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Volcanoes are erupting in The Philippines, but on-fire Australia received some welcome rain. The Iran war cries have been called off and The Donald’s military powers are about to be hamstrung by the Senate. Meanwhile, his impeachment trial is starting, and we’re all on Twitter for a front-row seat.

Demon Drugs and Moral Panics

Featuring Maia Szalavitz

Is drug use always harmful? How does empathy play a role in addiction? Could it be more beneficial to approach drug use as a public health issue rather than a criminal one? In this episode, we speak with Maia Szalavitz, an award-winning journalist and author, about the potential benefits of harm reduction for addiction treatment and addressing larger societal issues. Plus, we take a look at smart guns and serial killers.

Prefer to read? Check out the Audio Transcript

[Audio Clip]

Zachary Karabell (ZK): What could go right? I’m Zachary Karabell, the founder of The Progress Network, and I’m joined on this podcast as always by Emma Varvaloucas, the executive director of The Progress Network. And What Could Go Right? is our weekly podcast where we talk to people, sometimes members of The Progress Network, sometimes not, who are taking a more constructive view, a more constructive attitude toward all the destructive things in the world.

Emma Varvaloucas (EV): Yeah. So one of those voices is Maia Szalavitz, who we’re gonna be speaking to today. She’s a columnist at The New York Times where she covers drugs, addiction, and public policy. She’s also the author of a few books. The most recent one is Undoing Drugs: The Untold Story of Harm Reduction and the Future of Addiction.

ZK: And on the topic of addiction, we’re gonna look today and discuss about how our cultural attitudes about addiction, particularly drug addiction, have changed largely for the better over the past decades in ways that I think are startling and surprising and actually quite hopeful about other change that might happen in our world. Things that seem like they will never change, that we are stuck in a destructive rut, can suddenly, on a dime, shift. But they’ve often shifted because voices and people have been spending years, if not decades, urging for that shift, working for that shift, creating ideas and new frameworks that say, hey, the way we’re doing things doesn’t work. We could be doing better. So let’s do it.

Maia, thank you so much for joining us today. Obviously, no one would know this except you and I that we’ve known each other for many decades since college and have been— I think both of us thinking about issues about America and drug policy. And the drug thing, I mean, when we were in college in the— whatever, whenever that was a while back, it seemed like the last thing in the world, given that this was like the beginning of the war on drugs, that American attitudes about drugs, about things that we called illegal drugs, let’s be clear about that, that it seemed like just never in my lifetime would those attitudes soften.

Maia Szalavitz (MS): Yeah. So my most recent book, Undoing Drugs, is actually about precisely that. Like how did we go from just say no, lock ’em all up, addiction is a character flaw, to legal marijuana in, I think, more than half the states now, continuing to go. Two states have legal psychedelics for therapeutic use. Harm reduction has been adopted by the Biden administration if only sporadically. But you know, definitely prior to that, the whole concept of being kind to drug users and keeping them alive if they weren’t willing to immediately become abstinent was just, you know—

I mean, just after I was in college with you, I had my own addiction struggles and I was injecting drugs. And this was the mid-’80s and it was the worst time to be injecting drugs in New York City. 50% of people who were doing so were already HIV positive and I didn’t even know. Once I found out that this was a risk for people who shot drugs, I immediately became outraged that not only did people not want to tell us how to protect ourselves, which was as easy as cleaning your needles with bleach, but they wanted to actively discourage people from finding this out, let alone give them clean needles because otherwise it would encourage drug use and the young kids who would see that we survived would be badly influenced. And I just thought that’s just a horrible thing. And I saw that gay people were organizing ACT UP with a big inspiration and I was just, why don’t we have that for people with addiction?

And so once I managed to get into recovery myself, I basically began a career in journalism trying to understand why we have this ridiculous policy. And one of the fundamental reasons, I rapidly learned, is racism. And one of the biggest reasons that we’ve been able to move away from this has been sort of one gross kind of force, which is, oh gosh, the opioid epidemic is white, so therefore we could be nice to people. And the much more salutary influence is that of Michelle Alexander and her book, The New Jim Crow, which— there was enormous support for the war on drugs in black communities for a really long time. And she unraveled why that is a bad idea. And that change stopped giving white politicians cover for supporting this very racist policy.

And so between that, the marijuana legalization movement and the fact that states that legalized pot did not have the sky fall or mad men suddenly running in the streets stabbing people everywhere. In fact, there’s more that goes on in places that have not legalized. But the fact that this big bugaboo that everybody was so terrified of, and what about the children? And pretty much nothing happened, at least in relation to that directly. So we’ve had all of these forces. And yeah, in the ’80s and ’90s, it was really difficult to imagine. I mean, even talking about decriminalizing possession of marijuana, oh no, you’re gonna send the wrong message. And as well, we’ve been sending the right message for God knows how many years now at this point, and what do we have? The worst overdose death crisis in history.

