Answer Addiction

Tag: harm reduction

  • US Health Chief Announces Support For Needle Exchange Programs

    US Health Chief Announces Support For Needle Exchange Programs

    The Health Secretary’s reversal on needle exchange programs may be related to a new 2030 deadline related to HIV.

    Speaking at the National HIV Prevention Conference on Tuesday, Health and Human Services Secretary Alex Azar expressed support for needle exchange programs as a way to stop the spread of HIV.

    Republicans like Azar have largely resisted these programs, believing that they will encourage drug use—but evidence to the contrary appears to have convinced the HHS Secretary otherwise.

    “Syringe services programs aren’t necessarily the first thing that comes to mind when you think about a Republican health secretary, but we’re in a battle between sickness and health, between life and death,” Azar said during his speech according to The Hill. “The public health evidence for targeted interventions here is strong, and supporting communities when they need to use these tools means fewer infections and healthier lives for our fellow Americans.”

    Needle exchange programs have existed for years, but are as important as ever with the national opioid crisis. These programs have reduced the spread of dangerous viruses such as HIV and hepatitis C through intravenous drug use. The first such program in the U.S. was established in 1988 in Tacoma, Washington, and was rewarded with a 60% reduction in new hepatitis B and C cases.

    Studies over the decades have also consistently found that these services do not increase the number of intravenous drug users. At the same time, needle exchange programs cost significantly less than treating new cases of HIV and hepatitis.

    However, the larger Trump administration still opposes these programs as well as safe injection sites where individuals can use drugs without fear of arrest, and in the presence of medical professionals who both provide clean equipment and are ready to save lives in case of an overdose.

    In February, the Department of Justice sued Safehouse, a non-profit organization based in Philadelphia, to prevent them from opening the country’s first safe injection site.

    Azar’s reversal on needle exchange programs may be related to a new 2030 deadline related to HIV. Earlier this month, the Trump administration revealed its 2020 budget proposal, which included a request for $291 million for an ambitious plan to end the “HIV epidemic” in a decade.

    “For the first time in modern history, America has the ability to end the epidemic, with the availability of biomedical interventions such as antiretroviral therapy and pre-exposure prophylaxis (PrEP),” the budget plan reads.

    With Azar’s statements at the National HIV Prevention Conference, it appears that needle exchange programs could become a part of these efforts. Most of the $291 million requested will be given to the Centers for Disease Control and Prevention (CDC), which supports and helps to fund these services.

    View the original article at thefix.com

  • How Harm Reductionists Keep the Faith

    How Harm Reductionists Keep the Faith

    Morning to evening, nearly seven days a week, Karen and Michelle endure taxing commutes to bring harm reduction services to drug users in North Carolina’s hard-hit, rural areas.

    It’s a bitterly cold afternoon in early March as Karen Lowe and I pick our way down the broken sidewalks of a semi-abandoned neighborhood in Statesville, North Carolina. All around us, squatter houses stretch for blocks. Every window is busted or boarded up. Thin, dirty mattresses lie on sunken porches and feral dogs scrounge in the trash-strewn yards for scraps. Some residents are huddled inside for warmth, though in most of these homes, there is no electricity.

    The neighborhood is a depressing sight, but it’s hard to feel blue when you’re on outreach with Karen Lowe. Co-founder of the Olive Branch Ministry, a faith-based non-profit that brings harm reduction services to the seven foothill counties of North Carolina, Karen is the embodiment of love.

    Harm Reduction in the Deep South

    As I burrow into my thin jacket, Karen strolls down the middle of the street extending warm greetings to the few brave souls who venture outside. Though the pockets of her cargo pants are bursting with clean syringes, naloxone, and other supplies to prevent death and disease among people who use drugs, she doesn’t flaunt her wares.

    “I just want people to see me,” she explains. “It’s about building trust. They know why I’m here. If they need something, they’ll come to me.”

    As we walk, the 52-year-old fills me in on the colorful cast of characters who call this neighborhood home, including a man who claims he hasn’t bathed in a year and an old woman who pees on the sidewalk. Karen describes everyone with great affection.

    “There is a certain kind of love that goes with being an untouchable,” she says. “And [the people of this community] have it. But it’s not allowed to grow.”

    There certainly isn’t much growing in this neighborhood. Judging by the columned porches on every house and what looks like abandoned flower gardens, this was probably once a desirable place to live. But shifting economic winds have devastated entire cities in the South and Statesville is no exception. 

    A small inland city—population 26,000—Statesville boasts neither North Carolina’s green mountain range nor its sparkling coastline. It’s stranded in the flatland area of the state, mostly buried under strip malls and fast food restaurants. But despite so few bragging rights, Statesville embraces its Southern pride, describing itself on its website as “a city where fish is fried (as our Lord intended they be) and a bottle of Kraft French Dressing is good enough for anybody — so get over yourself.” Also true to its Southern roots, while Statesville has recently invested in a splash park and a $330,000 home for veterans (more than double the average price of a house in the area), the city has allowed this particular neighborhood, in which residents are almost all black, to fall into ruin. The only people who venture into this place are the churches who occasionally come evangelizing and of course, the police, who make neighborhoods like this one their second home.

