Gordon Casey meets me at my hotel in downtown Vancouver, Canada, and we walk over to the Downtown Eastside together, along West Pender Street, cutting across Victory Square. Across the square, actually a tiny triangular park that slopes down toward Hastings Street, is the Victory Square Cenotaph, a monument to the 59,544 Canadians who died in World War I. Facing Hastings Street, the granite pillar reads: “Their name liveth for evermore.” Facing Hamilton: “Is it nothing to you.” Facing Pender: “All ye that pass by.”
The park is quiet, still. It’s a sunny day. A few people are asleep on benches.
“I wonder if we’ll put up memorials to all the overdose victims, if we’ll recognize this as the health disaster that it is one day?” Gordon asks aloud. He points out that the number of dead honored by the cenotaph is far fewer than the over seventy thousand Americans who died of a drug overdose in 2017.1
“I wonder,” I mutter, “for the drug war.”
We walk across to West Hastings and after a few blocks, after we pass a mural in honor of the Ohio-raised activist-poet Bud Osborn, Gordon stops by a man leaning over in the middle of the sidewalk. He asks the man if he’s okay, gives him a little nudge, and sees that he’s still breathing.
“I always like to check to make sure people are okay.” But he also says he’s careful to give people their space and respect.
This community of about eighteen thousand people is one of the poorest not only in Vancouver but in urban Canada in general.2 Over the years, the Downtown Eastside has become a nexus for all kinds of harm-reduction interventions, with multiple methadone clinics, a bank for the unhoused and people who use drugs, clinics offering heroin-assisted treatment, a community center for women and indigenous people, and the headquarters for Vancouver Area Network of Drug Users (VANDU), a community center with couches and a chill-out room. With its SRO housing, the neighborhood attracts people who are poor and who use drugs. In some ways, the community is a safe space for them, a place where they can live without judgment and have access to resources.
For my first visit to the Downtown Eastside, Gordon hands me off to Gerald “Spike” Peachey, who’ll be my community guide. Today happens to be “cheque day,” and as Spike says wryly, “Everyone’s a millionaire today!” Combine that with the dry weather, and the sidewalks for several blocks are packed with people using drugs or leaning over, those on stimulants shaking a bit. It is, at first glance, overwhelming. Spike walks quickly, and I struggle to keep up with him and pay attention to the world around me. He takes me from one safe consumption site or overdose prevention site to the next. On one alley he points out an outdoor space for people who smoke their drugs to hang out.
Spike has a mustache and long, straight black hair, topped by a black ball cap. His face is long, animated—he reminds me of Frank Zappa, thin and quirky and brilliant. As he shuffles up the sidewalk, he greets everyone he recognizes admonishing, “Stay safe!” And when there’s a lull in our conversation he says, “We don’t have an overdose crisis. We have a stigma crisis.” He repeats this phrase several times throughout the day. He’s wearing gray slacks and a button-down like he’s fighting that stigma as hard as possible.
“Once you’re labeled poor or drug seeking, you get treated like shit,” he says. “We’re not human, we’re just drug users.” He is more than one thing, he says.
His life has been complicated. Spike was hit by a distracted driver on September 5, 2007, and spent ten months in a hospital suffering from numerous fractures including to his back and skull. The pain was intense and debilitating. He was on oxycodone and methadone for two years and then was cut off and went to the streets and did whatever he could to support his habit. Now he runs an anti-stigma campaign in his community, which includes taking nurses, doctors, and journalists like me around, and he also works at Brave Technology Coop as an outreach specialist. In 2018, he received the Nursing Excellence Award from Nurses and Nurse Practitioners of British Columbia.3 Spike is more than one thing, more than one life, more than one experience.
