Harm Reduction: A Personal Journey

Rev. Alexander E. Sharp Harm Reduction

Many wage war against harm reduction, opposing clean needle exchanges, Naloxone, and other life-saving drugs. Some religious leaders, especially Evangelicals and Catholics, oppose harm reduction because they find all drug use to be immoral.

CNDP believes harm reduction to be profoundly moral and to reflect the deepest values of our religious faith. We advocate  a health not punishment response to drug use.

To understand harm reduction through first-hand experience, we approached Laura Fry, who directs patient and family services for Live4Lali, a Northern Illinois non-profit that works with individuals and families struggling with substance abuse.

In the following interview, CNDP Executive Director Rev. Alexander Sharp asked Laura to describe how she learned about harm reduction, what it is, and how she applies it in her work.

Al: What is harm reduction?

Laura: We all practice harm reduction every day. In my training sessions, when I ask, “Who practices harm reduction?” at first no hands go up. Then I ask, “Okay, who put a seat-belt on when they got in their car to come here?” Everybody’s hand goes up. We didn’t always have airbags or fluoride in our water. Harm reduction has evolved over the years. It’s anything we can learn or do that might prevent harm to people.

Al: So how does it apply to drug use, and how did you discover it?

Laura: My son was an IV heroin user. Seven years ago, when he was actively using, I would sack his room and throw out or break everything that I found, every pipe, every syringe. I even found his Naloxone [which revives people who have overdosed]. I had no idea what it was.

When I first heard about harm reduction, I didn’t know how I felt about giving drugs to drug users. But I learned that in places like San Francisco, where harm reduction was practiced, deaths dropped because of needle exchanges.

People who are addicted are going to use drugs. If someone with a substance use disorder finds a needle in a puddle, there is a good chance they will use it and even share it with others. When I was an emergency room nurse, a lot of IV drug users came in with abscesses because of reusing needles, sharing needles, not knowing how to inject properly. Those injuries could have been prevented.

Al: Drugs harm people. Why not simply say to drug users, “Look, you’ve got to stop. We’ve got 12-Step meetings that insist that you stop if you’re going to be part of those meetings.” What’s wrong with that?

Laura: Unfortunately, stopping doesn’t tend to stick with a chronic relapsing brain disease. That’s like saying to a person with diabetes, “you should try to produce enough insulin today.” It’s not possible.

People who don’t understand this reality wonder, “Why are you going in and out of rehab? Why are you going in and out of jail?” They think about drug use as an individual flaw. We have to look at the systems that are supporting this population and identify whether they are appropriately serving people in need. The emphasis on abstinence can set people up to fail.

Al: But isn’t abstinence the only way to recovery for some people?

Laura: Absolutely. But what data shows us is that treatment and recovery need to be individualized. A person who has three kids and a full-time job just cannot spend thirty days in an inpatient facility. For that person an evening outpatient program, treatment by an addiction specialist, and medication can be incredibly supportive.

There are definitely some people who need an inpatient program or who can only exist by total abstinence and going to four or five meetings a week. I respect that if that’s what works for you. But people are pretty complex and there are other areas that need to be addressed and other types of recovery programs available. Some people I know with opioid use disorder now use cannabis, medically or recreationally. If it helps you and you’re leading a productive life, and you’re alive, that’s a no-brainer.

Al: What you do for Live4Lali?

Laura: My title is director of patient and family services.  I oversee all  programming, whether in the community or in-house. We have multiple peer-to-peer recovery groups like SMART Recovery, a 25-year-old nonprofit organization that provides real life day-to-day tools for how to work your recovery. It uses cognitive behavior therapy and rational emotive behavior techniques.

Al: Are participants expected to go to meetings sometimes for the rest of their life, as often is the case with 12-Steps?

Laura: No. You graduate from SMART. One of the things that I say is, “I am not going to be sitting in this room 35 years from now with all of you all. People have come to me and said, ‘You know, I think I’ve gotten everything I can get out of this, and I want to discuss that with you.’”

Al: Can someone who’s going through the program continue to use drugs?

