Answer Addiction

Tag: North Carolina

  • Harm Reduction vs. Gentrification in Asheville, North Carolina

    Harm Reduction vs. Gentrification in Asheville, North Carolina

    “Harm reduction is on the front lines [of drug overdose] but we have to argue for our existence and the lives of the people we serve. That is unconscionable.”

    In August 2018, Hillary Brown received a bizarre notice from the city of Asheville. The small syringe exchange program that Brown ran three hours a week in the backroom of a bookstore was ordered to shut down within 30 days for operating an illegal homeless shelter.

    At first, 31-year-old Brown, the sole employee of harm reduction nonprofit Steady Collective in western North Carolina, thought it was a joke. Every Tuesday since 2016 the Steady Collective had visited the backroom at Firestorm Books to hand out sterile syringes, condoms, and overdose prevention supplies to people at risk for overdose and drug-related infections.

    Syringe Exchange or Homeless Shelter?

    Separated from the bookstore by a curtain, the backroom is dimly lit and bare except for a couple of red-cushioned church pews against a wall and two gray folding tables where Brown lays out the supplies. The room contains no food, no beds, no bathrooms, and no showers. People who stop by to stock up on supplies rarely linger more than five minutes. And many of them do have homes.

    Brown followed up with the notice, which had been served to the building’s other tenants as well: Firestorm Books & Coffee, 12 Baskets (a small free-lunch program operating in the basement), and Kairos West, a community center run by the Episcopal Church. All four tenants were accused of violating zoning laws having to do with the operation of a homeless shelter in the city’s rapidly gentrifying west end. A $100 per diem penalty would be levied against all tenants if the Steady Collective did not cease operations within 30 days.

    The initial notice of violation seemed bizarre, but it was only a hint of the ongoing legal battle it would spark.

    Within the 30-day grace period, the city withdrew the notices of violation from 12 Baskets and Kairos West, leaving Firestorm Books and the Steady Collective to face the legal hurdles alone.

    Remarkably, Firestorm Books, which could have easily saved itself by asking the Steady Collective to stop coming on Tuesdays, chose to dig in for a fight, risking its 10-year business history and the livelihood of its four employees.

    Beck, one of Firestorm’s co-owners, explains that the Firestorm team see themselves as “community organizers first and business people second.” Throwing a community nonprofit out to save their own skins would run counter to their business and personal ethos.

    Lucky for Firestorm and Steady Collective, local attorney John Noor offered to take the case pro bono. Noor has worked the case since September and helped secure meetings between city management and the Steady Collective.

    Attracting the Wrong Kind of People

    According to Brown, during one meeting to make the case for why a small once-a-week syringe exchange should not be classified as a homeless shelter, a city official commented: “It’s less about what you do and more about who you serve.”

    Brown considers this a rare—and likely accidental—moment of honesty. The city wasn’t arguing against the need for the program or its efficacy. (There are mountains of evidence that point to syringe exchange programs as safe and effective for reducing bloodborne disease transmission and overdose death). And Asheville is in desperate need of help. Its surrounding county, Buncombe, has one of the highest overdose rates in western North Carolina. The Steady Collective, one of the few programs in the city that attempts to mitigate the overdose crisis, reported 719 successful overdose reversals since 2016—no other program in the county can claim those results.

    But as the city official admitted, it’s not about what the program does. It’s not about science or results or lives saved or providing resources to a population in desperate need. No, the city’s concern is the program attracting the “wrong kind” of people to a rapidly gentrifying part of the city; the eyesore of folks who might look homeless gathering on a street that is trying hard to look hip. And the fear of what “those people” might bring.

    Asheville’s tactics mirror similar efforts by other cities and states, including Los Angeles, Charleston, Claremont, and Lawrence County, to shut down syringe exchanges. “Zoning violations” are a favorite tool, as are concerns about discarded needles (a problem that can be addressed through syringe disposal bins) and policymakers’ personal discomfort with the idea of harm reduction.

    “At a time of crisis we are having resources taken away,” says Brown. “Harm reduction is on the front lines [of drug overdose] but we have to argue for our existence and the lives of the people we serve. That is unconscionable.”

