Tag: harm reduction

We Need Harm Reduction for All Drugs, Not Just Opioids
While we’ve made great strides with harm reduction for people who use opioids, we’re slow to provide non-abstinence-based treatment for people who use other drugs.

A quick glance at the news reveals the catastrophic effects of opioids across the nation: around 120 people a day die from opioid-related overdoses. It’s so devastating that the nation is calling it an opioid epidemic. Yet even as we watch this tragedy unfold, we’re missing the point.

By focusing exclusively on opioids, we’re overlooking the harm caused by other deadly drugs. How can we highlight harm reduction resources if we only focus our efforts on people who use one class of drug?

The Problem with the Opioid “Epidemic”

According to the Centers for Disease Control and Prevention, more than 700,000 people died from a drug overdose between 1999 and 2017. Sixty-eight percent of those deaths in 2017 involved an opioid — approximately 70,200. However, that’s not the 100 percent that the “epidemic” coverage would have us believe.

While I’m not arguing that the opioid-related deaths shouldn’t be covered — they should! — I am saying the problem with zeroing in on the opioid epidemic is that we are focusing too narrowly on the harms caused by one drug and are blinding ourselves to the impact of other deadly drugs. We should be reporting on those, too.

A more accurate picture of drug-related deaths in 2017, according to the CDC, looks like this:
- Alcohol was responsible for the deaths of 88,000 people
- Cocaine misuse killed 13,942 people
- Benzodiazepine misuse was responsible for 11,537 deaths
- Psychostimulant misuse, including methamphetamines, was responsible for 10,333 deaths.
Those aren’t insignificant numbers, so why are they being overlooked? I asked recovery activist Brooke Feldman for her perspective.

“The sensationalized and narrow focus on opioids fails to account for the fact that people who develop an opioid use disorder typically used other drugs before and alongside opioids,” Feldman said. “So, we really have a polysubstance use situation, not merely an opioid use situation.”

She continues, “Focusing on opioids only had led to the erection of an opioid-only infrastructure that will be useless for the next great drug binge and is barely relevant to address the deadliest drug used, which is alcohol.”

The Deadliest Drug: Alcohol

Alcohol is responsible for more deaths than any other drug. But we overlook it for two reasons: because it’s legal, and because it’s a socially acceptable drug. Not only that, but advertising actively promotes its use — you only have to look on Instagram or Etsy to see how widely excessive use of alcohol is normalized — especially among mothers and millennials. These advertisers have been smart to market alcohol as a means of self-care — encouraging drinking to help unwind from the stresses of the week — and as a means of coping with motherhood.

Social media reinforces the message that alcohol is a tool to cope with stress and something that should be paired with our favorite stress-relieving activities, like yoga. Captions on Instagram read like “Vino and vinyasa,” “Mommy’s medicine,” “Mommy juice,” “It’s wine o’clock,” “Surviving motherhood one bottle at a time,” and “When being an adult starts to get you down, just remember that now you can buy wine whenever you want.”

Perhaps what is most insidious about alcohol is that it heavily impacts marginalized and oppressed communities. For example, Black women over 45 are the fastest-growing population with alcohol use disorder. And the LGBTQ+ community is 18 percent more likely to have alcohol use disorder than the general population.

Alcohol aside, looking at the harm done by other drugs, we can see that opioids are no longer the leading cause of drug-related death in some states. In Oregon, statistics show, deaths related to meth outnumber those that involve one of the most common opioids, heroin. In fact, there has been a threefold increase in meth-related deaths over the last ten years, despite the restriction on pseudoephedrine products, which now require a prescription.

Similarly, in Missouri, which was ground zero for home-based meth labs 20 years ago, the recent spotlight on opioids has overshadowed an influx of a stronger, purer kind of methamphetamine. Deaths related to the new and improved drug are on the rise.

Oregon’s state medical examiner Karen Gunson speaks to this disparity of focusing on opioids over other deaths and the damage that those other drugs cause. “Opioids are pretty lethal and can cause death by themselves, but meth is insidious. It kills you in stages and it affects the fabric of society more than opioids. It just doesn’t kill people. It is chaos itself.”

Abstinence Is Not Attainable for Everyone

Our approach to recovery has been too one-dimensional, stating that complete abstinence is the goal. But this perspective is outdated. Abstinence isn’t attainable for everyone. If it were, then more people would be in recovery. However, harm reduction is attainable. It reduces deaths, treats medical conditions related to drug use, reduces the transmission of diseases, and provides options for treatment services. In fact, people who use safe injection sites are four times more likely to access treatment.

“Whether it is with problematic use of alcohol, tobacco, cocaine, methamphetamine, etc. use, centering harm-reduction principles and practices would likely engage more people than an abysmal 1 out of 10 people who could use but do not receive SUD (Substance Use Disorder) treatment,” Feldman explains. “Requiring immediate and total abstinence rather than seeking to address overall well-being and quality of life concerns is a barrier to engagement — and sadly, it is placing the focus more on symptom reduction than it is on what is causing the symptom of chaotic drug use in the first place.”

Harm Reduction for All Drugs Means Fewer Deaths

Our focus on the opioid crisis has helped improve harm reduction resources — like the increased availability of naloxone to reverse overdoses, and the more accepted use of pharmacotherapy and medication-assisted treatment (which has now been endorsed as a primary treatment by the Substance Abuse and Mental Health Services Administration), and some safe injection sites — but it has also meant we aren’t concentrating as much on research, funding, and education devoted to harm reduction practices for other harmful drugs. The result is that we have fewer resources and less awareness when it comes to keeping people who use non-opioid drugs safe.

We need to look at reducing harm across the spectrum of drug use to reduce all deaths. More safe usage sites, clean tools, safe disposal bins, medical assistance, education, referral to other support services, and access to pharmacotherapy (including drugs to treat or mitigate harms of alcohol use disorder and the development of new medications for help with other substances). Specialized treatment other than abstinence should be accessible for people who use all drugs — not just opioids.

View the original article at thefix.com
30 September 2019
Should Narcan Training Be The New CPR?

“Who should carry Narcan? The same people who should carry an EpiPen: anyone who’s around someone who might need it. And, in today’s opioid crisis, that’s nearly everyone.”

Each year, 12 million Americans are trained to deliver lifesaving CPR. Vastly fewer are trained to use the opioid overdose reversing drug, Narcan.

Dr. Mark Calarco, national medical director for clinical diagnostics of American Addiction Centers, says that we need to make Narcan training the new CPR, getting more people to carry the lifesaving drug and administer it in emergencies.

“With tens of thousands of American lives lost each year to drug overdose, it’s critical that we begin training Americans to administer Narcan (naloxone), just as we did with CPR, to help save the lives of our neighbors, family members and friends,” Calarco writes for MedCity News.

Surgeon General Wants All Americans To Carry Narcan

In April, Surgeon General Jerome Adams called on all Americans to carry Narcan and learn how to use it.