EV: Maia, I’m wondering if you could dig a little bit into what harm reduction is. I didn’t even realize that the Biden administration had adopted that as its approach. I’m hoping you could give the basic explanation, what is it, what is it trying to do, practically speaking, what does it look like?

MS: Harm reduction is the idea in drug policy that we should be focused primarily on stopping people from getting hurt, not stopping them from getting hot. In action, the most classic example is syringe exchange. You give people clean needles so they won’t get blood-borne diseases. And so that when they do get into recovery, which most people do eventually, they will not have life-threatening illnesses that need to be treated very expensively if that is your concern. So there are sort of various levels of acceptance of harm reduction. It could be anything from legalizing to— because in many cases, prohibition is causing more harm than the substances themselves. And so if you’re thinking about this in a harm reduction context, it’s, well, if we wanna reduce the most harm, these laws are actually increasing harm.

So that, of course, has not been embraced by the Biden administration, but what they have said is that their official drug policy includes harm reduction measures, which are everything from syringe exchange to distributing the overdose antidote naloxone to having housing where abstinence is not required. Although, interestingly enough, that started in the Bush administration because so much of homelessness, people were never getting housed because you had to jump through all these hoops. Yeah, it all gets over before I get housed. That’s really gonna happen, right? So, I mean, occasionally, obviously, but it has been embraced sort of on a small level within the policies that are officially called harm reduction, but not so much on the level of thinking about what we do.

And I mean, a classic example would be something like, okay, we had over-prescribing of opioids. A lot of people misunderstand this because they think that the people who got addicted were pain patients. 80% of people who misuse prescription opioids did not have a prescription for them when they started. So these are overwhelmingly not pain patients. And a lot of pain patients are suffering because they can no longer get access to medications that actually help them. But that is another topic. So what did we do when we discovered that we had this going on? Okay, we’ll cut the medical supply. This will solve this. And so we cut the medical supply, it’s back down to, by some measures, the rates before OxyContin was introduced. So it’s really quite low. And in fact, at that time in the ’90s, this was seen, quite rightly, as people did not have enough access to them when they were dying or had severe chronic pain that was the equivalent of death kind of pains that you were gonna have for 30 years, not just a few months.

So anyway, so we just cut the medical supply back down to where it was when we widely acknowledged that it was not adequate even before pharma marketing pushed that too far. So, okay, we did this, we did not do a single thing to help all those patients, whether they were pain patients who were getting cut off and still had pain or they were people with addiction who were getting medical opioids, which are much safer than street fentanyl. So we just cut them off and oh, gee, how did it happen that gangsters came in there? If you have a harm reduction view, you cannot create a policy that does more harm. When you’re thinking through policy, you have to think, oh, okay, what’s gonna happen if we stop this? Oh, yeah, addiction actually exists, so people are gonna try to find another source. They’re not gonna be cured when you just take away one source of the substance. If only that were true, but it is absolutely not, right? That’s just an example from recent history.

But really, harm reduction requires thinking of policy in context. And so, for example, another one would be, we have this herb called kratom, nobody really knows how to pronounce it, but I’ve asked too many times and nobody really— people just pronounce it how they want. But anyway, this stuff is essentially a very mild opioid and it’s available as a supplement because we don’t regulate supplements very well. But so there was this whole, oh gosh, this is an opioid, we should ban this. It’s bad. Well, in the context of fentanyl, you wanna ban an opioid that is incredibly hard to overdose on? That would be really stupid. And in fact, so far, and for the first time in recent memorable history, the FDA wanted to ban it and they didn’t. They weren’t able to because people said, this is a really stupid idea.

ZK: I guess the flip side of my optimism about changing attitudes toward marijuana and legalization, changing attitudes towards the therapeutic use of psychedelics is it’s almost as if you look at the past hundred years of policy toward various mind-altering substances, let’s just call them that, it’s almost as if American society kind of needs a drug demonization of choice at any given moment. So you have the end of prohibition in 19— you have prohibition in the ’20s, demon alcohol, destroying families, ruining stuff, and then you have the repeal of prohibition and suddenly marijuana becomes like the— Reefer Madness and it’s the thing that’s gonna destroy families and on and on and on. And then really in the past 10 to 15 years, almost in weirdly inverse lockstep with relaxed attitude towards marijuana and psychedelics, you have this intense reaction against all opioids to the point where if you watch Dopesick on, I think it was Hulu, Patrick Radden Keefe’s book, Empire of Pain, the Sacklers are depicted as these sort of, you know, maniacal— I mean, maybe they were, right? I don’t even know—

MS: I just have to dump it in here because The New York Times, I think last week or recently had another piece about the evil Sacklers funding something. All of this focus— yes, they are bad, they did bad things, but if you continue to focus on the medical supply, when we have street fentanyl killing at least a hundred thousand people per year, this is really stupid. What you are going to do by further cutting the medical supply is further increase the market for street fentanyl. And Dopesick, promoted, unfortunately a lot of ridiculous myths about the addictiveness of opioids. For example, there’s that ridiculous scene where the doctor, somebody’s— he’s about to have surgery, oh no, I can’t have opioids because I will turn into you a zombie. Dude, you’re not at risk.