The current overdose crisis in Vancouver is really the second one in the city’s history. The first was in the 1990s. At the time, a drug users union formed in response to the rising number of deaths, especially in the Downtown Eastside neighborhood. The union members organized and protested publicly, in ways that no one expected drug users to do. They planted a thousand white crosses in Vancouver’s Oppenheimer Park, disrupted city council meetings, and started underground safe injection sites. As journalist Travis Lupick describes in his thorough and important chronicle of the VANDU, published in 2017, the people who risked so much to make these things happen are little known outside of certain circles.4 When Lupick visits Ohio, he has trouble finding anyone who knows who Bud Osborn was—he was an activist, the poet laureate of his Vancouver community, and a key advocate for a safe injection site. Born in Battle Creek, Michigan, but raised in Toledo, Ohio, Osborn wrote of and for his community in his poem “1000 Crosses in Oppenheimer Park”:
Our purpose is to live in community
and community is care
care for one another
care for those least able to care for themselves
care for all
care in action
and there is no one to care
if you do not care5
Eventually, in 2003, the city’s underground safe consumption sites became Insite, North America’s first safe, legal injection site, a place where, as of writing, no one has ever died of an overdose.6 That’s saying something, given that in 2018 alone there were 189,837 visits to Insite by 5,436 individuals.7 People bring their own drugs—the site has an exemption from the government—and inject while being monitored by nurses with naloxone and oxygen at the ready. Insite can also be a gateway to treatment if people are interested: there’s a withdrawal management and treatment program above the facility.
But since fentanyl and its analogs arrived in 2016, the overdose rate in Vancouver has shot up over 80 percent and there has been an even more urgent need to figure out ways to keep people alive.8 Once again, activists responded by setting up their own emergency facilities, calling them overdose prevention sites (OPSs), in places where people who use drugs frequent. Even in a country with universal health care, it took activists to launch this public health response. One person I spoke with referred to them as “death prevention sites” or “lifeguard stations.” Now there’s a network of at least seven OPSs in the Downtown Eastside and over forty in British Columbia. These low-barrier sites, run mostly by people who use drugs and their allies, offer a quiet, dry space off the streets for drug use with naloxone at the ready. Most sites are for intravenous drug users, but there are also sites for people who smoke. Since December 2016, according to the Portland Hotel Society, “OPS have facilitated over 130,000 visits and reversed over 1,000 overdose events, without a single fatality.”9
After Spike takes me to visit the lobby of Insite, which feels a bit like a doctor’s office waiting room, we move on to the Molson Overdose Prevention Site (MOPS), run by the Portland Hotel Society, the same nonprofit that runs Insite. Molson is set up in an old corner bank; along the walls are eight metal tables below a gorgeous vaulted ceiling. It’s less medicalized than Insite, and with its white walls and wood floors reminds me of a yoga studio. Doug Dees, who works here, says that MOPS relies on the expertise of people who use drugs, who better understand overdose than “any Joe Blow, white middle class, white bread, is gonna have.” MOPS’s status here is temporary, though, he says. Its three-year exemption ends this year—but the problem of overdose persists. Dees says that will just send people back to the alleys and the back rooms, and more will die. He asserts that OPSs keep the proverbial bathtub from overflowing.
The real problem is that there is no safe supply—it’s a refrain I heard time and again in Vancouver. As long as there’s prohibition, there will be no control over what enters the drug supply. Nothing is regulated. People who use drugs are at the whims of the market and of drug dealers who are not chemists by trade. Dennis Cauchon’s research on carfentanil in Ohio underscores this point about the iron law of prohibition.
As Doug and I talk in the alley outside MOPS, a steady stream goes in and out of the site. Young people. Old people. People who are homeless. People who are housed.
“Does it ever get to you?” I ask.
“Of course it does. My mom passed away in 2016 and my dad passed away in January. And I’m finally able to grieve, but I don’t know how to grieve anymore because I’ve lost so many people over the years.”