“We should think of naloxone like an EpiPen or CPR. Unfortunately, over half of the overdoses that are occurring are occurring in homes, so we want everyone to be armed to respond,” Adams told NPR at the time.

Stigma Persists

And yet, stigma against mental illness and addiction has kept this from happening, Calarco writes.

“While there’s some controversy over making Narcan so readily and widely available, the reluctance is based mostly on the stigma associated with addiction and mental health issues, and an overall lack of understanding about how addiction impacts an individual and the community. The truth is, addiction and overdose can affect anyone. It doesn’t discriminate based on income, gender, ethnicity, or background,” he writes.

While Calarco says he would “encourage everyone to take a CPR course,” he noted that CPR is physically taxing and difficult to learn, and 45% of people who need it will die from their condition anyway.

“In contrast, administering naloxone (Narcan) is relatively easy for non-medical personnel, and giving it quickly after an opioid overdose rapidly reverses respiratory depression—the primary cause of death. It is extremely safe, effective, and works in seconds,” Calarco writes.

Forty-nine states allow anyone to carry and administer Narcan. In most areas, getting trained is as simple as going to your pharmacy, asking for a kit (which is usually covered by insurance) and listening to the pharmacist for a few minutes. This is a step everyone should take, Calarco writes.

Saving Lives

“Who exactly should carry Narcan? The same people who should carry an EpiPen: anyone who’s around someone who might need it. And, in today’s opioid crisis, that’s nearly everyone.”

Taking this small step could be lifesaving, he writes.

“Carry it with you at all times and hope you never have to use it,” Calarco writes. “But know that you could be the difference between life and death for someone if you do.”

View the original article at thefix.com

27 September 2019
Should I Stop Vaping?

Are the alarming headlines justified? And should the risks associated with vaping be a deterrent when the alternative is smoking cigarettes?

Over the past few weeks we’ve seen a surge of headlines that say vaping may be more harmful than we might have initially thought. Seven deaths have been linked to the use of e-cigarettes. In response, some states have banned vaping products. However, naysayers — including experts — argue that a knee-jerk reaction by health agencies is premature, overlooks the harm reduction that vaping achieves, and could cause a potential public health disaster.

If smoking is the de facto predecessor of vaping, then e-cigarettes should be examined within the context of nicotine delivery systems as a whole. Smoking is the leading cause of preventable death in the United States. Should the risk associated with vaping be a deterrent when the alternative is smoking cigarettes?

Some in the recovery community say that it shouldn’t. Many former cigarette smokers have replaced their “analog” smokes with e-cigarettes, using vaping as a means of harm reduction that swaps out cancer-causing tobacco with a safer means of nicotine delivery. Recovery purists and some clinicians, however, argue that smokers are trading one addiction for another and express concerns that, lower risk or not, most vapers are still ingesting large amounts of highly addictive nicotine. They also point to this recent rash of deaths as evidence against vaping.

Before we address the question of harm reduction, though, do the alarming headlines have any merit in science? And given that e-cigarettes have been around for 15 years, why are we only seeing deaths now?

Recent Media Coverage of Vaping

The American Medical Association (AMA) recently labeled vaping “an urgent public health epidemic,” and physicians have urged the Food and Drug Administration (FDA) to act. The AMA claims that research has shown that the use of e-cigarettes and vaping products is unsafe and causes addiction, however the statement does not provide the supporting research. The AMA also says they “applaud steps to remove flavored e-cigarette products from the market.”

The Centers for Disease Control and Prevention (CDC) issued a statement that together with the FDA, local health departments, and other clinical and public health partners, they are investigating a multi-state outbreak of lung disease associated with e-cigarette products. The FDA echoed the CDC’s concern, calling the outbreak “a frightening public health phenomenon.”

Dr. Dana Meaney-Delman, who is leading the CDC’s investigation, said in a statement, “The recent rise of acute lung illnesses linked to vaping has deepened concerns about the safety of the devices.”

But why now? People have been vaping for over a decade. The CDC’s Meaney-Delman says, “We’re all wondering if this is new or just newly recognized.”

The Facts About E-Cigarettes

Here’s what we know: As of this writing (9/21/19), the CDC states that 530 cases of lung illness have been reported from 38 states, and seven deaths have been attributed to vaping. Most affected patients also reported a history of using vaping products that contain THC.

The CDC does not yet know the specific causes of these illnesses: “The investigation has not identified any specific e-cigarette or vaping products (devices, liquids, refill pods, and/or cartridges) or substance that is linked to all cases.” Regardless, for those who are concerned with these issues, the CDC recommends refraining from using all vaping or e-cigarette products until they know more.

Elsewhere on the website, the CDC still states that e-cigarettes have the potential to benefit adult smokers as a substitute for regular cigarettes.

Because of the media coverage and caution by public health agencies, we are seeing increasing action across the US: New York’s former mayor, Michael R. Bloomberg, has committed $160 million to ban flavored e-cigarettes, Governor Gretchen Whitmer issued an executive order to ban the sale of flavored vaping products in Michigan, San Francisco has banned the sale of e-cigarettes, and President Donald Trump says the FDA will ban flavored e-cigarettes.

For Adolescents, Nicotine (in Any Form) May Harm the Brain

Is this a knee-jerk reaction? It seems that some of the pressure is a result of parents and politicians who are concerned that flavored vaping products are responsible for the surge in teen use. That’s understandable, given the potential for nicotine to harm the developing brain. According to the CDC, one in five high schoolers and one in 20 middle schoolers vape.

For adults, however, there appears to be conflicting statements by researchers, doctors, and health officials.

In a September 2019 article, Dr. Robert Shmerling at Harvard echoed the CDC’s bottom line: Experts are unsure if vaping is causing these lung problems, and lung disease has not been linked to a specific brand or flavor of e-cigarette. A more likely culprit, they claim, is a chemical contaminant within the inhaled vapors that is causing an allergic reaction or immune system response.

This belief is supported by a study that came out last year linking the chemical flavors within e-cigarettes to an adverse effect. Dr. Sven-Eric Jordt, PhD, one of the authors of the study, recently told The Guardian that “the liquids vaporised by e-cigarettes are chemically unstable and form new chemicals that irritate the airways and may have other toxic effects.” These new chemicals are not disclosed by the manufacturers to users.

Dr. Michael Siegel, a professor at Boston University, claims that health officials and physicians are not telling the full story: In every case in which a specific e-liquid has been identified, that e-liquid has been found to contain THC — a fact corroborated by the CDC. He states that the e-liquids in some of these cases were oil-based and typically purchased off the street; therefore, their ingredients are not strictly regulated. It is these oil-based THC liquids that are known to cause acute respiratory illness.

Similarly, the Washington Post reported that the FDA investigation found the same vitamin E-derived oil in cannabis products that were used by those found to be suffering vaping-related illnesses throughout the country.