    But Karen brings cheer to this desolate area. Twelve years ago, she was homeless herself, struggling with mental illness and depression, and searching for both a literal and metaphorical place to set down roots. She found a surrogate family and a calling in a faith-based organization in Greensboro that provides services to people living with HIV. The community welcomed Karen with open arms and she became a regular at meetings, outreach events, and retreats, which she describes as “mad love and dealing with yourself, everybody crying and snotting.”

    Not Your Typical Faith-Based Outreach Organization

    Karen says she knew then that her life was about to change in remarkable ways. And was it ever. A couple years into her involvement with the faith community she met the love of her life, Michelle Mathis, a woman who shared her passion for helping people in need. Though they have the same heart for harm reduction, the pair is about as opposite as two people can be. Michelle exudes elegance with a powdered face and coiffed hair that somehow survive even in the god-awfullest North Carolina humidity. Her partner is more salt-of-the-earth.

    “I did the make-up and heels thing when I was young…somebody should have stopped me,” Karen laughs.

    The yin to the other’s yang, the two married in a private ceremony in 2009 where they exchanged olive branches instead of rings, thus creating what would become their joint life’s work, The Olive Branch Ministry.

    Olive Branch is not your typical faith-based outreach organization—and not just because its founders are an interracial queer couple spreading the word of Jesus in the Deep South. True to the tenets of harm reduction, whose guiding philosophy is “meet people where they are at,” Karen and Michelle serve without pretense or expectation.

    “We say faith is why we do [this work], but it’s not what we do,” Michelle explains to me over the phone. “If someone asks us to pray for them, we will pray for people…We take the message of harm reduction to faith communities…but we don’t evangelize.”

    During afternoon outreach with Karen, she utters not a whisper about faith. And yet, if God’s love for others were perfume, you’d smell her coming from blocks away. Helping others comes as naturally to her as breathing. Several times during our conversation she offers to assist me personally with everything from community partnerships to my writing career, and after I mention casually I’ll be traveling abroad soon, she offers me money to buy a goat or chicken for a family in need.

    Morning to evening, nearly seven days a week, Karen and Michelle endure taxing commutes to bring harm reduction services to drug users in North Carolina’s hard-hit, rural areas. They ask nothing in return for their services. In fact, they seem critical of faith-based groups who use community outreach programs as a carrot to boost membership.

    “It’s hard to be trusted in a neighborhood like this [because people think] everyone wants to take them to church,” Karen explains, adding that this is why she maintains such a low-key presence on outreach. Instead of rolling up in a van stashed with free giveaways, she roams the streets where people can see her, offering nothing but a greeting unless she is asked.

    The Intersection Between Faith Communities and Harm Reduction

    The Olive Branch Ministry’s approach could serve as an example for how faith-based communities and harm reduction can work together. The relationship is not always harmonious: some in the faith community accuse harm reductionists of enabling drug use or not doing enough to discourage problematic behavior. Conversely, many harm reductionists criticize faith groups for the hypocrisy of claiming to serve “the least of these” while refusing to help drug users, who belong to one of the most stigmatized and marginalized of all groups. Even when faith-based organizations do offer assistance, some peddle a strict, abstinence-only agenda or approach outreach with an attitude that appears to place more importance on gathering lost souls into the flock than on addressing people’s immediate needs.

    But despite the tenuous history between the groups, there is much cause for hope. Across the country, faith-based groups like The Olive Branch Ministry, Judson Memorial Church in New York City, St. Paul’s Episcopal Church in Arkansas, the national Interfaith Criminal Justice Coalition, and many more are forming active partnerships with harm reduction groups. Other organizations, including the United Methodist Church, Presbyterian Church (U.S.A.), United Church of Christ and National Council on Jewish Women have publicly proclaimed their support for harm reduction programs.

    The relationship between the faith community and harm reduction shows promise and room for growth. Especially in the South where faith is so important and drug users have so few services, these alliances are critical to stem the tide of deaths and disease caused by an unregulated drug supply, draconian laws, lack of sterile equipment, dearth of adequate treatment, stigma, and misunderstanding about what causes drug use to become problematic for many people.

    “I feel that faith communities in general think that harm reductionists are a bunch of left wing radicals,” says Michelle. “They think that we will come in and demand that the church hold drug user union meetings and do syringe exchange, but they don’t realize that we meet the congregation where they are…we figure out where they are comfortable and [decide] how to go from there.”

    Harm reduction groups and faith communities need to work together rather than at cross-purposes in order to reach and help as many people as possible. It’s not always easy to find common ground; an olive branch is a good place to start.

    View the original article at thefix.com

  • Four Advocates on How Harm Reduction Can Change the Trajectory of the Opioid Crisis

    Four Advocates on How Harm Reduction Can Change the Trajectory of the Opioid Crisis

    There is overwhelming evidence that harm reduction keeps people alive and can bring them into recovery, yet it’s still met with opposition. We ask four harm reduction workers what inspires them and what we can do to help.

