In February 2019, at about the same moment that Donald Trump declared a “national emergency” to secure funds to build a wall, I was waiting to meet Sheila Humphrey-Craig, an activist affiliated with Harm Reduction Ohio, at a McDonald’s in Dayton.1 A lanky, twenty-something white man with pockmarks on his face put a blue backpack over his red coat, walked out one door, ambled down the sidewalk, and then entered through another door of the restaurant. He took off his backpack. Sat down. Stood up again. Walked out. Repeat. Two booths away, an African American woman wearing a bandanna began nodding off, clipped moaning noises coming from somewhere inside her.
The big news, the reason I am here, is that Verily Life Sciences (whose parent company is Alphabet, which also owns Google) is building an opioid use disorder treatment and recovery center in Dayton, a city once referred to as the overdose capital of America. The center, called OneFifteen, is slated to open in a few months, with transitional housing opening in 2020.2 Verily will apply data analytics in an effort to tailor treatment and track the progress of patients in and out of health care and criminal justice systems. Community and business leaders are excited. They cite Dayton’s impressive turnaround as the main reason for Verily’s interest. In November 2018, The New York Times ran a story about how Dayton has managed to significantly decrease the scourge of opioid overdoses as citizens banded together to address the problem.3 The Center for American Progress has called Dayton’s community coalition a model for other communities to follow.4 They note the city’s all-hands-on-deck approach, which includes better data collection, a disease model for treating addiction, and widespread access to naloxone.
Sheila Humphrey-Craig doesn’t seem impressed by all this talk of Dayton’s turnaround or of “Google” coming to town. An ex–punk rocker, the fifty-something Sheila wears a black hoodie that reads “I love people who use drugs.” When she can, she drives around town in her pickup, handing out naloxone and fentanyl testing strips. As soon as I see her walk into the McDonald’s, she turns around and walks out with a man she recognized, knowing he needed some naloxone. Like Trish, Sheila does this because she has seen too many young people overdose, too many young people die. Handing out fentanyl testing strips and naloxone is a quick way to prevent more. And like Trish, she has a son who has struggled with heroin. Sheila’s son has been sober for a while now. “He exercises,” she says. “That’s his trip, and he practices mindfulness.” But if he ever goes back to that lifestyle, she wants him to be safe.
“And I’m doing it for all these other friends that he’s lost and are gone.”
“How many friends has he lost?” I ask.
“Oh God, too many,” she replies. “Too many. I’d say over twenty. Really. ’Cause all of his friends are gone. That man I was talking to before I came in, all of his friends are gone. It’s sad, that everybody you know is gone. They’re so young. I’ve had all my life peppered with death here and there, but I’m an old woman and I absorb it … How can a young person, twenty-one years old, how do they deal with twenty of their friends dead?”
“Yeah.”
“That right there does a number on their brain. They don’t realize it, but they are in shock, and they don’t know to deal with it, except to just ignore it. They can’t dwell on it—if they sit and dwell, they just become so depressed. Then they go back.”
That’s why she does it, she says, because none of those people deserved to die. And when the overdoses were highest around here, when a lot of people were dying, her son was using. At that time, between mid-2016 and mid-2017, things were especially dire as Ohio was hit by a surge in overdose deaths.5 The drug supply was tainted with potent opioids, and many people who use drugs were dying. In May 2017, People magazine ran the story of the tragic drug overdose death of a handsome airline pilot and his beautiful wife.6 The couple was found in their home by their son—their Centerville, Ohio, community was shocked to learn that the coroner found cocaine as well as illicitly manufactured carfentanil—a fentanyl analog that’s a hundred times more potent and is used primarily to tranquilize elephants and other large mammals—in their bodies.7 Of course, theirs was just another story about an overdose death amid a national frenzy over opioid overdose deaths.
A 2018 CDC study revealed that from July 1, 2016, to June 30, 2017, there were 1,106 carfentanil-related deaths in Ohio versus 130 in nine other states.8 The death rate was 9.52 per 100,000 residents versus 0.45 per 100,000 in the other states. Something was definitely happening in the Buckeye State—something that wasn’t happening elsewhere. Numbers were high in Dayton, but they were also high in Cincinnati and Akron, which had to use refrigerated trucks because the city morgue was full.9 Search-and-seizure data from the Ohio Bureau of Criminal Investigation during this period makes it clear that, of the thousands of seizures, very few were of pure carfentanil, an indication that this super-potent drug didn’t need to spread throughout the drug supply to wreak havoc.10
Dennis Cauchon wrote several stories for his Harm Reduction Ohio website arguing that the spike in deaths was directly attributable to the increase of carfentanil found in the drug supply:
In the illegal drug marketplace, the speck-sized potency of carfentanil kills at a magnitude that is multiples beyond fentanyl. The increase is not incremental, it is exponential—just as fentanyl kills at a magnitude beyond heroin, and heroin kills at a magnitude beyond morphine, and morphine at a magnitude beyond opium. The drug war’s relentless pressure on smugglers, sellers, and users to switch from bulky drugs (heroin, morphine, opium) to tiny, compact ones is why carfentanil is used in drug markets. Small drugs are a rational choice for smugglers and dealers.11
He pointed out that the high from fentanyl and carfentanil is not as long-lasting at that from heroin, and therefore its control of the market can’t be because of consumer demand. “Although it may seem counterintuitive, easing up on heroin—by reducing sentences and cutting back on eradication of poppy fields—is the smart ‘supply side’ way to get rid of carfentanil and reduce overdose death,” he writes.12 This is, essentially, “the iron law of prohibition,” a concept attributed to cannabis activist Richard Cowan, which asserts that the more we ramp up law enforcement, the more potent illicit substances will become.13 In his book Chasing the Scream, Johann Hari explains the idea this way: “If no mild intoxicants are available, plenty of people will use a more extreme intoxicant, because it’s better than nothing. Prohibition always narrows the market to the most potent possible substance.”14 The war on drugs has pushed people who use opioids toward more dangerous substances.
