Remembering the Patron Saint of Harm Reduction

Where does one begin to describe the loss of a man responsible for saving thousands? The passing of our friend, mentor, and hero, Dan Bigg of the Chicago Recovery Alliance, this past August, was and is a devastating loss for harm reductionist around the world.

Dan who pioneered harm reduction, safe syringe needle exchanges, and naloxone access was the most compassionate, fierce and loving advocate for public health, HIV, and substance use disorder. His empathetic, genuine, servant leadership- a difficult leadership style to pull off and one in which Dan managed so effortlessly- is responsible for the public’s access to the life-saving overdose reversal drug, narcan.

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The impact of his years of advocacy is immeasurable as Dan, who was named Chicagoan of the Year in 2017, trained and advised countless individuals, like myself, to administer naloxone.

I feel deeply honored to have worked with Dan, privileged to have had the opportunity to learn from him, and forever changed by his unique, insightful, and sensible perspective on drug use, harm reduction, and creating positive change.

Last fall I had the pleasure of sitting down with Dan over coffee to interview him for a class project. While my typical interactions with Dan were all business- picking up naloxone and speaking at various events with him- that day I snagged his time to learn about him, the formation of CRA, and what he believed was necessary to change the world’s understanding of HIV and drug use.

During our time together, I scribbled down notes about his work on Native American Reservations, where he first saw harm reduction practiced, how he and a dozen friends noticed a lack of services or organizations that addressed HIV and drug use simultaneously so consequently formed one, and how CRA took a year to define “recovery” as “any positive change”.

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But what I took away most from our meeting was the profound acceptance and compassion for “meeting people where they are at” in recovery as CRA defined it. It is a tid bit of advice I carry with me and strive to apply in all aspect of my life everyday and will continue to do so while carrying on the work Dan dedicated his life to.

Dan’s dedication to harm reduction through compassion is at the core of Wake the Nation’s values.

Over the last month our team assembled 1000 naloxone kits for CRA’s trucks which are strategically stationed throughout the Chicago area. We encourage you to learn more about Dan’s work, the Chicago Recovery Alliance and how you can access naloxone, better yet, we invite you to contact us to become an overdose prevention trainer and carry on the life-saving work Dan made possible.

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Language matters: “Achieving” Sobriety, Defining your Recovery, and Reducing Harm

 

Sobriety is defined as the state of being sober and the definition of sober, is outdated, referring to being unaffected by alcohol. (Interesting, how it only mentions alcohol, right?) Today most people reference being sober in regards to being free from mind altering substances. And truthfully, when you factor caffeine, nicotine, and psychotropic medications in there, most people are not sober. So can we talk about the glorified pedestal we put sobriety on? And maybe take it down a notch?

When people use the phrase “achieving sobriety” they inadvertently imply that not being sober is an act of failure -if that’s the case, the majority of the world is failing at life. Fortunately, that’s not the case. (Sidebar: Psychotropic medications for example have been an effective and beneficial option to those who need them.) Sobriety isn’t something you achieve or fail to accomplish. Yes, if you can do it, be proud, because it’s definitely difficult to do and maintain, especially for those who have had an addiction. However, let’s be sure the language we use doesn’t put others down in the process.

^^This reminds me of the mom politics surrounding childbirth. Women who endure the pain of a non-medicated vaginal delivery are often proud of their pain medication-free delivery method. And to them, I say, “Way to go!” However, it does not make you a better mom than the woman in the room next door with an epidural.

Not having substance use disorder doesn’t make you a better person than someone who does.

All this said, please consider the word “achieve” when you are talking about sobriety.

Further, in a recent conversation with Dan Bigg who is often referred to as the, “Patron Saint of Harm reduction” and the director of the Chicago Recovery Alliance, I found myself reevaluating the word, “recovery” a term he defines as, “any positive change”. This coincides well with the definitions of recovery according to various dictionaries which define it as, “the act, process, duration, or an instance of recovering” and “a return to a normal or healthy condition”. With recovery often being seen as a process, or current state of being, and seeing as most people don’t use it in the past tense claiming to “be recovered” from substance use disorder, perhaps recovery is what we should encourage people towards, instead of sobriety.

You see, sobriety, being looked at with its high and holy zero-tolerance policy, it’s pretty difficult to acquire. As mentioned, most people don’t have it going on. Further, the word has recently evoked controversy among those in recovery over whether those who use medically assisted treatment are able to consider themselves sober. By current definition, which only references alcohol, the answer is yes. And if you are going to use today’s interpretation of the word – free from mind altering substances- well than no one who uses caffeine, nicotine, psychotropic medications, or has an occasional alcoholic beverage is ever always sober.

See the word sober, as it’s defined, carries no real time frame. So I’m not sure when or why we allowed sobriety to be the golden standard of recovery, but I think it’s time we all see recovery as individualized as the people and treatment plans for those with substance use disorder.

Perhaps those with substance use disorder and those impacted by substance use disorder should simply work toward recovery through reducing harm and any positive change.

#DefineYourOwnRecovery

P.S. I’m not done

A follow up to Mr. Vincent’s post on Narcan

People like to poke holes, I get it. I wanted this to be a discussion, so let’s discuss! Below are some comments I’ve seen in response to David Vincent’s status and our letter to him. (note: I used “narcan” and “naloxone” interchangeably. It’s a matter of name brand versus generic)

“Comparing apples to oranges. Cancer is cellular malfunction. Addiction is a mental disorder. Narcan is a once lifesaving measure to revive. Narcan does not cure addiction.”

