In Philadelphia, the city of Brotherly Love, community leaders, service providers, and key public officials have joined together to bring safe injection to their city. At the proposed facility, aptly named “Safehouse,” individuals struggling with addiction could use drugs under medical supervision. This would be the first such program in the United States. But on February 6, the U.S. District Attorney in the Eastern District of Pennsylvania sued to keep Safehouse from opening its doors. William McSwain argued that it would violate the Controlled Substance Act, which is intended to ban the operation of “crack houses.” When Clergy for a New Drug Policy was asked recently to join an amicus brief rejecting efforts to block Safehouse, we couldn’t say “yes” fast enough. Here is why. The United States is woefully and shamefully lacking when it comes to supervised injection facilities (SIFs). Worldwide, there are over 120 in 12 countries, including Australia. As we reported last month, the score in North America is: Canada 44, U.S. 0. The arguments on behalf of Safehouse are strong. Evaluations of SIFs have demonstrated that they: reduce both overdose deaths and infections due to unclean needles; increase access to health care; and provide opportunity for treatment without requiring it. Nor have there been negative consequences such as an increase in crime or public disorder where facilities are located. The amicus brief invokes the Religious Freedom Restoration Act of 1993 (RFRA). It argues that in moving against Safehouse, the U.S. attorney is “substantially impair(ing) the ability of its Christian and Jewish Board Members to practice at least two tenets that they sincerely hold.” It raises an interesting and important question: if you were asked to draft a brief that supported an SIF based on your faith, how would you make the case? What would you consider to be the religious values at stake? The amicus brief offers two fundamental concepts. First, all humans are created in the image of God. We have “a unique and unrivaled status in creation.” (All quotes are from the brief.) This special status lies at the heart of the commandment to love others as ourselves: “all therefore have value and significance and are worthy of others’ time, understanding, and advocacy.” Guided by this concept, the brief argues that “In attempting to prevent adherents from providing care to those affected by the opioid crisis, the U.S. Attorney has dehumanized those in need and thus tainted God’s image… (and ) has also put the affected outside the reach of the community…thereby distancing neighbors from each other and God’s love. The end result demeans the affected and strips them of their dignity, leaving God’s image in tatters.” Second, the brief asserts the inherent dignity and immeasurable worth of each human being. It argues that “in recognizing the dignity and humanity in all, Jesus announced that everyone, including the poor, the sick, and the sinners, are worthy of salvation and protection.” It follows that “all humans, even opioid addicts, possess an intrinsic, sacred worth that adherents must honor with respect.” The drafters of the amicus brief make clear that it draws upon the core tenets of the Judeo-Christian, Islamic, and other traditions. But in the final analysis, perhaps it does not entirely matter what its supporters call themselves and which faiths are represented. When Safehouse is finally up and running, it will embody the fundamental injunction that we love our neighbor. To love our neighbor is to know God. In this sense, Safehouse is a religious organization. This is why it is worthy of our support. Rev. Alexander E. Sharp, Executive Director
There is a new church on the horizon. It usually operates out of the back ends of cars, often after dark and late into the night. So far it exists in six locations in Maine as well as in six other states. It is called the Church of Safe Injection. Its founder is a 26-year old drug recovery coach named Jesse Harvey. He preaches the Gospel of Harm Reduction: we should use all possible measures to protect drug users from the harm of their drug use. Measures include clean needle exchanges, and, in the case of potential overdose deaths, a life-saving substance called naloxone. “All too often, people who use drugs are offered only two choices, ‘Get sober or die.’” Harvey wrote recently in the Portland Herald. “Jesus would have rejected this shameful and lethal binary….’Let all that you do be done in love,’ states 1 Corinthians 16:14. Too often when ‘religious’ people attack us on Facebook, their hate shines through and they betray this passage. They betray Jesus.” Last October Harvey started loading up the trunk of his 2017 Honda with sterile needles, naloxone, rubber tourniquets, alcohol swabs, and other materials to avoid infection. Every week, usually in the evening, he drives to a site in Lewiston where drug users congregate. He makes these supplies available to all who need them. For many, these gatherings seem almost like a mass. Harvey himself has no doubt he is doing what Jesus would have done: “If syringes had been around in Jesus’ day, He would have supported safe injection, and he would have made sure the people he hung out with had access to sterile supplies.” While many states have now authorized needle exchanges, 15 do not, and services that do exist are often sparse. Maine, which spans over 35,385 square miles, offers only six, mostly in the southern part of the state. Only four make naloxone available. Harvey is certified as a minister by the Universal Life church, which ordains individuals to perform weddings, baptisms, funerals, and