What’s the Harm in Harm Reduction?

Every day, in every way, legions of Americans take to the streets in order to distribute life-saving harm reduction supplies to people who suffer from Substance Use Disorder (SUD). And every day, in every way, countless government agencies refuse to help. We’d like to know Why?

So would Jack Shuler. Shuler’s an English Professor at Denison University in Granville, Ohio. That places him right in the heart of the country’s opioid crisis. He’s also an author and writer, which gives him places to voice his concerns. Shuler’s primary concern is what’s occurring in his own backyard, and he’s been raising his voice accordingly.

In 2020 that meant This is Ohio: The Overdose Crisis and the Struggle for a New America (Counterpoint), a frontline look at a backcountry struggle where we the people who want to help are given no official encouragement and even less governmental assistance. That doesn’t make their efforts any less heroic, mind you — quite the contrary. But it sure makes a mockery of We the People.

Just recently Shuler delivered “What Those in Power Are Missing About the Opioid Epidemic” (The Atlantic), a harm reduction advocacy piece that really needs to be tagged a Must Read. Sure, both book and article are as acute as it gets. But if this backcountry problem is ever going to even be semi solved, the backcountry overseers need to first read Shuler’s piece. They’ll then of course also need to heed its advice.

That, unfortunately, seems increasingly unlikely.

“In the years that I’ve reported on this crisis,” writes Shuler, “I’ve seen local-government officials act ineffectively, sometimes in direct contradiction to the recommendations of experts. Even today, with a supportive federal government, I’ve seen pushback against the kinds of harm-reduction efforts that research shows can save lives and prevent disease.”

Shuler’s talking about providing supplies like syringes, Neosporin, saline, test strips and the overdose-reversal drug naloxone. All of the above save lives. Big time. They also significantly reduce the spread of HIV and other blood-borne diseases. Yet somehow most of the mentioned have ended up on officials’ Do Not Distribute list. This is especially true in largely rural towns and counties, where access to harm reduction is even more important.

Anti-Drug or Anti-People?

We understand being anti-drug, but being anti-people too? That we simply can’t understand. Nevertheless, recent developments are showing a distinct bias to a large swath of the population. It’s not just in Ohio either. But across the entire country.

Shuler cites rural Scott County, Indiana, where county commissioners voted to shut down a local syringe-service program despite the fact that it successfully stopped the biggest HIV outbreak in recent U.S history. “This was [just][ another perfect example of why politicians should not have control over public health programs,” West Virginia University epidemiology professor Robin Pollini told Mother Jones‘ Senior Reporter Julia Lurie.

Pollini was right. Shuler goes on to cite similar moves from state lawmakers in North Carolina, as well as the city council in Atlantic City. In West Virginia however, another well-chronicled crisis point, both “Governor Jim Justice and local city-council leaders [got together to] roll back syringe programs and signed into law measures that further restrict access to syringes and free health care.” As you might suspect, “West Virginians are already seeing the repercussions.”

But as Shuler points out — and as the AP’s John Raby deeply makes evident — these aren’t ordinary repercussions. In fact, the CDC considers the state’s current uptick in HIV transmissions to be “the most concerning in the United States.”

And yet…

Perhaps these overseers just don’t like people who suffer from SUD. Maybe they’re against people with limited income. It could be a case of ex-con bias. Or it might simply be more of the NIMBYism we’ve seen stretching across these once United States. Whatever the reason, it seems to indicate bias. It also seems short-sighted. After all, the cost of a few needle exchange programs surely doesn’t rival the cost of a few dozen chronic hospital patients. And what if these diseases are passed along to children or drug-free community members? Should they also be made to suffer some supposed moral indignation?

Harm Reduction Heroes

Thankfully not everyone is of the same mind as the above-mentioned legislators and their kind. In fact, there’s a growing contingent of folks who’ve decided to take the matter into their own hands. Shuler’s tracked down a good few of them, and he enthusiastically shares their stories via both book and magazine.