    Harm reduction has been a contentious topic for a while: staunch 12-step proponents who insist that abstinence is the only way to achieve recovery are met with resistance from a growing number of harm reduction activists who consider the reality of drug use more holistically while advocating for individual choice and safety. Many of us have deep-seated beliefs and strong feelings about recovery, but now more than ever we need to analyze and hopefully remove our biases, accept the overwhelming data in favor of harm reduction, and face the failed policies that have led to a national crisis. Every day 130 people die from opioid overdose in the U.S., and misuse of prescription opioids costs us an estimated 78.5 billion dollars each year.

    Abstinence alone isn’t working. If it were, we wouldn’t have an epidemic on our hands. Perhaps this realization is why we are seeing an increase in harm reduction measures—increased naloxone access, fentanyl testing strips, Good Samaritan laws, and needle exchange programs. And they work: many individuals enter recovery through various harm reduction programs. But regardless of whether people get treatment or not, harm reduction measures prevent disease and save lives.

    What Is Harm Reduction?

    Harm reduction is frequently misunderstood. Often people think it means the use of medication-assisted treatments (pharmacology), or moderating drug use instead of eliminating it entirely. But these are narrow definitions. Harm reduction is not a particular pathway of recovery; it is a means of reducing the harm associated with drug use.

    According to the Harm Reduction Coalition, “Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”

    The philosophy of harm reduction accepts that drug use is complex and multifaceted, and that it involves a range of behaviors from frequent use to total abstinence. It acknowledges that some ways of using drugs are clearly safer than others. Harm reduction includes strategies such as safer use, managed use, needle exchanges, supervised injection sites, treatment instead of jail, and abstinence. It advocates for meeting the individual where they are and addressing their reasons for using and the conditions surrounding their drug use. Successful implementation of harm reduction should lead to well-being for individuals and communities, but not necessarily cessation of all drug use.

    Tracey Helton Mitchell, Devin Reaves, Brooke Feldman, and Chad Sabora advocate for the acceptance and practice of harm reduction. We asked what motivated them to pursue their activism and how we can all be more mindful of harm reduction principles.

    Tracey Helton Mitchell

    Tracey Helton Mitchell came into the public eye when she was featured in HBO’s documentary Black Tar Heroin, which documented her life on the streets on San Francisco. After she found recovery, she rebuilt her life and went back to school for a bachelor’s degree in business administration and a master’s in public administration. She has dedicated her life to advocating for the individual needs of people with addiction. She documents her journey in her book The Big Fix: Hope After Heroin.

    In 2016 Tracey told NPR that “We need to have a variety of different kinds of treatment interventions that address people’s needs.” In response to the argument that harm reduction measures such as needle exchange enable drug use, she said: “We’re not encouraging people to do anything, we’re taking a look at their public health behaviors and then addressing what the particular needs are, so look at the cost of one syringe versus the cost of someone getting hepatitis C and having to take care of them for a lifetime.”

    What motivated you to work in harm reduction?

    I started in harm reduction in response to the overdose crisis that was happening in San Francisco and the Pacific Northwest in the late 90s. I knew many people who had died, including Jennifer H., a person I loved very much. 

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    Harm reduction is seen by many in the recovery community as a crutch when it should be seen as a lifeline. Harm reduction should be included as part of a continuum of care with a wide variety of options based around what is best for the person. Too much focus has been made on “abstinence only” as the standard for recovery. We need to broaden our scope. 

    See also: Naloxone and the High Price of Doing Nothing

    Devin Reaves

    Devin Reaves, MSW, is a community organizer and grassroots advocacy leader who is in long-term recovery. He is also the co-founder and executive director of the Pennsylvania Harm Reduction Coalition (PAHRC), serves on the Camden County Addiction Awareness Task Force, and sits on the board of directors for the Association of Recovery High Schools. He has worked on the expansion of access to naloxone, the implementation of Good Samaritan policies, and the development of youth-oriented systems, and he is leading conversations to bring about public health policy changes in the area of substance use disorders.

    PAHRC’s mission is to promote the health, dignity, and human rights of individuals who use drugs and the communities affected by drug use.

    What motivated you to work in harm reduction?

    As someone in recovery who lost a lot of friends to substance use disorder, when I learned about Narcan, I wanted it to be more available because I was sick of my friends dying. Seeing that harm reduction wasn’t utilized made me want to fight to see more of it: syringe services programs or more innovative programs.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    We can provide Fentanyl testing strips, Narcan, and sterile needles to use. For those seeking recovery, we should also provide Narcan because they are still at risk. What people don’t know about harm reduction is that individuals in programs of harm reduction are five times more likely to enter treatment—it is a pathway of recovery. 

    Brooke Feldman

    Brooke Feldman, MSW, is a social justice activist who identifies as a member of the LGBTQ+ community and a person in long-term recovery from substance use disorder. She has spent the past decade advocating for wellness and long-term recovery being accessible to all.