First of all, the one thing that people never think about is, okay, let’s say you get opioids in the hospital, you don’t even have a prescription. Most people are not comfortable buying street drug if they haven’t previously done so. Even if you have previously done so, especially to not get ripped off [laughs], it is hard to do. You don’t get supplied with a drug dealer when you get opioids in the hospital. The thing that is also really annoying, so, okay, all of the opioid companies and Purdue, they said, oh, only 1% of people who get exposed medically get addicted. That is actually true with one caveat. If they don’t have a prior history of addiction of any type. And so, most addictions, 90% of addictions, begin before the age of 25. So if you’re talking about a 40-year-old woman with MS who has zero history of addiction, the chances that you’re gonna give her a prescription and she’s gonna start robbing pharmacies are enormously low. But we can’t have this subtlety in our policies, right?

And I do think, yes, we have this history of we have one demon drug after another. That is definitely a thing. But we also go through periods where there really isn’t. I mean, methamphetamine sort of was a drug scare, but it really didn’t affect that many people. And perhaps more importantly for not creating a drug scare, it’s really rare in New York City except for among gay men. We’re a coke town. It’s actually really interesting. Nobody can really explain. It may be that the, whatever, consumer, the drug dealers prefer selling— they have connections [inaudible], whatever it is. But the thing is that we also have plenty of other areas to create moral panics, unfortunately, which we are seeing around trans people right now. And so while we definitely tend to go from one drug scare to another, which of course is really great in like, okay, I won’t do that drug that my older sister nearly died from. I’ll do this one instead because this one is not demonized yet. And it’s just a stupid way to do policy.

EV: Demon drugs and moral panics aside, do you think that there is increasing acceptance around addiction issues? I mean, I was thinking about this because John Mulaney, who of course is a celebrity, he’s a standup comic, but his whole Netflix special that just came out was an hour and 15 minutes on him going through addiction, which, to your point, started apparently at age 14.

Audio Clip: When I first got to rehab, one of my biggest fears was that everyone was going to recognize me. Gradually, a new fear took over. I’m not exaggerating to be funny. [laughs] No one knew who I was and it was driving me bananas. Please don’t repeat this. It was in the newspaper that I was in rehab and I left it out. I was like, hey, oh my God, the paper’s here, get in here, you addicts, oh my God. Oh, I wonder what’s inside.

EV: It’s hard to imagine— and again, he’s a celebrity. He’s sort of held to different standards, but it’s hard to imagine that happening 10 years ago. I mean, I am sort of of the era when celebrities going to rehab was like, oh my God.

MS: Well no, I disagree. Like everybody got to rehab. I think it began to become destigmatized in the ’80s when— the peak of this probably would’ve been early ’90s when New York Magazine ran a story about why single women should go to AA to pick up men.

EV: [Laughs] I’m really glad I missed that.

MS: Right. And this is when the movie The Player came out and people who didn’t have problems were going to AA because that’s where the deals were being made. So there was this whole recovery thing. The destigmatization of recovery has really come a long way, I think. What has not been destigmatized is continuing active use. What also has not been destigmatized, unfortunately, is anything other than 12-step treatment. And we still have this idea that is the one true way and that if you don’t recover that way, you’re not really in recovery. And if you use medication, you’re not really in recovery. Also, is there a rockstar that hasn’t gone to rehab? Naively, when I was trying to organize around [laughs]— trying to get people to do something around AIDS [inaudible] drug use, I’m like, okay, every guitarist, probably every bass player and drummer too, singers, whatever, they all shoot off. So why wouldn’t they do a benefit for needle exchange? This seems like a good thing to— but of course, they didn’t want that to be their image even though they sang songs like heroin or cocaine, you know, Heroin by Clapton and Cocaine by [inaudible] [laughs]. No, I’ve got them backwards. The point being that they did plenty that glamorized drugs during their careers and the idea that now they would only support people who are already abstinent or people who are willing to go and attempt to be abstinent, okay, so we’re gonna let them get AIDS when they relapse or before they are able to get into treatment? This is ridiculous, but I was obviously very naive about the commercial pressures [laughs] on musicians and how actually rock and roll they are.