He says that in the past sixteen years of doing this work, he has lost at least two hundred people, people he knew and loved and respected. The juxtapositions of his life haunt him as well—the people suffering through cold winters standing in doorways waiting for a warm space to open up. Just knowing that people he cared about were suffering. “I would go home and feel guilty ’cause I had my fuzzy blankie with an adult beverage,” he says.
Spike jumps in and says we have to keep moving—there are still many places to go. So we move. To VANDU’s headquarters, to Brave’s headquarters, to another OPS. After a couple of hours he asks, “Are you hungry?”
I am. I’m also tired and need a minute to sit and process all I’ve seen and heard. So we stop at a diner called Save on Meats and belly up to the counter.
As soon as we sit down, Spike asks, “Have you been trained to use naloxone?”
I have, but not with the intramuscular kit he has—it’s all needles and vials and intimidating to an amateur like me. I’ve been trained with a nasal spray (Narcan) that reminds me of the allergy medicine Flonase I have to take in the spring. Spike walks me through the steps. A few people in a booth behind us stare as he pulls out the needle and one vial. Spike ignores them, rushing through the steps two times, and then asking me if I have any questions. Over the sound system in the background, Dolly Parton’s voice croons, “I can see the light of a clear blue morning.”
I’m about to ask him to go over the part where you pull the drug up from the vial when Spike says, “I need to go get my medicine. I’ll be back in about fifteen minutes.”
He dashes out as Dolly sings, “Everything’s going to be all right. / It’s gonna be okay,” and I watch as he heads across the street to Providence Health Care’s Crosstown Clinic, which claims to be the only clinic in North America that provides prescription diacetylmorphine, a.k.a. heroin, as part of a heroin-assisted treatment (HAT) program.10 One of the doctors there, Dr. Scott MacDonald, explained to me later that the Swiss have been doing this since 1994. Now, he says, the United States and Canada are in the midst of a health emergency, and yet, even after multiple randomized control studies have proven that HAT is safe and effective and certainly cost-effective, Crosstown is still the only place offering it. Select patients come in every day for injections under the supervision of medical professionals. In Canada, some clinics are now offering the opioid hydromorphone (Dilaudid) for a similar treatment, but Crosstown is the only clinic offering prescription diacetylmorphine, the real deal. Decades of research from Europe and Canada suggest that it works for people who do not respond to methadone or buprenorphine. Dr. MacDonald says that research also shows that HAT is associated with reduced mortality, property damage, and violent crime, and reduces taxpayer burdens. His patients’ lives are stabilized because they are no longer out seeking illicit drugs. There should be widespread support for this treatment, he says. And yet there isn’t—even amid a crisis.
There are only two hundred people in the Crosstown HAT program. Spike counts himself among that lucky few and has come to Crosstown up to three times a day for his dose for the past eight years.11 It’s the only treatment that has really worked for him, he says, and he believes it has saved his life by giving him access to a regular and safe supply. He is now able to work part-time and is no longer, in his words, “wheelin’, dealin’, and stealin’.” Research bears this out. In the first study at Crosstown, conducted from 2005 to 2008 and published in The New England Journal of Medicine in 2009, researchers from the University of British Columbia found that HAT was superior to methadone.12 With HAT, Dr. MacDonald explained to me, “you have better attention and care, and it reduced illicit drug use and accessing of the illicit opioids.”
That’s just it—HAT gets people in the door, people like Spike, who says that he hadn’t had regular access to health care for years until he started at Crosstown.13 Now he does. And, Dr. MacDonald points out, no one in the program has died from an illicit drug overdose. Some people use less and less heroin or transition to oral treatments, or to methadone. And some stop using altogether.14
It’s difficult to move public opinion on something like this, but Dr. MacDonald is hopeful and sees HAT as key to the larger project of harm reduction. “It is an incremental step towards safe supply and decriminalization or regulation of opioids and substances,” he says. “There’s no risk to the public. There’s no drug that’s being diverted.” Besides, it is so much cheaper to provide HAT than to deal with the social costs—from incarceration to emergency services to theft—that can be connected to the use of illicit opioids.