    What motivated you to work in harm reduction?

    Well, I think I was pretty primed to embrace harm reduction principles over 10 years ago when I was taught what are called “recovery-oriented” care principles. Back in 2008, and only a few years into my own recovery journey, I was working for an organization called PRO-ACT at Philly’s first Recovery Community Center. We had a sign on the wall that greeted people with, “How can I help you with YOUR recovery?” and we were educated and trained in practices such as meeting people where they’re at, supporting people in working toward their own goals rather than our goals for them, recognizing that abstinence is not the goal for everybody, and embracing diversity in recovery experiences and mosaics of pathways. My experience with what we call recovery-oriented practice over the past decade set the stage for harm reduction principles and practices to fit perfectly. Unfortunately, while I have found my own professional experience, education, and training in recovery-oriented care to fit neatly with harm reduction, I still see many gaps between the harm reduction and recovery movements. A large motivator for me currently is the strong desire to bridge those gaps, to highlight shared goals and values, and to be part of unifying the two movements wherever possible. I believe people die in the cracks of the divide, and I hope to serve as part of the glue that seals the cracks.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    I think that if we center the human rights of choice, self-determination and autonomy when it comes to directing the course of one’s own life, we become more inclusive of harm reduction principles across the board. One concrete area for centering these principles is that of the use—or declined use—of medications to treat opioid use disorders. People have a right to utilize evidence-based medications to aid in their recovery, and people also have a right to decline the use of medication as part of their recovery. Nobody should face discrimination or refusal of resources, supports, and services based on this choice of what to put in their bodies. Also, one of the things I love about the harm reduction movement is the social justice focus. In my experience, the harm reduction movement centers the roles that oppression and marginalization play when it comes to how our systems, and society at large, respond differently to drug use depending on the skin color or socioeconomic status of the drug user. I think that centering social justice would put us all in the right position when it comes to both people currently using drugs and people in recovery, however that recovery is self-defined.

    Chad Sabora

    Chad Sabora is the co-founder and executive director of the Missouri Network for Opiate Reform and Recovery (Mo Network), an organization that offers services to those struggling with substance use disorder and their loved ones. He has been the focus of several episodes of the show Drug Wars on Fusion and was part of an Emmy award-winning episode of NBC News with Brian Williams. Sabora has been an expert correspondent on CNN and MSNBC. He is also president and co-founder of the nonprofit Rebel Recovery Florida, and he is on the board of directors of the Discovery Institute for Addictive Disorders in Marlboro, New Jersey. Sabora is also known for filming himself while touching fentanyl, thus debunking the myth that you can overdose through skin contact with the illicit substance.

    Uniquely experienced as a former prosecutor and a person in long-term recovery, Sabora left legal practice in favor of pursuing drug policy reform and advocacy. He founded Mo Network in 2013, where he heads their work on legislative policy reform. Sabora and Mo Network focus on expanding services based on evidence-based solutions, and they lobby for more effective drug policy locally in Missouri and also at the federal level.

    He has helped write, advocate for, and pass several pieces of legislation in Missouri, namely first responder access to Narcan, third-party and over-the-counter access to Narcan, 911 Good Samaritan immunity, and access to medication-assisted treatment in various environments such as addiction treatment, mental health facilities, family court, and for certain frequently-overlooked populations such as veterans.

    What motivated you to work in harm reduction?

    The overwhelming data, basic common sense, failed policies of the past, and unconditional love was the motivation.

    How can we include more of the principles of harm reduction when dealing with people in recovery, and those actively taking drugs?

    Inclusion will come in time, as long as we stay vigilant. Changing moral compasses and inherent biases could take a generation before we see the full impact.

    Read Chad’s rules for staying alive while using drugs (including how to use naloxone to reverse an opioid overdose)

     

    A Call to Action: We Need Harm Reduction Now

    The evidence is clear: If we provide the education and resources for people to use drugs safely, we reduce disease and save lives. Frequently we open the door to recovery. Isn’t it time for us all to start advocating for (or at least accepting) harm reduction wherever and whenever we can?

    View the original article at thefix.com

  • Feds Sue To Stop Safe Injection Site In Philadelphia

    Feds Sue To Stop Safe Injection Site In Philadelphia

    Federal authorities are invoking a “crack house statute” from the ’80s in their attempt to stop the opening of the site.

    Federal authorities in Philadelphia are suing to stop the opening of a safe injection site in the city. 

    “These folks have good intentions and they’re trying their best to combat the opioid epidemic,” William McSwain, the U.S. attorney for the Eastern District of Pennsylvania, told NPR. “But this step of opening an injection site crosses the line.”

    McSwain is suing to stop Safehouse, a nonprofit, from opening a supervised injection site. The organization has said that it has support of city officials and plans to open the site this year. However, McSwain said that the site—where people would bring drugs to inject under medical supervision—is illegal.  

    “If Safehouse or others want to open this type of site, they need to steer their efforts to get the law changed,” he said. 