Laura: SMART Recovery encourages abstinence, but we make no judgment on that. Some people continue to use. We encourage any positive change. If I see someone who was an IV heroin user and now they’re smoking pot, that is a positive step. We encourage any positive change. It all comes down to: How are your behaviors? Are you an active member of society? Are you working? Are you functioning in your family? Do people like you again? Are you being responsible? Do you like yourself?

Al: What is medically-assisted treatment? Is that part of what you teach?

Laura: Well, I call it medication assisted recovery. We should think of it this way: if the pancreas doesn’t produce insulin, replacement insulin is needed. Medication-assisted recovery helps people who use opioids, alcohol, and tobacco in much the same way. People can be on these medications the rest of their lives. I have a dear friend whose son has been on methadone for nine years now. He’s a lawyer, he has two children, he’s married. Who cares? We don’t question this type of approach for any other chronic illness.

Al: Can you imagine a safe consumption facility? [SCFs are facilities that permit drug users to self-administer under medical supervision. Treatment capacity is available on site, but is not required. Over 60 such facilities exist in Europe and Australia. Only one exists in North America, none in the U.S.]

Laura: Oh, yes I can, but I don’t know if people are ready. People still believe that safe consumption sites are going to encourage people to use drugs.

Al: How do you answer that?

Laura: I’d like to take them to the trunk of my car and say, “I drive around with syringes all day. I’ve never been tempted to be an IV drug user.” Do you know what harm reduction enables? It enables health. Last summer when we started our mobile needle exchange, people were very hesitant to use the program but eventually could see that there’s no judgment, there’s no expectation. There is love. After a while, they said, “Talk to me about treatment.”

Obviously, the national response to addiction hasn’t been working. When I started out, 99 people were dying a day. Now it’s 192. So why not try love and compassion, especially when we know it works?

Al: What about treatment? I understand that in the U.S. we have treatment available for only one out of 10 who need it. You and I have talked about Portugal, where treatment is available for everyone. Would that be part of an answer?

Laura: Of course more treatment capacity would help. But not if it is just an intensive inpatient program that only teaches you one approach. Different levels of care are appropriate for different individuals, based on a validated diagnostic tool. Many treatment programs aren’t working with people on how to find a job or how to dress for an interview. Real life stuff. 

Housing is a great example. If we cannot find sustainable, supportive recovery housing for individuals leaving residential treatment, how does that bolster their resilience and motivation to stay with their recovery plan? What happens now is, people are often secluded for 30 days, which is necessary to break that cycle of use, but then they’re out and there’s no follow-up or connection. It’s really risky to rely on that model, especially without addressing harm reduction.

Al: It seems to me there are two parts to the war on drugs. We can support the use of the force of the state to try to cut down trafficking. Then there is the war against users. Where did the idea come from that we ought to be arresting people for using drugs?

Laura: Using punitive sanctions has been an American ideology that has proven to be ineffective. This is in essence controlling people’s behaviors through policy.  It comes from the myth that bad people use drugs. But we’re actively working to change that, and we’re seeing success.

Live4Lali has developed diversion programming and now we have a lot of law enforcement that want to help people. They’re starting programs where people can come into the police department with their drugs and their paraphernalia, drop it on the counter, and say, “I need help.” I’ve brought people into the police department five or six times. What we’ve seen is compassion. It just blows my mind. People in uniform hugging drug users and holding their hands and saying, “We’re going to help you.”

Al: Has all of your experience with drug use —in your personal life and your clinical work— given you any insight into how people change?

Laura: I lead meetings where I pass around a hand mirror and say, “I want each one of you to look in this mirror and tell yourself you love yourself and why. One thing about you … I don’t care what it is. You have nice eyelashes. I don’t care what it is.” I did this a couple of weeks ago, and I had people moved to tears. People say, “I never thought about myself like that.”

Al: How do they do that? It’s kind of hard to do.

Laura: Practice, practice. You’ve got to change those self-perceptions. I say, “I’m 58 years old. Don’t start this as late as I did. Start your path of discovery now, and learn to love yourself. If you don’t have it inside first, you can have the best job, all the money in the world, it won’t help.”

Al: Is love from other people part of this?

Laura: Absolutely. That’s one of the most important things about recovery.  And, then, turning around, giving back. Volunteer at a dog shelter, Meals on Wheels. Get out of your own head, help someone who might be a little less fortunate than you.

