Answer Addiction

Tag: Tessie Castillo

  • 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

  • How Fentanyl Hysteria Leads to Harmful and Ineffective Drug Laws

    How Fentanyl Hysteria Leads to Harmful and Ineffective Drug Laws

    We might as well accept reality and direct our efforts towards making drugs less deadly, in the same way that we accept the risks of driving a car, but also try to prevent accidents.

    My only experience with fentanyl was when I was pregnant. I was on a hospital bed writhing in agony when a nurse injected me with the synthetic opioid commonly used for pain management in laboring women. The drug calmed me and I soon gave birth to a healthy baby girl.

    That was before fentanyl moved from the hospitals to the streets, tainting the illicit drug supply and ratcheting up an already alarming death toll from overdose.

    Since then, deaths from synthetic opioids (mostly fentanyl) have begun a steep climb, jumping 540% in the past three years alone. More than half of the opioids in the U.S. are now laced with fentanyl and the fear surrounding the drug is palpable. Some people claim you can overdose on the drug just from touching it. As a result of this hysteria, many first responders are afraid to respond to overdoses for fear of coming into contact with fentanyl. Meanwhile, states are scrambling to pass laws responding to the ever-changing landscape of fentanyl and its many derivatives.

    Alice Bell, who works to reduce overdose deaths through Prevention Point Pittsburgh, a syringe exchange program, says that there are reasons to be concerned about fentanyl. In Allegheny County, Pennsylvania, where her program operates, the opioid was involved in 20% of deaths in 2014. In 2016 the number tripled to 63% and today fentanyl is present in 74% of drug-related overdose deaths.

    “Fentanyl is much stronger than heroin and other opiates,” Bell explains. “It is easy to get a high dose without realizing it… Because it is fast acting there is a smaller window before people [overdose].”

    What Is Fentanyl and How Is It Dangerous?

    Fentanyl, a synthetic opioid created to mimic the effects of natural opioids (which are derived from opium poppy plants), was first introduced in 1959 as an anesthetic and pain reliever for surgery and cancer patients. It wasn’t until 2014 that unregulated forms of fentanyl began arriving in the U.S. from China. Because these analogues are cheap to buy and highly potent, they’re often mixed into supplies of other illicit drugs, such as heroin, cocaine, or pills. People buying or selling drugs on the streets may have no idea whether the product contains fentanyl, or how strong it is. This lack of knowledge has contributed to skyrocketing rates of overdose deaths across the country.

    As Bell explains, because illicit fentanyl is mixed into other drugs in unregulated environments, it is hard to mix it uniformly. Thus, one person might get a very strong dose while another might get a weaker dose, even though both samples came from the same supply. Bell likens it to “mixing pancake batter and getting chunks.”

    But although Bell acknowledges the dangers of a fentanyl-laced drug supply, she also emphasizes that much of the panic surrounding fentanyl and its effects is misleading—including false rumors about Narcan-resistant fentanyl or people overdosing just from touching the substance.

    Dan Ciccarone, a professor at the University of California, San Francisco who has spent the last four years studying fentanyl, agrees that while there are reasons to be concerned, responding to the challenge with policies rooted in fear and misinformation only makes matters worse. He points out that the problem is not so much fentanyl itself, but the fact that it’s being added to other drugs in unknown amounts.

    “We have to take some of the hysteria and the irrationally out of it,” he says. “If we say the problem is heroin and heroin contaminants, [we] treat the problem differently than if [we] say it’s a new drug and it’s killing our teenagers.”

    How to address the fentanyl-related overdoses is a question vexing many policymakers. In the past few years, state legislatures have spun off in wildly different directions. Some have attempted to curb overdoses through the introduction of 911 Good Samaritan laws and expanding availability of naloxone, syringe exchange programs, and treatment options for people who use drugs problematically. Some have implemented diversion programs and sentencing reforms designed to keep people who struggle with addiction out of jail and to connect them to programs that address the root cause of addiction. Others are enacting ever-harsher penalties for crimes involving fentanyl. In fact, many states are doing all of these things at once, oblivious, it seems, to the fact that some of these new policies contradict or even cancel each other out.