start congregations. He carries a card that identifies him as a “disciple & acolyte.” The Church of Safe Injection has only three rules for members: they must welcome people of all faiths, including atheists; serve all marginalized people; and, of course, commit to supporting harm reduction. For the most part, the individuals have gathered outdoors. But there have been some house meetings along readings, including scripture. The location within a physical structure will bring Harvey closer to what has been his goal from the beginning: a safe injection site where individuals can administer their own drugs under supervised care to insure safe and clear conditions. Such sites exist in at least 60 cities spread across Western Europe, Canada, and Australia. They are illegal in the United States, but strong support exists in Boston, New York, Philadelphia, San Francisco, and Seattle. Harvey’s strategy at this point is: first, to incorporate the church as a not-for-profit; and, then, to apply for a religious exemption from federal law. He is looking to a 2006 Supreme Court decision that permitted a small sect to continue import a mind-altering drug – ayahuasca – for use in religious services. At the end of the day, what Jesse Harvey is doing is an act of civil disobedience. He is breaking the law. He distributes more than the limit of 10 needles at a time permitted in Maine. He also has never obtained certification to operate a needle exchange facility. He sees no alternative. “Overwhelmingly, the churches I’ve reached out to are not interested in helping people who use drugs…Politicians, law enforcement, and health care haven’t taken the lead here, so our church is,” he writes. “Join the Church of Safe Injection and save lives.” “We do not encourage drug use. However, it is our sincere religious belief that people who use drugs do not deserve to die, not when there is a proven, cost-efficient, feasible, compassionate solution that can be so easily implemented.” Who among us can disagree? Rev. Alexander E. Sharp, Executive Director
(We had the opportunity to speak with Jesse Harvey, founder of the Church of Safe Injection, by phone last week. We were especially interested in whether he has been able to engage mainline churches in responding to the opioid crisis –ed.) AL: Tell us more about yourself and your religious faith. JESSE: I’m in recovery and I’ve been to a bunch of AA meetings and I believe in a higher power. I’ve tried going to many churches here in Portland. I’ve considered myself a believer in some higher power for maybe five years. But it’s really only been since I started this work that I’ve really come to think of myself as a religious person. I’m interfaith. I don’t necessarily subscribe to any one belief over another. We have seen so many people disenfranchised by traditional religion and churches. AL: What do you feel you are accomplishing right now with the Church of Safe Injection? We are getting naloxone out there and exchanging syringes. We are distributing other harm reduction supplies. There are other organizations that serve far more people than we do. With us it’s sort of catch-as-catch-can. We try to be as regular as possible with the people that we know, but we can only serve about one in every thousand people in Lewiston and Auburn that need it. Our real output, our real product, if you will, is changing the narrative, inspiring the macro sort of conversation. It’s like guerrilla theater if some other advocates and I get arrested, which we are thinking about doing in the coming month. AL: Did you come up with the concept of church because of the theater messaging part, or would you like to move toward a more formal church structure? JESSE: Absolutely, yes. That’s what actually our Bangor branch does. It has weekly meetings. It uses scripture. When I did my Narcan training in Auburn last week, I read a scripture. It is a real church. It’s non-traditional but certainly we would love to move into more conventional spaces as well — whether a physical building and whether tradition X,Y or Z. Just so we can capture that audience as well. AL: Have you established any program connections with “mainline” churches? Jesse: I’ve done two Narcan trainings, one in Biddeford, Maine and one in Auburn, Maine, both Unitarian Universalist. I have reached out to so many churches. I’ve let them know about the urgency of what we are doing. I’ve quoted Matthew: 31-46. I never hear back. AL: I know Chicago pretty well. I’ve worked in Illinois and lived in Chicago for 35 years. I can’t find a mainline church where one might even detect a hint that we are faced with national opioid crisis. JESSE: Its really disillusioning, to tell you the truth. AL: Recently I called a friend at Chicago Recovery Alliance, which is licensed to do the kind of work you do. They operate out of a large van. I asked whether any churches, especially in neighborhoods where the risk of overdose and drug infections is greatest, had ever reached out to them. So far that hasn’t happened. JESSE: I actually have been thinking a lot about purchasing a van. As soon as the church is built up enough in terms of people and media coverage and legal assistance and partnerships, I’m going to start operating safer drug consumption spaces. Probably in the back of this van I’m talking about. It would be foolish to do it now because I would just get thrown in jail or prison for no good reason. But in a few months, if things continue at the pace they’re continuing at right now, we will do this. When we do, I think religious intervention to save lives and to keep people safe is a real possibility.