    Fighting City Hall to Help Drug Users

    Earlier this month I traveled to Asheville to witness the state’s largest legal battle over syringe exchange with my own eyes. The day I visited, Brown and a volunteer were in Firestorm’s backroom riffling through bags of packaged syringes, condoms, Band-aids and naloxone, a medicine used to reverse opioid overdose.

    Although Brown remained calm throughout our interview, the past few months of legal battles have taken an emotional toll.

    “What is really exhausting is to hear [the city] debate people’s dignity,” Brown said. The legal process “has undone me in ways I wasn’t prepared for.”

    Brown described the frustration of having people come into the exchange crying over the loss of a loved one to overdose who “can’t talk about the loss [outside the harm reduction program] because they are engaged in a criminal activity.”

    And the whole process hasn’t exactly occurred in the open.

    “The city of Asheville wants to talk behind closed doors and go through their rules. They don’t want the public to know [what they are doing],” said Brown.

    In March, after months of legal wrangling, the city finally made an offer: the Steady Collective could operate under the classification of “medical clinic” if they kept a physician on site during all hours of operation.

    Brown described the offer as a slap in the face. The tiny exchange can barely afford a single employee to run operations. To pay a supervising physician—when the only real task is to hand out non-prescription supplies from the back of a bookstore—is a non-starter. (Notably, the Steady Collective operates another exchange on Wednesdays out of a church in a non-gentrifying part of town; the city has not required that location to keep medical personnel on site.)

    Thanks to legal help, the Steady Collective was able to counter the offer and settle for an agreement to keep a nurse on site. They are the only syringe exchange in the state with such a requirement.

    The day I visited, Vanessa Bourgeois was the on-site nurse. Bourgeois works weekends at a local hospital but volunteers on Tuesdays for the Steady Collective where she puts packets of syringes and condoms in plastic bags and hands them across the table to participants—hardly work that requires a nursing license.

    The absurdity of the predicament is not lost on her.

    “This is not a situation that needs a nurse,” she says bluntly. “Harm reduction is appropriate for laypeople.”

    Though she is happy to support the Steady Collective’s work, she denounces the city’s actions as “part of the narrative to make people who use drugs seem dangerous or scary.”

    Because Bourgeois volunteers her time during exchange hours, the Steady Collective and Firestorm Books are no longer under threat of being shut down. But to Brown, their work is far from over.

    Asheville Impedes Harm Reduction Efforts

    Asheville, a city often touted as one of North Carolina’s “most progressive,” has shown little evidence of progressive thinking towards drug users in any of its major government facilities. When North Carolina legalized syringe exchange in 2016, Asheville police responded aggressively, ripping up the ID cards that syringe exchange participants are required to carry by law.

    In 2018, Mission Hospital, the largest medical facility in Asheville, implemented a draconian policy against drugs users: If any patient is suspected of IV drug use, regardless of the medical condition for which they are being seen, hospital staff will confiscate their electronic possessions, refuse them visitors, and keep a staff member in the room at all times to supervise them.

    And the City of Asheville Planning Department has not given up their war on harm reduction. The city plans to write syringe exchanges into the zoning code, which would allow the city to impose restrictions on their locations. Brown believes fighting against such legislation is “the most important issue facing harm reduction in the state” and urges other programs not to be complacent.

    Asked what the Steady Collective would do differently if faced with the situation again, Brown says that the organization would be more aggressive about raising public awareness of the city’s actions and mobilizing people to fight back. At the time, the concern was that drawing too much negative attention to the city would disrupt the negotiation process. But now Brown sees that there was never much negotiation to begin with.

    To other harm reduction programs facing similar threats, Brown advises: “Be more vocal about the process. Invite other people in. Organize the community to fight back. Mobilize medical professionals and faith leaders.”

    North Carolina accomplished a great feat when it legalized syringe exchange programs in 2016. But the real work still lies ahead. We still live in a world that stigmatizes and devalues the lives of people who use drugs. Until this changes, every harm reduction program in every community is at risk. People who use drugs and their allies must stick together. Stay vigilant. And be ready for the fights when they come.


    Maribel Lopez and Hillary Brown at the church location

    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

  • Woman Accused Of Lacing Co-Worker's Drink With Meth

    Woman Accused Of Lacing Co-Worker's Drink With Meth

    The woman says she is being framed and plans to fight the charges being levied against her.

