On a warm Friday morning in early June 2018, several public health professionals sit in a bland white-walled boardroom. The dozen people gathered here constitute the core members of Licking County’s prescription drug overdose task force. The group is discussing new grant funding when one health worker says that what they really need is access to people who use drugs to better collect real-time information and, perhaps, educate them.
Someone suggests a syringe exchange.
“Remember how people responded to naloxone distribution?” someone murmurs.
And then a gentleman speaks up. He’s in his late fifties, has a full head of rumpled gray hair, and wears flat-front Levi’s, a cotton flannel shirt, and white New Balance walking shoes.
“I’m Dennis Cauchon from Harm Reduction Ohio. The time is now. The time for a needle exchange is here. It can get done.”
Dennis explains that from a public health perspective, a syringe services program (SSP) is a no-brainer. SSPs help reduce needlestick injuries (accidental punctures) and the spread of infectious diseases (hep C and HIV).1 They save taxpayers money. SSPs are also a place to build relationships with people who use drugs, to offer health care, to distribute naloxone, and, maybe, to open a door to treatment.2
Dennis, a former USA Today reporter and editor who took a buyout after twenty-seven years of reporting, has joined this meeting for the first time, and he’s prepared. He notes that SSPs, once frowned upon in many parts of the country, are becoming commonplace. He points out that currently Ohio has fourteen that he knows of and will have, he hopes, twenty by the end of the year (as of March 2020, there were programs in twenty-one counties). Recognizing their cost-effectiveness (needles are cheaper than HIV or hep C treatment), the Republican-controlled Ohio legislature approved syringe exchange programs in 2015 as part of the state budget.3 This is important in Licking County, where the number of hepatitis C cases has tripled in the last decade and where HIV cases involving IV drug use are on the rise.4 From 2014 to 2018, there was a 25 percent increase in new HIV cases and a 38.8 percent increase in hep C; from 2015 to 2018, there was also a 20 percent increase in hep B cases.5
“You’re in the sweet spot—not a leader or a follower. You guys would have to be creative, and it would take someone like me sitting down in my suit and tie.” He chuckles.
There’s visible support in the room; there’s also visible concern. When the Licking County Health Department began distributing naloxone as part of a statewide program, the social media backlash was immediate. People accused the health department of enabling drug use.
Dennis agrees that it will be a challenge—to face down the stigma, the moralizing, the suggestions that people who use drugs should just stop. He’s not daunted. It’s not in his nature to be. Dennis is scrappy, persistent, and at times an admittedly annoying bulldog who sinks his teeth into a problem and won’t quit until it’s resolved.
At USA Today, Dennis earned a reputation as a bit of a muckraker. After stints at the Sun Herald (the paper of Biloxi, Mississippi) and the Clarion-Ledger (Jackson, Mississippi), he became a financial reporter for USA Today in Arlington, Virginia. Over time, he went on to cover national affairs, eventually trying his hand at editing.
In the aftermath of the September 11, 2001, terrorist attacks, Dennis’s editor told him to find a story about first responders—to talk with police, firefighters, and EMTs and find out how they were coping. When he arrived in New York City after the four-hour train ride from D.C., every other reporter was looking for the same story. So he did the thing that still gets him into trouble: he found a problem and began poking at it. He was curious about the number of people who died and felt that it was a knowable number. He started calling landlords and found out who the tenants were and how many checked in to their offices on the morning of 9/11. He discovered that the count was around 2,800 (the total was eventually determined to be 2,606).6 The story, which included his count, explored why the numbers weren’t higher, noting that building design and evacuation drills, as well as fate, played a role. It was a story that fit with his beat, which he describes as “interesting stuff you haven’t read elsewhere.” Stories about prisons in Alabama, about hurricanes, about Ted Turner, about elections, about African American church burnings. For almost thirty years. Story after story.
After the buyout, Dennis became an independent local journalist in the tiny college town of Granville, Ohio, just west of Newark. Given his affinity for numbers and slicing through bureaucratic red tape—as well as his investigative chops—he became a bit of a lightning rod in the community. He blogged about making the community safer for walkers, about the need to scrap a proposed plan to drug-test high school students, and about the village fire department moving its headquarters.
“I was doing nothing different,” Dennis says. “They were getting the full monty. Little town gets this investigative reporter.”
One of the hallmarks of a good investigative reporter is that they can sometimes irritate people and court controversy. But Dennis never seems to let it get to him.
His office, in a narrow hallway above a local coffee shop, even looks like a journalist’s. He works at a desk shoved in the corner of a room with half-opened file cabinet drawers, empty coffee cups, and a view of the highway through a window that hasn’t been cleaned in years—there’s an old wasp’s nest stuck between the window glass and the storm window. Old Wi-Fi passwords are tacked to the walls above piles of books and files.
