested in the way we use cameras in neighborhoods in all kinds of places.
	But the thing is that from my point of view, You see a patient on the street suffering of schizophrenia, suffering of the fact that he or she is using drugs, suffering of the fact that he or she is homeless.
	You have to do something about it.
	And you can say that it's his right to be there, but it's not a right to make the neighborhood disturbances.
	So, in our opinion, there's always a way that police get involved, but not only the police, because the police is not going to solve it, otherwise they would have solved it a long way ago.
	So, I know that there are laws in your country that are different than in ours.
	But the fact that you have patients on the street and that you do not act on it, that's the same in both countries.
	And there's no law that says to me that I'm not allowed to help a patient.
	Because if there is in the Netherlands, we would discuss that.
	And now you leave patients on the street.
	And what has been the reaction of the mayors who have come to visit you?
	Just talk about which cities have come to visit you and then...
	If any of them have adopted your protocols, and which cities are doing the best?
	I think Miami is working on it.
	I think San Francisco, what they do is not working at all.
	Danfra has, to my opinion, a big problem, but it's small.
	And the local community is very aware and the local government is working on it.
	Atlanta is a little difficult, what I saw.
	It depends on the political will, whether or not it's going to be successful or not.
	And that concerns me.
	Generally speaking, did the mayor's Were they impressed by what you were doing?
	Did they say, okay, we're going to take this home and learn?
	No.
	No, no.
	The thing is that I'm not, what I say is not a religion.
	So you have to steal whatever you can use.
	And make other mistakes.
	That's the way I'm in this situation.
	So I'm fine with everything.
	But if you do not do anything, I told one of them, probably the problem is not big enough, otherwise you would have changed the situation.
	And that's how I feel.
	And those laws, I understand that it's more difficult, but there is something in between doing nothing and changing the situation.
	Why do you say Atlanta is particularly difficult?
	I didn't see that the local government...
	The thing is that I spoke to those mayors, so I have to make sure that the conversation that I had with them stays between him and me.
	So I'm trying to be polite.
	Yeah, okay, I get it.
	But it doesn't work.
	You actually went and visited the cities, right?
	Yes.
	And which of the cities was worse?
	San Francisco would be my guess.
	Yes.
	And then Denver second?
	Yes.
	But I've been to Los Angeles.
	I've been to Dallas, Houston.
	But it's not that big in Dallas and Houston because of, I don't know why, but it's not that big.
	And how long did it take you to start seeing results?
	It took us about a year or two, three to get small results and the big results after four, five, six years.
	Does the public in Amsterdam realize what you've done with the program?
	No.
	No?
	No, the thing is that your cameraman is much younger than I am.
	And he thought it was going bad.
	He Googled it.
	And the next time that we saw it, he said, yes, it was really bad.
	So we have two things that are important differences.
	One, we had that situation 30 years ago.
	And people do not use heroin or opiates because of the fact that they think it's a loser drug.
	You didn't have that situation.
	So we think it's a loser drug.
	My cameraman is not going to start using opiates because he knows it's a loser drug.
	If you see people who've been using opiates heroin for a longer period, it's not a very good advertising.
	We know that it's a loser drug.
	There's another difference In law, when we prescribe opiates because of pain, we have a national-wide registration On who we give opiates.
	And we are not allowed to give opiates that long as U.S. doctors can.
	At some point, we have to stop.
	And if we do not stop, the government will ask us, why didn't you stop the opiates?
	So that's a difference in law and a difference in how we prescribe opiates.
	Are there any drugs that your cameraman considers winter drugs?
	A Coke.
	And he's laughing about it because I know what it is.
	Cocaine is a winner drug.
	Okay.
	Excuse me?
	How about mushrooms?
	Mushrooms.
	Nobody uses mushrooms in the Netherlands because they make you sick.
	Yeah, they make you sick.
	I'm not going to ask.
	But they make you sick.
	It's not going to work because you have to eat it.
	Everything that you have to eat...