“People who use drugs and those who love them have helped reverse thousands of overdoses in the United States,” writes Shuler, “saving friends, family members, and strangers. They’ve done this work without recognition, without fanfare, and sometimes at great risk to themselves.”

People like Trish Perry, “the mother of a son with substance-use disorder.” After her local board of health voted against a needle exchange program, she “decided to continue getting lifesaving supplies directly into the hands of the people who need them most.” So “every Saturday, rain or shine, Perry distributes harm-reduction supplies” from a street corner in Newark, Ohio.

People like Columbus [Ohio] Kappa Foundation, an alumni organization for members of Kappa Alpha Psi, which distributes naloxone in churches, barber shops and sometimes even door-to-door. Or Brooke Parker, who helps run a Charleston, West Virginia street-outreach harm-reduction organization called SOAR (Solutions Oriented Addiction Response), which persists, despite being hit with tremendous pushback. Or the preacher, writer, and harm-reduction advocate Blyth Barnow, who considers harm reduction to be nothing short of an act of Radical Love.

Shuler duly heralds these harm reduction heroes. He wants us to know who they are and what they do. More, he wants us to know that who they are and what they do is important, not just in their particular part of the country, but throughout the entire United States. After all, over 90,000 Americans died last year, and they most certainly didn’t all live in Newark, Ohio.

Harm Reduction to the Rescue

Shuler’s call is loud and clear. So let’s let him shout for himself.

Federal, state, and local governments should heed the advice of harm-reduction advocates. Because the drug supply is full of fentanyl, people need more fentanyl-testing strips, safe consumption spaces, and access to regulated medication. Allowing harm-reduction programs to use federal dollars to purchase syringes, which is currently prohibited, would be an important policy change. Funding to fight the opioid epidemic, as well as the opioid settlement money from lawsuits against pharmaceutical companies, needs to reach grassroots programs in order to help them become more sustainable.

Finally, more official harm-reduction work should move out of health departments and into the streets. Syringe-service programs can be gateways to better health and, if folks are ready, to treatment. They are a place for people to experience radical love and potentially build connections—to nonjudgmental health care and to a supportive community.

Amen.

Is Enough Really Enough?

Is Shuler’s Atlantic piece acute enough to have its point heard and heeded? Hard to say. It’s certainly on the sharp side of acuity. But there’s a pretty thick thicket of bias to cut through. It definitely can’t hurt though. And if it changes the mind of even a single legislator, well, that’s one step closer to common sense. Plus, the more folks hear about such harm reduction heroes, the more inclined they’ll be to support them, as well as their efforts. They’ll also likely find that these efforts are helping someone close to their own home, especially in the smaller municipalities, where the opioid crisis has hit just about every family.

Frankly, nobody knows what it’ll take to get the overseers to see over things with clarity and compassion. But if they wish to continue having a burgeoning populace to oversee, they’ll want to switch up their stance and soon. Because their rigid positions — and unenlightened laws — could very well wipe out a serious chunk of the rural population.

“This is what happens when public health fails,” SOAR’s Brooke Parker told Jack Shuler. We’re holding out for the day when she can say “this is what happens when public health succeeds.” The more Parkers and Perrys and Shulers there are in this world of ours, the more likely we’ll all live to hear such a sentiment. Let’s hope it’s on the soon side of soonest.

With Great Gratitude

Healing Properties wholeheartedly thanks Jack Shuler, The Atlantic and all the other reporters and outlets who continue to cover the opioid crisis. Their continued diligence is doing much to hold both culprits and officials accountable for what they do and don’t do. And that diligence should be recognized. We’d also like to thank all the harm reduction heroes who continue to go above and beyond despite what seems to be an increasing array of obstacles and naysaying. On the surface it appears to be a largely thankless task; nevertheless, we’re sure there are scores upon scores of families out there who are deeply grateful for all the life-saving measures taken on behalf of their loved ones. If you need help, with harm reduction or anything else, please give us a call.

(Image Courtesy ACLU-West Virginia: Click here for further information about their Harm Reduction efforts.)