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<p>The Southern Harm Reduction and Drug Policy Conference was held in Asheville last week, convening advocates working along the front lines of the opioid epidemic.

By Taylor Sisk

“I’m a preacher that comes from the streets, I’m a preacher that comes from crack cocaine. I’m a preacher that comes from a gun in his hand and a pipe in his other, the Bible sitting on top of them both.”

The speaker was Kenny Glasgow, founder and director of The Ordinary People’s Society in Dothan, Ala., and his audience was those assembled last week in Asheville for the annual Southern Harm Reduction and Drug Policy Conference.

“I’m a preacher that comes from all this here that you stand for,” Glasgow proceeded, in classic preacher-man cadence.

What these frontline harm reduction advocates stand for is heightened awareness and broader acceptance of life-saving avenues. The harm reduction movement focuses not on getting users to quit drugs immediately, but on keeping them alive and as healthy as possible until the day they themselves may decide to quit.

“I’m a preacher that comes from all this here that you stand for,” Kenny Glasgow told attendees of the Southern Harm Reduction and Drug Policy Conference. Photo credit: Taylor Sisk

It’s also about preventing others at risk of contracting sexually transmitted infections, HIV and hepatitis from dying.

The conference – hosted by the North Carolina Harm Reduction Coalition and a dozen or so other organizations from throughout the South – was a blend of education, substantiation, socializing and good old-fashioned praise-the-lord testifying.

It was an opportunity to retool and refuel for work ahead.

The harm reduction community has accomplished quite a bit in the South lately. Legislation is being enacted in North Carolina and elsewhere. Alliances with law enforcement and public health officials are allowing more effective policies to be put into practice.

“We’ve changed so many laws all over the South,” Glasgow reminded his congregation of colleagues, gathering handclaps and a smattering of amens.

“I’m talking about the South,” he said, celebrating the passage of legislation that allows law enforcement officers and EMTs throughout the region to administer the opioid antidote naloxone, saving lives.

[pullquote_right]Like what you read on NC Health News? Help make it possible. Make a donation today. As little as $5/ month will help keep us going![/pullquote_right]Notably, such legislation is in many cases, as in North Carolina, sponsored by conservative politicians from rural areas, which have been especially hard hit in recent years by opioid overdose.

Current trends are shattering the myth that intravenous drug use is practiced predominantly by urban people of color, said longtime harm reduction advocate Dan Bigg.

“These are white people,” Bigg told conference attendees, referencing those who are contracting HIV or are overdosing on prescription painkillers and heroin.

Those in power, he said, are now saying, “‘Oh, my god, this could affect the very fabric of my being, my family.’”

Making connections

Bigg is the founder of the Chicago Recovery Alliance. He started a needle exchange program in 1992 and naloxone distribution in ’96.

HIV deaths were on the rise in the early ’90s, sometimes doubling in a single year in Chicago, Bigg said. He and his colleagues soon recognized that in addition to protecting against infection and overdose, their work enabled them to make connections and build relationships that facilitated addressing other issues.

The Chicago Recovery Alliance has since administered more than 125,000 hepatitis vaccinations.

Dan Bigg, founder of the Chicago Recovery Alliance, says race has played a primary role in broadening awareness of opioid addiction. Photo credit: Taylor Sisk

Meanwhile, in the past few years the use of opioids has been on a precipitous rise in nonurban areas. A Centers for Disease Control and Prevention study released last month found that central Appalachian Kentucky, Tennessee, Virginia and West Virginia experienced a 364 percent increase between 2006 and 2012 in cases of acute hepatitis C infection among 30-year-olds and younger.

Treatment for opioid dependency concurrently increased 21 percent, with 73 percent of those who reported dependency saying injection was their primary means of administering the drugs.

Those affected were primarily non-Hispanic-whites. The rate of infection was more than double in nonurban areas than in urban.

Rural epidemics

Austin, Indiana rests just beyond the periphery of Appalachia, 36 miles north of Louisville.

Austin is experiencing an HIV outbreak, largely attributed to the injection of crushed painkillers, a practice recent studies have shown to be more common in rural areas. The drug of first choice is Opana, which dissolves relatively easy in water.

Some 160 HIV cases have been reported in this town of 4,200 people. Louisville’s Courier-Journal quoted CDC director Thomas Frieden as saying of Austin, “They’ve had more people infected with HIV through injection drug use than in all of New York City last year.”

Frieden said treating those infected will cost some $100 million.

In North Carolina, Wilkes County had the third-highest opioid overdose rate in the country in 2007. A harm reduction initiative called Project Lazarus was subsequently initiated, launching the distribution of naloxone and an education campaign. Between 2009 and 2011, the unintentional-overdose rate in the county dropped from 46.6 per 100,000 residents to 13 per 100,000.

The Project Lazarus model is now in practice in all of North Carolina’s 100 counties.

A ‘watershed moment’

Bigg reiterated in a post-conference interview his theory on why this “quiet epidemic,” as Hillary Clinton has now referred to it, isn’t as quiet as it once was: “Nonurban white people are susceptible. That’s what Indiana is proving.”

The Atlanta Harm Reduction Coalition’s Ronnie Kemp spoke of volunteers coming out to the streets to offer him help. Photo credit: Taylor Sisk

“Can a wise politician risk ignoring the problem?” he asked. “It’s not taking good care of one’s constituents; it’s not taking good care of one’s constituents’ money.”

To those who attended a conference breakout session on lessons from the Austin epidemic, Bigg underscored the urgency of taking full advantage of what he termed a “watershed moment” in harm reduction advocacy.

People from a range of disciplines with varying primary concerns are coming together to save lives like never before, he said. The expertise of street-level advocates, many of whom know from first-hand experience what’s most needed, is essential to moving forward.

Ronnie Kemp attended the conference in his capacity as a volunteer with the Atlanta Harm Reduction Coalition and a former user. He talked of those who had helped him, coming “into the dope trap” to reach out, to ask what he needed, to converse, “meeting me where I was at” and not lecturing him on where he should be headed.

Much more of that is required, Kemp said, and it must be done with limited resources.

“In the South, when we do harm reduction and drug-policy reform, we’re mostly doing it from the heart,” Robert Childs, the North Carolina Harm Reduction Coalition’s executive director, said. “We’re doing it because we’re directly impacted.”

“Every time we get depressed, we need to give ourselves a hand,” Glasgow said, elevating yet again an already amped assembly.

“Every time we get frustrated with our work,” he offered, “look back at what we’ve done, and say, ‘Guess what? We did it in North Carolina, we did it in South Carolina, we did it in Alabama – we did it in Red states.’”

N.C. Harm Reduction Coalition advocacy and communications coordinator Tessie Castillo emphasized that advocates here in the South are breaking new ground.

“I think the South is following the rest of the country in terms of passing similar overdose-prevention legislation, but one major difference is law enforcement involvement,” Castillo said.

“Southerners are recognizing law enforcement as a necessary ally.”

Alliance’s are built; more lives are saved.

“We’ve got some hope,” Kemp said. “We’re going to help each other. And we’re going to work this thing out.”

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