ZK: It’s funny you mentioned this ’cause there’s also this whole strain of reality that doesn’t enter into the mix at all because it’s frankly more banal. So we talk about addiction and people who whose lies fall apart. My friend, Ann Marlowe, I think in the ’90s, wrote this book, Heroin A to Z. It was a memoir about her as a very successful high-powered headhunter who also had an active continuous heroin habit. And this was not like a defense of her having a heroin habit any more than books about people drinking as a defense of being an alcoholic. It was an articulation of you can actually be a high functioning drug user. Right? That it’s not like one shot of anything—

MS: Most people who use drugs are not addicted. Even when you’re talking about something like heroin, probably 30% of users become addicted at max. Typically, the range is 10 to 20% for alcohol, cocaine, methamphetamine, and heroin. It’s a little bit less for weed. It’s a little bit more for nicotine in the form of cigarettes. And it’s almost non-existent for the classic psychedelics. So a lot of the drug war was about teaching people lies, creating this idea that, oh, we can’t tell people that only 10 to 20— because that’s a high rate of addiction actually. But would you fly in a plane that crashes 20% of the time? But we couldn’t tell people, oh no, that 80% don’t, oh no, we can’t be talking about that.

And also, I think actually when we’re talking about what brought about the change in drug policy, a undermentioned thing is the internet because when the internet first started, it was populated by deadheads , computer geeks, people who liked drugs basically. And there was honest information about the risks and benefits that was on there. It took many years before the prohibitionists caught up with the pro-legalization message that was throughout the early internet. And I think I had a letter in the New England Journal of Medicine because somebody wrote, oh my God, people are getting their drug information from these strange sites. They should be going to the honest government sites. Really? Honest? [Laughs] Like the marijuana turns you into a heroin addict instantly. I mean, to be fair, the government sites have become much better, and if you are actually looking in the medical literature, you would find much more honest stuff. But honest information on drugs from the DEA and the drug czar?

EV: I’m curious where we are actually in terms of the medical literature on addiction. So I’m imagining that has also improved or just changed. I know it used to be addiction was considered to be a brain disease. Is that still where we’re at? Or what does current research say?

MS: Disease is a cultural term. It’s not a medical term. What used to be argued, in my view, dumbly, was addiction is a disease because drugs change the brain. Okay, so learning is a disease, right? Because learning changes the brain, right? Walking is— I mean, [laughs] it’s just— it’s a dumb argument. Everything that has an impact or sensory experience changes the brain. Otherwise, you couldn’t experience it, unless you’re talking about the soul, which we don’t really wanna be doing in a scientific context, right? So the problem with seeing addiction as a brain disease are— there’s twofold problem. One is this has become extremely associated with the 12-step view that abstinence is the only acceptable way to treat it. The 12-step groups and people who sort of believe in that ideology say, it’s a chronic progressive brain disease.

But the thing is, if you actually look at the literature— and most of the findings in the addiction literature are really old. They’re just now way more replicated. If you looked at the medical literature compared to what the popular press was saying at any given time, there was much more sense because when you actually have to do an experiment, unless you’re a dishonest scientist, you’re gonna have to deal with what the actual results are rather than, okay, well this will fit into my propaganda so I’ll publish this and I’ll put this in the file drawer, which I actually think there’s a lot of file drawer literature on the harms of marijuana that failed to pan out. And also, people don’t like to publish null results anyway.

The point there is that yes, the medical understanding has expanded. And part of this is because it really was a back order for many years and really the only people who wanted anything to do with it were doctors and researchers who work in recovery or some kind of drug users themselves. So the American Society for Addiction Medicine, which thankfully has really changed a lot, but it was originally founded by diehard 12-steppers who oppose the use of medication even though probably 20 years ago we already knew that for opioid addiction, the only thing that reduces the death rate is staying on methadone or buprenorphine. Now buprenorphine is newer, but methadone’s been known for years. 50% reduction in mortality with staying on these drugs. So advocating abstinence in light of that, in my view, is malpractice.

Now, again, this does not mean that individual patients should not aim for abstinence if that’s what they wanna do, especially since obtaining these drugs, especially methadone, from our horrible system is a horrible pain in the butt. You often have to go every day, your counselor can say, oh no, you can’t go on that business trip— I mean, it’s really bad and there are people working to change this. But the data has really been there for a really long time. It’s now pretty well replicated. In terms of how do we see addiction, I have obviously written a book that argues for seeing it as a learning disorder or a developmental disorder, and I think what was interesting when I was writing the book was some neuroscientists were like, oh, everybody knows that. Why would you write about that? I’m like, everybody does not know this.

EV: [Laughs].

MS: The main concept in the field is disease and the main concept in the field is disease that turns you into a zombie where you have no free will and that you are having basically something like Alzheimer’s. But when you look at how people with addiction actually behave, that is just not what happens. People don’t shoot up in the middle of the street if they have any other option [laughs]. They don’t shoot up in front of the cops if they have any other option, which means that they can delay use, which means that they’re not zombies in the sense that they have zero free will.