    A North Carolina woman took a workplace dispute to the next level when she reportedly laced a coworker’s drink with methamphetamine as part of an on-going disagreement, causing him to need medical attention.

    Charissa Walker, 41, has been charged with possession of meth and felony contaminating food and drink. She was allegedly caught on video surveillance putting drugs into a coworkers drink in the break room of BeoCare, a medical equipment factory in Hudson, North Carolina, according to WSOC TV.

    Police say that the man whose drink she tampered with ingested an unknown quantity of meth. He went to the hospital, where he tested positive for the drug and told police that he had been poisoned. 

    Walker told a reporter that she knew the man whose drink was tampered with, but she wasn’t the one to put drugs in his drink. 

    “There was an ongoing situation and I was just blown away. I didn’t know what to think,” Walker said.

    Police asked to search her vehicle and reportedly found drugs there, but Walker said she is being framed. 

    “They asked if they could search my vehicle and I said sure,” she said. “They searched my vehicle and I think it was all like a complete setup.”

    Although the co-worker was okay, the police say that the situation could have been a lot worse. 

    “With an unknown amount of a controlled substance like methamphetamine, you never know what dangers it may pose,” Hudson Police Chief Richard Blevins said. “You never know what underlying health conditions that may have a negative effect on so it’s definitely a very dangerous situation.”

    Walker was released from jail on a $15,000 bond and said that she plans to fight the charges and hire a lawyer to help her do so. 

    The nation is reportedly experiencing a rise in meth-related overdoses. While the drug was once made in small batches locally, it is now being pushed by Mexican cartels who are manufacturing it for cheaper than ever. 

    Last month, the DEA warned parents to be aware of meth in their children’s Halloween candy, since edible forms of the drug have been spotted. 

    “These treats can look like traditional candies, but can have harmful effects if consumed by a child,” the DEA said in a news release. “The DEA and law enforcement agencies throughout the country have seen an increase of seizures of drug-laced edibles, including but not limited to chocolates, suckers and gummies.”

    View the original article at thefix.com

  • Bringing Harm Reduction to Haywood County

    Bringing Harm Reduction to Haywood County

    The man in the camouflage shirt who emerges from the cabin is drawn and thin with circles under his eyes. He tenses at my presence, especially once Jeremy tells him I am there to write an article.

    It is a cloudy evening and mosquitoes patrol in full force as Nancy Bauman and I pick our way gingerly over trash-strewn ground, searching for syringes. Under a creekside bridge splashed with graffiti, a pair of neatly folded jeans, a plastic bag of food items, and a pair of shoes offer evidence of a homeless encampment.

    As we search, Nancy opens up about her life as a former injection drug user. She recounts how her only brother died of a heroin overdose shortly after returning from Vietnam. Her own struggle with addiction began through recreational drug use with homecoming soldiers, and years ago she lost her husband to hepatitis C infection. Drugs ruled much of her youth, but Nancy has spunk. She entertains me with tales of how she used to run an illegal syringe exchange program with two Catholic nuns in Los Angeles. 

    As I listen to Nancy, I am not putting much effort into the search for syringes. Truth be told, I feel guilty about picking through someone’s home and also for the assumption that a homeless person must also be an injection drug user. Under the bridge, Nancy and I find nothing but an overturned shopping cart, bits of trash, and a spoon. When the time comes to return to the health department, I feel relieved.

    Nancy and I drive back to the health department to rejoin the rest of the newly formed Substance Use Task Force of Haywood County, North Carolina. The community syringe pick-up event is the inaugural event for this group, which is comprised of public health employees, harm reduction advocates, law enforcement personnel and impacted citizens who hope to address the growing incidence of drug use in Haywood County. The dozen or so members are an eager bunch, well-intentioned but so far lacking clear direction on how to tackle such a complex problem. The group finds only two discarded syringes that evening; still, enthusiasm reigns.