When I talk about HAT with people back home in Ohio, some are shocked and others feel sorry for folks who must go to a clinic to get medicine three times a day. But the alternative? For someone like Spike, it could be a whole lot worse. Spike says this treatment has saved his life and I believe him. In and around the Downtown Eastside there are many IV drug users injecting illicit fentanyl. There are people overdosing and dying. Spike circumvents those hazards by safely injecting a pharmaceutical-grade drug.
When Spike returns to the diner from getting his medicine, our food is ready. I devour a cheeseburger, and he polishes off a plate of fries and a milkshake. We talk about fast food, the weather, about his plans for doing more tours around the community as a way to fight stigma.
Then he says, “You ready to go? There’s more to see.”
Coco Culbertson, senior manager of programs at the Portland Hotel Society, reminded me that none of the harm-reduction programs established in Downtown Eastside came without a fight. “Activists in this community twenty years ago,” she says, “dragged [those in power] kicking and screaming, and publicly shamed people in order to get anything done.” It took years of educating voters and citizens and implementing programs without permission. It took activists willing to risk their freedom in order to protect the ones they loved.
I will admit that when I first walked into an OPS, I felt uncomfortable (all those needles and all that blood). But then when I took a deep breath and observed what was actually happening—people working together, wiping seats down with disinfectant, distributing sterile syringes, looking out for one another, helping one another—I realized I was looking at an empowered community.
Few people are more responsible for fostering this empowered community than the folks who helped organize VANDU, like Bud Osborn, Dean Wilson, and Ann Livingston. Ann, in particular, is sort of a grande dame of activism in this neighborhood. After some back and forth, she meets me in the lobby of the swank Parq Hotel and Casino. She’s helping check in people from the Canadian Association of People Who Use Drugs (CAPUD) who are attending a conference organized by the British Columbia Centre on Substance Use.15 The juxtapositions are uncanny—the gorgeous lobby with a waist-high glass table in the center covered in fresh cut flowers and Livingston, sitting in a high-back chair in jeans and a dark blue polo, a large bag of naloxone in front of her, and a pile of papers in her hand.
“Well, we’re going to have users here, so I just want to make sure everyone’s safe. Do you need some?” she asks.
“No, Spike gave me some already,” I tell her.
“Oh, Spike’s good!”
And then a group walks in, lots of jeans and leather jackets, one woman in a camo crop top. A knowing smile comes across Ann’s face. She shouts, “Here are the drug users!”
They all turn and walk over to her—lots of hugs and hellos. She tells me that these are some of the folks from the drug users union who have come to speak at the conference and, more important, to hold people accountable and to have their seats at the table. In many ways, they do have a seat at the table.
Right now, though, they are struggling with the overdose deaths. CAPUD is arguing for a safe supply—for better access to heroin and not fentanyl.16 It will be another struggle, but it is a struggle Ann seems ready to support. In a concept document published in February 2019, CAPUD writes, “In the midst of the worst overdose epidemic in Canada’s history, 11 people are dying every day. Most of the deaths are related to the rise of fentanyl and its analogues adulterating the illicit drug market.”17 This is a human rights crisis, the writers argue, precipitated by a drug policy that dehumanizes people, and a regulated drug supply would help to address this. In my own “baptized in Just Say No” mind, this document, this idea, seems at first beyond radical. And yet, there is overwhelming evidence to support it, not the least of which is Spike and his vibrant and beautiful life.
Ann Livingston has the social and cultural capital to help the safe supply effort—she has the look of a somewhat-crunchy baby boomer, is kind almost to a fault, and is the smartest person in the room. She’s also absolutely funny. When she’s checking people in to make sure they have a room in the hotel, she carries on a running conversation with me about her own work as a community organizer, and how to do that work with a stigmatized group like people who use drugs. She says she learned a lot from Chicago-based activist John L. McKnight’s idea of asset-based community development, building on a group’s available skills and potential.18 One second she’s talking theory, and the next she’s cross-checking her own list of attendees with the hotel’s list. She’s trying to read the names and, exasperated, says, “What the hell happened to twelve-point font!”