So the learning disorder perspective, first of all, it accounts for the fact that gee, it typically comes on at a time that’s a sensitive period in brain development, like virtually all other psychiatric conditions, right? I think 75% of all mental illness manifests before 25. So there’s a sensitive period in brain development that’s going on when you’re a teenager and that’s when these things often manifest. Other conditions like autism, you can see earlier, but there’s stuff that’s going on in the adolescent brain that can go wrong, thankfully for most people does not.

The other thing that really deals a fatal blow to the chronic progressive brain disease, first of all, most people recover, but second of all, the rate of recovery is about 15% per year kind of regardless. And so a lot of treatment centers will show, oh we got an 80% success rate. Basically, what they do is they’re really horrible to people. 80% of people drop out in the first two weeks. They have their 80% success rate among graduates, which is 15%, which is the natural rate of recovery. So they select out for the unmotivated folks. Anyway, I could teach an entire course on how to lie with statistics, with addiction treatment data.

ZK: Yeah, I mean and the studies are really— they’re problematic in terms of their datasets. They’re problematic in terms of their methodology. They’re almost impossible in terms of their control groups. I mean, mostly because you can’t take a thousand 15-year-olds, have 200 of them do heroin regularly, 200 of them do a placebo that they think is heroin, and 600 do nothing, and then study their lives for the next 20 years. I mean, if you really wanted to understand the potential— and also somehow normalize for diet and environment and two-parent, one-parent, all these other environmental factors. But we make these assumptions, some of which are, I guess, legitimately correlative. I mean, early studies of the lethality of nicotine were based largely on correlative stuff, not—

MS: Absolutely. Just huge massive correlation.

ZK: Right. But you also had a much larger set of humans. I mean, if 200 people did heroin, you’d probably come out with an understanding of what the actual risks were.

MS: What’s interesting is we have a pretty good natural experiment on that, which is Vietnam. The American soldiers who went there, around 50% used heroin or opium to the point where they were actually physically dependent. And so Nixon, everybody was panicking, these people are gonna come home and they’re gonna spread heroin addiction all over the place and it’s gonna be a nightmare. What happened when they came home was actually only about 15% tried it again once they were home. And only about 1% to 2% actually developed long-term addiction, which is pretty similar to the population rate for opioid addiction in general. So we can say that, yeah, they were in a pretty stressful situation over there. They were taken out of that stressful situation.

Now, there is also some people that will have switched to alcohol or other substances, but the main point is that most people who have access to a pretty decent life do not become addicted to opioids. And the people who do become addicted to opioids overwhelmingly have histories of childhood trauma and/or mental illness or other developmental differences like autism or whatever. It’s not like people who are happy and good at coping get exposed to a substance and then throw away their lives. That maybe happens very rarely, but for the most part, what happens is people discover something that fixes something in them and eventually it stops working and causes a lot of harm. At first it seems like, ah, I’ve solved this problem. And so if you don’t have that problem to solve and you do have alternative things that make your life worth living, you’re probably not going to— I hear this all the time from people who are like, oh yeah, somebody gave me OxyContin because I broke my leg or whatever, and that was the best thing ever. And I knew that I better not mess with that because I did not want to lose my job or my wife or my cat. So those are the stories you never hear ’cause they’re really boring. Who would buy an addiction memoir that was that? Or who will we hear from are the people who would get in trouble who are the minority?

EV: You had a staggering statistic in one of your recent columns in the Times that had to do with what you just said, which is that nearly 75% of women with a heroin addiction were sexually abused as children. I was blown away by that. Where are we, I guess, when it comes to the therapy conversation? Because I have this sort of pop therapy idea that we’ve come a long way, right? That it’s more available, that people have better access to it, that it’s just more an open part of the conversation. Would you agree with that?

MS: Well, the problem is that historically, addiction treatment itself has been traumatic. If you weren’t on methadone, the main method of treatment was the therapeutic community. This arose out of a cult called Synanon. The idea was AA isn’t tough enough, so AA wants you to admit you’re powerless over the substance, will make you feel powerless by— AA wants you to get humility, will humiliate you. It was attack therapy. And this is still, unfortunately, prevalent in a lot of places. And it is horrible, especially for women who are survivors of sexual abuse.