    We are debriefed by members of the North Carolina Harm Reduction Coalition (NCHRC), which in spring 2018 hired three staff members for the area under a grant funded by the Aetna Foundation. Haywood County, and western North Carolina in general, is relatively new territory for NCHRC, which has more established programs in eastern and central parts of the state. In one sense, this is an advantage since advocates can draw on the experience of harm reduction programs in other counties. In another sense, it is a disadvantage. Few people in Haywood County have even heard of the term “harm reduction.” Appalachian residents, often tough and resistant to change, are not easily convinced and stigma against drug users runs deep. For the three new staff members, Gariann Yochym, Virgil Hayes, and Jeremy Sharp, the task of introducing harm reduction to Haywood County is both challenge and an opportunity.

    After the task force disbands, I join Jeremy Sharp to deliver supplies to participants of the mobile syringe exchange program he has helped establish. The clouds have rolled away and the sun is just beginning to set behind the backdrop of the Blue Ridge mountains. We drive past picturesque fields of hay bales and grain silos. The town is so pretty it almost looks painted. We pull up to a log cabin with a single tire swing swaying in the breeze under a tree.

    But the beauty ends here. The man in the camouflage shirt who emerges from the cabin is drawn and thin with circles under his eyes. He tenses at my presence, especially once Jeremy tells him I am there to write an article. As a peace offering, I put away my notebook.

    Jeremy delivers syringes and naloxone to the man and his wife, who emerges from the house. The wife gives a sobering account of her recent arrest for drug possession and the agony of opioid withdrawal she endured while in jail. She asks Jeremy for help getting Suboxone treatment for opioid use and he offers to connect her to his co-worker, Gariann, who can arrange an appointment. Jeremy is quirky but likeable, and the couple’s affection for him is clear.

    When we are back in the car and I have use of my notebook again, Jeremy admits that the stories of death and despair that he encounters on a daily basis can get to him. “I walk into people’s lives for 20 minutes to do an exchange and it can be overwhelming to hear even just a description of all the things they are going through,” he says. 

    “But,” he adds, brightening. “There is nothing like that first naloxone reversal.”

    The struggle to find hope in a grim situation is one that plagues other advocates as well. NCHRC’s Gariann Yochym, who connects Haywood County program participants to social services, lives this fight every day.

    At first glance, Gariann gives off strong hippie vibes. She hails from Asheville, North Carolina’s most notoriously liberal city, but was born and raised in the hills of West Virginia. She glides easily between country twang and the Queen’s English, comfortable in both worlds but fully belonging to neither. In that way, she is well-suited to the work in Haywood County, which necessitates a level of mastery in both progressive public health policy and rural resistance to change.

    Since arriving in Haywood County, Yochym has been laying foundational work to connect drug users to services that can help them improve their health. Introducing harm reduction to an often hostile political environment is not easy. When I first ask Yochym what she thinks of her job, she offers a sunny response: She loves to help people and make a difference. But with prodding, she admits that the work can be difficult.

    “Trying to build relationships and respect, sometimes I don’t know when I should bite my tongue or hold my ground,” she says. “It can be challenging to build new partnerships, but I think we all recognize the importance of working together to address these complex problems.”

    Haywood County is a microcosm of the challenges that harm reduction faces in general. Though the harm reduction movement has existed for decades, in many ways it is still the new kid in town, pushing back against centuries of punitive and abstinence-only approaches to drug use. Long a stronghold in northern states, harm reduction has more recently begun laying foundation in southern states, where politics can be antagonistic. For advocates, the constant dilemma of when to compromise and when to hold firm is exhausting. Bringing opposite sides together often means that neither gets what it wants, and advocates are criticized both for pushing too hard and not pushing hard enough.

    Virgil Hayes, who supervises the Haywood County staff and programs, also lives under this constant pressure. “Not everyone is where you would like them to be in terms of support for harm reduction,” he says as we talk over lunch at a small diner. “We need to understand that change is inevitable, but people need time to part ways with what they have always known.”

    Hayes seems to embrace the opportunity that Haywood County presents. “It’s been an adventure,” he says, smiling and shaking his head. I sense this is an understatement.

    Hayes sees his most important task as working to create a seat at the decision-making table for active drug users. Even in other parts of the state where harm reduction is more accepted, there is still a tendency for non-impacted professionals to speak on behalf of people who use drugs. However, while in other counties stakeholders may have already marked their territory and become resistant to new voices, Haywood County has the opportunity to invite those voices from the beginning. Hayes and his co-workers are actively working to do just that.