Al: You saw your son struggling with addiction. What do you say to parents who are experiencing the same things you did?

Laura: The first question I ask them: “What are you doing for yourself?” Then, I teach them first person language. Instead of saying, “You are going to kill yourself! How could you do this to me?” try saying “I am really afraid that something bad is going to happen, and that makes me feel anxious. I feel like I haven’t done my job right. I feel like I am not supporting you in the way I should.” The people who are stuck in this brain disease have more shame than we could ever give them. They don’t need us, as parents to say “You’re destroying our family.” You don’t think they know that? Compulsion in their brain is driving them to keep doing it.

I just see families out there, so many friends, who have lost their loved ones, who say now, “I wish I had known about harm reduction. If I had known about methadone, I know that it would’ve worked for my son.”

Civil Asset Forfeiture On Trial

Tom Houseman Ending Forfeiture Seizure

Civil asset forfeiture is one of the most controversial weapons in the arsenal of law enforcement. While some argue that it is crucial to the maintenance of “law and order,” critics on both sides of the aisle believe that it is an unconstitutional abuse of power that amounts to a trial without a jury. Now the Supreme Court has an opportunity to drastically curtail this power.

If there is truth in the adage “crime doesn’t pay,” it is because one of the goals of the criminal justice system is to ensure that people do not profit off of breaking the law. One crucial tool in this strategy is asset forfeiture, the ability of law enforcement to seize the ill-gotten gains of criminals, and to prevent them from committing further crimes. But while it is hard to argue against such a tool, the argument gets murkier concerning civil asset forfeiture.

In June we wrote about how civil asset forfeiture allows police to seize money and property from people under the pretense that it was used in connection with a crime, often without securing a conviction or even pressing charges. Stories abound of police pulling over drivers and seizing large sums of cash without even allegations of a crime having been committed.

However, civil asset forfeiture can also be used by law enforcement in the case of a conviction, if the goal is to circumvent restrictions on excessive fines. Recently, the United States Supreme Court heard arguments in Timbs v Indiana, a case that could limit the ability of state law enforcement to seize the property of their citizens in such cases.

In 2013, Tyson Timbs was arrested for selling heroin out of his car, and pled guilty to a crime that carries a maximum fine of $10,000. However, Timbs’ Land Rover is valued at $40,000, which exceeds the maximum fine, prohibiting law enforcement from seizing the vehicle through the criminal process. In search of a loophole, Indiana police seized the vehicle through the civil process, hoping that doing so would prevent Timbs from being able to challenge the seizure.

In dispute is whether or not civil asset forfeiture of this kind violates the eighth amendment protection against excessive fines. A state trial court sided with Timbs, but the Indiana State Supreme Court overruled this decision, stating that “the Excessive Fines Clause does not bar the State from forfeiting Defendant’s vehicle.” The case is now in the hands of the US Supreme Court.

Due in several months, the Supreme Court’s decision could have an enormous impact on the ability of states to seize property through the civil process. Since civil asset forfeiture involves, essentially, charging property with being involved in a crime, rather than the charging the person who committed the crime directly, the decision will rest on whether the Eighth Amendment applies to these cases. “We all agree that the Excessive Fines Clause is incorporated against the states,” stated Justice Gorsuch during arguments. “Whether this particular fine qualifies because it’s an in rem [property] forfeiture, another question.”

If the Court decides that the Eighth Amendment does apply to civil asset forfeiture, it may limit the ability of states to seize property without a conviction. If seizing property through the civil process is deemed an excessive fine, it could be argued that any civil asset forfeiture not connected to a criminal conviction could be considered excessive.

“So what is to happen if a state needing revenue says anyone who speeds has to forfeit the Bugatti, Mercedes, or a special Ferrari?” asked Justice Breyer. This argument, while obviously absurd, gets to the heart of why so many object to the way civil asset forfeiture is used around the country.

Ultimately, the Supreme Court is unlikely to make such a broad and sweeping ruling. Civil asset forfeiture continues to be a major problem around the country. On November 20th, the Nashville City Council in Tennessee voted 25-5 to renew its federal-state “equitable sharing” program, thereby circumventing a recently passed state restriction on seizures. Only six states, plus the District of Columbia, have banned equitable sharing.