For several years, Dennis sat in this room writing stories for his own blogs and doing freelance work to pay the bills. But as the overdose numbers began to rise in Ohio, Dennis could not help himself.
“To me the greatest social injustice of our generation is the drug war. Half a million drug offenders in prison. The destruction to black neighborhoods. The damage to families is largely due to the drug war.”
He says that, as he heard prosecutors announce that they knew they couldn’t arrest their way out of the overdose crisis in one breath and then try to do just that in the next, he couldn’t keep quiet. He had found a new problem to poke.
Dennis started a blog called Harm Reduction Ohio, which became a nonprofit with the same name advocating for policies that reduce the negative consequences connected to drug use. He also began blogging about the need to actually treat the spike in overdoses as a health crisis rather than a criminal one, and began sharing his stories through social media. He wrote op-eds. He spoke in legislative hearings. He began pestering state crime labs for access to drug seizure data. He discovered that the Ohio Department of Health had failed to submit a form to the U.S. Centers for Disease Control and Prevention that would give the state access to $7.6 million that could be used to support needle exchanges. (The state eventually did submit the form after he wrote a blog post about it.)7 He began applying his reporting skills to his work as an activist, to promoting harm-reduction policies around the state.
For people who use drugs, harm reduction encourages making positive changes: using sterile equipment, encouraging safer use by testing drugs for fentanyl, creating calm spaces for people who are “overamping” from stimulant use.8 It can also simply mean providing housing or a place to hang out during the day for people who are homeless. Harm reduction can also mean evidence-based but controversial things, like safe injection sites, places where people who use drugs can do so in the company of others and mitigate the chances of dying from an accidental overdose. Harm reduction also involves SSPs and community-based distribution of naloxone, an idea pioneered by Dan Bigg and the Chicago Recovery Alliance in the 1990s.9 Bigg thought then that if it was a helpful medicine that was used in hospitals, giving it to people who know the most about drug use and making them the first responders was an even better approach, one that could save even more lives. Research shows he was right—community-based naloxone distribution is one of the most effective tools we have to address the overdose crisis.10
As a way to address substance use disorder, a harm-reduction approach counters the widely accepted wisdom of an abstinence-only approach, noting that addiction is complicated and sometimes it’s best to start where people are.11 Maia Szalavitz writes, “To help people overcome learning problems, they must be treated with compassion and respect. All types of students do better in schools where they feel welcomed and safe … People learn best in environments where they feel connected to others—not places dominated by a sense of threat and fear.”12 Harm reduction, she continues, “allows people to learn new skills and then move away from drugs, rather than attempting to force them to do the reverse.”13 Harm reduction isn’t in opposition to treatment; it could be viewed as a low-level part of a continuum of care that includes outpatient and inpatient treatment. To that end, medication-assisted treatment for addiction is an important part of a good harm-reduction program.
It’s important to keep in mind the broader context of harm reduction. Applied medical anthropologist Lesly-Marie Buer reminds us that harm reduction is political, that it “is a social justice movement that supports the dignity and rights of people who use drugs.” She explains further: “Many harm reduction programs have roots in 1980s activism around HIV, and most of the organizations I have worked with exist thanks to the unrelenting labor of queer activists.”14 (And, I would add, poor people and people of color.) Harm reduction counters neoliberal attitudes toward drug use, she says, as “exemplified by the War on Drugs focus on punishment. Instead of trying to enforce abstinence—viewing individuals as the site of punitive state intervention—these initiatives try to reduce the harms, both medical and social, associated with drug use.” In other words, central to this public health approach is that addiction is a public health issue, not a criminal one.
Dennis decided to see if the county where he lived could support a syringe exchange program—and perhaps provide space for one. Harm Reduction Ohio was started as an advocacy group, but now they’re becoming a service organization as well because in some places they are advocating for something that no other organization is prepared to take on. So in Licking County, the first step was to find a space and resources to start one, and the second was to get the approval of the county board of health (which oversees the department of health). For that, he would need community support.15
In late August, Dennis walks up to a microphone at an Overdose Awareness Day rally in downtown Newark that Trish organizes.16 There’s a good-sized crowd for a hot, humid afternoon. The summer has passed, and there’s still no syringe exchange in Licking County. People are still overdosing.
He begins awkwardly. His hands are shoved into his pockets. And his voice is not coming through the speakers. Someone walks forward to adjust the microphone, moving it closer to his mouth. He’s wearing a long-sleeve light pink Oxford shirt and his walking shoes. He looks uncomfortable, nervous.
“We hear a lot from people about the crisis, but not enough from the addicts themselves,” Dennis says. He explains that if anything is going to change, we need to start listening to people who use drugs. He talks about the disability rights movement and the slogan “nothing about us without us.”
There’s some feedback from the mic.
Dennis picks up speed, saying that users are also people. They are people with families. People with homes and lives and jobs. They are people who also happen to be users. Drug use does not and should not define them. And, he says, we need to support them. We need to promote harm reduction. We need a syringe exchange.