And so the whole idea was we break you down because you have too much of a big ego and you are too arrogant. Yeah, okay, maybe that was fine for the white people who originally— like the white men who originally [laughs] originated this stuff. But the vast majority of people with addiction are not like that and are not on top of things and need to be brought down. In fact, if you just think about it from common sense, who’s more likely to recover, a doctor who has a practice and a wife and a kid and a cat and a dog and whatever, or the homeless guy on the street? I’m gonna bet on the doctor, right? But to be fair, there have definitely been advances in treatment and there’s this whole movement now to make treatment trauma informed. Now, you can’t do that if you are attacking and humiliating people because that is trauma producing. Some people of course just pick up the buzzword and they don’t change what they’re doing. But there certainly is a much greater awareness of the role of trauma in addiction.

And one of the things about that 75% figure, which also was horrifying to me, was that half of that group was abused more than once. It was an ongoing thing. It wasn’t just a one-off incident. So it was like a life. And I can’t remember if I used this there, but there was a sort of poetic term for the childhoods of most people with heroin addiction, not in my case, but in many, called shattered childhood. They basically had just— everything was ruinous. And if you look at those adverse childhood experiences studies, you find, I think it’s something like eight times greater risk of becoming an injection drug user if you have five or more different types of child traumatic experience compared to if you have none. And most people have at least one. But even having one actually doubles your odds of addiction.

A lot of the times too, people have both trauma and mental illness because oftentimes what turns a predisposition to mental illness into an actual illness is the trauma, especially at a young age. So what we’re trying to do and hopefully moving away from, is punishing people for trying to feel better and trying to feel okay. And that produces more desire to use drugs, not less, because you’re taking away the thing that the people use to cope and not giving them other skills.

ZK: So Maia, you’ve been doing this column for The New York Times for more than a year now. In a world of noise, the Times remains still a more prominent platform that gets more attention. I mean, I noticed this when I’ve done stuff for them. It doesn’t have the impact that it might have once had culturally, but it still has a lot more than most. What are you noticing in terms of feedback? There’s obviously some degree of validation of the arguments you’ve been making. I’m not saying the Times necessarily, in its columnists, endorses the views thereof, but there is a willingness to feel like this is a resonant viewpoint. Are you finding that in terms of your reactions? Has that changed some of your sense of where the culture is?

MS: I mean, yeah, the fact that I was able to become a contributing opinion writer there definitely shows more openness to these perspectives. And so that has been obviously really great for me. I always wanted to do this. I’m having a lot of fun. And yeah, first of all, people call you back really quickly [laughs].

ZK: [Laughs].

EV: [Laughs] that’s nice.

MS: But aside from that, yeah, I mean, I get enormous amounts of feedback. I think mostly positive. If you write about 12-step and don’t say it’s the best thing or the only thing, you’re gonna get majorly attacked. And that did happen around that particular column. I am not anti-12-step, but I do not think we should be forcing people into it. But yeah, it’s been really interesting to see how views that were definitely out of the mainstream even 10, 15 years ago are beginning to be accepted, especially since we’ve seen the failure of the punitive approach.

I mean, do we really think locking more people up for fentanyl is gonna fix this? I mean, fentanyl’s like— you could supply an entire city with an amount that’s this big. You’re never gonna prevent that by supply side. And who are you gonna bust? You’re gonna bust the lower level people ’cause they’re easier to bust. And who are those people? They’re gonna be people who are addicted themselves. We’re just gonna continue mass incarceration by doing that. So that was a digression, but it’s been really great doing this and I I just wanna do it for as long as I can and just get as much accurate and informed information out there to people ’cause just the whole area is just filled with ridiculous myths.

ZK: Well, I’ve certainly been enjoying the columns and I’m very pleased that you have that platform. I mean, everything you’ve been writing for the past decades has been— I find brave, and in a culture— I mean, the culture has moved more in your direction, right? So you’ve been where you are where you’ve been much more like the outsider saying, hey, hey, wait a minute, and in ways that I think are quite validating, right? Things have moved and part of the point that we do The Progress Network and we do this podcast is cultural shifts happen very slowly until they happen very quickly. And the way in which they do is the idea universe is seated like pebbles in a pond, right? You know the ripples are going somewhere. You just don’t know when they’re gonna hit [inaudible], what effect they’re gonna have. And you have been one of a series of voices, Michael Paul and some others, who have clearly germinated seeds of change that have now blossomed. And that’s really impressive. And I think you could do a little self-backpatting occasionally for that. So keep doing what you’re doing and we will keep listening to what you say.

MS: Thank you so much for having me.

EV: Thank you, Maia.

We covered a lot of ground there in a pretty short period of time. We didn’t get to some of the pushback, which people might have listening to this, but I do find Maia’s columns to be extremely educational, especially when she says there are a lot of myths out there that need to be rewritten. That’s how I’ve certainly found my limited educational experience paying attention to this conversation that most of the things, most of the pop knowledge that I had in my head about addiction don’t turn out to be correct and what works when it comes to addiction don’t turn out to be correct.