There are still only three states that have completely banned civil asset forfeiture. Police around the country continue to abuse their power in the War on Drugs by seizing cash and property under the pretense of stopping drug trafficking. While the Supreme Court’s decision in Timbs v. Indiana could create an additional hurdle in this process, only abolishing civil asset forfeiture will ensure the end of these abuses.

Tom Houseman, Policy Director

The Midterm Elections: A Very Good Day

grygielny Decriminalization, Marijuana Legalization, Medical Marijuana

Let us be grateful for our U.S. federal system. In the face of a Washington bureaucracy mired in inertia and self-preservation, and a U.S. Congress reluctant to act, it is the individual states that will finally shut down our nation’s tragic and failed War on Drugs.

At the federal level, the Drug Enforcement Administration –ostrich-like – still labels marijuana a Schedule 1 drug with “no currently accepted medical use.” National policies are shamefully ambivalent about harm reduction measures such as clean needle exchanges, naloxone, and medically assisted treatment. Private prison expenditures are steadily growing under the Trump administration.  Civil asset forfeiture is still federal policy.

That’s why we must celebrate what happened in Michigan, Missouri, Utah, and Florida on November 6.

As our Drug Policy State Grading Map makes clear, each state has its own story to tell about where it ranks in the effort to end the War on Drugs and what it has just contributed to this goal.

Michigan became the first in the Midwest to approve marijuana for recreational use, joining nine from the East and West.  It raised its drug policy map grade for marijuana to an “A”, thereby achieving a composite grade across our entire agenda of B-, up from C+.  It falls short of a higher grade because of its punitive position on civil asset forfeiture and a limited Good Samaritan law.  

Voters in Utah approved a ballot initiative legalizing medical marijuana.  This is remarkable in a state where over 60% of the electorate is Mormon, that is, members of the Church of Jesus Christ of Latter- day Saints, a religion which counsels its members to avoid any substance that might be habit forming, including tobacco, coffee and tea.

Even after the ballot initiative, Utah’s grade on marijuana policy remains “C”.  It is unlikely any time soon to join the 30 states that have either decriminalized marijuana or legalized it for recreational use.  

Utah thus provides a significant precedent for those in other states trying to decide whether to move forward with medical marijuana.  I have just returned from recruiting clergy in South Carolina to support medical marijuana next year. When I point out that Mormons, even with their commitment to abstaining from all stimulants, can support marijuana as medicine because it brings healing, clergy get the point.

Missouri also approved medical marijuana, thus raising its marijuana laws to a “B”.  They have yet to decriminalize marijuana, that is, treating low-level possession as a civil offense, like a traffic ticket.

When it comes to “game changers”, perhaps the most remarkable event of November 6 was what happened it Florida.  Voters approved a state constitutional amendment to restore voting rights to felons who have served their sentences, including parole and probation.  This will change the status of 1.5 million individuals starting January 8.

Although this measure does not involve drug laws, it is part of our agenda. Why? Because it is the War on Drugs that has deprived so many people of the right to vote: over 6.1 million individuals are disenfranchised across the nation due to felony convictions.  Almost 50% of those in federal and 15% in state prisons currently are incarcerated for drug offenses.

Despite this dramatic step forward, Florida’s grade under this category increases only to a C+.  The state continues to limit access of convicted felons to supplemental assistance under the SNAP program and also operates private prisons. Both these policies harm large numbers of those convicted of low-level drug possession.  

With the state actions in Michigan, Utah, and Missouri on November 6, thirty-three states, encompassing at least 65% of the national population, will soon permit medical marijuana.  Ten have now voted to tax and regulate marijuana for recreational use. Florida has decided it will no longer deny 1.5 million citizens their constitutional rights.

All in all, it was a very good day.

Rev. Alexander E. Sharp, Executive Director 

Book Review: American Prison

grygielny Privatization of Prisons

If Fyodor Dostoevsky was right when he said that  “the degree of civilization in a society can be judged by entering its prisons,” then journalist Shane Bauer wants us to know just how uncivilized we are. More importantly, in his new book American Prison: A Reporter’s Undercover Journey Into the Business of Punishment, he wants to expose the truth of the private prison industry’s inhumane treatment of prisoners for the sake of boosting profit margins. The result might be the most important book about criminal justice in the United States since Michelle Alexander’s The New Jim Crow.