Then she catches herself, takes a deep breath, and gazes across the hotel lobby as two tall and pouty blond women in heels—one carrying a toy dog—flounce by. She chuckles, self-aware enough to see the humor in this scene, two worlds colliding.
People who use drugs are rarely given the space to organize and to build fellowship—when they do so, it disrupts so many middle-class assumptions. The challenge that the Newark Think Tank on Poverty faces—to open up a space and to admit anyone into it—is similar. Ann says she learned early to try to do some basic things: Keep out of the way. Have something for everyone who shows up (VANDU offered five dollars and a snack). Meet on Saturdays. Listen to their words and then use them. Be observant and take notes. (Use big paper so people can see what you’re doing and can correct you). And always start by asking: What do you think a drug user group could accomplish?19
“And then you have to ask, ‘What are the issues?’ and then it’s just a tsunami,” she says. She pauses, then says, as if to reiterate, “So you have to listen, and the facilitator should have a strong middle-class sense of ‘No one should take that shit!’ Then you discuss and figure out a solution, and then you act.”
Two days later, in a packed conference room at the same hotel, Judy Darcy, a member of British Columbia’s legislature and the province’s first-ever minister for mental health and addiction, is giving an opening address to over six hundred conference attendees. She’s talking about the government’s role in addressing the overdose crisis.
A tall man with a shock of white hair stands up and shouts, “It’s not good enough, Minister.”
Darcy gets quiet.
The man continues, “This is an emergency health situation without an emergency health response. Please to the government—stop gaslighting us. Meet with drug users. Give us a proper seat at the table. This is not working. It’s feeling so grim right now. We met with you last year, and one of the people in that meeting is now dead … We are not on an emergency response footing. We are on a status quo footing. And I beg you to please change that.”
Lots of applause.
The man is Garth Mullins, a journalist and activist from Vancouver. Crackdown, the groundbreaking podcast he hosts, centers on the experiences of people who use drugs as correspondents from the front lines of a war.20 It considers them the most important people in this crisis, and they are also the ones doing the reporting. The podcast also centers on a healthy dose of righteous, justified anger. Anger may not always win you friends, and sometimes it will not help build alliances, but the reality is that sometimes anger comes from a place of truth. I’d heard Garth speak the day before about lukewarm government responses, about the civil disobedience of people trying to save lives. “Any attempt to address this must start with smashing white supremacy,” he said. Colonization, racism, and overdose are wrapped up together. These things are, and should be, anger provoking.
As I listened to Garth, my mind turned to Ohio, where people are dying from unintentional drug overdoses, from languishing in prisons and jails, from the repercussions of being incarcerated, from living in a country that pays lip service to care. All of these things can be fixed. Sometimes anger is justified. And in Canada, it seemed to me, some people are angry. Which is an appropriate response. But it’s not a response I’ve seen often enough in the United States.
After witnessing Garth Mullins speak out so eloquently and with such force, I texted my wife: “37 million people live in Canada. 4k overdose deaths in 2017. 12 million people in Ohio. 5,111 overdose deaths in 2017. Why are we not freaking out?”
She responds: “Because we don’t believe in the social contract anymore.” A few minutes pass and she texts again: “I’m not sure what that means, but it sounds smart.”
She’s right, though. As European Enlightenment thinkers John Locke, Jean-Jacques Rousseau, and Hugo Grotius described it, the theory of the social contract says that we give up some of our individual freedoms in order to be protected by a government that is, essentially, us. But we’re not protecting each other anymore—if we ever have. There are certainly outliers—this book is full of them—but until we all recognize the crisis we’re in, we’re putting Band-Aids on a bullet wound. And as Bruce Alexander, Lisa Roberts, and Spike Peachey explain, the problem is not the overdoses, it’s dislocation.
