By Rose Hoban
In Greensboro this week, friends and loved ones of some of those who’ve died gathered to remember and grieve. And then to organize.
On Monday night, the pews of College Park Baptist Church were about half full of mourners, masked and some distanced from one another, but at least together. At the base of the altar was an arrangement of candles, flowers and a red syringe disposal box. Around the room were scattered signboards in the shape of tombstones with handwritten lettering, some reading:
- Rob Card Dad, Artist, Brother 1-22-19 48 forever
- “Papa Lee” My best friend EVER
- William Burns, Forever 41
- Kaitlyn Drake, Daughter, Sister, Best friend to everyone, Miss you forever. 1/7/1996-7/29/20
All died of opioid overdoses.
In addition to almost 640,000 deaths from COVID-19 to mourn, the epidemic of opioid overdose has continued, largely out of sight, with at least 94,000 Americans lost during 2020 alone.
The state Department of Health and Human Services counts at least 2,322 opioid deaths in North Carolina during 2020. The Centers for Disease Control and Prevention estimates that because of undercounting, it’s more likely that at least 3,164 people in North Carolina died from overdose during the year.
It’s a sharp uptick from the prior two years when the number of deaths had started to drift downward.
“Tonight, we give our loved ones the recognition and homegoing many were denied,” intoned Erica Poellot, a guest from Judson Memorial Church in New York City where she works as an outreach minister to substance-using communities there. “We give ourselves space together to mourn, to connect and to vision a way forward.”
“People who use drugs, people who do sex work, harm reductionists are beloved and cherished by all that is sacred and divine,” Poellot prayed, who used substances in the past. “Ours is a wisdom born of surviving.”
Poellot was invited by leaders from the North Carolina Survivors Union, an organization with deep ties to College Park Baptist. The organization runs a nearby syringe exchange which operates out of College Park on Wednesday afternoons and provides counseling, support and, at times, naloxone rescue services for those who use opioids and other street drugs. Most of the people working with NC Survivors Union are correct or former substance users, many now use medication-assisted treatment.
“A lot of people, our young people, and they don’t know the power of service, and ritual,” said Louise Vincent, head of the NC Survivors Union. “They were hurting, and they just didn’t have the money or services or they were embarrassed, you know, families that are embarrassed. So we said, you know, they deserve a service.”
Resource: North Carolina syringe exchange programs
In contrast to the solemnity of Monday evening, on Tuesday night many of the same people struck a more strident tone, as they talked through where the harm reduction movement goes now and strategized their way forward.
“This day is about demanding more,” Vincent told Tuesday’s crowd of about 75 gathered under a tent in College Park Baptist’s parking lot. “And saying we can’t have this amount of people dying of drug overdose. We’ve lost so many people and I see so many people I love standing here today and I don’t want to lose any more of you.”
The theme for this year’s opioid awareness event was “beyond naloxone.” Vincent explained that the opioid overdose reversal drug is an important tool to keep people alive, but simply having naloxone in widespread circulation is not enough.
“You do come next to death,” with naloxone, she said, noting that she required revival for overdose when she was still a user. “People that have been naloxoned a bunch of times are not the same people, right? I mean, they lack oxygen, [they have] brain trauma, all sorts of stuff.”
Resource: North Carolina’s Opioid Action Plan
Vincent’s goal is to build increased acceptance and use for medication-assisted treatment (MAT) which uses pharmaceuticals such as buprenorphine, to tamp down drug cravings and allow substance users to get into treatment and back to their lives.
Only about 1,500 health care providers in North Carolina have gone through training to be able to prescribe buprenorphine, and federal rules limit the number of people each provider is permitted to prescribe the drug to. Meanwhile, a 2019 DHHS analysis estimated that at least 332,464 North Carolinians are misusing opioids.
“We’ve got methadone, but why are we not using it in ways that are useful?,” Vincent asked. She explained that for a substance user to get access to methadone, they have to visit a clinic daily for months, sometimes years, before they might be able to take a dose home. The restrictions of methadone treatment, considered the gold standard, become barriers.
Instead, many people remain on street drugs that have been cut with contaminants by dealers who look to stretch the drugs they sell.
So, harm reduction becomes necessary until people are ready and able to seek treatment.
“When we prioritize harm reduction we put saving lives first,” said author Maia Szalavitz, who spoke to the crowd. “We understand that whether the risk people are taking is injecting heroin or socializing during COVID, people will rarely instantly stop or avoid risk entirely. So we need to provide practical ways for people to protect themselves.
“We measure our effectiveness only by determining whether our efforts help people survive and thrive.”
Other speakers from local and state agencies advocated for more cooperation with emergency services, more access to therapy, health care and social services for substance users and improving the state’s Good Samaritan law. A DHHS official talked about the state’s strategic plan to reduce overdoses.
Building trust with a machine
This year, the Survivors Union got help in their efforts from an unlikely source, Nan Goldin, a documentary photographer who spent years capturing the downtown New York City rock and punk scenes during the tumultuous 70s and 80s.
“I was using drugs since I was a teenager,” Goldin told the crowd. “I was on and off opioids, or whatever, all kinds of drugs for 50 years. And a few years ago, I overdosed like most of you, or many of you have on fentanyl. And I went to a clinic and I was so fortunate to go to a clinic that believes in evidence-based treatment.”
She’s now on medication-assisted treatment, taking Subutex, a prescription form of buprenorphine, that’s one of the cornerstone drugs for MAT patients. She found out about the North Carolina Survivors Union through her New York connections, such as Poellot, who have been networking with other harm reduction activists around the country.
“I want to say that all those years, I was alone in my drug use. I wish I’d known all of you. I wish I’d had this community that is so empowering. And it’s doing so much good. And is keeping each other alive,” she said. “All we have is each other.”
Goldin, whose photographs can sell for thousands of dollars, donated some of her proceeds to purchase a Fourier-Transform Infrared Spectrometer (FT-IR), a type of portable mass spectrometer that can be used to test street drugs for contaminants often used to stretch the supply. The $35,000 machine will remain at the syringe exchange program in College Park Baptist’s basement, where local users can bring in their drugs to get tested to see if they’ve got dangerous additives in them.
UNC Chapel Hill injury prevention researcher Nab Dasgupta said that his program has been able to train members of the NC Survivors Union to use the FT-IR machine themselves, “which has been an incredibly cool process of citizen science.”
It’s more than just research.
“What we’ve learned here in Greensboro this past year is that drug checking is about empowering,” Dasgupta told Tuesday’s crowd. “It’s about helping people make better choices about their bodies with timely information. We can’t wait for people to die of an overdose and get autopsy results.”
He described that the technology is being used, for example, at music festivals throughout Europe, Australia and Canada.
“Research has shown that many will throw away drugs if they don’t contain what they expect,” he said.
The research also shows that users are more likely to seek treatment if they’re involved with harm reduction activities.
“Drug checking is also an essential public health response to a treacherous drug supply to an unrelenting increase in overdose deaths,” he said. “Finally, thanks to Nan we have it here in North Carolina.”
Then the crowd raised their hands to christen the FT-IR machine “Nan,” after Goldin.
“I’m so proud of it,” said Goldin to applause and laughter. “I love the idea that you’ll be like, ‘Where’s Nan? Bring Nan over here, we need to use Nan.’”