2023 Decriminalization of Paraphernalia and Residue

Go ahead. Hello, everybody. Welcome to Health Chatter and today's episode, a very interesting episode on harm reduction and the Steve Rumler Hope legislation. We've got three wonderful, wonderful guests with us. We'll get to those three in just a minute. I want to thank our illustrious crew who makes our Health Chatter broadcasts. successful. Maddie Levine-Wolf, Aaron Collins, Deandra Howard, and Sheridan Nygaard do all our great research and help us with recording these shows. Then we have Matthew Campbell, who's our production guru, who makes sure everything comes out to you, the listening audience, in perfect form. Then, of course, I have to really, really thank my great co-host, Clarence Jones, having a good time doing this. And it's our over, I think it's our 72nd show. 
So we're looking forward to it as well. Finally, Human Partnership is our community sponsor. They are involved in a variety of different health-related events and programs in the community. And we recommend highly to check out their website at humanpartnership.org. With that, Clarence, I'm going to turn the mic over to you, and you can introduce our great guest for today's show. Well, you know, Stan, thank you very much. I'm very excited about this, too. And I think that Pearl made sure that we understood the legislation. She said it is a decriminalization of paraphernalia and residue legislation that we're going to be talking about today. And I think that... This is one of the reasons why we wanted to talk about it because there's some new legislation that's coming on. 
We're very fortunate to have some really world-class leaders here. I'm going to let Dr. Rhonda Marie Chocolis, who happens to be the president of the Minnesota Pharmaceutical Board, she's going to take the lead for this one because she is much more familiar with this. I want to just thank her for for being here with us as we begin to talk about this very, very important topic. Dr. Rhonda Marie, how are you? I'm fantastic and amazing. Thank you for having me. It's an honor and privilege to be here. I do want to say, like my disclaimer, like my views don't necessarily represent the board as a collective. However, I'm very passionate about public health and in particular, harm reduction. So thank you for having me today. 
And Yes. Yes. Oh, I think I'll let you introduce our guests or just let them introduce ourselves. I think it'd be important to really talk about how we got here or how I got here. Roughly a year ago, a gentleman by the name of Eddie, who will introduce himself, came to the Minnesota Board of Pharmacy and discussed the importance of changing the laws and what pharmacists do for syringes. So we'll get into that later, but I will turn the mic over to Eddie. Thank you, Dr. Chocolis, and for all of your hard work here across the state of Minnesota. We couldn't have done this without the Pharmacy Board's partnership. My name is Eddie Krumpetich. I'm a person of lived experience. I've been using methamphetamine since the age of 19. 
I have survived substance use disorder, and I'm also the chair of the Minnesota Harm Reduction Collaborative. And I also work for other organizations nationally, writing legislation and developing a grassroots mobilization around that. We were the lead writers of the legalization of drug paraphernalia and drug residue, which happened to be the very first provision of its kind in the nation. So we are very proud of not only our partnerships with the Pharmacy Board, the Minnesota Medical Association and others, Our number one and most important goal here is that we save lives and we represent Black, brown, indigenous communities who are the most disproportionately affected by substance use and the criminalization efforts that have resulted. So I'll turn this over to Pearl, who is one of my partners and one of those individuals who helped pass this law. 
Thank you, Eddie. My name is Pearl Evans. I am a person of lived experience. I have been clean for the past seven years, and I got involved in this work. Last year, I started having conversations with Eddie about harm reduction and what it looked like in Minnesota, the criminalization of Black folks. And I currently work at the Minnesota Department of Health, but on this legislation, I served in the role as a community member. So I just wanted to put that out there that I am here today and all of my work on the Minnesota Harm Reduction Collaborative is through my role as a person of lived experience. And I am excited to be here and to provide some education and be part of this conversation with everyone. 
Thank you. I'll turn it back over to Dr. Rhonda. Sure. Well, thank you for having me. And so I, again, would like to kind of talk about how the Minnesota Board or how my experience came into be with this particular topic. I have a very, very large family. I grew up with people, even though we were rooted in the church, people who had substance abuse issue, heroin issues. I learned very early on that if you wanted to hide the tracks from people, people you could shoot in between your fingers and toes. And so I saw firsthand what the stigma and criminalization of substance use did to my family, did to my community. And fast forward, I had the opportunity to hear very compelling testimony that Eddie provided to the Minnesota Board of Pharmacy about what we were doing here. 