When I moved about the Downtown Eastside neighborhood with Spike, he always introduced me as “Jack from Ohio,” and some of the people I met would express genuine concern and sorrow for what is happening there. Coco Culbertson at the Portland Hotel Society was one of them. She told me that she studied with Bruce Alexander at Simon Fraser University and that his work has had a profound influence on her.
“I do believe that we are psychosocially disconnected,” she said. “You see it everywhere you look.” She called what was happening “this monster” and stumbled over what term to use. She’s said opioid crisis and overdose crisis. “I think I’ve said all the things. I’m sick of all of them, and none of them feel appropriate, to be quite honest. It feels like genocide to me. It feels like structural genocide against a certain population, but I usually say opioid overdose crisis because that’s what it is.”
When I first exchanged emails with Gordon Casey, I was surprised to notice this line of text underneath his name and contact info: “The Brave Technology Coop is situated on unceded xwməθkwəỷəm (Musqueam), Skwxwú7mesh (Squamish), and Səľílwətaʔ/Selilwitulh (Tsleil-Waututh) territory.” It includes a link to a map of the world. You can type your location in and discover whose lands you are currently on. And indeed the Downtown Eastside, where Gordon works, has a large number of indigenous peoples (and across Canada, First Nations people have the highest rate of overdoses).21 This was my first encounter with widespread use of “land recognition”—an acknowledgment and recognition of history, of violence, and of genocide. After attending a few lectures in Vancouver, I learned that it’s considered common courtesy to say that you’re about to speak on lands that are unceded, on lands that are the home to the Musqueam, Squamish, and Salish people.
What would this sound like in the United States? What would we say? How could we acknowledge the brokenness that some of us who are so privileged, like me, simply skirt past on our daily walks? A land recognition acknowledgment is not about guilt or about living in the past. It is about living in a present in which we come to terms with the trauma of the past, acknowledge it, and use that acknowledgment to try to imagine a way forward. I am writing from Ohio. I respectfully acknowledge that I am writing on the lands of the Wyandot, Shawnee, Delaware, and Seneca-Cayuga nations, and the ancestral people who built the Octagon and Great Circle Earthworks. I acknowledge this history. I acknowledge that there is much we do not speak of. I acknowledge that we have work to do.
For all of the harm-reduction efforts I observed there, Vancouver’s Downtown Eastside is no Shangri-la for drug use. It’s clear that there is dislocation, as Bruce Alexander might say. The neighborhood is a tough place, a concentrated pocket of poverty and substance use disorder. And it’s a neighborhood being squeezed by a cutthroat housing market, by—if I’m going to be brave enough to say it (to borrow from Allen Schwartz)—gentrification. On a July 2019 episode of Crackdown, Garth Mullins reported from the Downtown Eastside of the increased police presence there—especially in alleys outside overdose prevention sites—a common response when a neighborhood is being gentrified.22 The juxtapositions are obvious. Across from the Crosstown Clinic is a hipster coffee shop full of people wearing headphones staring at laptops. I could feel it as I sat there drinking a cup of black coffee and taking notes. I stared out the floor-to-ceiling glass window at the corner of Abbot and West Hastings to the clinic, perched on a corner next to a laundry and dry cleaner.
People enter the clinic. They get their medicine. They leave. The world does not end. Then I see Spike coming out of Crosstown. I jump up from my seat and go outside to greet him. He introduces me to his friend, who launches straightaway into a story about a recent health scare. He had a high fever and felt awful. Spike told him they should go to the ER immediately. They had trouble flagging down a cab—no one would stop—until Spike stood out in the street in front of one. Then, when they made it to the hospital, the folks in the ER told them they didn’t have any wheelchairs. Spike’s friend has limited mobility because of multiple sclerosis. It turned out that Spike’s friend had pneumonia and stayed in the hospital for weeks.
