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.”

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.  

“…My World Came to a Crashing Halt.”

grygielny Drug Education, Guest Pieces, Harm Reduction

Guest Blog by Kim Brown, President, QC Harm Reduction On May 25th, 2011 my world came to a crashing halt. My thirty-three-year-old son Andy died from an accidental heroin overdose. We knew he was in trouble, we knew he injected drugs, and most of all, we knew we were at risk of losing him…and then we did. I was a single mom working as a nurse, and I adored my kids. Now one was gone. The damage done to a family when a child and sibling dies is staggering, especially when the death is caused by a drug overdose. The shame and stigma directed your way after losing a child to an overdose is quite debilitating. In any event, there were no neighbors with casseroles or offers to help and very few condolences. I was introduced to harm reduction when I sought support for my grief online. I discovered GRASP, Grief Recovery After A Substance Passing, and found other mothers to whom I could talk. GRASP literally saved my life. While pouring out my heart to these mothers I’d met, I was struck by their absolute certainty that our children’s deaths could have been prevented. Had we been able to access harm reduction tools, including naloxone, clean needles, and safe spaces for them, maybe our kids would still be here. With this knowledge, I began to turn my grief into advocacy. We founded QC Harm Reduction, our 501(c)3, non-profit organization in 2015, but had been seeking allies to support naloxone training and distribution since 2012. Iowa did not have a naloxone access bill, so we began to advocate for one at our state capitol. Finally, in 2016, after four grueling years, our law was passed. As we attempted to build support for training and distribution in our community, we continued to get pushback from many stakeholders. Stigma, shame, and a focus on abstinence were sadly still the rule of the day. My dear friend, a former Catholic Worker, Michael Gayman, introduced me to some folks in the faith community who operate The Center, Love in Action (LINK). They listened as I explained how a simple harm reduction tool, such as naloxone, could save the lives of people who use drugs. Our mission was well received, and they invited QC Harm Reduction to be a partner organization. As a result, we have been able to reach those directly impacted by drug use at The Center, in Davenport, Iowa, and through our street outreach. We have partnered with the homeless shelters in our community and have expanded our street outreach and services. QC Harm Reduction, in addition to distributing naloxone, now provides HIV and Hepatitis C testing, all free of charge. Unfortunately, Iowa has yet approved needle exchanges.  We are working to change this. We also distribute food, clothing, backpacks, and other items necessary for survival, including, importantly, love and acceptance to those who are often discarded and forgotten. I am deeply grateful to The Center and their faith community for the love and support they’ve shown me, QCHR, and those individuals we are helping to serve. We are trying to get people to connect the dots.  People on the streets are put in jail for low-level drug offenses, and they are often parents. This is disrupting the lives of children and families, and the human costs are too great. The Center and QCHR believe strongly that harm reduction is a human right and that everyone is entitled to safety and compassion.  Love is love. Every life is worth saving.

Community Healing in the Aftermath of the War on Drugs: A Sermon by James Kowalsky

Sanya Singh Drug Education, Harm Reduction, Marijuana Legalization, Racial Inequality

