Yesterday, I was handing out Naloxone and a man approached the table
Man: What are these?
Me: Naloxone kits. They are for reversing opiate overdoses. Ya know heroin, opana, stuff like that.
Man: Oh, I use heroin.
Me: Ok, well let me show you how to use the kit and then you can take it with you.
Man: No, that’s ok. I use alone. So if I overdose…well, I won’t be able to give it to myself. It won’t matter.
This guy immediately dropped his head, tears pooling in his eyes, and started to back away from the table. I stopped him so we could have a conversation about the importance of using with friends. He ended up taking a kit.
This man did not want a treatment list (though we have them). He didn’t need a “tough love” lecture about how he is messing up other people’s lives. He wanted somebody to listen to him for five minutes, hear how he feels about his use, and hand him what he needs without condition.
I was scrolling through my facebook feed earlier this month and this story, written by my friend Hillary Brownsmith, caught my eye. I got in touch with Hillary soon after to ask her if I could interview her for the blog. Hillary is a founding board member of The Steady Collective, Asheville’s new harm reduction and needle exchange organization. The Steady Collective works with opioid users in the community, providing Naloxone kits, support, and education . All of the members of the organization work on a volunteer basis. This week, I sat down with Hillary to ask her about the work that they’re doing in the community.
Brenna: You’ve been involved in various activist causes over the years. What is it about needle exchange that compels you? Why this cause?
Hillary: I first heard about harm reduction right after I moved to Asheville. I went to a sex worker’s summit that was co-hosted by NC Harm Reduction; they mostly do harm reduction work with drug users. During that time I heard people talk about needle exchange and some other stuff they do for drug users, both intravenous and non intravenous, that helps make their lives whole and promotes their wellness. I found it to be an interesting way of thinking about working with drug users- a kinder, less punitive way. I feel like a lot of recovery programs are pretty punitive and act like drug use is a moral failing.
B: The work you do is all volunteer. How do you balance your activism with a need to do paid work?
H: I have two paid jobs, and lately I’ve been devoting probably more than ten hours a week to the Jerry Williams situation and also to The Steady Collective, and I have a kid on top of that, so I often feel like I’m running in eight million directions.
I’ve been thinking a lot about this lately. I feel like I work harder and am more committed to work I’m not paid for, and I feel really committed to these missions, both the Jerry Williams cause and The Steady Collective. It’s not that I don’t feel committed to my paid work, but it is different, and so while it’s a hard balance I know that I have to do this work that doesn’t drain my soul. I think that’s the balance: knowing that I have to do stuff that’s more “activisty” to feel fulfilled.
B: Can you talk a little bit about what this work looks like? What do you actually do on a day to day basis? How are you interacting with the community?
H: I should clarify: we say we’re a needle exchange program, but we’ve been waiting for the legalization of needle exchange to occur, which just happened in early July. McCrory signed the bill and we’re glad that he did one decent thing this year. Unfortunately it was tacked on to a bodycam bill that made police bodycam footage not available to the public. It was a very mixed experience- we all thought that we would be super excited when needle exchange was legalized, but in the end it wasn’t very celebratory because it was forced into this bad bill.
Up until this point we’ve been waiting in the wings, talking to our contacts in other places where needle exchange has already happened- other states, and folks who have been doing needle exchange underground for decades. We’ve been getting materials and ideas from them, and now that it’s legal we’re drawing up policies and getting ready.
Up until this point we’ve been handing out Naloxone and talking to drug users about basic safety: sort of informal harm reduction counseling. Here’s a good example: every week we’re at Haywood Street Congregation and we pass out Naloxone there to homeless folks who are coming in for lunch. We give out free intranasal kits- we’ll hand somebody a kit, explain how to use it, how to identify an overdose if they’re not familiar, how to dispense the drug and then call 911. Sometimes folks will share that they are the active user, others will say “this is for my friend.” There are a lot of “friends” that are using opioids.
So then we’ll ask if they’re using with friends; we always want to promote using with others so that you’re not alone, because you can’t give yourself Naloxone. This is important because a lot of heroin is being cut with fentanyl here, so it’s very strong. Drug dealers don’t touch fentanyl; they wear gloves, because it can absorb through your skin and kill you. They cut it into the heroin because the use rate is so high in North Carolina that we actually don’t have enough heroin coming in to meet demand. So drug dealers will mix in coffee grounds or dirt and it will make the drug weaker and then you can’t get high, so then they’ll cut in fentanyl. But too much fentanyl and you’re gone. Folks who have used for a decade will get a batch of heroin with fentanyl in it and be gone.
So we want folks to be careful. We aren’t just writing you off for using; we actually care that you show up next week so we can have another conversation. That’s why we’re called The Steady Collective, because we’re a steady presence for people. We started as a support group for drug users; it was a support group you could come to and still be actively using: there was no judgement about that. We did goal setting, but in a pretty loose way. We were aiming for any positive change.
B: You’re dispensing the overdose reversal drug Naloxone to heroin users in the community. What does it do and why is it important?
H: Our Naloxone comes through an organization called North Carolina Harm Reduction. They’ve done a really good job of distributing in North Carolina; we’re lucky to have them because Naloxone is getting more and more expensive. As opioid use grows, (and we have a particularly difficult problem in Appalachia) the drug company that is making naloxone is also jacking up the price. There was a grant that came through for $100,000, and that’s how we got the naloxone that we’re using currently, this intranasal naloxone. In the past we’ve used intramuscular naloxone which freaks some people out.