CDC’s Guidelines: Unnecessarily Broad

While Siegel acknowledges we aren’t in a position to draw conclusions about THC oils or to say that street products are definitely to blame, he believes the CDC’s recommendations are unnecessarily broad and consequently harmful, since people who vape may think it’s safer to go back to smoking cigarettes.

“I cannot overemphasize how insane this policy is,” he says. “From a public health perspective, it makes absolutely no sense to ban these fake cigarettes but to allow the real ones to remain on the shelves.”

Instead, Siegel suggests, the CDC could offer more specific and useful guidance to the public, specifically: Do not vape THC oils (including butane hash oil), do not use any oil-based vaping e-liquid product, and refrain from buying products off the street or using any e-liquid that doesn’t disclose its ingredients. To reduce risk, people should “stick to products being sold at retail stores, especially closed cartridges where there is no risk of contamination or the presence of unknown drugs.”

Switching from smoking tobacco to e-cigarettes is a proven harm reduction strategy supported by health officials and used by individuals in recovery.

Lara Frazier, a person in long-term recovery, explained, “I am in abstinence-based recovery and quit smoking cigarettes over four years ago, thanks to e-cigarettes.” Regarding the recent deaths associated with vaping, she says: “There is mass hysteria about vaping, with people not being properly educated on what is actually occurring.”

Frazier is concerned about the consequences of recent official warnings: “Nicotine addiction is like any addiction, and banning flavors will likely not result in less nicotine being smoked. This could cause more harm because the teenagers will have to find black-market cartridges, make their own juice, and/or switch to smoking cigarettes.”

She continues, “I think it’s ridiculous that they are going to ban all flavored juices that aren’t tobacco-based on five (now seven) deaths and illness without properly looking at the data or researching the cause of the illness.”

Vaping as Harm Reduction

There is world-wide support and evidence for vaping as harm reduction. A study conducted by the New England Journal of Medicine found that vaping was nearly twice as effective as conventional nicotine replacement products for smoking cessation.

In the UK, Public Health England also supports vaping as a harm reduction strategy. Even in light of the recent concerns, their position has stayed the same: “Our advice on e-cigarettes remains unchanged — vaping isn’t completely risk-free but is far less harmful than smoking tobacco. There is no situation where it would be better for your health to continue smoking rather than switching completely to vaping,” they said.

Yaël Ossowski, deputy director of the Consumer Choice Center, urged President Trump to consider the facts before reacting hastily and pushing for a ban, arguing that vaping is a less harmful alternative for consuming nicotine. Ossowski cites a 2016 report by the UK’s Royal College of Physicians, which reviewed the science, public policy, regulation, and ethics surrounding vaping and concluded that e-cigarettes should be promoted widely as a substitute for smoking. The report also sought to clear up misinformation about vaping and long-term harm, stating that while there is a possibility of harm from e-cigarettes, it is unlikely to exceed five percent of that associated with tobacco products.

Smoking Cigarettes Is Still The Leading Cause of Preventable Death

According to the Centers for Disease Control and Prevention, more than 16 million Americans are living with a disease caused by smoking. We have abundant evidence that smoking leads to disease and disability, harming nearly every organ in the body. It causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease. It also increases the risk for tuberculosis, eye diseases, and autoimmune conditions.

Worldwide, the use of tobacco products is responsible for more than seven million deaths each year. In the U.S., 480,000 people die every year from smoking, and 41,000 people die as a result of secondhand smoke. Economically, smoking has a huge impact on the United States: it costs $170 billion a year in direct medical care, and $156 million in lost productivity.

Smoking remains the leading cause of preventable death.

At this point, the evidence supports vaping as an effective means of harm reduction, thus outweighing the limited risks. Further, public health officials have yet to complete their investigations into these risks so they can conclusively identify the cause of the deaths attributed to vaping. It seems foolish to enforce blanket bans on e-cigarettes, as that may cause further harm by pushing people toward buying black-market vaping products or resuming smoking cigarettes.

View the original article at thefix.com

24 September 2019
Pennsylvania Giving Away Free Naloxone To Combat Overdoses

The state is set to give away one free dose of naloxone on September 25th from 9 AM to 3 PM.

Residents of Pennsylvania were able to claim a free dose of naloxone last Wednesday (Sept. 18), thanks to Governor Tom Wolf and the state’s Department of Health. The medication was made available to anyone who wanted it, whether they used opioid drugs or simply wanted to hang on to a dose just in case.

Naloxone has made waves as something of a miracle drug, able to instantly reverse an opioid overdose with a single injection or nasal spray. By binding to opioid receptors in the brain, naloxone can and has saved many lives.

Increasing Access To Naloxone

Advocates for increasing the accessibility of naloxone believe it is simply a common sense approach that must be undertaken to combat the opioid crisis.

“Naloxone has one function: to reverse the effects of opioids on the brain and respiratory system to save someone’s life,” Pennsylvania Health Secretary Dr. Rachel Levine said. “It is impossible to get someone into treatment who is dead. In 2018, more than 4,400 people died from a drug overdose. Every Pennsylvanian has a role to play as a potential first responder and can save a life by having naloxone on hand and using it if they come across someone who has overdosed.”

Another Naloxone Giveaway Is Coming Up

The lifesaving medication could be claimed for free in 87 locations across the state, including state health centers and municipal health departments. The state will do another round of freebies on September 25th from 9 AM to 3 PM.

This kind of progressive policy to combat overdoses has been done before in New Jersey, which gave away doses of the stuff for free through select pharmacies on June 18th this year. Such approaches were based on a study that showed that a combination of increased access to naloxone and Good Samaritan laws could save lives.

“Naloxone access and Good Samaritan laws are associated with 14% and 15% reductions, respectively, in opioid overdose deaths,” read the paper, published in Addictive Behaviors. “Among African-Americans, naloxone and Good Samaritan laws reduce opioid overdose deaths by 23% and 26% respectively. Neither of these harm reduction measures result in increases in non-medical opioid use.”

Better yet, this was achieved without the negative effects some predicted. Critics of such programs believed that with such a strong safety net, people may use more opioids than before, but the data do not support anything like this happening.

“The scourge of opioids continues to devastate families and communities across our state, and we must do everything we can to end the opioid epidemic,” said New Jersey Governor Phil Murphy. “Through this initiative, people who are battling with addiction will be able to receive access to this critical medication and help them get on a path to recovery.”

View the original article at thefix.com

23 September 2019
Why Aren't There More People of Color in the Recovery Movement?

For many white people, recovery is a redemption story, proof that they were good people all along. For people of color, a known history of drug use might be the only excuse a prospective employer needs to shut the door.

When Art Woodard walked into his first Alcoholics Anonymous meeting in New Haven, Connecticut, a sea of white faces turned to stare at him. Some of the faces showed kindness; others hostility. Most people just watched as he took a seat in the back of the room.

Woodard’s shoulders slumped. As a black man who had recently graduated Yale, he was used to being the only person of color in a room. Still, he thought, it would have been nice to share the recovery journey with other black folks.