Before this act, pharmacists were able to sell 10 syringes, but a lot of stigma was surrounding that. I saw when BIPOC people would come into the pharmacy, they would be shamed. Sometimes they would be turned away with nothing to turn to. And often that led to people sharing needles, becoming infected with different diseases such as HIV and Hep C. And then what we saw during COVID was just astronomical rise in HIV and Hep C, a lot of it due to substance use. So with that, I just had a question because I know like we all use terms interchangeably and kind of say addiction, substance abuse, substance use disorder. Pearl, could you kind of tell me what is the difference between like substance use or addiction or the correct terminology that we should be using? 
destigmatized language around the topics of substance use and addiction. Substance use disorder, well addiction, substance use disorder is a chronic treatable condition. Opioid use disorder is also a treatable medical condition and substance use disorder is destigmatize the language of addiction. So how do we start using language that is non-stigmatizing when we're talking about addiction? So we use the term substance use disorder instead of addiction because addiction, it has stigma attached to it. And so the science has told us that using language less stigmatizing language is helpful as we have conversations with folks about their current use. And it is also helpful for family and friends as they have knowledge on healthier terms to use as opposed to using addiction. Because addiction is stigmatized and it often makes folks who are currently in active use 
to feel less than. So we want folks to feel comfortable in having conversations with their family, community members, or doctors about their use and how they can get help with their use. So as we're talking about opioid use disorder, opioid use disorder is referred to, classifies the use of any opiate. So that's Percocet, oxycodone, methadone, heroin, any opioid. So it's referred to as a disorder instead of an addiction. So those are the destigmatizing phrases to use when having conversations about substance use disorder and opioid use disorder. So Clarence, you've got a question. Yeah, I want to know, we've been throwing around this term harm reduction. What exactly does that mean so that people can understand why we're having this conversation? Clarence, that's a good question. 
So we know that drug use happens. So just saying no instilled this ideal that either you say no to drugs or you use drugs and you're a bad person. We know that those criminalization efforts have not worked. I'm going to give you a little statistic here, which is just incredible. Since 1970 up to 2015, criminalization has increased in the state of Minnesota 282%. In that time, overdoses increased 342%. So we knew it wasn't working. And so what we had to acknowledge was if people are using substances, how do we keep them alive? long enough so they can make good choices in their life for them and their community. So decades of research got put into this, and they said, wow, we really missed the boat here. 
And we said, we need to make use safer. We need to make it more accessible to public health initiatives. And so what we did was we redefined what substance use was. You weren't a bad person if you were using substances. You had a chronic or semi-chronic or condition that could be treated. But we also wanted to put that onus on the person who was using substances. And what we found was is that if you tell somebody to use unused supplies like unused syringes or unused paraphernalia, they were 50 percent less likely to incur an infectious disease like HIV. That's an astronomical number. And otherwise, there was a five times higher likelihood that you would go to treatment. So, I mean, you really did hear that right. 
So if just say no. didn't increase treatment, harm reduction, saying drug use is okay, we're going to use safely, increases treatment five times the national average. So harm reduction just meets somebody where they're at in their substance use, how to be safer, how to make communities safer, and get people over to public health. Eddie, one of the things that you've mentioned in the course of the conversation so far is paraphernalia. and residue. Okay, so could you clarify for the audience exactly what you mean by paraphernalia, what you mean by residue? Yeah, sure. So let's go out to the bar for a second and you have a glass of beer, right? You have your favorite IPA. That glass would be considered paraphernalia. Okay, so you pick up the glass, you use the glass to drink the beer. 
That glass is paraphernalia. The residue would be like what's left over. the foam the bubbles and that little bit of beer at the bottom. That's what we define as residue for drugs. So what we decided to do is we said, okay, wait a second. If we want people to use safely and the science says that paraphernalia should be legalized, the reason was is we wanted to lower infectious diseases. We wanted to bring people to syringe service providers. And so we said all paraphernalia, no matter what it is is going to be legal because we didn't want to put stigma on one form or the other. And since we did that, we've seen a transition over to smoking. And so why is that a big deal? 