In his sermon “Community Healing in the Aftermath of the War on Drugs” James Kowalsky reflects on drug use in our society and harm reduction as the most appropriate response.  James worked at Heartland Health Outreach in Chicago for seven years and is currently a graduate student at the School of Social Service Administration at the University of Chicago. The sermon was preached at Prairie Circle Unitarian Universalist Congregation.  We provide excerpts here with a link to the full text. I’m going to start this sermon with a few questions for you to consider. Many of these questions don’t have absolute answers. They are questions we should ask ourselves so that we know where we stand and try to figure out how these beliefs we hold, impact the action we are willing to take. What does a drug user look like?… For many of us when we picture what a drug user looks like we imagine someone looking dirty and disheveled, living on the streets with beer bottles or needles scattered around their body. We picture a desperate and dangerous criminal, willing to harm anyone in order to feed their addiction… In a study published in the Journal of Alcohol and Drug Education in 1995, a survey asked people to envision a drug user and describe that person. 95% of respondents described a black person. This is the case despite that fact that the majority of people who use drugs in our country are white. African-Americans make up about 15% of the people who use drugs, roughly equal to their proportion of the general population. When we picture who a drug user is, we don’t readily think of the successful people who have used drugs—executives, scientists, writers, musicians, politicians, Presidents. It would be inaccurate to say that people who use drugs or have used drugs are bad people, or are unproductive members of our communities. In fact, the overwhelming majority of people who try a drug—any drug—will not have a serious problem with that drug in their lifetime. Yet, this image of a drug user as a failure and threat persists… What is a drug? In general, we would define a drug as a substance that we put into our bodies that alters our mood or physiological state; the caffeine we use to help us get out of bed at the start of the day; the medicine we take to control our blood sugar, blood pressure, or moderate other symptoms that may prohibit us from taking care of business; the glass of wine we use to unwind after a long day at work. All of these are substances we put into our body to alter the way we think and feel… This does not mean that drugs are not harmful. Certainly, all drugs have the capacity to harm people. Partially, we have a skewed perspective of drug users because the people who are most negatively impacted by their use, are inherently more likely to need help and encounter systems like hospitals, treatment programs, and law enforcement. However, we’ve exaggerated the likelihood of harm in order to scare people away from trying drugs… Our relationship with any drug—legal or not—can range from harmful to helpful…Environment matters. Journalist Johann Hari talks about harmful use being a product of disconnection. Dr. Gabor Mate talks about addictions being rooted in painful experiences. Norman Zinberg points to the combination of three sets of factors he calls drug, set, and setting—factors related to the drug and how it’s used, the individual and their circumstances, and the environment they use in… We also know that experiencing trauma in early childhood increases the likelihood that people will have a harmful relationship with drugs. Yet, we live in a country that demonizes the drug user—they are a person who has made bad decisions and must live with the consequences. We see drug use as an individual choice and an individual problem. We try to interrupt that problem by punishing their bad choices and isolating people from everything that is familiar to them. But, what child chooses to be neglected or abused? What person chooses to be left without a support system when their parent or caregiver dies? Nobody chooses the circumstances that often precede harmful relationships with drugs. But, it’s far simpler to point to the individual and never consider the environment that they come from. That way, we don’t have to think about how poverty, a poor education system, a lack of economic opportunities, unstable housing, or growing up in a neighborhood where you regularly witness community violence, all make it more likely that people will have a harmful relationship with drugs. In fact, it is these circumstances, not drug use, where African-Americans are disproportionately represented… Much like drug use itself, punishment and isolation don’t just impact the individual. They damage the environment as well; they take the parent away from their child, remove brothers and sisters from families. By removing community members, we promote disconnection and thereby increase the likelihood of harmful drug use for the people left behind… We need to shift away from focusing our energy on trying to eliminate drug use altogether. That is and always has been an unrealistic goal. Drugs have been used for thousands of years, across continents and cultures. Drugs are a part of our lives and we all have relationships with them. We need to focus on the harms we consider most egregious and address them instead. We’ve tried, what some would call, a tough love approach for too long. It’s time we just try love. We need to shift from seeing harmful drug use as an individual problem that we solve with punishment, to a community problem that we solve with healing… One approach that does just that, and is gaining traction, is called harm reduction. Harm reduction is the practice of using drugs in less risky ways. When we drink responsibly, we are practicing harm reduction. We eat food before drinking, drink water, we practice moderation and limit our total number of drinks, we don’t drive when we’ve had too much to drink. These are all harm reduction choices we regularly make. As we make harm reduction choices with alcohol, we can make similar choices with other drugs… Beyond this individual practice, harm reduction is a philosophy—a belief in the human rights of people who use drugs. Harm reduction promotes the idea that regardless of what a person puts in their body, they should not be denied their basic human rights… As members of a faith community, your congregation has a unique opportunity to offer connection and healing to people in need. Matthew 11:28 tells us, Come to me, all you who are weary and burdened, and I will give you rest. The church has long been a place where people have sought out sanctuary. Extend an olive branch to the people who experience the severe consequences of drug use. Too often, people who struggle with their drug use don’t seek out help, because they think that love and support will only be available to them if they are ready to stop using altogether. We need to dispel the myth that belonging to this community is contingent on abstinence from all drugs. Because it’s not. We know that because we’re all here… Instead of focusing on trying to get people to stop using drugs, we can focus on trying to understand how and why they are using drugs. In order to understand people, we need to be willing to listen. Healing happens in relationships. We should focus on building a connection with people. Learn about their lives. Find out about their story, ask them about their hopes and dreams, ask them about what’s missing in their life. Almost certainly, one of the things they’re missing is someone who’ll ask those questions and respectfully listen. Remember, that person who is struggling is likely trying to disconnect from some source of pain. Give them love, give them connection, give them rest, help them heal, and you will help our communities heal. Amen

Yom Kippur: Intoxication, Collective Responsibility, and Harm Reduction

James Kowalsky Guest Pieces, Harm Reduction, Jewish Perspectives

Rabbi Jacob Schram (Ben Stiller in Keeping the Faith) called Yom Kippur the Super Bowl of the Jewish calendar. It’s probably the most coveted ticket of the year for temple-goers, so it makes sense to say that. To me, Yom Kippur is more like a combination of Lent and New Year’s. If you don’t know, Yom Kippur, which occurred just over a week agond, is the Jewish Day of Atonement, the last chance to make yourself right with God before the books are closed for the year. Yom Kippur also falls eight days after Rosh Hashanah, New Year’s Day on the Hebrew calendar. In addition to repenting for what we’ve done wrong in the past year, Jewish people use Yom Kippur as a time to recommit ourselves to do good deeds in the coming year. Essentially, we’re atoning and making resolutions all at the same time. In thinking about this High Holiday, I realized some of the ways that it’s linked to my thoughts on drugs and drug policy.