“None of these stories are like mine”

As his fellow AAers stood up to tell their stories, Woodard found he couldn’t concentrate. None of these stories are like mine, he thought. Many of the stories involved childhood abuse or mental health issues. For Woodard, heavy drinking didn’t start until he graduated from Yale, when he finally couldn’t take the weight of living in a white world where he constantly felt the need to prove himself, to justify his presence, to assure others he wasn’t a threat.

“I got drunk because I thought I had fooled an institution into giving me a degree I didn’t deserve,” he says in a phone interview. “I never really felt I had a place in the world…I embraced alcohol because I needed a release for that insecurity.”

Woodard never returned to that AA meeting, during which not a single person approached or welcomed him. Luckily, he found a program specifically for people of color elsewhere in the city. When the program nearly folded for lack of funds, he wrote grants to keep it afloat—he was adamant about continuing his recovery journey alongside his peers.

Over the years Woodard became more visible within the wider recovery movement. He became a public speaker and trainer, often co-leading health and recovery trainings with his friend Jim, who was white. But the specter of race was never far off.

“I can honestly say that every position or opportunity that I was able to achieve was achievable through a Caucasian male offering me opportunities,” he says. “I was invisible in those settings if I didn’t have [a white person] to speak for me.”

He endured the barbs from the people who ignored Woodard if he asked a question, directing their answer to Jim, and the people who expressed astonishment at his “good English,” as they put it. And always, the experience of his first AA meeting came back; almost every recovery space was a sea of white faces.

Racial Bias, Recovery, and Criminal Justice

Woodard’s experience as a person of color in the recovery movement is not unique. It’s no secret that the movement is largely dominated by Caucasians, whether in staff or leadership positions, on organizational boards, or among membership. Why do so few people of color play visible roles within the recovery community, especially given how much the effects of harsh drug policy and chaotic drug use have devastated many communities of color? To merely blame racism, though it certainly plays a role, is oversimplifying a complex problem.

One of the reasons we don’t see many people of color in leadership positions within the recovery movement is that it can be harder for people of color to sustain recovery at all. We all know someone who spent a good chunk of their twenties using drugs or alcohol problematically. Perhaps they went to jail once or twice. Perhaps they were even homeless for a while. But today that person is married with children, thriving at a good job, and talks about recovery to anyone who will listen. That person is also probably white.

Sustained recovery is not as easy for a person of color. For black men, especially, once the criminal justice system sinks its teeth into you, it doesn’t let go. There is little room for mistakes in a world that expects you to fail, and we all know the statistics: Despite similar rates of drug use, people of color are more likely to be arrested for drug crimes than white people, serve longer sentences for the same crimes, and find it harder to break the cycle once it starts.

Even for people of color who are able to find and sustain recovery despite the odds against them, they likely won’t be as quick to advertise their new status. For many white people, recovery is a redemption story, proof that they were good people all along. For people of color, a known history of drug use might be the only excuse a prospective employer needs to shut the door.

For evidence of racial bias in recovery, one need only pick up the nearest newspaper or turn on the TV. When the story is about a white drug user, the addiction or overdose death is reported as a tragic loss of potential. But a person of color can suffer a death completely unrelated to drugs—being shot unarmed by a cop, for example—and the public will dig into his past for any evidence of drug use or criminal behavior, then use this information to justify the murder. Any drug history of any kind is enough to brand a person of color for life.

The overdose crisis presents a conundrum. On the one hand, it provides an influx of funding and sympathy to a movement in desperate need of both. On the other hand, it exacerbates the racial divide by further entrenching the narrative of white recovery as redemptive and black or brown recovery as something else.

Follow the Money

Donald McDonald, a white man from Raleigh, North Carolina with 15 years in recovery, explains, “The opioid crisis is seen as a white issue not just because of the predominantly white images we see in the news. It’s this message about the ‘worthy afflicted.’ We hear about people with legitimate pain receiving lawfully prescribed pain relief. We can then vilify the pill or the pharmaceutical company – not the person experiencing addiction. Historically this has not been the black experience in America.”

The people whose faces are presented as sympathetic victims are almost always white. And this is no mere coincidence. The recovery movement is made up of people who have long suffered heavy stigma, but now, for the first time, thanks to the attention that the overdose crisis has sparked, the movement is experiencing more public sympathy and financial support.

Laurie Johnson-Wade, an African American woman who leads recovery efforts in Kensington, Pennsylvania, says that money lies at the heart of the exclusion of people of color in recovery spaces.

“If you show my face [as a black woman] or if you use me as the leader at a conference then you are not going to get the money that you would have if you had somebody representing a different community,” she says. “I think those in the recovery movement started out with good intentions, but if you want to win, you have to play the game…At the end of the day, it is all about dollars and cents.”

Organizations are putting forward their most sympathetic faces to potential funders and allies—and the whiter and more connected to prescription pills (as opposed to street drugs), the better. Keeping the conversation revolving around pharmaceutical companies also makes it seem as though problematic drug use is a new phenomenon, which allows us to ignore the last few decades of harsh drug policies that have decimated communities of color.

Devin Reaves, Executive Director of the Pennsylvania Harm Reduction Coalition and a black man in recovery, explains, “There is hyper focus on Big Pharma creating the opioid epidemic, but [problematic drug use] has been going on in the black community for a long time.”

These narratives and “solutions,” in which drug problems among white people are the primary focus, further drive people of color away from recovery. Too often, out of genuine desire to be colorblind and put racial strife behind us, people believe that what works for white people should work for everyone. But that is not true in most spaces, and especially not in the recovery space, where racist drug policies have created a very different environment for people of color.

“I don’t like it when white folks tell me how black I should be”

Reaves, who often finds himself the lone person of color trying to shift recovery conversations towards criminal justice reform and strong economic policies, says it’s more than just uncomfortable. It can challenge a person’s very identity.

“[The recovery movement] is a pretty white space and when you go into white spaces they want you to talk white, dress white,” says Reaves, who says he has been reprimanded many times by white people for being too outspoken about race. “I don’t like it when white folks tell me how black I should be.”

For a person of color, living in a predominantly white world can be exhausting. You have to watch your behavior lest someone consider your very presence a threat. You never know when you might encounter someone who will show open hostility towards you. You have to put up with constant micro-aggressions. And often you are a solitary voice trying to remind everyone not to forget about people of color, not to pursue solutions that only benefit white people, not to pretend that race doesn’t matter.

Woodard explains that there is a price to getting ahead. The people who “succeed” in a primarily white environment are the ones who act in a way that white people consider socially acceptable. But when someone else is dictating the terms of your behavior—sometimes literally, sometimes passive aggressively—that experience can change you. Spend enough time straddling two worlds and you may find that you no longer belong in either.

“People of color [who spend a lot of time in a white world] get locked into these insecurities,” explains Woodard. “There is an environment we want to have success in, but that environment is changing us.”