    The federal authorities cite a portion of the Controlled Substances Act that was written during the 1980s when people were concerned about the crack epidemic. The so-called crack house statute makes it illegal to operate a place to make, store, distribute or use illegal drugs. The law was originally written to prosecute people operating crack houses, but authorities have used it in other circumstances, said Alex Kreit, a law professor at Thomas Jefferson School of Law in San Diego and a drug policy specialist. 

    However, Kreit noted that this is the first time authorities will try to use the law against a safe injection site. 

    “It is completely untested in terms of how federal law will apply to safe injection sites,” he said. “People will be watching this very closely—particularly in other cities that have expressed their intention of starting a safe injection site.”

    Although Philadelphia has been at the forefront of the supervised injection site debate, other cities from around the country are considering similar measures. There are no safe injection sites in the U.S., but data from Canada and other countries indicate that such facilities can help stop the spread of disease and reduce overdose deaths because medical professionals are on hand.

    Proponents also argue that the sites will be able to connect drug users with resources including treatment. 

    Despite this, McSwain said in a letter to Safehouse that the law “makes no exception for entities, such as Safehouse, who claim a benevolent purpose.”

    Safehouse’s vice president and attorney Ronda Goldfein said that she’s confident that a federal judge will recognize that the site is not the intended target of the statute. 

    “We have a disagreement on the analysis and intention of the law. We don’t think it was intended to prevent activities such as this, and perhaps it will take a court’s ruling to move the issue forward.”

    View the original article at thefix.com

  • How I Came To "Believe” In Safe Injection Sites

    How I Came To "Believe” In Safe Injection Sites

    The part of me that understands service is the backbone of my recovery, demands something other than pretending that there aren’t options available to people still suffering.  

    So last night I’m at a town hall event on drug addiction and someone mentions safe injection sites in the audience. My heart begins to pound from having my hand up and hoping to get called on, so I can ask about this, among other topics.  

    The panel looks around at each other trying to see who will bite first, as it’s clearly a controversial topic. Finally, the one “token recovery guy” speaks up, “You know, studies are positive, but people are very opposed to the idea, and the last time we had a discussion about it a fight nearly broke out.”

    And so, I wanted to get up. And I wanted to have that fight.  

    But I was taught to cease fighting anything and anyone. What about fighting substance use disorder? I thought my disease was doing pushups? Certainly, this disease is wreaking havoc across our country, especially with the younger generations, and what are we, as a community, prepared to do about it?  

    Who is fighting on the front lines? While communities claim “not in my backyard” absolution, so do the “anonymous people” who are in recovery in this country. They are told to have no opinion on outside issues. But, to me, this isn’t an outside issue, because the part of me that understands service is the backbone of my recovery, demands something other than pretending that there aren’t options available to people still suffering.  

    Thankfully, I have met many who are rank and file generals in this fight, however compared to the #’s we could have, it is disappointing, and makes creating change in our communities even more difficult.  

    Clearly, safe injection options are not a solution, but saying “he or she must not have wanted it enough” when they drop out of the only pathway we are offering, which for mainstream recovery is a 12-step program, is an even less valid answer.  

    12-step can be successful, alongside other treatment modalities, but it is often seen as “the” solution and not “a” solution.

    And what about statistics? Research shows that overdose rates decrease around the area of the safe injection site. If this statistic alone isn’t a good enough reason to support them how about that the rate of people who were entering treatment in those areas increased? 

    Look, don’t get me wrong, I was once on the other side of this conversation. I had a lot of misguided beliefs before I entered recovery. I once thought when I was 16 and my drinking career had just begun, that if I could get my dad to give me driving lessons while I was drinking, I wouldn’t have a drinking and driving problem!

    Clearly being open-minded that my own thinking could be wrong is an important aspect of recovery, and so while I was made to think I should be open-minded about the program, I was indoctrinated to believe recovery was a static black-and-white thing, and that I was a miracle because I didn’t use, and while this may be true, it also underlined another assumption, that those who didn’t make it were not entitled to these miracles.  

    The idea that there is a level of participation required for someone to enter recovery is not lost on me, but the fact of the matter is, more and more people, especially those from the younger generations, are struggling to find their way in recovery and our answer to the staggering overdose and relapse rates is “they must not have been ready.”  

    So now what? What do we do with people who aren’t ready? Tell them to go out and give their substances another try? Drugs which could easily kill them in one shot? In my mind, if someone is not ready for abstinence-based recovery it isn’t that they have failed, it’s that they may not have reached that point yet, they may never reach that point, and who are we to say what that should look like.  

    There are many people who reach a significant “bottom,” only to find themselves using again. Can anyone say, who is honest with themselves, that a “bottom” is what creates recovery? Surely it can help, but there are many who hit that point and beyond, and for those people, while their lives continue to crumble around them, what is available?

    To me, this is why we need to offer as many solutions to this problem as we can. Not offering alternative methods like safe injection sites, or medically assisted treatment, is like saying to someone who has diabetes they can’t go to the hospital for support, or shouldn’t have to take insulin, they should just use their higher power, and if they can’t clearly, they don’t want to be healthy enough.