Because without legislative handicaps or without barriers, what we've now done is transition from the highest rate of infection, which is the syringe, to smoking, which has a drastically lower rates of infection and also the curbing of drug use. So we wanted to lower stigma. We wanted to make sure that people knew that using substances was neither bad nor good. but it happened. And the paraphernalia, things like syringes, using smokables, for example, to smoke your substances, ways to inject cottons, tins, cookers, things like that. Okay. That's a good clarification. Yeah. So let me ask this question. I mean, it seemed like, and again, you know, because this is health chatter, it seems like there were would be a lot of opposition to some kind of legislation like this because people would say that any kind of support of this legislation would mean that you approve of drug use. 
Do you have that kind of a pushback? Well, I'll make it pretty simple. So prohibition in the late 19-teens, Woodrow Wilson's in office, they get rid of alcohol. They wanted to, and see if this relates, they wanted to remove the scourge of society. So they get rid of alcohol. In one decade, What happened? We had the development of organized crime, gangsters, mobsters, crime went up. We knew that there was a problem. So the United States said, wow, that's an issue. And they looked back and they go, hmm, we better legalize alcohol again. So they got rid of that. Let's go to the Nixon administration. Nixon decides to do the same thing with drugs. And we saw organized crime, gangsters, mobsters, the exact same result. 
There was no difference, except now our situation. system has lasted almost three generations. This is a racist first type policy, which we know has affected so many people in our urban communities, urban and rural communities. And so not only does it not enable drug use, it makes things drastically worse. So we increase people's time in jail where they have a 27 times higher likelihood of dying if released from jail without referral networks and naloxone. um we have done a poor job of meeting the science where it's at. And the easiest way to transition that is goes, wow, the same exact thing happened during alcohol that's happening right now. So let me, let me ask this question is, is, um, you know, with this legislation and and rhonda i'll let you kind of lead the discussion around the, the actual legislation a little bit here, but, um, how do you know, I'm kind of dealing with the question at the end here, but 
How do you know if a law like this is really gonna make a difference? Is there a measurement, for those of us in public health, we always like to measure things to make sure that we're making a difference one way or the other. Is there a way that we're gonna be doing that? And if so, who is responsible for that measurement? Or on the other hand, don't we care about the measurement just so as long as we have some kind of law in effect that people know will decrease stigma? Well, I would like to take a step back and kind of go back to from the public health or medical perspective. One, we need to do a better job when we're teaching. A lot of times when we're in school, substance abuse is kind of disorder as entitled addiction that automatically induces stigma. 
It's not something that we talk about. It's done from a very poison control standpoint. But what we know now with this framework, the fact that we're saying it is a disorder, it is something that is treatable, we have to put our medical hats and our public health framework on. We have to start thinking about, yes, there's the pharmacology and the science. And when people say trust the science, the science will actually tell us that this is definitely a medical issue. So I can tell you personally from a pharmacist perspective what I've seen, and then I know I'll let others talk. Before this legislation was passed, there would be, I would say, people, hundreds of people that I would run into and have the opportunity to talk to, to say like, actually the pharmacy is the last place they wanted to come and get syringes, at least in the city, because of how people were viewed, 
We weren't able to connect people with resources. We weren't able to provide comprehensive services and actually refer out. What I have seen in some of the areas that I used to see syringes outside of the pharmacy, I don't see that anymore. Actually, I see in the city people who I've encountered who will come in for other things saying that they have been able to be connected with syringe service providers. And I've even seen those people get access to medication-assisted treatment. Now, I don't have hard data to support that, but I say anytime you save a life or you impact a person's life, you think about that ripple effect. So I think that is so important. But when we go into that legislation, we have to start thinking about, again, those people who 
were disproportionately affected by stuff. I've seen people be picked up for maybe a crack pipe or having a syringe. When I worked in the inner city, when I'm in Edina and I see somebody maybe who had the same things, they didn't have the same problem. So I think this legislation kind of really gets at the bigger issue. We want to treat people as humans, we want to make sure people are connected with communities, and we want to make sure that when people are ready, we meet them where they're at. So, all right, let's talk about the law. So, you know, from a personal perspective, you know, Pearl, can you start talking about the implications that a law like this has from your perspective, and then Eddie, maybe you can get into the actual logistics of the law itself. 