For many people, that is too steep a price to pay, which is why historically white spaces often remain that way. It takes a long time for enough trailblazers to change the environment to one that feels safe and welcoming to people of color.

How to Be More Inclusive

So how do we start that process of change so that recovery environments become more inclusive?

Donald McDonald says that the first step is to acknowledge that race and gender inequality exists in recovery spaces and then to take action to correct it. He admits that although there is awareness within the recovery community about the lack of space for people of color, it hasn’t yet translated into action on a large scale.

Devin Reaves says that people of color should be represented on organization boards, in community meetings and at conferences…but not in a way that implies mere tokenism.

“Every movement should be trying to find the next generation of advocates and pull them up,” he says. “Give people an opportunity to excel, but also try to mitigate the harms of being a black person in an all-white space.”

Laurie Johnson-Wade says that rather than asking for more inclusion in white spaces, people of color have to organize on their own and become a “constituency of consequence.”

Some self-organizing is already happening. At the 2018 Harm Reduction Conference in New Orleans, leaders of color came together prior to the main conference to hammer out priority issues for their communities. They are tired of having their identities challenged by a world that continues to put their issues on the back burner, tired of the steep price of participation in a white space. And tired of asking permission to speak.

“We have to make ourselves visible, almost like a force to be reckoned with,” says Johnson-Wade. “We have to pull our own resources together and say we are going to do this work regardless. We will not sit around and wait.”

View the original article at thefix.com

17 September 2019
Feds Try To Block Philly Safe Injection Site

Advocates and opponents of a proposed safe injection site pled their case during a recent federal hearing.

In Philadelphia, drug addiction is rampant. The city has struggled to clean up homeless encampments riddled with drug use and disease, but that just pushed the problem elsewhere.

Now, the city’s mayor and other officials support a controversial plan: opening America’s first supervised injection site.

The federal government, however, is fighting to stop that. The Trump administration filed a lawsuit in February, and on Thursday (Sept. 5) during a federal hearing, William M. McSwain, United States Attorney for the Eastern District of Pennsylvania, personally argued that the proposed safe injection site is illegal.

Crack House Statute

“If this opens up, the whole point of it existing is for addicts to come and use drugs,” McSwain said, according to the Philly Voice. That would violate the so-called “crack house statute,” a portion of the Controlled Substances Act introduced in the 1980s that makes it illegal to “manage any site for the purpose of unlawfully using a controlled substance,” the Voice reported.

In court, advocates and opponents debated the purpose of a safe injection site. McSwain and his team argued that the purpose is for people to use drugs, making the site illegal. But attorneys for Safehouse, a nonprofit that plans to open the proposed site, said that the purpose is to save lives and connect people with treatment.

Saving Lives, Offering Treatment

“I dispute the idea that we’re inviting people for drug use. We’re inviting people to stay to be proximal to medical support,” said Ilana Eisenstein, chief attorney for Safehouse.

Ronda Goldfein, vice president of Safehouse, said that although the idea seems radical, it is not inherently different from the work that’s already being done with needle exchanges and Narcan programs.

She said, “If the law allows for the provision of clean equipment, and the law allows for the provision of naloxone to save your life, does the law really not allow you to provide support in that thin sliver in between those federal permissible activities?”

However, McSwain argued that the seemingly small difference is a big deal.

“If Safehouse pulled an emergency truck up to the park where people are shooting up, I don’t think [the statute] would reach that,” he said. “If they had people come into the unit, that would be different.”

The judge in the case could make a ruling at this point, or could request more hearings to decide whether or not the plans for the safe injection site can move forward. Safehouse and many people around Philly are holding out hope for another tool in the fight against overdose deaths.

“We recognize there’s a crisis here,” Goldfein said. “The goal would be to open as soon as possible.”

View the original article at thefix.com

14 September 2019
Elizabeth Warren, Bernie Sanders Endorse Supervised Injection Facilities

Warren, Sanders and de Blasio are the only 2020 presidential candidates who have voiced support for SIFs.

US Sens. Elizabeth Warren and Bernie Sanders endorsed safer consumption spaces in late August, a position lauded by harm reduction advocates.

Safer consumption spaces, also known as supervised injection facilities (SIFs) or overdose prevention sites, “are clinical but community-oriented spaces” where people may use under medical supervision and have a place to access information about treatment for substance use disorder.

Those in favor of SIFs say “the facilities keep people alive during the drug-using phases of their lives, while also offering them a hand up to a new and better life.”

Their Endorsements

Both Warren and Sanders, who are running for president, said they would support SIFs, if elected.

As reported by The Hill, Sanders would “legalize safe injection sites and needle exchanges around the country, and support pilot programs for supervised injection sites, which have been shown to substantially reduce drug overdose deaths.”

Warren would “support evidence-based safe injection sites and needle exchanges and expand the availability” of naloxone.

Lindsay LaSalle, director of public health law and policy with the Drug Policy Alliance, said the candidates’ endorsement is “significant.” “It shows that there are candidates who, in the context of the opioid crisis… that they’re willing to think outside of the box and look at interventions that have proven successful in other countries.”

SIFs Around The World

There are approximately 120 safer consumption spaces currently operating in 12 countries, according to the Drug Policy Alliance.

A visit to Vancouver’s Insite was able to convince Philadelphia Police Commissioner Richard Ross that his city needed to follow suit. He said the experience changed him from being “adamantly against [the sites] to having an open mind.”

Safehouse, the organization trying to open the nation’s first safer consumption spaces in Philadelphia, will fight the good fight in court against the federal government, which has sued the organization for violating federal law.

“Either way it’s decided, it will set the first legal precedent in the country,” said LaSalle.

Harm reduction and recovery advocate, Ryan Hampton, told Truthout that he would have attempted recovery sooner had he had access to safer consumption spaces.

“I would have found my way into recovery much sooner, because I would have established trust with a clinician, a qualified health care provider, instead of some shady treatment center that was just trying to rip off my insurance company, or my mother,” Hampton said.

View the original article at thefix.com

5 September 2019
Harm Reduction Nonprofit Sues Facebook Over Censorship

“We are fighting for the rights of all users of the Internet to appeal from social media giants’ decisions,” the nonprofit’s rep told The Fix.

A Polish non-profit organization is suing Facebook for allegedly censoring its harm reduction content by deleting groups and pages on the social media platform that were related to helping people who use and are addicted to drugs.

The Civil Society Drug Policy Initiative (Społeczna Inicjatywa Narkopolityki, or SIN) filed the lawsuit in May and received a favorable ruling by the District Court in Warsaw in June, though Facebook can still appeal.

The case is ongoing, but the court made an interim ruling prohibiting the social media company from removing any more fan pages, profiles or groups run by SIN on Facebook or Instagram.

The ruling also requires Facebook to store backups of the pages, profiles and groups it already deleted so that they can be restored should SIN win the overall suit. Facebook can appeal the ruling, but SIN is encouraged by this result.