    Ultimately, the small team is game for the challenge of bringing harm reduction to Haywood County.

    “I am inspired by the way this community has come together and opened themselves up to our program,” says Yochym. “We have been welcomed with an incredible amount of hospitality and support from unlikely partners.”

    Hayes thinks that education will be key to getting people on board with harm reduction. “People’s hearts change when they realize everything is not what it seems,” he says. He hopes to draw attention and resources to rural counties, where the effects of drug use are often swept under the rug.

    “I want to show how this problem impacts all areas across race, gender, class and geography,” he says. “I want to pull the covers back and show the issue is just as bad here [as in cities] and to present solutions for what we are going to do to change it.”

    It is not easy being dropped into a geographically isolated area and launching a harm reduction program without much precedent or guidance, relying on intuition and experience to know when to compromise and when to stand your ground. It’s an even bigger challenge to fight centuries of stigma to bring active drug users to the decision-making table. But if anyone can do it, I think Haywood County can.

    View the original article at thefix.com

  • Pawn Stars: The Opioid Edition

    Pawn Stars: The Opioid Edition

    If you are at risk for overdose or use needles to shoot up drugs, come see Brandi and she’ll take care of you – no frills, no questions, no judgment.

    On a cold November morning in 2015, Brandi Tanner and her husband stopped to pick up their 10-year-old niece from her grandmother’s house.

    “Grandma’s sleeping funny,” said the little girl when they came to the door. She wasn’t dressed for school, as she usually would be at this time of morning. Concerned, Tanner and her husband stepped into the house and headed for his mother’s bedroom. They knocked on the door, but no one answered. Glancing at each other with wide eyes, they swung open the door. Grandma had rolled off the bed and her body was wedged between the dresser and the nightstand. She wasn’t breathing.

    “I didn’t really have time to process that she was dead,” says Tanner. “The only thing I could think was ‘Damn, I need to call people. I need get the family out of the house so the police can take pictures.’”

    Tanner’s mother-in-law had died of an opioid overdose, an increasingly common cause of death in Vance County, North Carolina. Tanner herself had previously struggled with dependence on opioids and though the years she’d seen the prevalence of addiction rise in her community.

    “It was so hard to see my husband lose his mother,” she says. “I wanted to do something to help him and other people, but I didn’t know what to do.”

    About a month after her mother-in-law’s death, Tanner was working at a pawn shop where she had been employed for several years. It was right before closing and she was tired. Every day people came into the shop to sell items in order to buy opioids. And it seemed like every week she received news of someone else who had lost a family member. She had just started to shut down the register when a tall stranger strode into the shop.

    “There were other employees in the store but he headed straight for me like he knew I was the one who needed him,” Tanner recalls. “He walked up and asked if I wanted to help save lives from overdose. I was like, hell yeah. Where do I sign up?”

    The tall stranger was Loftin Wilson, an outreach worker with the North Carolina Harm Reduction Coalition, a statewide nonprofit that works to reduce death and disease among people impacted by drugs. That year, the organization had received a federal grant to prevent overdose death in Vance County in partnership with the Granville-Vance District Health Department. Over the past few years, the two agencies have worked closely to increase access to harm reduction services and medication-assisted treatment in Vance County.

    Vance is a rural community of fewer than 50,000 people. Driving through, one can’t help but notice large, pillared villas adjacent to dilapidated trailer parks, a scene that amidst acres of yellowing tobacco fields is reminiscent of plantations and slave quarters. In Vance County, a quarter of the population lives below the poverty line and addiction has flourished. From 2008-2013 Vance had the highest rate of heroin overdose deaths in the state: 4.9 residents per 100,000 compared to the state average of 1.0 per 100,000 (NC Injury Violence Prevention Surveillance Data). But those were sunnier days. By 2016, the heroin overdose rate for Vance County had jumped to 11.2 per 100,000. In 2017, based on provisional data, it was 24.2 per 100,000 (NC Office of Medical Examiners) and 2018 is already shaping up to be the deadliest year yet.

