Book Review- Addiction Nation Offers a Path to Those in Need

Tom Houseman Harm Reduction

Addiction Nation opens with a deeply personal story told in visceral detail. It describes  the weeks that author Timothy McMahon King spent in an intensive care unit, suffering from pancreatitis, on the verge of organ failure and death. He describes the agonizing pain he suffered, as well as the only resource that brought him any relief: opioids, specifically fentanyl. “Addiction Nation is my story,” he writes, “but it is our story too.” The subtitle of the book is What the Opioid Crisis Reveals About Us. King is not a journalist, nor is Addiction Nation a PhD thesis. The opioid crisis, and the challenges of treating substance use disorder, have been examined by several authors, from Gabor Maté to Beth Macy to Sam Quinones. King references their writing, as well as the mountain of research done on the spread of opioid use disorder, but his approach is unique. Instead it is King’s personal experience, and his faith-driven approach to recovery, that power Addiction Nation. King experienced opioid use disorder, describing his addiction to opioids that began with his time in the hospital. He is extremely lucky, and he understands that. “My story is one of early detection,” he explains, “of things that went right. It is a story that should be more common than it is… If everyone had what I had, the opioid crisis would not be what it is today.” King grew up in a religious household, and he has spent his life pondering and understanding the role that faith plays in his life. Few authors have explored the relationship between faith and addiction as deeply as King, or in a way that is as accessible to a Christian audience. Those who do not share this perspective may find the biblical allegories and quotes off-putting, as if King’s religious background detracts from the seriousness of his writing. But for those who share this worldview, it offers fascinating insight into how people treat both themselves and others. “Addiction is a kind of faith gone wrong,” King posits. King explains how he was able to come to terms with his own addiction and gain control of it. He needed to reckon with his own shame, fueled by the stigma that addiction was a “moral failing,” a sign of a weak will and a weak mind. Using his own experience as a jumping-off point, he tries to explain how complex addiction is, how universal an experience it is, and how shame and “tough love” are often the worst ways to handle it. King’s goal is loftier than garnering sympathy for people who use drugs, or pushing policy proposals that will save lives, although he does both. He wants to diagnose all of us, and help us understand how our lives have become steeped in addiction. “The idea of addiction as a disease,” he writes, ‘allowed me to let down my defenses and accept help.” But he also explores the idea of the so-called Disease Model of addiction and finds it imperfect and lacking. King argues that the opioid crisis, and addiction in general, is “more than a disease.” It is a complex hydra of impulses and emotions, a mobius strip of blame, shame, need, and fear, a vicious, self-reinforcing cycle. In order to defeat it, we must first untangle it and understand it. The drug addictions plaguing communities, cocaine and meth and heroin, have been exacerbated by politicians who, rather than trying to help people in need, choose to “wage war on our citizens.” These “tough on crime” policies have fed on racial stereotypes of “super predators” and “welfare queens,” but they hid the growing problem of drug addiction surging in affluent white communities as well as poor rural communities. King believes that addiction “reveals something about our culture, our economy, and our world that is very much considered ‘normal’ but is actually destroying what is human.” Opioids, he explains, “are not the cause of addiction, even though they are addictive.” Instead, addiction is driven by a desire to escape pain. For some that pain is physical, as it was for King, but for others it is emotional, psychological, even spiritual. Poverty, isolation, and hopelessness are all types of pain from which addiction offers a momentary escape at a great cost. There are no easy answers to the addiction crisis, because King explains that addiction itself is the easy answer. Instead, he promotes the idea of slow, deliberate changes made on both the personal and the systemic level. That is what King means when he writes about faith: that faith in ourselves, each other, and the slow process of growth are the only way to overcome addiction. We must grapple with our own shame and fear in order to promote positivity, rather than condemning addicts out of a misplaced superiority. “To struggle with control of our own actions is at the heart of what it means to be human.” As the opioid epidemic rages, more and more people either struggle with their own substance use disorders or know and love someone mired in addiction. These are the people for whom Addiction Nation is written: people who are afraid, who don’t know what to do, who know that the old answers won’t work and are looking for new solutions. For Christian audiences, and people who find strength in their faith, King’s story and perspective are inspiring and enlightening. For  anyone scared or ashamed, the ideas explored in Addiction Nation will help them remember the most important message in overcoming addiction: You are not alone. We are all in this together. Tom Houseman, Policy Director

Clergy Join Suit to Keep Drug Users Safe

Rev. Alexander E. Sharp Harm Reduction

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

The Church of Safe Injection Saves Lives

Rev. Alexander E. Sharp Drug Education, Faith Perspectives, Harm Reduction

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

Jesse Harvey: My Faith and Work

Rev. Alexander E. Sharp Harm Reduction

(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.

The Dangerous War on Syringe Exchange Programs

Tom Houseman Drug Education, Harm Reduction, Uncategorized

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