B: It’s like Pulp Fiction.
H: (laughs) Sort of, except you don’t do it in anybody’s heart. That’s not real.
It’s not going to last as long as anticipated because of how much we’re distributing right now. There have been nearly 700 reversal in Asheville in the last 3 years. And that’s the community based distribution of Naloxone; that doesn’t include first responders or hospitals . It’s saving a lot of lives and at the same time we just can’t get enough of it. We’ve gotten to the point where we’re trying to be clear that we’re distributing to active users first. In the past we’ve sort of given it to anyone who asked- you know, “I have a friend who has a friend” kind of deal.
B: I’ve been following your posts on facebook, and one thing I’ve been struck by is the idea that you’re providing as much of an emotional service as a logistical or practical one. Do you have any thoughts about that? Does that feel like part of the work to you?
H: I think anytime you do work with people who feel like no one really cares whether they live or die there’s some other work you’re doing besides case work, and that’s to hear people. I think that’s really true for drug users, because we’ve got all of this bullshit in America about drug use being a “moral failing.”
I don’t see recovery as the end goal in all of this, I think I see survival as the end goal. I know folks who are very recovery oriented and they have a lot of things to say to people in harm reduction, like “you’re enabling.” What we always say is “you can’t go into recovery if you’re dead.” So we do the front line work of sitting with people and not making any judgements. We hear about where people are and we hear about the pain of living wherever they are, of seeing all of their friends use and feeling like they don’t have any options.
B: There’s a lot of controversy about best practices for helping people who struggle with addiction. What are the top three things you wish the general public knew about opioid use and treatment?
H: I think one of the big things is that dependency and addiction are different. Dependency is something that happens to your body and your brain that you don’t have any control over. So anybody, pretty much, can be given opioids for a while and they’ll become dependent, though they might not necessarily become addicted.
Addiction means that you continue to do something despite negative consequences. Lots of people drink alcohol, but as soon as you get your first DUI we’d say “hmm, maybe it’s time to pull back from your use.” After you get two or three DUIs we would say you’re addicted to alcohol because you continue to drink despite having to pay a lot of money and keep interacting with the police.
Dependency comes first and that isn’t moral- that’s just your body doing what it does. Addiction comes after, because dependency is so strong.
I also wish people understood some things about the way we do recovery in the US. This is not a thing we’ve perfected; other countries do recovery and care for drug users much better than we do, and part of the way that they do that is by understanding that medication assisted treatment is not a bad thing.
In the United States we say that people who use things like suboxone and vivitrol so that they don’t use heroin or other opioids aren’t “clean,” but that language of “clean” and “dirty” is super problematic. We’re not “clean” because we don’t use drugs. That doesn’t make you whole and sinless. People really need to think about the religious language they’re using, because that’s like some purity code shit that we don’t need to keep doing. Drug users aren’t “dirty.” They’re using drugs.
A lot of people ask “what if you have to use suboxone forever?” Yeah, what if you do? Culturally, we think it’s okay if somebody has an anxiety disorder or they’re depressed and they have to take drugs forever. We want that person to be able to do the things that they want to do in their life. And if depression has knocked you off course, then okay, you take a drug for depression forever, and that’s okay. I think we can just do that for drug users too. It’s okay if this is your future.
B: How can readers help this cause most effectively?
H: I don’t always talk about policy stuff in the other activism I do, but I think here, really advocating at a policy level for harm reduction efforts like needle exchange is important. Sometimes it’s an easier sell for people to advocate for Naloxone, but needle exchange goes hand in hand. There’s been an underground needle exchange that’s been going on for years here, and a year ago they were doing about seven thousand needles a month, and this year they’re doing thirty thousand needles a month. So we have to understand that we need more and more naloxone and we also need more and more needles, or we can expect to see our Hep C rates and our HIV rates go up. People think that the HIV epidemic is over, well, I’m here to tell you that it’s started again.
Indiana has already experienced this. If you need to see a state that’s in the throes of the problem you can look at Indiana. Mike Pence, the Republican vice presidential candidate, is real conservative, but he also realized that Indiana had to have needle exchange. Had to have it. So this is not a liberal/conservative issue. This is an issue of you’re going to have a bunch of dead folks on your hands if you don’t handle this.
In addition to that, local needle exchanges (and there are a lot, even if it’s not legal in the state) really need money. Needles aren’t expensive, but when we’re doing the kind of volume we’re doing that’s gotta happen.
I would also encourage people in NC to push their local pharmacy to sell needles over the counter. A lot of people don’t realize this, but access to needles here doesn’t have anything to do with legislation. It’s up to the discretion of the pharmacist. So there are pharmacy chains that are more likely to sell you needles, even if you don’t have a prescription, and there are pharmacies that won’t do that. And that’s all just a lack of understanding or a moral judgement on the part of the pharmacist. That’s a lot of power. If you don’t give somebody a needle, they’re still gonna use heroin. It’s pretty much the same logic as saying “if we don’t give kids condoms then they won’t have sex!” It doesn’t work. That’s not how we stop this.
*Photo courtesy of the Australian Heroin Diaries