    The chance meeting between Wilson and Tanner at the pawn shop proved to be pivotal to outreach efforts in Vance County. Wilson had years of overdose prevention experience in a neighboring county, Durham, but Tanner knew her community and everyone in it. The two teamed up and began reaching out to people in need. Driving around in Wilson’s rattling pick-up, they visited the homes of people at risk for opioid overdose to distribute naloxone kits.

    The following summer, the North Carolina General Assembly legalized syringe exchange programs, and Wilson and Tanner began delivering sterile injection supplies along with naloxone. By 2018, a grant from the Aetna Foundation to combat opioid overdose had enabled them to purchase a van in which to transport supplies and to expand outreach work in Vance County.

    In July 2018 I visited Tanner at the pawn shop, where she still works. Thanks to Tanner’s efforts, the pawn shop has become a de facto site for syringe exchange and overdose prevention. Walking into the shop, the first thing I notice is that Tanner packs a glock on her right hip. It’s necessary these days in Vance County, which has seen a remarkable rise in drug-related gang violence this year. In March 2018, nine people were shot over a span of two weeks in Henderson, a small town of 15,000 residents. In May, four more people were killed in less than a week, prompting Henderson Mayor Eddie Ellington to make a formal plea to the state for resources. One of the murders occurred at a hotel a stone’s throw from the pawn shop.

    The danger doesn’t seem to faze Tanner. She weaves through displays of jewelry, rifles, and old DVDs as customers drop in to buy and sell. It’s a respectable stream of business for a Monday afternoon. Tanner handles the customers with ease, teasing them in a thick southern twang, inquiring after their kids and families, and discussing the murders, which more than one person brings up unprompted. She calls everyone “baby” and is the kind of person who will buy gift cards and toiletries just so she can slip them unnoticed into a customer’s bag if she knows the individual is down on her luck.

    Later in the afternoon, a young female enters the shop. She and Tanner nod at each other without exchanging words. Tanner finishes up a transaction with a customer and slips out the back door. She is gone for a couple of minutes, then reappears alone. This, I come to find, is what overdose prevention looks like in Vance County.

    “I used to hand out [overdose prevention supplies] from inside the shop, but people were embarrassed to come in and be seen taking them,” explains Tanner. “Now people just text me to let me know they are coming. Sometimes they come in the shop and other times I just leave my truck open out back and they get the supplies and leave.”

    Henderson is the kind of town where everyone knows everyone’s business. News travels fast and so do rumors. Even though almost everyone has someone in their family using opioids, stigma still runs deep, so Tanner doesn’t advertise the exchange. Word travels by mouth: If you are at risk for overdose or use needles to shoot up drugs, come see Brandi and she’ll take care of you – no frills, no questions, no judgment. She sees a couple participants a day on weekdays and nearly a dozen every Friday and Saturday. A couple times a week she drives her truck to visit people who don’t have transportation, just to make sure they are taken care of too.

    I ask Tanner to take me to her truck where she keeps the supplies, and she obliges, leading me behind the store to a dusty parking lot where her SUV is stuffed with naloxone, syringes, and other sterile injection equipment. I pepper her with questions as she moves the boxes around to show me what’s inside.

    Tanner looks younger than her 35 years, but acts much older. Over the next half hour she recounts a life of homelessness, addiction, incarceration, losing friend after friend to opioid overdose, and finding her mother-in-law’s body three years ago. She relates the stories as though we were discussing the weather, completely emotionless, but still, you can tell it hurts.

    “I try not to think about it,” she says with a wave of her hand when asked how she handles the trauma of losing so many people. Later, she admits that some nights she sits at home and writes down her feelings, then tears up the thoughts and throws them away.

    “It’s hard not to get attached to people if you see them every week,” she acknowledges. “But I do the work because I want to help my town and my people. This is the place where my kids are growing up.”

    We go back inside and I take a last look around the store. The blue-screened computers and racks of DVDs create the feeling that you’ve gone back in time, yet in some ways this pawn shop is the most forward-thinking entity in Vance County. Here, people received tools to save lives even before they were legal.

    Before leaving Vance’s open fields to return to the city, I ask Tanner if she has a final message for people at risk for opioid overdose. For a moment, her voice hardens.

    “I know what it feels like to not have anybody give a shit if you are here or not,” she says. Then her tone softens. “But I want people to know they are not alone. There are people out there who care and can help.”

    View the original article at thefix.com