Thank you, Stan. So what this law does, I think I said it at the beginning, it allows syringe service programs to become legal. So before this, individual syringe service programs did not have legal legal definition. So now with the legal definition, they can operate in the state of Minnesota. It also allows for a syringe service program staff to not be fearful in working at a syringe service program. And then it goes on a little further to it doesn't say how many syringes a person It doesn't limit the number of syringes a person could access when they go into a pharmacy. So a person could go in and say they want 20 syringes. And so this law allows them to get the number of syringes that they think they need with the goal of reducing infectious diseases. 
And this law also, it allows folks to, and Eddie mentioned this earlier, it allows people who might have a crack pipe on them or some syringes on them, it allows them to be able to freely go to a syringe service program without fear of being arrested to exchange, get more syringes, meet with someone at a syringe service program to possibly explore services. have the freedom to be able to not feel stigmatized, not feel fearful when they are visiting a syringe service program or when they are visiting a Minnesota pharmacy looking to purchase syringes. So this bill allows folks to access what they need to make a better choice to in their use. And I'll turn it over to Eddie now. Yeah, Pearl, you nailed that. 
Thank you. Pearl's been a member of the Collaborative since the very beginning, and we could not have done it without her. So the law was rather simple. We wanted to legitimize syringe service providers. We know that if you visit a syringe service provider, 50% reduction in infectious diseases, police are relatively supportive, also increase in treatment. But then we saw further opportunity when we were talking with Dr. Draculis at the pharmacy board, we knew that those programs many times don't exist in rural Minnesota. So we got rid of the syringe number that could be dispersed by pharmacists. We wanted Minnesota pharmacists to be able to disperse as many syringes as necessary to meet the community needs. Then we went further than that and we said, wow, we want to make sure that people can test substances 
Because right now with fentanyl and a lot of the other substances that are killing a lot of Minnesotans, what we want is to be able to test those substances to see what's in it. So we opened that up as well. So now you can have fentanyl test strips and xylosine test strips. And the paraphernalia legalization came after. And Stan, you mentioned something earlier about the hard data. I have that hard data because we've done the research at the ground level. And we also went out and talked to our syringe service providers. This is in three and a half months. And the reason we've gained national attention here lately and have been a possible voice for national studies is because in three and a half months, we have seen a drastic increase at our syringe service providers of not only new clients, but return over clients. 
And those referral systems are not only happening, but that pivot to public health has been amplified immediately. So we know that good things are on the horizon. The next thing is that Minneapolis had a news conference the other day, and this was the police department. And they mentioned that they have not been arresting people at low level crime. But then they went on to discuss how they made large amounts of drug seizures at the sales level. So why is that important? They have acknowledged that less arrests for personal possession, less arrests for paraphernalia does not mean you're not going to stop sales. So we knew that was going to happen. So now we're pivoting there as well. And we're seeing that transition to smoking. 
So we have qualitative and quantitative data to back up these initial laws. And so now Minnesota has all of a sudden become the voice of harm reduction across the nation. And we're glad to take and amplify those voices. But we have to do a lot better. I want to get a little personal here for a second. We have to do a lot better job amplifying the voices of our black, brown, indigenous communities. I grew up in a multiracial family. And yesterday I was on the phone with my brother while he called. And my brother is black. And he called 911 yesterday. And I listened to him get arrested on the phone. I listened to him get arrested on the phone. And as he was getting arrested, telling me, Eddie, I'm going to get arrested because I'm black. 
This is something that I don't have to deal with as a white man. And substance use disorder takes three times as many black people here in the state of Minnesota and 10 times as many indigenous individuals. It's disgusting. And I say that with a lot of emphasis because that is a lot of our focus this year. And we're just so glad to be a part of this, but we got to do better. Absolutely. So help me distinguish the... the Steve Rumler Hope legislation, which is really a form of a Good Samaritan law, I think. And if indeed it is, how does it differ in and of itself from the regular, the other Good Samaritan laws that are in effect? So one thing that I'll say about the Steve Rumler law is that 
It was passed, Eddie, correct me, 2012? Is that correct? Or 2014? Right around that time. I don't want to get, but right around that time, girl. So Steve Rumbler law was passed to prevent, to remove the fear, the stigmatization of calling to get help for someone who was having an overdose. We were in the second, maybe the third wave of the opioid crisis at the time. So at the time, that law met the need. And there are some complications with Steve's law because it only covers the individual who made the call. And it's still up to the police to determine who will be arrested. So Steve Law, it was the first in the state of Minnesota to raise awareness around the overdose crisis. 