    Opioid Confusion and Contradictory Drug Policies

    In 2017, Louisiana passed a bill that reduced prison sentences for drug possession convictions. But the same law created a new mandatory minimum sentence for illegally possessing opioid painkillers (such as fentanyl). Maryland likewise enacted legislation in 2016 to reduce penalties for drug users and sellers, but the very next year created a new penalty for drugs containing fentanyl that extends prison sentences up to 10 years. In 2017, North Carolina cracked down on synthetic fentanyl and created a task force to reform opioid sentencing laws in literally the same bill. On the federal level, the passage of The First Step Act, which reduces mandatory minimum and three-strike laws, came on the heels of the former Attorney General’s declaration to relentlessly prosecute every case involving any amount of fentanyl.

    In essence, many governments are passing laws that lessen penalties for opioid-related crimes, while simultaneously enacting laws that further criminalize fentanyl (an opioid).

    For Michael Collins, Director of the Office of National Affairs at the Drug Policy Alliance, the confusion stems from a desire to respond and a lack of knowledge about the most effective way to do so.

    “Policymakers feel pressure to do something,” he explains. “In the absence of public health measures that they are familiar with, legislators will dust off their Drug War playbook and go towards punitive measures…certainly there is no evidence that those penalties will decrease overdose deaths.”

    Collins’ explanation echoes my own experience as a lobbyist advocating against drug-induced homicide laws in North Carolina. Like many states, North Carolina is responding to increases in fentanyl-related deaths by introducing legislation that would allow prosecutors to charge people with murder if they distribute a drug that leads to an overdose. It’s a typical punish-first response that not only is proven ineffective at reducing overdose deaths, but could potentially increase overdose deaths by negating the state’s 911 Good Samaritan law, which was enacted in 2013 to encourage people to call 911 to report an overdose. If lawmakers agree that fear of being charged with possession of drugs is enough to deter someone from calling 911, surely they see that fear of being charged with murder would even further discourage life-saving medical calls.

    But, as I discovered, it is hard to reason with a politician, a prosecutor, or a law enforcement official who is under intense pressure from their community to “do something.” Of course to address the problem of people selling drugs that lead to overdose, we need to tackle the underlying factors that lead people to sell drugs in the first place, such as the need to support a personal drug habit or lack of economic alternatives. But proposing solutions such as more drug treatment centers, jobs programs for low-income neighborhoods, greater investment in vocational education…all these are high-cost, long-term solutions. And officials are being pressured to find answers now.

    Increasing penalties against drug dealers is quick, relatively simple, and the cost is picked up by local court systems, not by the politicians who passed the law. Better yet, harsher penalties sound like a solution that satisfies the public’s need for accountability.

    Incarceration and Stricter Laws Cause More Crime and Deaths

    The problem with using the criminal justice system to address complex issues like drug use is that we imagine the system to be far more effective than it actually is. We probably wouldn’t celebrate laws that incarcerate more people if we realized that locking up one drug dealer merely causes another to take his place. We probably wouldn’t be so anxious to pour billions of dollars into law enforcement efforts to disrupt drug supplies if we realized that U.S. illicit drug market is estimated at $100 billion annually, while law enforcement only seize between $440 and $770 million in drug money per year—around 0.5% of the total value. We might not swallow the $1 trillion price tag of the War on Drugs if we realized that after all this money spent and all the families disrupted from incarceration due to nonviolent crimes, drugs are now cheaper, more plentiful, and more deadly than ever before.

    To effectively lower the demand for drugs or decrease overdose deaths, we need to think outside the box.

    Alice Bell explains, “If you want to encourage people to avoid more dangerous drugs, you have to allow people access to less dangerous drugs.”

    That is certainly not a solution that politicians want to hear. It doesn’t “sound good.” But it would do far more to reduce overdose deaths than all our efforts to slap people with longer prison sentences. We need to help politicians confront their fear of drugs and to understand that drugs always have been and always will be a part of our communities. We might as well accept reality and direct our efforts towards making drugs less deadly, in the same way that we accept the risks of driving a car, but also try to prevent accidents. Most people age out of addiction—if they live long enough to do so. There is no reason that taking a hit of a mood-altering substance should be akin to Russian Roulette.