ZK: I think not doing a lot of the pushback in that conversation is fine, especially because the pushback remains the dominant discussion anyway, that those stories and those realities are so palpably part of our collective awareness about the use of drugs. And look, part of the problem, which Maia does very well to draw attention to, is the line between scheduled substances, illegal and prescribed, in terms of their pharmacology or in terms of their intensity is a completely arbitrary one. The human body doesn’t know from fentanyl to OxyContin to heroin, to pot to psychedelics, whether these substances are legal or illegal. It knows what the body is responding to as a substance.

And there’s a whole panoply of “drugs” that are prescription-based and legal, not including opioids, that are intensely powerful and can be intensely destructive, but that can also be intensely constructive. Most of these things were created for a purpose that was good, not a purpose that was bad. Most of the things that we call scheduled substances, human beings started doing because of a very natural and cross-cultural need to escape or need to transcend consciousness or need to have fun, you name it. Every culture of the time of human beings have been altering their minds forever and are likely to continue to do so. So I’m for one very sort of surprised and delighted that the conversation has become more nuanced, has become broader, has changed the knee jerk black and white simplicity that our culture has dealt with. I guess the opioids is a bit of a— that’s pretty black and white the way we deal with it right now. But I think these are good changes in our society, good in that we are developing a greater maturity and sophistication about how we look at these things and weigh the risks and weigh the benefits and weigh how we manage both.

EV: Yeah. And I do see in the long run that you could take some of the things that we’re wrestling with right now that we feel are going nowhere and it’s not so ridiculous, given this conversation that we just had about drugs, that 50 years from now, we would be in a completely different place.

ZK: Right. And you can do that like politically, oh, nothing will ever change politically or nothing will ever change in American demo— the way that structures of American democracy work or nothing will change about attitudes about climate. Things change, and they change dramatically and they change substantially. It’s just it’s sometimes not clear when, and only when you’re on the other side of that inflection point are you able to go, oh, right, that changed. But they look like they’re sclerotic. They look like they’re set in stone forever until everything shifts. All right. Shall we talk about the news?

EV: Yes, let’s do it.

We’re going to start with a fairly controversial topic, depending on who you ask in the United States, which is guns. There are pretty large swaths of the American public that agree on several different kinds of gun measures. So kind of the voter approval is there, but obviously, from a legislative sense, things are a lot more difficult. So starting with Team Blue right now, if you’re on Team Blue, this will be exciting for you. If you’re not on Team Blue you can skip the next 30 seconds of this podcast. Washington just became the latest state to ban assault rifles and semi-automatic weapons. It does need to withstand a court challenge, so we’ll see what happens around that. The ban that Illinois passed earlier in the year is right now in limbo in the courts, although they think that the ban will be upheld. And Colorado, which was once purple, now bluish, also just passed four new gun measures, which have to do with introducing a waiting period, that have to do with expanding red flag laws. So if you aren’t Team Blue and you’re really big on bans, mandates, legislation as a whole, there are some things that have been done very recently that you can feel happy about.

ZK: Here’s to the Team Blue side. And that may even be putting it in too stark terms. There’s a lot of people who are staunchly in favor of Second Amendment gun ownership rights, who feel that semi-automatic weapons, or at least unfettered access to semi-automatic weapons, is questionable at best.

EV: You’re right. I shouldn’t really say Team Blue or Team Red. I’m sort of doing it for ease, but maybe for Team Red, Team Purple, part of Team Blue, something interesting just happened, which is that smart guns are now on sale in the US for the first time ever.

Audio Clip: Tonight we take a look at a gun company with the goal of making firearms safer. They’re developing what they’re calling the personalized gun, a firearm designed to only be fired by an authenticated user, in this case, using his or her own fingerprint. But will smart gun technology be able to reduce the rising level of gun-related deaths in this country?

EV: This has been around as a concept since the early millennium, since the Clinton administration. They asked gun manufacturers to try to develop them. There was so much blowback from gun owners and the NRA that the big gun manufacturers just dropped the idea, partly because of that and probably because they just couldn’t get them to work. And what happened is that a 15-year-old who was from Colorado, he lived half an hour away from the Aurora shooting that happened a while ago now. He was really perturbed by that. He started on this project to develop a smart gun. He’s now 26 years old and they’re finally for sale. And if we can trust some reporters at NPR and Bloomberg and other outlets, they actually work. And of course, the benefit of smart guns being that if a child picks it up, they can’t fire it. If someone steals a gun from you, they can’t fire it. It’s only gonna be for an authorized user of that gun. So it remains to be seen now if people will buy them.

ZK: iPhone-powered gun.

Audio Clip: Traditionally, we have thought of the problem of gun violence in a pretty narrow way, simply as a criminal matter to deal with exclusively through our criminal justice system. By thinking of it as a public health problem, it really expands the way that you can think about potential solutions.