The Bigger Issue

A recent report by Vice outlined the larger problem of Facebook pages, groups, posts, and ads being deleted and accounts being banned for promoting harm reduction principles and products.

In one case, the social media manager for a nonprofit organization called BunkPolice was banned from placing any ads on the platform after submitting and getting approval for ads promoting fentanyl testing kits.

The kits are used to test batches of illicit drugs for the extremely potent opioid, fentanyl, which has been responsible for a large percentage of the recent overdose deaths in the U.S. However, they got caught up in Facebook’s efforts to stop drug trafficking on its platform.

Fighting Censorship

In response to this problem, SIN has launched a “#blocked” campaign to speak out against what it considers to be a worrying spread of content control by large social media companies and censorship.

“Online platforms such as Facebook, YouTube and Twitter increasingly control what you can see and say online. Algorithms follow users’ activity, while filters and moderators address alleged breaches of terms of service,” the campaign website reads. “Unfortunately, there has also been a number of instances when legal and valuable content was removed, including historical photos, war photography, publications documenting police brutality and other human rights’ violations, coverage of social protests, works of art and satire.”

The NGO also published a corresponding video on YouTube the day after filing its lawsuit against Facebook. The video warns about social media giants having too much control over the content that everyday people see, and cautions that “you too could end up on their blacklist.” For SIN, this goes beyond the goal of harm reduction to freedom of speech rights for all internet users.

“We are fighting for the rights of all users of the Internet to appeal from social media giants’ decisions,” said SIN representative Jerzy Afanasjew in an email to The Fix.

View the original article at thefix.com

25 July 2019
A Safe Place to Use Drugs: Lessons from Europe's Supervised Consumption Sites

“People are always against harm reduction programs at first. But once they see the results, their views change.” – Frederick Bernard, Liege Chief Commissioner of Police

My first visit to a safe consumption site (SCS), where people use illicit drugs under professional supervision, felt like a strange dream. On a tepid June day, I sat in a circular room decked with Star Wars posters in Liege, Belgium, drinking bitter coffee from a tiny plastic cup and listening to two Belgian police chiefs discuss the country’s first SCS, which had opened next to the police station nine months earlier. To my right, Liege Chief Commissioner Frederick Bernard praised the program for successfully removing illicit drug use from public spaces in Liege.

When I asked in halting French if the city had experienced pushback from other police or citizens about the site—especially considering that SCSs are illegal in Belgium—the commissioner waved his hand, saying, “People are always against harm reduction programs at first. But once they see the results, their views change.”

After our introductory meeting, Commissioner Bernard escorted a visiting police chief and me to the SCS, which was located on a pedestrian street near several restaurants and boutiques. Dominique Delhauteur, coordinator of TADAM, a private foundation that oversees the SCS, and a staff nurse met us at the door and welcomed us to a waiting area inside what looked like an old airplane hangar.

Using Illicit Drugs, with Supervision

A bald man with a long, forked beard and suspenders, it was hard to imagine that Delhauteur was once Belgium’s defense secretary. During our tour he recounted his bizarre journey from Parliament to coordinator of an illegal drug consumption site. Called Saf ti (a play on the word ‘safety’), the site had opened in September 2018.

“The city wanted to open a safe consumption room and they designated [TADAM] to open it,” explained Delhauteur, adding that mayor of Liege had been under pressure to do something about the open drug markets in Liege. “We were not put off by the illegality,” he adds, because local police supported the project from the beginning.

Currently, over 100 legal SCSs operate in 12 countries around the world, primarily Canada, Australia, and parts of Europe. Also called drug consumption rooms or supervised injection facilities, SCSs allow people to use drugs under the supervision of trained staff.

In order to prevent the spread of HIV, hepatitis C and other infections, SCSs offer sterile equipment for smoking or injecting drugs and provide education around safer use techniques. To prevent deaths, staff responds to overdoses and other emergencies. Most programs also offer wraparound services such as referrals to housing, healthcare, employment, and drug treatment programs. SCSs do not provide illicit drugs and forbid users to sell or share them onsite.

SCSs operate on a harm reduction model, which seeks to reduce the negative consequences of problematic drug use, such as death and disease, while at the same time recognizing that drug use is a part of our world. Harm reduction is a pragmatic approach to a complex problem, like providing condoms and safe sex education rather than pursuing the more elusive goal of abstinence for all people at all times.

Do Supervised Consumption Facilities Encourage Drug Use?

Opponents of SCSs argue that they encourage drug use—the same criticism often levied against other harm reduction programs such a syringe exchange or naloxone access. But although research on SCS outcomes is difficult (largely due to the ethical dilemma of creating a control group without access to SCSs and the difficulty of measuring illicit behaviors), existing reports point to positive outcomes for SCS users.

A 2014 review of 75 studies on SCSs around the world reported that the programs reduce drug use in public spaces, lower overdose rates, increase access to safer injection conditions (which can decrease infection and disease) and link users to healthcare. Other studies have reported lower overdose mortality, fewer ambulance calls, and a decrease in HIV infections among SCS participants.

A study published in Lancet on Insite, the first SCS in Vancouver, Canada, found a 35% decrease in overdose rates in the area immediately surrounding Insite (compared to a 9% decrease in the rest of the city). A study published in Addiction in 2007 reported that Insite users were 30% more likely to access drug treatment than non-participants. The study found no evidence that Insite increased or encouraged drug use.

How It Works

Saf ti – Liege, Belgium

During my tour of Saf ti in Liege, I was already aware of the benefits of SCSs (and their limitations, namely, that positive effects only extend to the site’s immediate area). But I wanted to see how the facilities actually worked.

Saf ti has only three rules: users must be 18 or older, they cannot sell or share drugs in the facility or surrounding area, and they must have a history of illicit drug use prior to their first visit. The program is open seven days a week at varying times and receives 50 or more visits per day, with some users returning several times a day. (To protect users’ privacy, our visit occurred outside operating hours.) Medical care for abscesses, burns (from smoking hot pipes), infections, or other complications is also available.

“We have a team of seven nurses, three social work educators, and two general practitioners who visit twice a week,” said Delhauter. “If someone asks for help, we listen and we help.”

After showing us the checkup room, which looked like any doctor’s office, Delhauteur led our little crew to the actual consumption area. Here, staff provides users with a tray containing sterile supplies for injecting (a syringe, a spoon, sterile water, alcohol wipes, and a filter to separate solid drugs from liquid after heating) or smoking (a pipe and a smoking filter). Heroin and cocaine are the primary drugs consumed at this site, with most heroin smoked and most cocaine injected (the reverse of drug trends in the U.S. and many other parts of Europe).

The injection room stands to the right of the supply counter. Several steel tables and chairs furnish the room, which is equipped with bright yellow biohazard containers to dispose of used injection materials.

Along one wall of the room, rows of tiny plastic drawers house multi-colored tourniquets, which are used to tie off the arm before injecting. Each tourniquet is labeled with the name of its owner so that it can be reused.