    Conservative economist Milton Friedman once said, “Only a crisis—actual or perceived—produces real change. When that crisis occurs, the actions that are taken depend on the ideas that are lying around. That, I believe, is our basic function: to develop alternatives to existing policies, to keep them alive and available until the politically impossible becomes the politically inevitable.”

    Fentanyl may be that catalytic crisis needed to produce change. In that case, we should work to turn tragedy into opportunity.

    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

  • A Space for Grief and Growth: The 12th National Harm Reduction Conference

    A Space for Grief and Growth: The 12th National Harm Reduction Conference

    When we demand answers without a deep, authentic understanding of the problem, we wind up putting band-aids on gangrene.

    As I wandered into the opening plenary at the 12th National Harm Reduction Conference in New Orleans last week, something felt off. It wasn’t just the four white-robed women on stage, solemn and elegant in contrast to the mostly grungy, tattooed crowd. It wasn’t the massive indigo chandeliers, which cast a somber blue over the room. It was an energy I couldn’t quite place at first. Then, slowly, it washed over me.

    Grief.

    Throughout the morning, as various speakers mounted the stage, the story of grief unfolded. The harm reduction movement is grieving the loss of one of our pillars, Dan Bigg, who died suddenly last August. We are grieving the political landscape, feeling vulnerable and scared as overdose deaths continue to mount and hard-won reforms in drug policy are reversed through a tide of drug-induced homicide laws and other punitive policies against drug users. And we are grieving the conflicts, hypocrisies and dysfunction present within our own movement that at times threatens to tear it apart.

    My last report on a harm reduction conference for The Fix was in 2014. At the time, I described harm reduction as a community standing at a crossroads. The 2014 conference in Baltimore embodied the culture clash of a movement that had started as a radical underground community of people who use drugs being overwhelmed by mainstream and professional interests. Tension crackled between old and new, as did fear of co-opting and straying too far from its radical roots. Now, four years later, some of those tensions have boiled over.

    One of the plenary speakers in New Orleans, Micah Frazier of The Living Room Project in Mexico, described the harm reduction community as a family full of love and dysfunction. With gentle admonition, Micah urged the crowd to watch how we treat each other and to be careful of how we engage in conflict.

    Another speaker, Erica Woodland of the National Queer and Trans Therapists of Color Network, offered a blunt account of how he had left harm reduction six years ago over concerns about the lack of black leadership in the movement and the devaluation of black expertise.

    “I got divorced from y’all,” Erica said, to a smattering of laughter. “I came back; we’re dating!” But he warned that the reunion would be brief unless harm reductionists could show capacity for change.

    Harm reduction has changed in the past few years. Several of the largest organizations have experienced a shift in leadership as white, male executives who held power for decades have been replaced by women and people of color.

    In fact every speaker touched on the need for a “changing of the guard” within harm reduction. They pointed out that the movement, supposedly centered around racial justice and recognizing the dignity of people who use drugs, does not always practice what it preaches. They criticized the prevalence of white, male leadership, while queer staff, people of color and active drug users are often reduced to underpaid “peer outreach” positions or token members of panels, trotted out for the public, then silenced once the cameras are gone. They stressed the pitfalls of sacrificing long-term vision for short-term gain, warned against co-opting by the public health system, and urged the crowd not to forget its roots.

    Change is coming. Change must come, the speakers insisted. And transition is not always pretty.

    Their words seared right through me.

    A few months ago, I left my position with the North Carolina Harm Reduction Coalition (NCHRC) after eight years as their advocacy and communications coordinator. The decision was voluntary, but born from a place of pain. The organization had recently gone through its own changing of the guard and the process had, at times, been ugly.

    In fact, the past couple years of my life have been marred by grief as the organization I have loved and helped grow, an organization that has done so much to advance harm reduction in hostile territory, has been tested and torn by the tension between demand for change and resistance to it. These past years have involved a lot of soul searching for me as I have second-guessed past decisions and wondered if I have allowed enough space for the voices of people most impacted by the drug war to lead.