	You can't register.
	How should I put it?
	It will come to you.
	And at some point you're stoned and you can't move and you have to wait until it's gone.
	So everything that you eat is...
	Now, if you are experienced, nobody...
	I'm not.
	But if you are experienced, you're not going to eat anything.
	So mushrooms is not a big thing.
	Neither is...
	We use a lot of weed and marijuana, but that's the same in the...
	How about crack cocaine?
	Excuse me?
	Crack cocaine.
	No, no, just cocaine.
	So there are some cultural differences.
	Yeah, there's cultural differences.
	But did you do, in the Netherlands, I know they had a big opiate problem at one point.
	Was there advertising that said, we're telling people this is a loser drug?
	No, no.
	At some point, everybody sees how it works and everybody sees how people look like after 10 years of using opiates.
	Heroin is not a very nice site.
	Yeah, and how does legalized heroin work in the Netherlands?
	Only by prescription.
	Only by a small amount of institutes.
	In Amsterdam, we started with 200 people who were very ill physical and or mentally as people who suffer from schizophrenia.
	And they were allowed to use heroin.
	We didn't give them heroin.
	They have to sit in a polyclinic, use it, go and come back.
	And there were about 200 or 300 patients that we do that with in Amsterdam.
	There were other parts in the Netherlands where they also did that, but we had, together with Rotterdam, the largest amount of patients who used heroin.
	At some point, they get healthy because you're not going to die of opiates.
	If you use it well, you're not going to die.
	So all of them are healthy.
	So they're not going to die of heroin.
	They die of the fact that they have lung diseases because of the fact that they smoke.
	So they are healthy.
	And what we saw is that some people stopped at some point using heroin.
	And most of them, they had the opportunity to use three or four times a day.
	They only come by once or twice now.
	Because they want to do something.
	They are addicted, but next to the heroin, they use methadone.
	And they have their normal life once or twice a day.
	So from a lot of using to a little using, that's the way it developed.
	And now we have about 40 or 50 patients that use heroin.
	It goes down and down and down and down with this approach that we have.
	You know, when the tolerance increases for the heroin, which is just part of the physiology of the drug, does the dose also increase over time?
	No, no, no, no.
	And because of the fact that we use methadone next to the heroin, you can stabilize it.
	How many methadone addicts do you have?
	I don't know.
	I think about a few hundred in Amsterdam.
	The difference between using methadone and heroin is the fact that if you want to do something wrong, you have the time to think it over.
	So we saw a decrease of criminal activity with that particular group because of their You can think it over.
	You will not get sick.
	If you're sick, you do different things than if you're not.
	You're more like extreme risky criminal behavior if you're getting sick.
	That's what I'm saying.
	So the police and the district attorney were very helpful to work with us if we provide their method.
	Because they get mellow.
	What is Miami doing?
	There's awareness.
	There's awareness of there's a problem and we have to do something about it.
	They had a lot of people like me coming over and ideas.
	So they're making steps.
	The awareness of the fact that there is a problem, that's step one, two, and three.
	And that's what they do there.
	How about the rest of Europe?
	Is anybody else doing it great?
	We have no problem about drugs at the moment.
	We have a problem.
	We have a problem.
	You're all of Europe.
	Yes, we have all of Europe.
	We do not have a problem with opiates and drugs.
	We have a problem with crime because the Netherlands is a very small country.
	When you drive three hours, you go from the bottom to the top or the other way around.
	So we're 80 million people, so we're small.
	And we are in the middle of distribution of mostly coke.
	So we have a crime problem, which we can only solve, to my opinion, in Europe.
	But we do not have a health problem with drugs.
	Our alcohol problem, if it concerns health, is bigger than the problem that we have with drugs.
	Rene, thank you so much.
	This has been very enlightening, and I'm so grateful to you for creating a template, a role model for the rest of us to be inspired by and perhaps to follow.
	Okay, thank you very much.
	Very nice to meet you.
	You too, Rene.
	Thank you.

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