    Change is possible without necessarily being at a point of relying on grace only. While I believe in grace and have my own stance on faith, I believe this “coveted” winners circle of recovery is an issue and is not saving lives, especially amongst young people.

    Do I believe willingness is an important key to recovery? Certainly, yet how many of us become willing along our path of using? So why would we not want to create opportunities for the people who are using, to not only stay alive, but be near recovery support services?  

    When someone has a reoccurrence of use, do we no longer consider them in recovery? Therefore, by that logic, anyone who is in active use has the potential to effect this same change in their lives. Hospitals, fire houses, police stations, med express, anywhere, anytime someone wants out of the cycle, it should be as easy as getting a flu shot. It is that easy to get high or drunk.

    Finding drugs is way easier than finding recovery, unfortunately, we don’t seem to be making much headway on that stat. It shouldn’t be so difficult to get help, and yet it is. Clearly, we have quite a way to go, and so while we stand at the frontlines arguing for much-needed treatment options, housing options, peer support options for people in early recovery, we need to also keep our eye on how we can affect those who haven’t gotten to that point yet.    

    So, I didn’t get up and fight at the town hall meeting, because I know that the only way change will be affected is if compassion and reason win over misunderstanding and hatred. The only way we can win, and by we, I mean the parents who lost children to overdoses, and by we, I mean the advocates who mentor peers who end up overdosed in alley ways, and never make it home to their families, is if we can convince society that shaming people is not working and giving them opportunities for change are the best ideas we have currently.   

    I understand clearly that this option is seen as enabling to some. That we are encouraging people to use by providing needles and a safe place to go. The concept is not lost on me, but current models are not working. Prevention talks often fall on deaf ears, and while it doesn’t mean we shouldn’t continue to try to reach people, it does mean we need to get real about whether we are doing all we can do to help prevent overdose deaths in this country. 

    If someone who is opposed has a better idea of how we can get the people in our communities, who are using illicit substances, out of the shadows and into the light where we can see them and help them, please by all means share it.  

    To me the big bad wolf in this situation is that we would have to admit as a community, that people in our community, have heroin problems. We don’t like to admit that, and unfortunately it’s killing people.  

    I would argue that whatever motives you have for being opposed to this option, check them against the idea that centralizing use as best as possible helps to a.) measure your community and its needs, b.) provide safety and support to a vulnerable part of the population c.) encourage the next step for people to move on with their lives and d.) minimize the risk to police and health care workers responding to overdoses.  

    One of these reasons alone in my mind is enough to at least give it a try. Saving just one life means so much, especially if it is your child, your brother, your sister or your parent. Sharing this pain with too many people in too short of a time period is how I came to believe in safe Injection sites. 

    Erik Beresnoy is a father, advocate, and a writer on topics that range from recovery, and spirituality to music and philosophy.  Erik has been an active member of the recovery movement since 2008, when he himself entered recovery, and began to not only repair his life but to also seek help repair his community by working to implement new strategies. His current projects include Empowerment Coaching for the Ammon Foundation, and implementing a transformational program in NYC called Dare to Dream for Synergy Education. He is a certified recovery coach as well as a board member for Rockland Recovery Homes. His other works can be viewed at soberspiritmeditation.com.

    View the original article at thefix.com

  • "Church of Safe Injection" Hopes to Save Lives Through Needle Exchange

    "Church of Safe Injection" Hopes to Save Lives Through Needle Exchange

    A 26-year-old former drug user turned recovery coach has founded a harm-reduction-based “church” that offers clean needles, Narcan and a welcoming brand of faith-driven dialogue to drug users.

    As the viability of safe injection sites continues to be debated across the globe, a 26-year-old former drug user turned recovery coach has found a following with a harm-reduction-based “church” that offers clean needles, the overdose reversal drug Narcan and a welcoming brand of faith-driven dialogue to drug users.

    As the Huffington Post noted, the tenets of Jesse Harvey’s “Church of Safe Injection” have been taken up by others in eight states, but his efforts have been met with resistance by some law enforcement and health officials who have abided by federal law that prohibits safe injection sites.

    Since late 2018, Harvey, who has been in recovery from drug and alcohol dependency for several years, has been operating his “church” from the back of his car, which he stations near a park frequented by drug users in Lewiston, Maine.

    With the help of volunteers, he offers free needles and a gospel that emphasizes inclusion and support for those in need. That approach informs the Church’s three basic principles: helping those in need, welcoming people of all faiths, as well as atheists, and keeping drug users healthy through harm reduction-based support.

    “Our religious belief is simply that people who use drugs don’t deserve to die,” Harvey told the Huffington Post.

    That philosophy has attracted others, especially those with religious backgrounds who have been dismayed by some traditional churches, which have rejected or condemned drug users.

    To date, 18 Churches of Safe Injection have been established in eight states, and Harvey hopes to incorporate the Church as a nonprofit in order to apply for religious exemption to the Controlled Substances Act so he can open a legal safe injection site.