-So true! That’s said, going back to Mr. Vincent’s post… Narcan is not treatment. Narcan is a life-saving opiate antagonist which reverses the effects of an opioid overdose. Not only is it not a cure, but it does not even treat addiction. Comparing narcan to chemo is not a realistic comparison.

“I was even more surprised to see my old roommate from rehab who’s still using post it. Why the self hate?”

-Good question! We have an idea why. Perhaps it’s because despite the Diagnostic and Statistical Manual of Mental Disorders 5th edition (DSM5), American culture hasn’t caught up with science’s understanding of addiction. This is evident by Mr. Vincent’s status. People with an addiction see posts like that, the comments that follow, and the mass amount of people who devalue their lives. How are people supposed to get help in a society that thinks they are better off dead? Whether Mr. Vincent intend to, he effectively reinforced a negative stigma that prevents PEOPLE from getting healthy.

It’s high past time we acknowledge addiction as a health issue not moral one. It wouldn’t be fair to assume another’s intentions. But I will say reinforcing that stigma could have been avoided. I question why instead of “narcan for addicts” (individual who suffers with a mental health disorder), Mr. Vincent didn’t reference insulin for those who suffer with diabetes. Since neither insulin nor narcan are free, this would have been a fair switch.

“They are giving away narcan at the local methadone clinic in the parking lot”

-Methadone is an opioid. Narcan reverses opioid overdose. (Personally, I think anytime someone is prescribed or being treated with an opioid, they should be taught about the addictive qualities and also be prescribed naloxone.) Also, someone at some point paid for that narcan so it could be given to those who need it.

“point being made is addicts need to be held accountable for their actions ,even when I was using , if I had ever needed it I would expect to be charged for it , I don’t expect anything for myself coming out of someone else’s pockets”

– It is appreciated that you don’t expect anything for yourself to come from someone else’s pocket. However, if it was a matter of your life or death -as is the case when naloxone is needed- know that I would choose your life. Without evening knowing you, from one human to another, I’d pick saving your life. If I had the ability, and the means, such has having a vile of naloxone that I paid for, I’d use it on you. I can’t imagine walking away from you, a human being, knowing I have the power to save your life and just choosing not to.

I don’t think it’s unrealistic to expect a little human decency.

As for responsibility, what should they be held responsible for? Being ill? The cost of narcan provided by the police? The police sign up to protect and serve. The police departments we’ve trained to carry and administer naloxone, also carry defribulators, they don’t charge a fee for that life-saving service. Why should naloxone be any different?

Perhaps this isn’t the case with every department, but maybe it should be. And finally, how often do we attend fundraisers for addiction treatment? Is there a three day walk by some well-known foundation traveling around the country raising money for addiction medicine research? Millions of “other” people’s dollars go into cancer research to find a cure. Can we say the same about a cure for addiction?
“Addiction has def [definitely] affected our lives.. but i don’t necessarily agree with narcan. I feel like it makes addicts [individuals who suffer with a mental health disorder] think they can always be saved…which isn’t the case”

People who are addicted to drugs have and will continue to use drug regardless of if naloxone is available. This is obvious by the amount of people who used before narcan was invented and made accessible and also by the amount of overdoses we see.

“Narcan is not free but my brothers life is worth more than a petty $672.80. I thank God for narcan!”

-Perfectly said. A person’s life is worth it.

A letter to David Vincent

A letter to Mr. David Vincent (and those sharing his post),

I’ve seen your Facebook post, as so many have. I think it’s worth a discussion.
davidvincent

I’ll start by admitting, I’m not sure I understand the placement of the quotation marks in your incredible inaccurate status. Unless it is there to imply sarcasm in regards to the word “free” given narcan is not free.

What makes you think it is free?

Narcan, or naloxone, is $5000 for the auto-inject, $150 for the nasal spray, and $45 for the vile and syringe at Walgreens, last I checked.  It isn’t always covered by insurance, unlike “chemo”. (Again, what’s up with the quotations?) It is made available for “free” by nonprofit organizations like the one I operate, which PAYS for it, and then gives it away because who am I or you or anyone else to judge the value of another person’s life?

Fun fact for you: The auto-inject naloxone was initially on the market for $400, but the price was raised to $5,000 as the demand for it increased. This may sound familiar if you are aware of Mylan’s appalling skyrocketing price of the epi-pen for anaphylaxis. One might argue pharmaceutical manufacturers see people’s lives as a matter of making profit. That said, if you want to have some kind of feelings or opinion about who gets treatment and who doesn’t…take it up with big pharma, start a nonprofit, or dish out the cash for someone else’s treatment. But deciding who gets to live and who gets to die based on YOUR interpretation of a disease – opposed to the definition in the DSM5 – is ignorant. And further, this uneducated “analogy” doesn’t actually help anyone. It does however, say a lot about the quality of individual who wrote it and arguably about those who share it. If the goal of posting it was to benefit cancer patients, it does absolutely nothing of the sort. What it does do, is hinder those who see it, who suffer with an addiction, from getting help. Perhaps helping people with addiction isn’t important to you or those who share it, but is it necessary to put those people down? That’s the only thing your status has accomplished. That and putting down the work of people who fought to change the laws to make narcan accessible.

You want to do something for cancer patients? Then actually do something! You can even call me up and I will gladly help you navigate setting up a 501c3, raise funds, donate my time and money, and hit up Washington as I’ve done for addiction. I’ll do it all without downplaying another health crisis and judging the value of another’s life.

Sincerely,
#wakethenation