“Go to a needle exchange and meet real users; they are humans, too,” Dennis says.
This is a new role for him—the activist, the public face of a growing movement that is bringing people together from around the community and the state, a movement that doesn’t judge, that is accepting.
Billy McCall has been in treatment since June at a place called The Landing, just east of Newark in Muskingum County. In journals he kept from that time, it’s clear that Billy was in need of nonjudgmental love and acceptance, if not from others, then from himself. He marked off each day, to measure either his sobriety or his stay in treatment. And he describes his choices in black-and-white terms: sobriety or using, life or death. He’s severe at times, criticizing himself, remembering Michelle especially, and feeling guilty that he lived and she did not.
“No amount of guilt,” Billy writes, “can solve the past.” He fills the pages of three wide-ruled composition books, the ones with the stiff black-and-white cardboard covers. On one of them he tapes a photo of his granddaughter. In another, at the back of the book, he writes “I Love U” in permanent marker.
He sketches a timeline of life events—when his house caught fire as a kid, when his mom went to prison, when he first smoked pot, when he was first arrested (for skateboarding), when he dropped out of school, when he first tried heroin. “I would take back the first time I used heroin,” he writes. “I see this as a turning point in my drug use.”
He also writes a letter to “dope,” saying that it loved him when he was “unlovable” and that it brought him joy when he was low. He writes about his love of the ocean, of being by the sea with a girlfriend in San Luis Obispo; with his grandfather in Hyannis Port, where he went to deliver a boat; Destin Beach, where he worked on a painting job for ten days. He thinks of the ocean, imagines the ocean, imagines swimming, and then remembers where he is and what he’s doing.
On the day that Billy gets out of treatment, he attends a public information session and forum about SSPs that Dennis organized at the county library. Billy’s hair is cut short (he donated the ponytail to Locks of Love). He looks like a new man. He tells me he’s ready to help push for a syringe exchange. It’s needed, he says. In a letter Dennis wrote to The Newark Advocate alerting the community of the event, he pointed out that on the ground things seem to be shifting, that a 2017 poll indicated that 50 percent of Ohioans support SSPs and 38 percent oppose them.17 This, he says, is because more and more people are connected to this overdose crisis. “When we know people who’ve died, we don’t see one-dimensional stereotypes,” he explains. “We see fathers and mothers, sons and daughters, friends and co-workers—people who are more than a struggle with drugs.” While SSPs may be cost-effective, he continues, “We [as an organization] care about drug users as people and want to keep them healthy and alive.”
At the event, Dennis is wearing a tie, the first time I have ever seen him wear one. He is hoping the community will support a syringe exchange program—and perhaps provide space for one. He has traveled around the state visiting exchanges. He also knows the rules: that the county board of health must approve the exchange, but that there must be a committed location for the exchange before they can approve it. To do that, he knows he must also have popular support.
Experts, including a professor from The Ohio State University, are given space to present the evidence, but there is also space for people with lived experience. They are front and center. They are also experts. Dylan Stanley has been sober for ninety days. Months ago, she was an active heroin user, and she remembers one morning with intense clarity. She was waiting to buy dope—tired and getting sick as she sat in her car in a parking lot. She saw someone jogging by in the early-morning light. They were healthy, living a “normal life,” she says. And she hated them for it. “When your money is ‘dope tokens,’” she told me later, “life is exhausting.” Tonight, though, Dylan speaks up with confidence and empathy for her present and past selves. Here, in a windowless meeting room at the Licking County Library, decked out in a purple “Overdose Awareness Month” T-shirt, she chokes up. It frustrates her that “the things you do become your identity,” but she says she was and is more than her addiction. She talks about keeping the same needles for months, but then she got access to a needle exchange and it changed her life. “These are people that matter. Just because someone is addicted to drugs does not mean that they don’t matter.” Dylan says she’s here tonight because the harm-reduction community takes her seriously and has empowered her to speak up. It’s a new feeling.
Dylan says that she got where she is today because she had access to an SSP in Columbus, Ohio, called Safe Point. She looks over to Rick Barclay, a program manager from Safe Point, a dark-haired man with a big grin and a can of Jolt Cola. Rick smiles at her in agreement.
Rick is also in recovery and dismisses outright any suggestion that harm reduction is enabling. “We have to meet people where they are,” he says. Some people in the room nod in agreement.
The library kicks everyone out after multiple calls over the intercom asking people to leave. Folks reluctantly exit and stand around outside in the cool of the evening, a hint of the setting sun over West Main Street. Billy is there, and Trish is grinning as she circulates through the crowd. I meet folks from OhioCAN, and Gordon Casey and Oona Krieg, two people from Vancouver, Canada, working on an app to help prevent overdoses. An hour after the event is over people are still talking. Dennis is chatting, engaged. He has found his legs.