EV: After guns, something [laughs] definitely less controversial and a little bit of an antidote to some of the nostalgia that people feel about oh, the times used to be much better. We used to have quite a few serial killers out on the loose in the ’70s, ’80s, and ’90s, in the ’00s actually, active serial killers, and now, if you look at the new data that’s come out, we are back to like 1930s, 1940s levels, something like 30 active serial killers. So we’ve had seen substantial drops, and that has to do with better policing, better tech, better surveillance, all these things. It’s weird because it seems to come with a accompanying rise of anxiety with parents, like they feel nervous about leaving their kids around these days. But at least when it comes to abductions and killers, we’re actually in a much better place than we used to be 50 years ago.

ZK: Man, that’s gonna be a real problem for streaming services and Hollywood, which has made-

EV: [Laughs].

ZK: -such a rich source material of show after show and movie after movie about hunting the serial killer, finding the serial killer, getting in the mind of the serial killer. If there’s no longer an adequate source of serial killers, you’re gonna have to find a whole other source to inspire your shows. I mean, that’s the one, I guess, downside of the absence of serial killers. And for those who may not be able to identify my sarcasm, that that was an example of it.

EV: Well, the good news for Netflix and so on, so they can always just go back into the ’70s. There were plenty.

ZK: That’s right.

EV: There were plenty [laughs].

ZK: That’s right. They could just do the historical version thereof. Do we have anything else this week other than the decline of serial killers and the rise of smart guns? I don’t know.

EV: Yes. Let’s touch on India really briefly. People may or might not know that India’s population officially surpassed China’s. People might be wondering why do we care? Well, we care because Morgan Stanley is forecasting that India’s economy is gonna become the third largest in the world by 2027, meaning India’s gonna become a major player. Inside all of that is also the fact that life has been getting a lot better for people in India. They have had internet access skyrocket, electricity access skyrocket. They have this cool system from the government that 99.9% of all adult Indians have a digital ID, which means they can send financial transfers from the government, direct payments without dealing with corruption or skimming. They can set up a bank account really easily, which anyone living in Greece will know that that’s something to be jealous about [laughs].

ZK: Anyone living in the United States. I mean, we still have lots of documentation. You gotta go in person. I mean, it’s hard to do here. It’s hard to do everywhere. As Progress Network member Fareed Zakaria pointed out in his columns this week, I was also in India in March, you really do feel like there’s a certain cliched wind at the sails feeling. And while some of the trends you talked about, economic growth forecasts have been pretty robust for 25 years and India has failed to sort of keep pace with its promise, that’s probably the best way to put it, bringing everyone into the digital sphere essentially isn’t just about the ease of financial transactions. It’s also developers can develop tools. It’s more of like an open-source platform. On the one hand, provides for high levels of privacy, but also high levels of public good. If we talked about China as the X factor in the global economic and political system, let’s say from 2000 till now, we may be well talking about India from here until whenever then is.

EV: So we’ll see you pretty soon, I think. And that’s all we have for today. So thank you, Zachary.

ZK: Thank you, Emma. And we will be back next week. Thank you all for listening.

EV: What Could Go Right? is produced by Andrew Steven. Executive produced by Jeff Umbro and The Podglomerate. To find out more about What Could Go Right?, The Progress Network, or to join the What Could Go Right? newsletter, visit Thanks for listening.


Meet the Hosts

Zachary Karabell

Emma Varvaloucas


Being Jewish Today

Featuring Noah Feldman

What does it mean to be a modern Jew? How do Jews in America handle their relationship to Israel, especially after the atrocities of October 7 and the subsequent war with Hamas? Zachary and Emma speak with Noah Feldman, Harvard professor and author of the new book 'To Be a Jew Today: A New Guide to God, Israel, and the Jewish People.' The Israel-Hamas war, levels of Jewishness, and how Gen Z sees things are talked about in today's conversation.

America’s Next Economy

Featuring Natalie Foster

What is the cost of not investing in families in America? How can economic security be guaranteed? Zachary and Emma speak with Natalie Foster, president of the Economic Security Project and author of the new book ‘The Guarantee: Inside the Fight for America’s Next Economy.’ Baby bonds, student loans, why so many Americans dislike dealing with the government, and raising the economic floor are among the topics discussed today.

Veterans and Invisible War

Featuring Phil Klay

In the modern age of warfare, what does it mean for Americans to enter the armed forces? Zachary and Emma speak with veteran and author Phil Klay about the disconnect many people who serve in our current wars feel when they return back home, as well as the lack of understanding that American civilians have toward the complexities of these conflicts. Yet the military remains a major factor in the government’s budget and in Americans' patriotic pride. This discussion leads to questions about the morals of modern warfare and the care the nation owes to the veterans who have provided their service and the allies who have assisted in our efforts.