Prison walls are designed to keep people in, but also to keep people out. The prison industrial complex, and in particular the private prison industry, thrives on secrecy and opacity. It is rare when news about what happens inside prisons leaks to the public, usually after a riot, or during the recent inmate hunger strikes. The prison industry seems to think that if it keeps its activity out of sight, it will remain, for most Americans, out of mind.

Shane Bauer, a journalist for Mother Jones Magazine, wanted to literally give the inside story on how private prisons are run. He applied for a corrections officer position at Winn Prison, run by the Corrections Corporation of America, which has since rebranded itself as CoreCivic. During the four months he worked in Winn, Bauer covertly recorded thousands of hours of audio, including conversations with prisoners, guards, and supervisors. The results are both sickening and revelatory.

It is obvious how little CCA cares about rehabilitating the inmates it is paid to incarcerate. The company is far more interested in maximizing its profits, often failing to provide prisoners with educational opportunities, recreation, or even adequate nutrition and healthcare. Bauer notes that inmates are not protected from each other, and that inmates who stab other inmates typically are neither charged with a crime nor shipped to a higher security prison.

Even in the case of an inmate suicide attempt, CCA’s priority is monetary, frequently classifying such attempts as “self-mutilation,” a distinction that allows the company to charge the inmate for a hospital visit.  CCA even seems apathetic about the possibility of prisoners breaking out of prison, with one inmate’s escape going unnoticed for hours due to unmanned watchtowers. The only active step CCA ever seems to take is to avoid liability in the case of an inmate death.

Bauer also depicts his fellow correction officers as cruel and callous. The prison is perpetually understaffed and the CO’s are barely paid more than minimum wage. The only seeming benefit of the position is the potential to abuse the power granted to them over prisoners, a power endorsed by those in charge. “If you are an officer and you do something one hundred percent wrong,” says one of the CO’s training Bauer, “I’m going to take your side right on the spot.”

Dehumanizing the inmates is specifically encouraged; at one point the prison’s assistant warden says that the goal of the CO’s is to “institutionalize” the prisoners, and that “We don’t want them to feel as though they are individuals. We want them, for lack of a better term, to feel like a herd of cattle.”

American Prison is a damning exposé, but the most compelling aspect of its narrative is the emotional challenges Bauer relates during his time as a CO. The psychological toll that working in a prison takes is immense, which explains why the rates of PTSD for prison guards is higher than for soldiers returning from Iraq or Afghanistan. “This job will drive you to drinking,” Bauer’s captain says to him.

Laced throughout the book is a history of the prison industry in the United States. Penitentiaries began as an alternative to hanging or whipping a convicted felon, and as early as 1825 states were leasing their prisoners out to serve as cheap labor for private companies. But two events, a century apart, were responsible for the two biggest booms in the incarceration rate. The first was the end of slavery, when Southern states began to use prison labor as a replacement for slave labor, and created laws designed to imprison swaths of African-Americans. The second was the War on Drugs of the 1970s.

When incarceration rates skyrocketed due to aggressive policing and extreme mandatory minimums for drug possession, states sought a way to expand their prison systems without taking on new debt, and newly created private prison corporations like CCA stepped in to fill that void. T. Don Hutto, co-founder of CCA, was also the head of the American Correctional Assocation, the largest private prison association in the country, a position he used to push for privatization.

By giving us a ground-level view of the deeply dysfunctional private prison system, as well as giving us the context for its rise to prominence, Bauer helps us understand that mass incarceration in America isn’t interested in rehabilitating prisoners and preparing them for life after prison. In fact, it has always valued profits over people. Equally horrifying and heartbreaking, American Prison is the wakeup call we need to finally reign in the practices of private prisons, and to overhaul our entire system of mass incarceration.

Tom Houseman, Policy Director

Responding to Addiction through Faith, Not “Fixing”

grygielny Faith Perspectives, Guest Pieces, Harm Reduction

Bob Feeny is a third-year student at the Divinity School at the University of Chicago. He is seeking ordination in the United Church of Christ. 