“See, this is what I was talking about,” Spike tells me. “We don’t have an overdose crisis. We have a stigma crisis.”
Despite the bad feelings that his story engenders, Spike is in a good mood. He just got his medicine and is delighted that we ran into each other. A guy on a Harley pulls up to the light. “Wow, nice bike!” Spike says. The man on the Harley looks over at Spike, smiles, and says, “Thank you!” And then, almost in the same moment, a group of mostly blond-haired teenage boys and girls with backpacks passes by, and Spike says, “Hello! Get home safe.” They barely look up. One of them sneers. Spike’s face drops.
“You don’t have to sneer!” Spike says to them as they wait for the light to change. “Just say, ‘Have a good day!’”
A stigma crisis is one that prevents people from giving space to people who use drugs, and prevents them from hearing what those people have to say. It also prevents people who use drugs from speaking up, and then those people end up overdosing alone and it starts all over.
In the United States, the struggle for safe injection sites, for harm-reduction practices in general, is heated and challenged by the persistent beating of the drum that demonizes drug users and calls for a ramped-up war on drugs. Over the summer of 2019, in Philadelphia, activists battled in the courts for a safe injection site—and eventually won (the DOJ appealed the decision).23 On Twitter, Charles King, a former ACT UP activist and lawyer, and current CEO of the New York nonprofit Housing Works, tagged a photo of a bus full of activists from the grassroots membership organization Voices of Community Activists & Leaders (VOCAL-NY) heading to Philadelphia to support the struggle there.
Things are coming full circle and a movement is growing—sometimes in the unlikeliest of places. Louise Vincent, the executive director the Urban Survivors Union (see chapter 7), works on an old computer sitting on a ratty desk in a squat, inconspicuous brick building with faded gray shutters on Grove Street near the corner of Glenwood in Greensboro, North Carolina. Shaded by a large oak, the building is across the street from Christ United Methodist Church and down the street from a corner store. The neighborhood is old and lush, close enough to the University of North Carolina–Greensboro and to downtown, as well as a bus line. But there’s nothing fancy about the building. Louise, I suspect, wouldn’t want it any other way. Inside, it looks a bit like a political campaign headquarters: posters with slogans and meeting notes cover the cinder-block walls above comfy couches, and the organization’s red-black-and-yellow logo can be seen on a window.
The Urban Survivors Union—one of the most innovative, stigma-busting, knowledge-spreading activist organizations in the country—is a part of a much larger movement spreading across the United States. This movement is shifting the narrative toward a human rights approach that is most perceptible on the ground. Louise says they began with about three unions and are now at about twenty-four and growing. There are users unions in New York and New England, California and Ohio, offering support and access to health care for members and building a platform to advocate for harm reduction, building a political movement even when it’s dangerous to do so. It’s hard to be a proud drug user, she says, because it’s criminal. “This is absolutely a war, people are traumatized,” she explains. “The systems set up that are supposed to take care of us have abandoned us.” People don’t overdose because of drugs all the time, she says; people overdose because of poverty. She says that the battle lies in helping people see that the social determinants of health have everything to do with what’s happening.
Louise has a master’s degree in public health, so she can draw the connections.24 She had a middle-class childhood but turned to drugs as a young person dealing with bipolar disorder. She says she sold drugs, but that barely kept her afloat; it was really just a way to support her habit. In 2003, she was charged with possession with intent to sell cocaine and was given treatment in lieu of prison—she says she was lucky, that in some ways her privileged background kept her from a worse sentence. And she has seen how bad it can get. In 2013, she lost her daughter to a drug overdose and was in a hit-and-run that led to the loss of her leg. When I first spoke with her two years ago, she was one of the first people I heard say the term human rights in the context of the overdose crisis. After watching states ramp up charges in response to overdose deaths, she helped start Reframe the Blame.