The smoking area stands to the left of the supply counter. The 12 steel smoking stalls resemble mini phone booths equipped with stools, tables for preparing drugs, and massive air vents to suck up smoke and sterilize the room. To facilitate cleaning and sterilization, every surface in the consumption area is metal.

Saf ti is clean, sterile, and professional, though I would hardly describe it as comfortable or inviting. Its purpose, of course, is to reduce health harms associated with illicit drug use, but it is also designed to conceal drug use from the public. The facility is hidden in plain sight on a busy street where passersby on their way to nearby shops and cafes would never guess that inside that unmarked warehouse, dozens of people take illegal drugs each day.

Quai 9 – Geneva, Switzerland

The Liege SCS was the first that I visited during a six-week drug policy tour through central Europe. The second facility, Quai 9 in Geneva, Switzerland, had a whole different personality.

If Saf ti hides in plain sight, Quai 9 makes no effort to hide at all. The building, a garish lime-green box, rises out of a concrete parking lot next to Geneva’s busiest train station. The setup to Quai 9 is similar to Saf ti. Before using the consumption rooms, participants enter a waiting area for intake. Quai 9’s waiting room resembles a coffee shop, except that in addition to espresso (served in tiny ceramic teacups), the shelves behind the expansive counter offer sterile drug use supplies, brochures on HIV and hepatitis C prevention, biohazard containers, and other resources. The room has tables and chairs and a medical office to the side where people can visit a nurse or doctor.

The Quai 9 consumption room is painted the same blinding green as the outside of the building. Several injection stations are equipped with biohazard containers for waste disposal and bottles of disinfectant for cleaning each station after use. In a smaller room cordoned off by a glass wall, users can sit at a metal table to smoke their drugs.

Quai 9 receives an average of 120 visits per day, 365 days a year. It opened in 2001 in response to a rash of infections and overdoses among Switzerland’s heroin user population. Like the rest of Europe and the United States, Switzerland experienced rapid growth in heroin use during the 1970s, accompanied by increases in overdose deaths and HIV transmission through needle sharing.

At first, Switzerland responded like the rest of the world, engaging law enforcement in harsh crackdowns on users and dealers. In the ensuing years, overdose deaths quadrupled from about 100 per year in the late 1970s to nearly 400 per year in the early 1990s. AIDS deaths related to injection drug use skyrocketed as well, from a handful per year in the early 1980s to a peak of 350 in 1994.

After Switzerland Implemented Harm Reduction Programs, Drug-Related Deaths Declined Sharply

But beginning in the late 1980s, Switzerland adopted a different approach to drug use, seeking to manage the harms rather than attempt to eliminate drugs altogether, which was proving impossible. The first SCS opened in Berne, Switzerland in 1986. In 1994, the Swiss also pioneered heroin-assisted treatment clinics, where heavily dependent users could receive prescription heroin under medical supervision, therefore reducing the user’s contact with the underground economy and associated crime. Since the implementation of these programs and harm reduction techniques, Switzerland has seen a 64% decline in drug-related deaths. The percentage of new HIV cases originating from injection drug use also plummeted from 50.7% during the 1990s to 2% in 2014.

Switzerland’s results could serve as a blueprint for drug policy in other countries, including the United States. In fact, in 2017 the American Medical Association threw their weight behind SCS, issuing a statement announcing the group had “voted to support the development of pilot facilities where people who use intravenous drugs can inject self-provided drugs under medical supervision.”

Plans to open SCSs are underway in several U.S. cities, though numerous roadblocks remain. In 2017, the Seattle City Council committed $1.3 million to open a site, while surrounding King County pledged $1 million towards the project. But Seattle’s new U.S. Attorney, who took office in April 2019, has vowed to block efforts.

Jesse Rawlins, Project Manager for the Public Defender Association, which is leading the SCS campaign, says that the Association is “rolling supervised consumption work into a larger local campaign focused on engagement and care for drug users.”

In 2018 New York City Mayor Bill DeBlasio put forth a pilot plan to open four SCSs, but the sites are still awaiting approval from the state Department of Health.

In May 2019, backed by a broad coalition of public and private sector stakeholders, a bill authorizing SCSs in San Francisco passed the California state Assembly. In January it will attempt to move through the Senate.

“We’ve done a lot of organizing and educating in San Francisco, and SCS has broad support here, but we continue to face frustrating delays, most recently the decision to hold the state legislation until next year,” says Laura Thomas of the San Francisco AIDS Foundation. “We know these delays are measured in lives lost and we’re looking for other ways to provide these services to keep people alive and get syringes off the streets.”

Safe Consumption Sites in the U.S. Face Opposition

In Philadelphia, a non-profit called Safehouse is suing the federal government for the right to open an SCS. The group enjoys support from local elected officials, including the mayor and the District Attorney, but federal prosecutors are gearing up for a court battle. Evidentiary hearings for U.S. v Safehouse are set for August 2019. The court’s decision may determine the future of SCS efforts across the nation.

“We have consistently maintained that overdose prevention, including supervised consumption, is a legal medical practice and not prohibited by federal law,” says Ronda Goldfein, Executive Director of the AIDS Law Project of Pennsylvania. “A win in Philadelphia will diminish the fear of criminal and civil liability and will encourage other communities to push forward with efforts to save lives.”

U.S. resistance to SCS echoes the pushback from Europeans, Canadians and Australians when they first considered the programs. The fear that harm reduction will encourage drug use remains ingrained in the national psyche despite science that contradicts these claims. But during times of crisis, people often become willing to set fears aside and try new solutions. Europe implemented harm reduction programs at the peak of drug and HIV epidemics. The U.S. is currently facing a historic overdose crisis. Harm reduction programs once considered politically impossible are launching all over the country. If trends continue, legal safe consumption rooms might be in the U.S. sooner than we think.

Peter Muyshondt, Dominique Delhauteur, Marylene Tommaso, and Tessie Castillo

View the original article at thefix.com

24 July 2019
Ithaca Drug Users' Union: Changing Perceptions and Fighting Stigma

“We don’t discourage use, but we don’t promote it either. We encourage people to participate in whatever kind of treatment would give them a better quality of life.”

Since the Introduction of the Ithaca Plan in 2016, Ithaca, New York has been part of the national conversation of progressive drug policy. The plan includes the use of Safe Injection Facilities where drug users can safely use under the supervision of a medical professional. Supporters of the facilities argue that users will never have the chance to get clean if they overdose first, and this facility allows them to stay alive until they are ready for treatment.

Three years later, Ithaca remains a politically progressive area with fairly progressive drug policies, but local drug users and former drug users see room for improvement in the way that they are treated in the legal system, health care, and treatment, to name a few. So, they’re forming a union.

Raising Awareness and Breaking Down Sterotypes

According to the Ithaca Drug Users’ Union mission statement, it is a group of former and current substance users “who confront the stigmas and injustice long suffered by drug users to replace them with fairness and compassion for all.” Since being formed earlier this year, the union members have already started planning protests and will be creating a television show to air on the local public access network every other week.