Dennis Cauchon writes:
Ask the wrong questions and you get the wrong answers. The objective questions to ask are hinted at in drug seizure data:
1. What exactly is causing sudden overdose deaths? and
2. Why do so many drugs contain deadly contaminants and adulterants? May I suggest a hypothesis: Prohibition kills. Always has, always will. Is doing so right now.15
Using data from the state, Dennis showed how quickly overdoses went down as carfentanil disappeared. State officials attributed the reduction in deaths, in large part, to their public policy reactions.16 Dayton’s mayor asserted that the drop had a lot to do with Governor John Kasich’s expanded Medicaid.17 And Senator Rob Portman helped push for the STOP Act, intended to keep carfentanil out of the U.S. mail—but that came almost a year after the spike in overdoses leveled out.18 The Dayton Daily News suggested there was no one reason for the decline, noting that efforts by law enforcement, work to expand access to treatment, programs that have “increased the availability of naloxone,” and even people who use drugs switching to other drugs have helped.19 The overdose spike certainly wasn’t the result of a spike in drug use, which seems to have held steady over time. Data from the Institute for Health Metrics and Evaluation out of the University of Washington suggests that in 1990, 5.33 percent of Americans had some alcohol or drug dependence. In 2016, the number was 5.47 percent.20 That’s only a slight increase over twenty-six years, and the figure itself is not as high as some people might imagine. So what happened to cause so many overdoses?
Sheila Humphrey-Craig is less polite than Dennis Cauchon and others in her assessment. “They didn’t do shit,” she says. “The drug supply got tainted, and then it wasn’t. That’s it.” Activists like Sheila might say that as long as we criminalize use, the drug supply will remain subject to becoming tainted. A spike like this will happen again—and as long as there’s a black market, we won’t see it coming. Ever.
Sheila and I finally leave the McDonald’s, and she takes me on a tour of Dayton. She shows me the West Side and where she used to live, where the treatment centers are, where the exchanges are. As we drive she points out landmarks, neighborhoods, and places where people have died from a drug overdose. Dayton is a beautiful city, but many parts are still recovering from its heavy industrial heyday. At one time NCR and GM employed tens of thousands; today the economy is dependent on health care, education, and the Wright-Patterson Air Force Base.21
“We used to have great tool and die shops all over Dayton. If you wanted anything fabricated … people had stuff set up in their garages. You could find somebody to make a prototype of whatever here in Dayton, Ohio.”
“Yeah.”
“We had a lot of innovations, a lot of inventors, but they’re all gone, they’re all gone. This is where they invented the pop top. You know, cans?”
In some ways, Sheila’s an innovator, an inventor, trying to figure out ways to meet community needs, to meet people where they’re at. Today, though, she’s frustrated by those she feels are slow to join her, to advance harm-reduction policies in her community. She looks at new construction and new businesses and sees panhandlers being run off. As we go through one neighborhood, she says, “See, this is all gentrification here. This is all crap. And then they put in these hipster doofus things.”
We drive through a warehouse district. Sheila points to one building that used to host punk shows back in the day when she was a punk rocker with a shaved head.
“Well, they’re all cleaned up now, but that used to be a big punk warehouse. We’d have shows there, and … you could rent a space for fifty bucks a month. We used to put on all kinds of shows. We brought in the U.K. Subs and Broken Bones, all those. NOFX. Dead Kennedys. They all played Dayton. Dayton was a fucking cool town at one time.”
Today Sheila is a full-on harm-reduction activist. She tells me that during the time when carfentanil first came through, her son was using. His girlfriend overdosed, but he had naloxone; then he overdosed, but someone near him had naloxone. “That’s why I always have it,” she says, but adds, “You don’t really know, you can’t, if it’s carfentanil unless you can test some way. Otherwise, it’s just a guess. And that’s the rub. Given the ways opioids are being sold these days, it’s a real crapshoot. It’s like the Wild Wild West. You know there is nothing uniform about it. Where one goes down, another one pops up and takes their place.”
But then, she says, it disappeared. “It disappeared just as mysteriously as it came to town. It’s gone. Okay. Who had control over that? Nobody. No public official had control over that.”
There had to be another way to deal with a tainted drug supply. When she learned about testing strips, she was sold. And now she has learned about safe injection sites (also called safe consumption sites)—it’s now her mission to educate others about them. This summer, she plans on driving around the state with a mock safe injection site to demonstrate to a skeptical public how they work. Sheila is not interested in waiting, or in joining committees, or in taking part in trials and feasibility studies.
“I’m not going to sit here and waste my time and try to convince people that don’t want to see. How can you reason with the unreasonable? You can’t. So you have to take matters into your own hands, and go around them. That’s what I do, I go around them. Yeah. I don’t give a damn anymore.”