    The plenary was an epiphany. All this time I had bathed in private shame thinking that NCHRC was alone in its struggle, uniquely unable to have tough conversations without dissolving into anger and defensiveness. Now, for the first time, I realized that the movement has been changing and hurting across the whole country. We had never been alone.

    The heaviness of this opening plenary hung over me for the remainder of the four-day conference. Even the siren call of New Orleans—the bright lights of Bourbon Street and hot gumbo spice—could not penetrate the fog. I don’t think I was the only person struggling. Even as other attendees greeted old friends and met new ones in between workshops, you could feel grief and tension hovering over everyone. There was no relief from it, not even in the blizzard of breakout sessions.

    I tried to attend some breakout sessions, of which there were a dizzying number including topics such as fentanyl, friction with police, racial justice, indigenous healing, queer drug use and much more. The breakout sessions seemed designed to ask questions, but not necessarily to answer them. This frustrated a lot of people. I overheard many grumbling conversations in the hallways about how such-and-such a panel had not provided a “solution” to the problem being discussed. Years, perhaps even months ago, I would have felt this way too. Today I feel differently.

    A couple of years ago I attended a town hall meeting hosted by activists and founding members of Black Lives Matter. After over an hour listening to them talk about racism and oppression, a white woman in the audience asked the question that had been burning in my brain the whole time: “How can we fix it?”

    The speaker responded by politely suggesting that the young woman have conversations with family and friends about racism. The woman sat down, seeming dissatisfied with such vague marching orders. I was disappointed myself and, I’ll admit, a little appalled that the speaker didn’t seem aware of the importance of giving people concrete actions so that they stay engaged in the movement. But today I see the wisdom in that answer. The speaker didn’t give that young woman, or me, an easy answer because we weren’t ready for one.

    Lately I have come to appreciate conversations that do not end with solutions. Most societal problems are so complex that any “solution” that can be discussed in a 60-minute panel is probably bullshit. Most of us know surface level things—racism is real, drug policy is killing people, there are too many people in prison—but we don’t truly understand the history or scope of these issues, especially if they don’t directly impact us. We want a quick recap of current affairs and a quick fix, but when we demand answers without a deep, authentic understanding of the problem, we wind up putting band-aids on gangrene.

    This, I think, is what the conference was attempting to do—to encourage discussion and exploration and self-reflection, not to provide instant gratification.

    I left New Orleans without answers, but with a great sense of responsibility to seek them, even if it takes a lifetime.


    Members of Harriet’s Apothecary open the conference with calls to be mindful and present.
    Image: Nigel Brundson

    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

  • Dan Bigg, The Godfather Of Harm Reduction, Has Passed Away

    Dan Bigg, The Godfather Of Harm Reduction, Has Passed Away

    Bigg, who co-founded the largest community-based naloxone distribution network in the country, was 59 years old. 

    On Tuesday, the harm reduction community lost a godfather. Dan Bigg, co-founder and Executive Director of the Chicago Recovery Alliance, died suddenly at home at 59 years old.

    Bigg started his journey to harm reduction in the mid-1980s working at the Illinois Health Association’s Drug Addiction AIDS Project. He was frustrated at the growing rate of HIV infection among people who injected drugs and how stigma often forced people with HIV out of their 12-step recovery programs, alienating them from support systems.

    Along with a few other people, he put together an HIV information and support group composed of active and former drug users. In time, the support group didn’t seem like enough. Bigg wanted to do more. So in 1992 he co-founded the Chicago Recovery Alliance (CRA), a place where former and active drug users and people with HIV could find community and health resources.

    One of Chicago Recovery Alliance’s first programs was a syringe exchange, which was against Illinois law at the time. But laws never stopped Bigg. By teaming up with public health researchers, CRA was able to start distributing sterile syringes to help prevent the spread of HIV. But that exchange was just the beginning.

    In 1996, Bigg’s dear friend and co-founder of CRA, John Szyler, died of a heroin overdose. In his grief, Bigg launched a new initiative, one that would eventually be replicated across the country and save tens of thousands of lives—the first community-based naloxone distribution program.