    However, Harvey’s goals run opposite of many state policies regarding needle exchange and safe injection sites. Maine has only six certified needle exchanges, none of which are located in Lewiston, and the state’s Center for Disease Control issued strict warnings to those exchanges about regulations after Harvey began attracting media attention.

    Eventually, Lewiston police warned him about possible misdemeanor charges for possessing more than 10 syringes at one time, which prompted Harvey to stop handing out clean needles.

    However, as the Post feature noted, he continues to offer Narcan and bags of supplies, including saline, alcohol wipes and rubber ties, to those who meet him in Lewiston. Harvey also hopes to start a drug users’ union in Maine, which would serve as a center for health and safety advocacy. In an op-ed penned for the Portland Press Herald in late 2018, Harvey summed up his goal for the church: “Politicians, law enforcement, and health care haven’t taken the lead here, so our church is.”

    View the original article at thefix.com

  • Fentanyl Test Strips: Important Tool Or False Security?

    Fentanyl Test Strips: Important Tool Or False Security?

    A recent study suggests that the testing strips should be widely distributed though some experts say the strips are not an adequate prevention measure.

    Last year, fentanyl became the most deadly drug in the country, responsible for more overdose deaths than any other substance. In addition to being found in — or even replacing — opioids like heroin and prescription pills, fentanyl has increasingly been detected in drugs like cocaine, whose users are at increased risk for overdose because they have not built up a tolerance to opioids. 

    That’s why some people say fentanyl test strips are an important tool to help cut back on opioid overdose deaths. Some users say they often have no idea whether the drugs they’re buying contain fentanyl, which is many times more powerful than other opioids and can cause an overdose in even a small amount.

    The test strips are able to detect the presence of the synthetic opioid, empowering users to make an informed decision about whether to take the drugs and about how much to use. 

    “Evidence to date suggests that people who use drugs often do not know whether fentanyl is present in what they are about to consume,” authors of a report prepared by the John Hopkins Bloomberg School of Public Health wrote last year. 

    The school conducted a study that found fentanyl test strips to be effective at detecting the drug. The researchers then interviewed people who use drugs about whether or not they would use the test strips: 84% said they were concerned about fentanyl, and 85% of people who thought they had taken fentanyl in the past said they wished they had known beforehand. Despite the drug’s powerful high, only 26% of users surveyed said that they sought drugs with fentanyl. 

    “Drug checking was viewed as an important means of overdose prevention, with 89% agreeing that it would make them feel better about protecting themselves from overdose. Interest in drug checking was associated with having witnessed an overdose and recently using a drug thought to contain fentanyl,” study authors wrote. 

    The study’s authors suggested that more agencies distribute fentanyl test strips. 

    “Drug checking strategies are reliable, practical and very much desired by those at greatest risk of overdose,” they wrote. “Drug checking services have the potential to facilitate access to treatment for substance use disorders and other essential services, as well as provide real-time data about local drug supplies for public health surveillance.”

    However, Assistant Secretary for Mental Health and Substance Use Elinore F. McCance-Katz wrote in an editorial on the SAMHSA website that fentanyl test strips are not a prevention measure that people should be focused on. 

    “Can’t the nation do better?” she wrote.

    She continues, “The entire approach is based on the premise that a drug user poised to use a drug is making rational choices, is weighing pros and cons, and is thinking completely logically about his or her drug use. Based on my clinical experience, I know this could not be further from the truth.” 

    Like needle exchanges, fentanyl test strips are likely to remain a controversial —but potentially lifesaving — tool. 

    View the original article at thefix.com

  • The State Of Harm Reduction Around The Globe

    The State Of Harm Reduction Around The Globe

    A new report breaks down the status of harm reduction programs around the world. 

    Even as opioid use continues wreaking havoc on some parts of the globe, the availability of harm reduction measures worldwide are relatively stagnant, as documented in a massive new report released this month.

    The number of countries with needle exchange or opioid substitution treatment has stayed relatively stable over the past four years, and a lack of funding in middle- and low-income countries has stunted the growth of service options available in some of the places most severely impacted, according to the “Global State of Harm Reduction” 2018 report issued this month by Harm Reduction International. 

    But there’s a significant exception to that trend: North America. Here, as opioid overdose figures rise, the harm reduction response is blossoming. Naloxone access, fentanyl testing strips, and needle exchange programs have become more common in the US and Canada – all possible signs of forward-thinking responses to a well-documented crisis. 

    “The US now has the fastest annual percentage rise of drug-related fatal overdose ever recorded,” the report notes, “with an increase of 21.4% between 2015- 2016 alone.” 

    Currently, the United States has 335 needle exchanges – a 37% increase since the last harm reduction report. Meanwhile, Canada has taken harm reduction efforts a step further, opening a total of 26 supervised injection sites. That sort of progressive action is still barred by federal law in the US, though some communities have considered addressing it both legislatively and in local action plans.

    There are, of course, still significant gaps. The availability of harm reduction in prisons is “woefully inadequate, falling far short of meeting both international human rights and public health standards,” according to the report. 