It was also the first law to destigmatize substance use and allow folks to get the help they need to save their loved one or family member or as a passerby to save someone. so that they could get the help and to reverse the overdose. But now that we are in what most folks are calling the fourth wave of the epidemic, we think the Steve Rumler law, Good Samaritan law, can go a little further. And also, one of the things about the Steve Rumler law is the police still has the power to determine who is arrested. And then there's also a cap on, like if you have less than three grams, then you would not be arrested. So it was to protect people who were using, to remove the fear so that they could call to get some help, but also not to allow individuals who were dealing drugs to have those same protections. 
So where we are today, in the overdose crisis, we think that Steve Rumbler's law can go a little further. And Eddie and I have talked about that, but I have not completely immersed myself in that piece. So I'll turn it over to Eddie, and he can take a deeper dive in how the Steve Rumbler law can be expanded to meet the needs of where we are today in in the fourth wave of the overdose crisis. Yeah, that's a really good explanation, Pearl, and thanks. The Steve Rumble law doesn't go far enough. We've known that from across the country. States like Maine have been passing laws that expand those protections with rather simple changes. We know that we don't want individuals who call 911 to be prosecuted for substance use. 
That's You know, that's the basic framework of the law. The language that's coming out currently is being formulated by many organizations here across the state, but we're taking our lead in this one from across the country, from states like Maine and others who realized that things like calling 911 should be protected, not only for the person there, but for secondary individuals as well. So when those language changes come out, we'll obviously be just giving those out. But until that point, we just don't know yet exactly what Minnesota is going to do. Clarence. Yeah. How widespread is the use of drugs in our communities? I think that, you know, people have different perspectives. But could you give me some stats, some data so that people understand how widespread this issue is? 
You can do it both in Minnesota and national. Yeah, sure. So it's just think about like how many people drink. Right. I mean, that's the way to really kind of think about it. More people die from alcohol than any other, quote, drug that exists. Drug substance use disorder affects about 10 percent, maybe less of people who use substances. So that means that nine out of 10 people who use substances and I'm not this is within a framework of that percentage. And that includes any substance. That includes any. So we're talking everything from alcohol to cannabis to methamphetamine. Some of those have higher addictability rates, but the amount of people who will transition over to substance use disorder is rather low. So we know that substance use disorder causes issues for individuals and communities, but those issues tend to be amplified because of the mental health that goes along with it and the consequences from those uses from people 
who unfortunately at those times are in chaotic use. And so what we're really doing is legislating to those individuals. So here's a question I have. And Eddie, I alluded to this before we got on the show. Okay, so this law is in effect in Minnesota. First, are there other states that have it in effect? And what do people do when they cross a border? Okay, so like, let's say somebody goes from Minnesota where there is a law into, let's just say, Wisconsin, for instance, that might not have a law. So what happens then? And if that indeed is a problem, then why aren't we facing just overall federal legislation? in this arena. Yes, so the this those are great questions um the first is is that you were not protected when you cross state lines um there you go yeah yeah not protected um we were the first state. 
Unfortunately, even regionally, we don't have those partners yet right uh to to form that reciprocity um or that legal reciprocity back and forth um what i can say is that nationally um we've been dragging our feet nationally for a long time. Things like the crack house statute, one of the most racist statutes that exists from the 1980s are the things that get in the way of, of transitioning this over. But if we know that if the federal government is not going to do this, we know if the federal government, because remember the federal government speaks for many different communities across this nation, right? So Minnesota, that our communities needed this Minnesota. So we had bipartisan support. We, we, we knew that it was time for us to make that change. 
And there weren't national, there weren't legal handicaps at the national level to do that. But I want, I'm interested to hear what Dr. Chikoulis has to say about this. Well, I mean, again, like, like you said, it is hard to kind of push the federal mandate. You know, up until recently, we had some states that actually didn't have good Samaritan laws that allowed people to administer Narcan without a prescription. to people who had clear signs of a visible overdose. And that's like, to me, very insane, right? That would be like saying, I can see somebody who has a blood sugar of 400 or 500, and I know they need insulin, but legally, I have to walk by and let them go into a diabetic coma. 