    At the time, naloxone, a medication used to reverse opioid overdose, was only available in ambulances and emergency room departments. Bigg put forth the novel and controversial idea to put naloxone into the hands of people who need it most—active drug users. He began working with medical doctors to figure out a distribution model that would be as hassle-free as possible for people who use drugs and their loved ones.

    The program was met with criticism from those who said that active drug users were not capable of utilizing naloxone properly, or that giving them access to a life-saving drug would encourage risky behavior. To these people, Bigg gave the middle finger. Any positive change as a person defines it for him or herself, was his philosophy. A life saved was certainly positive change.

    The CRA would become the largest community-based naloxone distribution network in the country and soon be replicated in dozens of other states.

    Bigg was honored with the Norman E. Zinberg Award for Achievement in the Field of Medicine at the International Drug Policy Reform Conference in 2015 and won numerous other awards. But he was not a man for frills or recognition. He continued the work tirelessly up until the day he died because he believed it was the right thing to do.

    The harm reduction community honors him. The people saved with community-based naloxone owe him their lives. The world has lost a legend.

    View the original article at thefix.com

  • How One Rural Community Is Fighting to Save Lives from Drug Overdose

    How One Rural Community Is Fighting to Save Lives from Drug Overdose

    “I don’t want another parent to pick out a casket. I don’t want another grandparent to have to look a grandchild in the eye and say ‘your momma is gone.’”

    The Driftwood Motel on Oak Island, North Carolina, has seen better days. All around it, pastel-colored vacation homes with kitschy names like After Dune Delight reel in tourists with promises of beachfront sunsets and shaded hammocks by the pier. Though the Driftwood Motel is also painted in cheerful pastels, the paint is flaking off in dry strips and littering the ground next to cigarette butts and busted beer bottles. Rhonda C. lives on the bottom floor of the Driftwood with her bed, couch and kitchen furniture crammed into a room with dark sheets that cover the windows. She is one of the motel’s many long-term residents – people drawn in by the $100 a week price tag who end up staying far longer than they had planned. A gray-haired, matronly woman, Rhonda looks after the other residents, especially the young ones who drift in and out in various stages of inebriation. She hadn’t been able to offer them much, until she met Margaret Bordeaux.

    Margaret is a petite, African American woman, quiet and unassuming until you get to know her fiery side. As an outreach worker for the North Carolina Harm Reduction Coalition, Margaret runs a mobile harm reduction unit in Brunswick County, a sparsely populated rural community hugging North Carolina’s Southeast coast. Brunswick is also one of the counties hardest hit by drug-related deaths in the state. At least once a week Margaret drives its lonely roads, seeking out places like the Driftwood Motel that collect people who have lost every other home. Thanks to a grant from the Aetna Foundation to combat the opioid epidemic, Margaret has a van stocked with supplies to help reduce drug-related death and disease. She gives out naloxone (a medicine that reverses overdose from opioids such as heroin, fentanyl, and prescription painkillers), syringes, and other resources, and she teaches people how to prevent, recognize and respond to an overdose.

    “I make friends and develop relationships in Brunswick County,” says Margaret. “Many of the people I’ve met here thought that naloxone and clean syringes were magical things only available in [cities]. No one has been coming out here to offer these services until now.”

    Some people are wary when Margaret first pulls up because they have been treated poorly by health care workers and aren’t accustomed to a warm, non-judgmental person offering them free services. But after a few visits, Margaret wins them over.

    “My whole life I have rooted for the underdog and the underserved,” says Margaret. “I want to care for people that society doesn’t care for. People use superficial reasons to ignore each other and I want to remove those reasons and say, hey, there is a person here.”

    Kathy Williams is one of the people whose lives Margaret has touched. A middle-aged, Caucasian woman with a defiant personality, Kathy’s backstory is the stuff of nightmares. She raised two kids as a single mom, Josh and Kirby. As an adult, Josh married a wonderful woman and had two children. Kirby struggled with drug use, and whenever she hit a rough spot, Josh and his wife would take her in and help her get back on her feet. But in 2011, Josh’s car was t-boned by a school bus. He, his wife, and both their young children died in the crash. The loss hit Kirby hard. Her drug use escalated and five years later, she too died of a drug overdose.