    And, despite the response in North America, service offerings worldwide have stayed more stagnant.

    “While our coverage of harm reduction policies and services has evolved and broadened in scope, the same cannot always be said for harm reduction in practice around the world,” the report notes. “Despite [the] heavy burden of diseases, effective harm reduction interventions that can help prevent their spread are severely lacking in many countries.”

    Currently, 86 countries offer some sort of needle exchange program – down from 90 in 2016. Bulgaria, Laos and the Philippines have shuttered their exchange programs in the face of punitive drug policies, while Argentina and Brazil have stopped offering such services as the number of injection drug users falls in those nations. 

    While the number of countries that offer exchanges has fallen slightly, the number with opioid substitution drugs available has gone up a bit. Since 2016, Cote d’Ivoire, Zanzibar, Bahrain, Kuwait, Palestine, Argentina and Costa Rica have all introduced or re-introduced medication-assisted treatments. 

    Overall, methadone is still the most commonly prescribed of those treatments, with buprenorphine falling into second place. Despite research espousing the use of heroin-assisted treatment as a harm reduction option, it’s only available in seven countries: Belgium, Canada, Denmark, Germany, the Netherlands, Switzerland and the UK. Though that’s still considered a radical option in many countries, it’s just one of the solutions experts have increasingly examined as more potent drugs continue appearing in underground supply chains.

    “The rise of illicit fentanyls themselves is just about the clearest case one can make for harm reduction: despite a literally poisonous supply, millions of people are still taking street opioids in an underground market that lacks quality control,” journalist Maia Szalavitz wrote in an introduction to the report. “It’s hard to argue that anything short of providing a safer supply – both through traditional medications like methadone and buprenorphine and via prescription heroin, hydromorphone (Dilaudid) and perhaps others – will be able to end the crisis, if done to scale.”

    And, aside from the continued toll of opioid use, amphetamine use is on the rise as well – but harm reduction options for speed users “remain underdeveloped,” according to the report. Safe consumption sites – in the regions where they’re available – continue to focus largely on injection use, leaving out those who smoke or snort their drugs. And, free drug testing services are limited mostly to festivals and clubs. 

    “While this all paints a bleak picture of harm reduction worldwide, there are examples of innovation and perseverance in this report that give hope and demonstrate that progress is possible,” the report’s authors wrote. “It is important, too, to not overlook the fact that harm reduction has come a long way over the past two decades. The evidence is clearly in favour of harm reduction. It is time that more countries acknowledge this and implement the services that are proven to advance public health and uphold human rights.”

    View the original article at thefix.com

  • Moscow's Only Harm Reduction Program Is Being Fined

    Moscow's Only Harm Reduction Program Is Being Fined

    The harm reduction program came to the attention of the Russian government due to its pamphlet providing safety advice about bath salts.

    The only harm reduction program in Moscow has been fined for what the government is calling “drug propaganda.” The small and dedicated group, The Andrey Rylkov Foundation (ARF), has been fined 800,000 roubles.

    The ARF provides the heroin-addicted population of Moscow with life-saving clean needles, HIV prevention and harm-reduction advice. Like many harm reduction programs here in America, the ARF was built on the idea that reducing the risk of disease and death for those addicted to injecting heroin keeps them alive and safe until they are ready to attempt sobriety.

    The ARF also provides condoms and naloxone – or Narcan as it is better known – for reversing a potential opioid overdose.

    The ARF came to the attention of the Russian government due to its pamphlet providing safety advice about synthetic cathinones (in slang, bath salts). The pamphlet, published in a newsletter for drug users called Hats and Bayan, advised users that if they took this dangerous drug, to begin with a small dose and to ingest water, pills and vitamin C along with it to assist in the body’s processing of the drug. The newsletter did not tell people to take the drug – it simply gave safety advice to people who had already decided to use it. 

    Vice stated that Amnesty International described the fine as “suffocating” because it will kill the organization if they cannot raise the amount of the fine by Christmas.  

    It is largely the spread of HIV that brought the ARF to life. Russia is currently the single largest heroin market in the world. Heroin from Afghanistan began to flood Russia after the fall of the Iron Curtain, and on the heels of the drug crisis was an HIV crisis brought on by the sharing of dirty needles.

    And just like here in America, the deadly drug fentanyl is dramatically increasing overdose deaths in Russia. Anya Sarang, president and co-founder of the ARF, told Vice, “Last year the number of ODs sharply went up, possibly because of fentanyl. We can’t say for sure, because there’s no official data, but the number of times someone’s called and told us they’ve had to use naloxone has doubled. So more people are overdosing.”

    In The Moscow Times, Masoud Dara, HIV specialist at the WHO, noted the importance of programs addressing the issue, “HIV starts off [in] key populations — meaning drug users, commercial sex workers and men having sex with men — but after that it [increases] exponentially… if there is no more intervention.”

    View the original article at thefix.com

  • Fighting the Drug War in Budget Motels and Prisons

    Fighting the Drug War in Budget Motels and Prisons

    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