Louise sees such initiatives as a way for some of the most stigmatized people to speak up for themselves. To that end, the board of the Urban Survivors Union is comprised of people who have used drugs—especially recently. She points out that it would make little sense not to engage people who understand and have experienced the fentanyl risk personally.
“And if the government’s not going to regulate, which they’re not, or get involved in any kind of meaningful way,” she adds, “then it’s going to be back to what it always is—drug users taking care of each other.”
“But,” I tell her, “people will say, ‘You can’t trust them. They lie a lot.’”
“Those are drug policy problems.”
“How are those drug policy problems?”
Louise launches into an explanation: “I mean, if I made cigarettes illegal today, the guys on the block are gonna do all kinds of shit for a Newport. We jack the price up, we make it difficult to get, we criminalize it, and we create all this stuff. I mean, it’s very expensive to be a drug user, and then you’re criminalized, and then you can’t get a job, and then you’re disconnected. People do all kinds of fucked-up shit, but drugs don’t make you do that. The most powerful drug I’ve ever used is alcohol. That’s the only drug I’ve ever woke up from, could have possibly done something terrible [while using], and not know why I did it or how I did it. We’ve created a world where we’ve blamed drugs for so much that people would actually think if you took drugs out of it, we’d have some sort of utopia, and we wouldn’t. They’re just a symptom.
“I’m not fighting a war for drug user rights so people can get high. It’s about human rights, it’s about racial justice, it’s about social justice. If we’re not talking about racial justice, we’re not doing our job. If we’re not taking a look at all these things, if we are not deconstructing this shit right now …” She pauses, and then asks, “Then what’s the point?”
For this to be a movement that privileges human rights, she argues, there must be space for the most marginalized: “The entire harm-reduction argument … is really that human life is valuable and all people should be treated with human rights, all people should be treated with dignity and respect, and we don’t ever throw people away.”
Louise points out that we cannot use imprisonment as a way to solve social and economic problems, or to address the lack of adequate health care. Or, as she says more straightforwardly, “Everybody has to shake their shit out and figure out this intersectional response. And once everybody does it, everybody stands their ground, this is my shit, this is your shit, and then we’ll have a movement.” Drug users are the perfect group to do it to because, for many of them, their lives are shaped by the justice system.
On a recent conference call that she organized, Louise cites Angela Davis’s book Freedom Is a Constant Struggle25 and says that the harm-reduction movement should be linked to human rights struggles around the world, that it needs to be linked to other movements for prison reform, for prison abolition. These movements, she says, are questioning the systems perpetuating the overdose crisis. And then, toward the end of the call, someone gives a shout-out to UnHarming Ohio, a nascent movement organizing people who are survivors of the drug war. The group has ten chapters around the state so far, and is working to ensure better access to naloxone. Amanda Kiger-Stoffel, one of the organizers, told me that they are working to end the war on drugs and on drug users. “We have to start naming this monster and naming it for what it is and take it out,” she said, reminding me of Coco Culbertson.
A movement is growing.26 Connections are being made. In the fall of 2019, Louise Vincent of the Urban Survivors Union tells Travis Lupick, writing for Yes! Magazine, “Drug-user unions are going to play a major role in ending this overdose epidemic … We have the knowledge and the tools to do that, we just don’t have the money and the resources. But with sustainable unions across the country, we cannot be ignored any longer.”27 Louise and Jess Tilley of the New England Users Union meet with people with lived experience at a harm-reduction conference in Iowa.28 Weeks later, Louise sounds an alarm: a syringe exchange had been shut down in Charleston, West Virginia, in 2018, and now there was growing cluster of HIV cases.29 Activists from around the region and as far away as New York City show up to pass out harm-reduction supplies. They stand on the steps of the statehouse with signs that read, “We see you West Virginia. Overdose death is a public health failure.”
They are naming the monster.