    Kathy tells this story completely dry-eyed. It’s as though she has endured so much pain that nothing can faze her anymore. These days she is raising her 14-year-old grandson, Kirby’s child, and also caring for her own aging parents. She is also one of the founding members of B.A.C.K. O.F.F., an organization of Brunswick County families who are fed up with losing their loved ones to drugs. What started as a support group in March 2017 has morphed into an organization with a mission to educate people about the realities of drug use and to help save lives.

    “A mother is not supposed to bury her child,” says Kathy. “I don’t want another parent to pick out a casket. I don’t want another grandparent to have to look a grandchild in the eye and say ‘your momma is gone.’”

    B.A.C.K. O.F.F., which stands for Bringing Addiction Crisis Knowledge, Offering Families Focus, makes and distributes overdose prevention kits containing naloxone to families with a loved one who uses opioids. They also spread awareness about North Carolina’s 911 Good Samaritan law, which protects people from prosecution if they seek medical assistance for an overdose. B.A.C.K. O.F.F. members provide community, resources and support for families impacted by drugs and offer space for honest talk about drug use. No denial, no sugarcoating, no pithy slogans about just saying no. Real talk from real families caught in the same struggle. But not everyone is willing to speak up.

    Elsewhere in Brunswick County, Alex Murillo has been trying to convince Hispanic parents who have lost child to drug poisoning to get involved in B.A.C.K. O.F.F. It hasn’t been easy.

    “Many Hispanics here deny that drug use is happening in their families,” says Alex, who recently lost his 19-year-old nephew to overdose. “If a parent loses a child to overdose, they say they died in their sleep. No one wants to talk about it.”

    A tall, dimpled man with a perpetual smile, Alex’s cheerful demeanor hides a tragic history. Alex is originally from Mexico. When he was brutally raped at 12 years old, his parents threw him out of the house, claiming he deserved to be raped because he “acted gay.” At 15 years old, Alex married a girl, but the marriage made him so miserable that he decided to come to the United States where he hoped to be able to express himself more freely. At the border he was apprehended by a human trafficking cartel and forced into sex slavery.

    “They forced me to take drugs. They beat me and pimped me out,” he says. “I was so shocked. I didn’t think things like that happened in the U.S.”

    Alex eventually escaped. He tried to join a church community but was turned away after admitting he was gay. He attempted suicide, but his brother found him passed out from a bottle of sleeping pills and took him to the hospital. When Alex woke days later, his attitude on life had changed.

    “I was surprised to be alive,” he says. “But I realized that I was still here for a reason and I decided to dedicate my life to helping other people.”

    Today Alex owns a small Hispanic tienda in Brunswick County where he offers help to anyone who comes to his doorstep, whether they are seeking food, advice, or help paying rent. Every year he hosts a multicultural festival in his store parking lot, though other Brunswick County residents have threatened to shut it down because they are unhappy with the area’s growing diversity. He is also happily married to his husband, who works in the store and supports Alex’s outreach efforts. Alex hopes to become more involved in educating the Hispanic community about drugs.

    “We can’t just ignore this problem. The drugs are in our schools. They are everywhere,” says Alex. “We need to do more outreach to the Hispanic community to teach them how to talk about drugs with their kids. They can’t just tell kids not to do drugs. Kids see their friends doing it and they want to try too. We need to have honest conversations as a community.”

    Margaret, Kathy and Alex may be an unlikely team, but together they are working to bring resources and hope to a county that has suffered devastating loss. Little by little, their efforts are making a difference. Margaret has helped people enter drug treatment programs and reconnect with family members where ties had been severed. Alex is making headway on opening up conversations about drugs in the Hispanic community. B.A.C.K. O.F.F. provides Kathy with an outlet to teach families how to help their loved ones who use drugs.

    “I used to look at a person who uses drugs as an addict, but now I look at them as someone’s brother, son or family member,” says Kathy. “I feel that if we had had these tools like naloxone, overdose education, and a support group years ago, my daughter might still be alive today.”