In a 1996 episode of the tv show Spin City, Deputy Mayor Mike Flaherty (Michael J. Fox) is discussing a proposed syringe exchange program with city hall’s Head of Minority Affairs, Carter Heywood (Michael Boatman). Flaherty would rather the city stick with its old plan of handing out AIDS prevention pamphlets, because “it’s almost impossible to inject narcotics with a pamphlet.” The scene is played for laughs, but there is an underlying truth. The US government has historically avoided harm reduction policies in favor of strategies that are less controversial, but also woefully ineffective. Syringe exchange programs have existed in the United States since the 1980s. They were created by community activists, without government support, as a response to the AIDS crisis. Since HIV is transmitted through blood, distributing clean needles reduced the risk that somebody could become infected with HIV after sharing a needle previously used by an HIV-positive person. Indeed, countless studies have shown that access to clean needles drastically reduces infection rates of not just HIV, but infections such as Hepatitis as well. In addition, those who repeatedly reuse needles risk a variety of infections. By providing drug users with clean, sterilized needles, syringe exchange programs are one of the most effective forms of harm reduction. As the opioid epidemic leads to increased rates of heroin use, syringe exchange programs are more important than ever. Unfortunately, draconian laws at the federal level and in many states make it extremely difficult for syringe exchange programs to help the people who need them most. U.S. Code Title 21 Section 863, also known as the “drug paraphernalia statute,” bans the distribution of drug paraphernalia. The Department of Justice defines drug paraphernalia as “any equipment that is used to produce, conceal, and consume illicit drugs,” a category broad enough that they mention “miniature spoons” as potential paraphernalia. Many states have similar laws, also vague enough that syringes are not always necessarily included. Even when syringe exchange programs are exempt, funding them publicly is an additional hurdle. Until 2016, it was illegal to use any federal funds to support syringe exchange programs. Even now, while funding these programs with federal money is legal, the money cannot be specifically used to purchase needles, a piece of legal tightrope-walking meant to deflect criticism that the government is “soft on drugs.” There are 15 states in which it is illegal to run a syringe exchange program, a diagonal stripe across the country from Idaho to Florida. In these states, which make up the bulk of the Midwest and the Southeast, drug paraphernalia laws forbid individuals from selling or distributing syringes if they have reason to believe that they will be used for illegal drug use. But even in states where syringe exchange programs are legal, hurdles created by state and local governments, as well as local law enforcement, make it unnecessarily difficult for harm reduction organizations to ensure that drug users have access to clean syringes. Illinois is one of the few states in the Midwest that allows syringe exchanges, but the onerous restrictions placed on these programs make the work far more difficult than it should be. Organizations like The Chicago Recovery Alliance must obtain a “research exemption” in order to distribute syringes, a barrier that makes it harder for them to reach the people who need them most. And there is, in fact, no need for more research on the efficacy of syringe exchange programs. Mountains of evidence show that such programs are cost effective for cities and states and that access to clean syringes lowers rates of HIV infection without leading to increased rates of drug use. Effective syringe exchange programs save lives and make communities safer. This has not stopped towns from shutting down needle exchange programs, or preventing them from opening, based on unfounded fears. Last year the mayor of Charleston, West Virginia forced a local syringe exchange program to shut down, claiming that too many used syringes were being found unreturned. This was a baseless claim; 9 out of every 10 needles distributed were returned to the program. Earlier this month, Scientific American dug into why so few syringe exchange programs exist in Virginia, one of the states hit hardest by the opioid crisis. One of the issues, they found, is that “the law [requires] any local community to obtain formal written consent from local law enforcement officers for programs to operate,” and “continues to criminalize possession of even sterile syringes” for the program’s customers. As a result, only three of the seventy-five eligible counties in Virginia have a syringe exchange program. The opioid epidemic is worsening by the year; more people are going to be using heroin, often without the resources they need to stay safe. Harm reduction is about helping people stay safe while offering them whatever support and assistance they need. No program does that more effectively than syringe exchange programs, yet too many states are stuck in a War on Drugs mindset that punishes and stigmatizes drug use. That approach has failed, and harm reduction is one of the new strategies that must be embraced. In the fictional world of Spin City, Deputy Mayor Flaherty shoots down the idea of a needle exchange program. “We are in a war against drugs, in case you haven’t noticed,” he tells Haywood. “That’s the same war we’ve been fighting the last forty years?” Haywood asks sarcastically. “How we doing?” More than twenty years after this scene was first shown on television, it seems that too many politicians have the same answer to that question as Michael J. Fox’s character did at the time: “Any day now.” Tom Houseman, Policy Director
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.”