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On paper, Nicole’s job is to deliver opioid overdose prevention supplies and make referrals, but in reality, she is a health care worker, mental health counselor, legal advisor, social worker, confidant and more.

Every morning Nicole Reynolds sits down at her kitchen table with a steaming cup of coffee in one hand and a phone in the other — she is looking at mugshots.

Scrolling through bleary-eyed photos of last night’s arrestees, she pauses at familiar faces and jots down the names. She checks missed messages on her phone and sometimes combs through the obituaries.

As an outreach worker with the North Carolina Harm Reduction Coalition (NCHRC), Nicole offers harm reduction services to people who use drugs problematically in Wake and Johnston counties. Through a grant from the Aetna Foundation, she provides free overdose prevention resources and referrals to social services such as housing, medical care, and drug detox.

It is not easy keeping track of such a transient population; many of her regular participants hang out at budget motels, but frequent police raids scatter them, leaving Nicole to figure out where they landed. So each morning she makes a list:

Who was arrested last night?
Who became homeless?
Who died?

Rural Outreach: Hope and Risk

One rainy November afternoon, I join Nicole as she visits her program participants in Johnston County. The 32-year-old is high energy today, exuding the caffeinated vigor of someone who didn’t sleep well and is trying to make up for it.

“Last night the police raided the hotel where I was doing HIV and hepatitis C testing,” she explains. “I got home late.”

She winds her long, red dreadlocks absently on her head before letting them fall back to her waist. I wonder, not for the first time, how her small frame holds up the weight of all that hair; she is tiny enough to disappear behind a telephone pole.

We drive 30 minutes to Johnston County, a rural district rife with dichotomies — fast food chains loom next to empty crop fields and strip club advertisements glitter beside “Jesus Saves” billboards. I ask Nicole to name the towns we pass through, but even she isn’t certain since identical Bojangle’s frame the outskirts of each one. Even the budget motels where we drop off naloxone look alike. Whatever their original colors, each moldy building is now stained with highway exhaust.

As we drive up to homes and motels, Nicole’s phone rings incessantly. People call for supplies. They call for referrals to drug detox and treatment. They call to ask how to bail a friend out of jail. They call to give updates on their abscess wounds. They call in a panic because someone has nodded off after taking drugs and everyone is afraid to call 911. They call for advice on leaving a violent boyfriend. They call to be tested for HIV. They call to report they just lost their homes. They call because they are lonely and just want to talk…

On paper, Nicole’s job is to deliver overdose prevention supplies and make referrals to social services. But in reality, she is a health care worker, a mental health counselor, a legal advisor, a social worker, a confidant, and a thousand other job descriptions whose collective weight threatens to crush her.

“I can’t be everything to everybody,” she tells me, sighing.

She tries to set boundaries: she doesn’t carry cash, since she is frequently asked for money; she turns off her work phone during non-work hours to avoid the onslaught of calls; she reminds participants that she cannot offer legal advice or perform medical procedures. (But still they ask.)

As we drive, Nicole frets over her latest dilemma. One of her participants, who recently gave birth, was beaten so badly by her boyfriend that her jawbone shattered. She has asked Nicole to watch her newborn while she gets her jaw wired shut at the hospital.

“I know I should say no,” Nicole says. She lapses into a rare silence. “But she has no one else.”

Nicole knows all too well how the stigma of problematic drug use can make someone feel alone. Years ago, she used and sold illicit drugs, even living at some of the hotels we visited. Today, she wears new life on her head—literally. She hasn’t cut her hair since she entered long-term recovery and now the scarlet dreadlocks are long enough to sit on.

The ability to find and relate to people struggling with chaotic drug use is one of the blessings and curses of hiring current or former drug users as outreach workers. Nicole is uniquely qualified for this job. But she is also uniquely vulnerable to burn-out. It’s hard to say no when you remember how badly you once needed help. And in addition to shouldering heavy workloads and emotional burden, outreach workers are often the most underpaid staff at any organization.

I marvel at how Nicole remains upbeat amidst the flood of crisis calls from her participants. Even as we visit homes and hotels, the same questions roil her mind:

Who was arrested last night?
Who became homeless?
Who died?

These questions are heavily intertwined. For opioid users in particular, any period of abstinence drastically increases the risk of overdose death. In fact, every time an opioid user spends a few days in jail without drugs, their risk of overdose spikes to 40 times that of the general population once they get out.

The War on Drugs: Overdose and Desperation

Nicole spends her mornings looking at mugshots for a reason. It is difficult for her to know when participants will be released from jail, but once they are, the race is on to find them before the Grim Reaper does.

The arrest of a high-level drug seller can usher in even bigger problems. When one dealer is taken off the street, users who rely on a steady supply of drugs to ward off withdrawal symptoms are driven to desperation: some will buy drugs from riskier, unknown sources; some will engage in more sex work or petty crime than usual to pay the higher prices caused by reduced supply; some will fall prey to contaminated batches of drugs (as existing supplies are mixed with other substances to spread them over a larger customer base). Overdose deaths usually rise — at least for a few days — until a new dealer takes over, supply normalizes, and business as usual resumes.

Truly, a single day spent learning supply and demand from Nicole Reynolds can expose the madness of the war on drugs.

* * *

Our last stop of the day is the bus station in Raleigh, North Carolina. As we exit the car, Nicole greets a tall, bearded man in a red shirt who has recently been let out of jail. Nicole is pleased that he contacted her during this risky post-release period. She gives him some supplies and advises him to take it slow if he uses drugs again.

But the next day, the man in the red shirt is dead.

After reading the news in a text from Nicole, I call to ask how she is doing.

“I don’t know,” she says. “Maybe if I had followed-up with him this morning he wouldn’t have overdosed…” She catches herself. “No. It’s not my fault,” she adds.

“Of course not,” I tell her. “We try to help, but most of this is out of our hands.”

As we hang up, I sigh. Forty times more likely to die after leaving jail. Who can beat those odds?

I picture Nicole at her kitchen the table this morning, coffee mug in one hand, scrolling through mugshots.

Who was arrested last night?
Who became homeless?
Who died?

View the original article at thefix.com

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