I am never sure where to begin the story of my brother Jeff’s addiction. This is largely due to the fact that his story is not mine; I can only tell my story of his addiction.  I did not know it then, but I think that my story of my brother’s addiction began on Christmas Eve, 2007.  We were in the apartment where my mom and brother lived.

My mother had recently stabilized after a few years of erratic bipolar swings and isolation worsened by an abusive relationship, and my brother had moved in with her after living with extended family for a few years.  We were spending Christmas together like a normal family. Things were good. We spent much of the evening with my aunt and uncle—both “functioning” alcoholics. At some point a bottle of vodka came out, and my 18-year old brother started drinking.  A few hours later he stood over the sink, violently ill. The next morning, instead of the up-at-dawn Christmas of our youth that I had hoped for, I sat around with my mother wondering when Jeff would emerge from upstairs.

Fast-forward to Tuesday, November 22nd, 2016. It has been 4 months since I learned that my 27-year old brother had become addicted to heroin—and he has just sent me a text that reads, “I’m sorry man, I am too sick to come out for Thanksgiving.”  I had been out to see him as he had gotten clean. He was confident, we had a vision for his future, I was so hopeful for him. Clearly, he had relapsed.

I could not begin to understand how this had happened.  He seemed so determined to change his life. But over time it became clear that willpower was not enough to keep my little brother clean.  His confidence began to seem foolish to me; my own hope, hubris. If I’m being honest, I resigned myself to the fact that my brother’s life was essentially over.  Given our family’s history of addiction and the staggering statistics surrounding this country’s opioid epidemic—this seemed like a warranted stance.

Addiction seems to be a demon that America simply cannot cast out.  Decades of the War on Drugs have done nothing to mitigate the problem.  We’ve spent an unfathomable amount of resources telling people to “just say no,” and trying to convince them along with ourselves, that if they just find something to be hopeful about, they are going to drum up the confidence it takes to beat addiction.  Our response has been in vain.

I wonder, however, if faith may offer us a unique perspective, one that has not yet been attempted.  It’s easy to mix up faith with hope. And certainly, the two are interrelated in many ways. However, as someone who loves an addict, I must admit that I am not capable of responding hopefully to every situation.  

But what if faith really isn’t about hope?  What if faith is less like seeing the light at the end of the tunnel, and more like just standing knee-deep in sludge, in a tunnel that seems to go on as far as we can see in either direction?  What if faith is simply being willing to stand in that hopeless place, and know that somehow, God is present?

I don’t know what the future holds for my brother.  I don’t know what to hope for, and quite frankly, I’m not sure that hope is really the best thing that people of faith can offer.  There are people everywhere willing to offer hope. Medical professionals, rehab centers, community health initiatives- these things all offer hope.  Some offer hope as a commodity, others are genuinely confident that addiction can be overcome. The truth is, all of these things are necessary at one point or another in recovery.  

But all of these things look past the person suffering, into the person they can be if they just believe in themselves.  I want to believe that when Jesus tells his disciples that they lack faith, what he’s really telling them is that they’ve failed to see the child for who he is.  In their excitement about the possibility of ‘fixing’ him, they’ve refused to bear witness to his brokenness; they haven’t stood in the dark and the muck.

I often struggle to imagine what it is that’s ultimately going to save my brother.  But maybe I don’t need to. Maybe faith doesn’t require me to visualize the positive ending.  Maybe it doesn’t require me to find a solution, or even to think that there is a solution. Maybe my mustard seed is having the courage to admit that I love my brother, Jeff, the addict, just as he is.  The person who may never hold a steady job. The person who may never find true love. The person who may die younger than I’d hoped.  

My prayer for the Church is that as a people who have been transformed by God’s grace, we would never give up hope that lives shattered by addiction can be redeemed.  I pray that we would never lose our confidence that our God is a God who keeps transforming lives, opening up possibilities that we could never have imagined.

With this hope, I pray that we will speak up about addiction, and champion research-based approaches to prevention, treatment, and policy reform regarding addiction.  But more than that, I pray that we as the Church would realize our truly unique contribution to casting out the demons of addiction: faith. Not the Hallmark version of faith, the one with the rosy flourishes and the sappy endings, but the faith that looks the demon square in the eyes, and refuses to stop seeing the soul that it tortures.