“We really felt it was a good way to get out our message and be out front and open with it,” said Brian Briggs, the union’s director and founder, about why the union decided to pursue a television show. “The other [drug user’s] unions are fighting for stuff that we think are basic rights and we have. If we don’t take the next step and take up that mantle and be willing to take that risk and be out front on TV, then who will?”

Local organizations like the Southern Tier AIDS Program (STAP) and the Ithaca REACH Project, which operates a low threshold harm reduction medical practice in Ithaca, have helped fight for harm reduction practices that many other places with drug unions don’t have. But it’s on the drug users, Briggs said, to fight for themselves and their rights. Part of that fight includes pushing back against stigma and breaking down stereotypes. By putting their authentic selves on television, Briggs wants to show people that drug users are just people.

“We’re not trying to antagonize anybody,” Briggs said. “We want people to just hear us and basically enjoy us. We’re a group of fun people and we have a blast. Maybe people can see us for that and just enjoy it.”

Brian Briggs shows off a potential logo for the union designed by one of the members.

Briggs has been a drug user since 1991. He was put on methadone for a spell then tried quitting cold turkey because he wanted to be done. When he got hurt playing hockey in the early 2000s, he became dependent on pain killers and tried going back to a traditional treatment center but didn’t feel like he could get the help he needed. In 2003 he went on Suboxone and went back to school with the goal of getting a master’s degree in social work, but he said that even though his urine tests were clean, his provider stopped prescribing him Suboxone because he wasn’t attending group meetings, which were part of his treatment plan. He used all the medical leaves he could with the community college he was attending but couldn’t go back to finish his degree.

Since 2007, Briggs has been a volunteer with STAP doing peer-delivered syringe exchange and spreading the word about harm reduction services in the community. In STAP he found a like-minded community that understood that traditional treatment and its strict rules doesn’t work for everyone.

“They agreed with me and believed me and I got involved in this whole movement,” he said. “I felt like I was sane again. I could say stuff like I want to be treated like a diabetic who needs insulin. If a diabetic goes to the doctor and the doctor says ‘How are you doing?’ and his blood sugar is all messed up, his health is bad because his diet has been terrible and he’s been eating Twinkies and Ho Hos, well he’s not following his treatment plan but he needs insulin to live.”

He was inspired to start a union after attending a conference last year and speaking with Jess Tilley, the creator of the first drug user’s union in New England. Earlier this year he started collecting members and holding regular meetings. It didn’t take long for him to find people who bring personal investment to the union’s mission, including his best friend Tony Sidle.

At first, Sidle, a former heroin user and dealer, said he didn’t want to be part of the union because it was Briggs’ thing. He went to the meetings when his friend asked him to but mostly to observe. He understands what Ithaca Drug Users Union sounds like. In his words, it sounds like “a shooting gallery.”

“That’s not what it’s for,” he said. “We don’t discourage use, but we don’t promote it either. We encourage people to participate in whatever kind of treatment would give them a better quality of life.”

Prohibition Feeds the Beast of Mass Incarceration

People in active addiction and people in active use, Sidle said, don’t get a fair shake or a voice. It’s part of why he joined the union and has become a very active member. Like Briggs, Sidle takes issue with the narrow ideas of treatment currently being used and sees prohibition as another way to feed the beast that is mass incarceration in the United States.

The union is not afraid to be public, as demonstrated by their participation in the recent Ithaca Festival parade, an annual community event that celebrates dozens of local organizations. Four of the members, including Sidle and Briggs, regularly attend meetings of the Criminal Justice and Alternatives to Incarceration committee (CJAI), headed by Dave Sanders, Tompkins County Criminal Justice Coordinator. The committee is made up of representatives from local organizations and municipal offices that work with incarcerated, or formerly incarcerated, individuals, with the goal of reducing the jail population and supporting the formerly incarcerated community. Sanders said he is impressed by the union members’ knowledge of the systems at play and the questions they bring to each conversation. He sees the union as an advocate group for drug users seeking help.

“I think that their ideas are very important, especially with how we’re moving things forward,” Sanders said. “I think there’s a place for that right now.”

The union’s next big stand will be a protest at the local hospital, Cayuga Medical Center, where multiple members of the union say they have been treated badly because of their history of drug use.

“If people are afraid to go into hospitals because of the way they are treated because of the drug addiction, then the chances [increase] of people dying from things that they shouldn’t die from, and losing arms, and making things exacerbated and further complicated than they need to be…that needs to change,” Sidle said.

Sidle was incarcerated for about 13 years on drug-related charges and was an active drug user for about 20 years. Now, he’s taking Suboxone, works at the local homeless shelter, and is the vice president of the union (even though he and Briggs both agree that titles don’t really matter). He’s been through traditional treatment a number of times but didn’t feel like he was actually being listened to, just judged. He doesn’t apologize or make excuses for his past use and dealing, but he wants people to stop treating him and other users like that is all they are.

Herb Howland-Bolton is a longtime friend of Sidle’s who started using drugs as a teenager. He joined the union because he doesn’t want other kids to go through what he did, and has had too many friends die from an overdose that could have been helped if the system was different.

“People died before they could advocate for themselves,” Howland-Bolton said of the shame and stigma that causes drug users to hide their use and put themselves in unsafe situations because of their addiction.

The union’s main goals are to confront the stigma against drug use that makes users hide and to promote treatment options outside of what is traditionally offered. While marching in the parade, and at the eventual protest, members will be holding signs that list the names of their dead friends and acquaintances, drug users who were sent through traditional treatment (sometimes multiple times) but for one reason or another, it didn’t work.

Traditional Treatment Can Be a Setup for Failure

Over and over, members of the union described the precariousness of traditional treatment methods. Missing a meeting could mean mandatory volunteer hours that they have to fit in between more meetings and work and life. A parole violation could mean being sent back to jail where their treatment plan would be interrupted. Getting out of rehab without a support system to help them find housing that isn’t with other users means they are often right back where they started.

Jane* is a member of the union who is also going through Ithaca City Drug Court, which is specifically for offenders whose charges are associated with drug use. Drug Court participants are expected to stay clean and get treatment and find a job or go back to school. It’s set up to be a nine-month program but she’s been in it for two years. Jane has done inpatient treatment multiple times and said she’s a perfect patient while there, but it’s never enough time to address the trauma that fuels her addiction. She’s currently doing an outpatient program, and thankfully she has a counselor who allows her to be honest and gives her flexibility.

“Right now, I’m free. I’m not in jail, I’m not in rehab, I’m out in the real world,” she said. “But, if one thing goes wrong, that’s gone. That’s all taken away. And that’s terrifying.”

Often, she feels, with traditional treatment, they aren’t given the opportunity to succeed. She sees the union as a place for support and connection for users or past users, support that isn’t offered in the current system.

*Not her real name

View the original article at thefix.com

19 July 2019