    At a small Mexican diner where we meet for lunch, I ask Kathy what her message is to people in rural communities impacted by drugs. For a moment, she is quiet. Finally she says:

    “I want people to know they are not alone. You might think you are alone, but there are so many of us going through the same thing. We can hold each other up.”

    View the original article at thefix.com

  • Harm Reduction: How to Engage Parent Advocates Effectively

    Harm Reduction: How to Engage Parent Advocates Effectively

    I’ve had to correct parents whose first line to any policymaker is “my kid was from a good family, not just some homeless person.”

    “I never thought I would end up here, but here I am. I choose to create beauty in the space left in this world that my daughter used to occupy” – Lettie Micheletto, mother of Megan McPhail, 1987-2014.

    Lettie Micheletto never thought she’d find herself on the steps of the General Assembly advocating for better treatment of people who use drugs. Neither did Shantae Owens, Tanya Smith, or Kathy Williams, all parents united by the loss of a child to drug poisoning. Stunned and grieving, these parents nevertheless possess a raw passion that makes them a force to be reckoned with. Like so many others across the country, they are mobilizing to demand change to how society treats people who use drugs and to memorialize the children they have lost.

    Undeniably, there is power behind directly impacted parents. In my years as a lobbyist for drug policy reform, I’ve seen the hardest, most tough-on-drugs legislators dissolve under the gentle tears of a mother pleading for reform. There is a connection between legislators and parents that no lobbyist or well-executed advocacy campaign could dream of forging alone. But at the same time, there are challenges to working with new, often unpredictable allies. So I thought I’d lay out, from my own experience, the top benefits and challenges of involving parents in harm reduction advocacy.

    Benefit #1: Effectiveness

    Parents who have lost a child to the drug war are a potent force for change. They have drive, motivation, and a unique ability to elicit sympathy. Nothing changes hearts and minds quite like a compelling, emotional story of personal loss. In some states, efforts to change drug policy have been led almost entirely by parent groups. In Georgia, parents rallied to pass one of the country’s most progressive 911 Good Samaritan laws. In Florida, a coalition of moms has been the driving force behind expansion of naloxone access. In Iowa and Illinois, parents are leading efforts to legalize syringe exchange programs. Everywhere, parents are standing up to declare that their children are more than just statistics.

    “If no one speaks up for our children and sheds the truth on the fact that they were bright, wonderful kids who had an illness that they simply couldn’t battle, nothing will change,” says Tanya Smith, who helped advocate for a Georgia’s 911 Medical Amnesty Law in 2014 after her daughter, Taylor, died of a reaction to methamphetamine the year prior.

    Parents can unravel the false narrative of drug users as inherently deviant or immoral and paint a true, complex portrait of people who use drugs and people who love them. They can show the devastation of loss on families and communities. Most importantly, they can help battle the number one obstacle to meaningful reform – stigma.

    Benefit #2: New Allies

    Most movements start with a small group of people with similar ideas who are passionate about reform. But in order to evoke lasting change on a macro level, movements need to expand – and that means welcoming new allies into the fold. This isn’t always easy. New allies don’t have the institutional history and knowledge of the movement. Sometimes they have more social or political power than the original group of activists, which is good for expanding influence, but can threaten to hijack the founders’ original intent. The harm reduction movement has seen a lot of this dynamic as it has grown in recent years, accruing allies such as faith leaders, recovery communities, first responders, public health professionals and impacted parents. There have been some growing pains and continued debate over the allies’ role, but the expansion has led to wider conversations about harm reduction and more advocacy wins. Parent advocates have played a large role in bringing conversations about harm reduction into homes and communities that were previously silent on drugs.

    Benefit #3 Finding an Outlet for Grief

    For many parents who have lost a child, simply getting through each day can be an enormous challenge. But pain can also be a powerful agent of change. Lettie Micheletto lost her 27-year-old daughter, Megan, to heroin poisoning in 2014. Since then, she has been part of bringing awareness about drug laws to other parents.

    “About six months after Megan’s death I crawled out from under my rock and began to work with a local coalition in my hometown to help educate and bring awareness of the opioid epidemic,” says Micheletto. “I am obsessed with spreading the message and talking to everyone I can, everywhere I go. I have many friends who have lost children, other family members or friends to overdose. It is a nightmare that many people live and many others ignore.”

