Responding to Heroin with Harm Reduction

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America’s current heroin crisis, when broken down into its many intricate moving parts, has evolved into nothing short of an epidemic, casting its pall over thousands of people across the nation. According to the Centers for Disease Control and Prevention (CDC), heroin-related deaths in the United States jumped by 39 percent from 2012 to 2013, while the rate of heroin-related overdoses nearly quadrupled.

A large reason for the uptick in heroin usage can be traced to its marriage to prescription painkillers. More than 75 percent of heroin addicts used opioids previously, and nearly half of heroin users between 2011 and 2013 were also addicted to painkillers. It’s almost no surprise, then, to find out that doctors are prescribing more opioid painkillers than ever before.

Ric Curtis, a professor of anthropology at John Jay College of Criminal Justice, says that despite these factors, the current outbreak isn’t necessarily more serious than previous drug epidemics, but contains an unfamiliar narrative based within previously “hidden populations.”

“I think it’s probably as severe as in the past, but it’s a different population this time,” Curtis explains to BTRtoday. “It’s rural and suburban populations rather than urban ones. When it was primarily in the city, it was sort of confined geographically, which makes a difference.”

The current heroin epidemic has also been characterized by the drug’s racial and socioeconomic shifts. More than 90 percent of new heroin users are white, and the gaps between user demographics, particularly income level, are shrinking rapidly. Heroin use among whites has increased more than 260 percent in the last five years alone, bringing new faces to the fight against its spread—and more national media coverage than ever before.

The media’s tendency to monitor the crisis more intently as it spreads into white communities has angered some outreach workers who have worked to change drug policies in communities of color for years.

Lorenzo Jones, the co-director and co-founder of the Katal Center for Health, Equity and Justice, says it’s something that he and other community organizers have to deal with.

“It is completely irresponsible for us as advocates, organizers, or even directly impacted people to shun the reality of the country we live in, and what people care about and value,” Jones tells BTRtoday. “We have to deal with the mentality of America honestly if we’re going to actually move forward.”

Jones doesn’t believe the media is the cause of the problem, but that an outlet will ultimately decide to cover the heroin epidemic in a way that appeals to its audience. In his eyes, it’s more important to focus on the work of advocates that have pushed the issue into the news.

“I love having this conversation, because we wrote most of that narrative,” Jones says. “The face they choose to put on it is what sells papers, but I would like to spend more time appreciating the strategy to move the issue.”

That strategy includes getting people to educate activists about their experiences with the drug, be it in the hands of a friend, family member, or from a first-person perspective. Before founding the Katal Center, Jones was the executive director of the Better Way Foundation, which juxtaposed the personal experiences of affected people to statistics in reports published about heroin use.

“What we were able to do was build new knowledge around this work,” Jones says. “Once people linked their stories to statistics that the state recognized, they were able to go and advocate for significant policy change around harm reduction.”

Harm reduction is a strategy designed to reduce the negative effects of drug use, from the spread of disease to mass incarceration. This includes safe injection sites, such as the one just opened in Ithaca, N.Y., as well programs like Seattle’s LEAD, which aims to redirect low-level drug and crime offenders to community based services, such as needle exchanges.

“We think the LEAD program is really going to help,” Jones says. “Not just to bring services to directly impacted people in the moment they need it, but also to educate people about how harm reduction gets it done when it’s state sponsored.”

It’s novel on a large scale, and provides a stark contrast to the demonizing drug war waged against heroin and crack cocaine in the 1980s and ‘90s. Marc Mauer, executive director of the Sentencing Project, says it’s much easier to implement such policies when a different racial portrayal changes the image of the drug altogether.

“The perception of marijuana in the 1930s was a drug that was used in the racy parts of town, in black and Mexican-American communities, and it was sort of this demon drug,” Mauer tells BTRtoday. “Along came the 1960s, and millions of white middle-class people started consuming marijuana, and societal attitudes changed almost overnight.”

The shift toward harm reduction has welcomed progress in a realm where excessive punishment once ruled supreme, even if it does have to do with the crisis bearing more of a white face than those of other drugs.

“One could argue that maybe this is just reflecting some of those changes in public consciousness around drug policy broadly, and that may be part of what’s going on, but I think the shift is pretty dramatic,” Mauer says. “We’re not seeing that kind of discussion for other drugs where there may be a different racial mix.”

Regardless, Jones believes in the importance of harm reduction not only for drug treatment, but also for the relationships between communities and law enforcement.

“A program like LEAD, done effectively, becomes a tool for the police department,” Jones explains. “And it’s also a way for the community to measure the police department’s effectiveness.”

While opponents of harm reduction policies might argue it’s simply letting offenders go and even providing them with free drugs, Jones says we have to think bigger to understand how the harsh actions of stringent drug policy enforcement affect entire communities and not just the users within it.

“This conversation isn’t about the person using drugs. This conversation is about the drug,” he says. “We have to have an expanded definition of the word harm, and then we have to have a more comprehensive response when we execute the work. It’s not about the harm and fear of the person, it’s about the damage to the community.”