For some people that may be, they can't see the comparison, but what we know is, again, I want to reiterate that this is a disorder that can be medically treated. I know we're getting close to time. And one thing that I would love to bring back and talk about is we kind of have entered the conversation in terms of Narcan. Narcan to me, like everybody's using it. It's become the new thing. People like it. It's quick. It's an easy fix. You can see the effects of somebody being reversed of an you know, an opioid overdose immediately. But what I do know as a pharmacist is that when people are given Narcan without having resources, they're actually more than likely to die of an overdose later because that withdrawal is so, so strong. 
And so one of my passions is really expanding the use of medication assisted treatment in particular in BIPOC communities, because I know of locations and clinics that, In the inner city where people who would take those spots, those designated spots, they would come in from the suburbs. And so our communities aren't left with providers who are willing to help them get MAT. I know in some states, pharmacists are able to do that. And hopefully Minnesota will join those states. Yeah. Clarence. I tell you, this has really been a, I know we're getting close to the end of our time, but this has really been a very interesting eye-opener for me. And I said this when we first started was that this was an area that I was not necessarily familiar with, but I know that it was something that was going to affect our communities. 
And so I appreciate Dr. Rhonda Marie, Eddie, and Pearl, and the rest of my crew for helping me to enter the conversation. And I know that we're going to be doing a community forum on December the 11th here at the Center for Changing Lives to talk more deeply about this conversation with the community because it is something that we have to address. So I just want to thank you all for the opportunity for me to learn, to enter into this conversation, but also to be able to encourage others to join in with us. You know, as I've listened to the discussion here, It's, what's really struck me is how is it that we can all be more sensitive to the needs of individuals across a variety of different medical, public health issues. 
And this certainly is one of them. You know, Rhonda, you mentioned somebody who might be diabetic and, you know, people are afraid to help them out. Or somebody who's having an apparent heart. heart attack and somebody is reluctant, for instance, to give CPR. All these ideas are together on how it is that we can help one another and hopefully save lives, intervene with people to truly help them. So I'll give each of you, Eddie, a quick second or two here to final thoughts. I just want to take the time to thank each of you for the invitation, which is something that is an honor to me. It's an honor to me to be here. Check us out at the Minnesota Harm Reduction Collaborative. 
What I want to emphasize here is that the law that was written last year by Pearl, myself, and the collaborative, and Dr. Chikoulis and others, this was written by people with lived experience and those who treat them. Yeah. written by us. And so when i emphasize this, we, like i talked about the national attention earlier and how many news articles and things like that we've had done, but it was because the street and those of us who have, who have used substances wrote the law. That is incredible in and of itself you know absolutely the law, none of them did we did it and it's just been an honor to work with everybody. And thanks for having me on. Yeah, Eddie, I agree with you. 
There's definitely a difference between sympathizing for an issue and empathizing, which you have related to here. Rhonda, thoughts? First of all, yeah, I want to kind of piggyback what you said. And I see this movement being from sympathizing, empathizing to mobilizing. The harm reduction collaborative isn't just people with lived experience. What the beauty of it is, there are people from a variety of disciplines. So you have pediatricians, you have nurse practitioners, you have pharmacists, you have lawyers, you have lobbyists, you have people who have been able to utilize the people who have the lived experience and mobilize those things and even educate providers in the community so that we can have a better community and the treat everybody's lives with the compassion that they deserve. 
And dignity and dignity. Absolutely. Pearl, last thoughts. Thank you. I just want to say that this law allows us to meet folks where they are at in their journey and to make healthier decisions. And everyone in the state has a role to play in harm reduction and and educating themselves on how to support individuals who might be in current use. And yeah, that's my final thoughts. We are on the road to play in harm reduction. Thank you all again. Thank you. Thank you. It helps me to enter the conversation. You know, I will tell you this, that my sense as just a public health professional is this. I feel as though I need to give you all a hug for doing this work because it seems so important. 
And I really appreciate your efforts in trying to get the message out to the public. So thank you, Eddie, Rhonda, Pearl, for being part of our show today. To all of you in the listening audience, keep health chatting away. Our next show will be on artificial intelligence. Bye for now.