    Thanks to Micheletto’s efforts, a North Carolina lawmaker recently included $100,000 in the state budget to raise awareness about the state’s 911 Good Samaritan law. For many parents, advocacy creates a much-needed opportunity to channel grief into purpose.

    Challenge #1 Working with Newbies

    Though there are many advantages to working with parent advocates, these efforts are not without challenge. Of course many parents are or have been involved with drug use themselves, but it seems the majority of parent advocates today had little knowledge of drugs, drug policy or harm reduction until it impacted their children. In many cases, they didn’t even know their child was experimenting with drugs until after his or her death. Then suddenly they are thrust into a world of grief and new concepts that seems foreign and daunting. They want to act, but they lack institutional knowledge of harm reduction, drug policy and the criminal justice system. This can create some very uncomfortable situations.

    Some of my most memorable face-palm moments have come from bringing well-meaning, but very green parents to advocate at the legislature. I’ve spent many an afternoon with parents trying to explain the problems with involuntary commitment laws or to untangle the save-the-user but kill-the-dealer narrative. I’ve had to correct parents whose first line to any policymaker is “my kid was from a good family, not just some homeless person.” Sometimes step one is just to teach the parents to stop using stigmatizing language like “addict” to describe their own child.

    It takes patience to educate a parent who has been steeped in stigmatizing attitudes towards people who use drugs until the problem hit home and to help change the way they think about drugs and drug policy. There are so many wonderful parent advocates today who understand harm reduction and how all of us – users, sellers and people who have never touched illicit drugs – are caught up in the net that has killed so many people. They didn’t all start out with that knowledge, but by meeting them where they are at, we can get them there.

    Challenge #2 White Power

    It is frequently pointed out that the rhetoric around drug policy has softened since opioids started killing children from white, affluent communities. Certainly the majority of parent advocates who appear in the news are white and middle-class. And while there is nothing wrong with parents of any race or class becoming vocal advocates for reform, the stark homogeneity of media coverage doesn’t reflect the rapidly changing demographics of drug-related deaths, especially around opioids. According to the Centers for Disease Control, from 2015 to 2016 the age-adjusted rate of drug overdose deaths involving any opioid rose by 25.9% among whites in the United States, but 32.6% among Hispanics, 36.4% among Asian/Pacific Islanders, and a whopping 56.1% among black Americans.

    Diversity is an important, and often missing component to parent advocacy. Correcting this can mean making the extra effort to pro-actively reach out to under-represented groups and create space for their voices. Out in rural Brunswick County, North Carolina, Kathy Williams and Alex Murillo are teaming up to do just that. Kathy Williams lost her 32-year-old daughter, Kirby, to an overdose in 2016. The following year she helped found B.A.C.K. O.F.F., an organization of feisty families who are fed up with losing their kids and have started to organize for change. Kathy and Alex are working to welcome Hispanic families into the group.

    “We had two recent deaths in the Hispanic community due to drugs,” says Murillo, who lost his 19-year-old nephew last year to an overdose. “I want to help get the Hispanic community involved in education around drugs, but it’s hard because parents won’t admit there is a problem. Here, if a child dies of an overdose, the parent will say they died in their sleep.”

    Overcoming cultural and even language differences to organize a diverse group of parent advocates can be difficult. Many of us, myself included, don’t do this as often as we should. But that extra effort can go a long way to showing policy-makers the true breadth and complexity of drug use.

    Shantae Owens, a parent advocate from New York, lost his 19-year-old son to heroin poisoning in 2017. “Whether it’s a white kid from Richmond or a black kid from New York, we need to put aside our differences and come together to solve a common problem,” says Owens. “The longer we keep looking at the one thing that separates us, the more people will die.”

    Shantae, Alex, Kathy, Lettie, and Tanya are among thousands of family members across the country united by tragedy, but also by strength. They may not have wanted or imagined ending up in this place, but they are here, creating beauty in the space where their loved ones used to be.

    View the original article at thefix.com