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Why Tennessee Lacks a Harm Reduction Infrastructure

Here in Tennessee, we ain’t got shit in the way of harm reduction. We’ve got six syringe services programs (SSP). And other than the often-exclusionary 12-step programs, the outdated rehabs, and the entirely-bullshit drug courts, probation, and parole programs, that’s about it.

But why? Why is Tennessee — and much of the South, particularly the rural South, by extension — so ass-backwards when it comes to harm reduction or drug policy? Why don’t we have what New York, California, or Washington has?

Is it because we’re evil?

Maybe because we hate “druggies” like me, the stereotypical behavior of which I’ve exemplified hundreds of times?

Or is it for other, more practical reasons?

The “Radical” Nature of Modern American Harm Reduction

Person holding three used syringes giving them to somebody with an open hand.
Syringe exchange in action in Burlington, Vermont. (Robert Nickelsberg/Getty Images)

Things like syringe exchanges, widespread drug-checking, supervised consumption sites, and access to a safe drug supply have long been viewed as “radical.” Of course, I don’t think they’re radical, nor do anybody else who considers themselves a “harm reductionist.”

However, the majority of Americans, especially Republicans and other right-leaning people, definitely do consider some or all of these things “radical,” even though two-thirds of Americans don’t support the criminalization of now-illicit drug possession and only one-tenth believe the War on Drugs is a success.

Areas that are more left-leaning than Tennessee have been more open to things like harm reduction-positive ideas, practices, and policies. These ideas have traditionally been a left-leaning thing — that’s the simplest way I can put it.

Politicians, Stakeholders, and Other Decision-Makers Have Pushed for Ineffective Approaches

Second, not only have right-leaning politicians and stakeholders failed to support effective strategies for dealing with drugs, they’ve actively campaigned for ineffective, largely-prevention-based strategies that actively hurt drug users like me.

Here in Tennessee, prevention coalitions are quite popular. According to the Tennessee Department of Mental Health & Substance Abuse Services’ “Substance Abuse Prevention Coalition Provider Contact List” — god damn what a mouthful! — there are 46 local prevention coalitions across the state, plus two statewide outfits.

We’ve got Prescription Drug Take Back Day, which raises awareness for dozens of secure prescription drug disposal bins around the Volunteer State, though they don’t accept syringes. This leads injection drug users like me to improperly dispose of syringes, sometimes throwing them on the roadside out of fear of being caught with them and catching criminal charges, having friends or family discover their injection drug use habit, or incur a work-related issue.

The Volunteer State is also home to 21 Regional Overdose Prevention Specialists, positions that were created in late 2017 to respond to the still-ongoing “opioid epidemic,” as many call it.

ROPS, as they’re known — pronounced “ropes” — hold public naloxone trainings and give out naloxone in Tennessee. The naloxone and the trainings are free, though ROPS systemically fail to reach active opioid users and others who are most at risk of opioid overdose.

I talked to one ROPS here in West Tennessee who told me they weren’t willing to distribute naloxone unless the recipients got trained to use it first — directly under their supervision, too. It’s easy to imagine how the long-mistreated, long-term, often-problematic drug users who the state claims to help aren’t too keen on visiting these trainings or accepting naloxone from ROPS.

Again, this isn’t to say ROPS are bad — our ROPS here in Region 6N, Melesa Lassiter, is great; she’s also laced me up several times over the past year or two, putting me on to tons of things I wouldn’t have otherwise learned. It’s just that, due to the distrust of resources that government agencies claim are for the most disadvantaged people, my fellow long-term, often-problematic drug users aren’t very open to the knowledge and naloxone ROPS provide.

I should note that naloxone is the lowest fruit on the proverbial harm reduction tree. Naloxone has no real contraindicationsdrug interactions, in other words — outside of causing precipitated withdrawal syndrome in opioid-dependent persons. Still, trading a second chance at life via naloxone-aided revival for an hour or two of peak withdrawal symptoms isn’t a bad deal.

Another note — naloxone doesn’t always cause withdrawal. I’ve had naloxone administered thrice — all in 2019 within a three-or-four-month period — and never experienced withdrawal as a result. A big reason for this, I think, is because my significant other, the person who administered the naloxone on all three occasions, never used a full dose of naloxone to bring me back. I know many people think you can’t reverse an opioid overdose without welcoming precipitated opioid withdrawal, but this isn’t true.

Third — We’ve Fallen Short, Ourselves

We harm reductionists haven’t done a good enough job of framing harm reduction-positive ideas in a way that most largely-right-leaning people will agree with — me included.

As I fleshed out in “How Outwardly Left-Leaning Harm Reductionists Hurt Our Cause,” people in the American South — rural Middle and West Tennessee, in my case — aren’t fond of things that seem politically correct or those that are associated with left-leaning values or ideas. Since many modern American harm reductionists are largely-left-leaning people, they tend to conflate our shared cause of helping active drug users like me with other things like non-drug-user-specific social equity efforts (e.g., pro-LGBT efforts).

I get it — some people want to bring about social change and level the playing field for traditionally-disadvantaged groups. This cause is worthy of merit — and I’m not just saying that because I’m bisexual and stand to benefit from pro-LGBT social equity efforts or because I was a sex worker for about four years and similarly stand to benefit from pro-sex worker social equity efforts. Oh, plus, I’ve always been low-income, so it’d help me triply if this playing field were leveled out. Just so you know I’ve got skin in the game — that’s all.

Regardless of what you, independently, value, we can’t escape the fact that most residents of Tennessee are averse to left-leaning or politically-correct things. If you want to expand harm reduction from states like Washington, California, and New York out to the completely-fucking-bare Volunteer State, you must be sensitive to the beliefs and attitudes of Tennesseans.

And, like I’ve mentioned, this isn’t just true for Tennesseans — it’s true for North Carolinians, Georgians, Kentuckians, and any other Southeastern state’s residents. Well, it also holds true for the largely-right-leaning states of North and South Dakota, Montana, and Wyoming, for example.

What’s the Solution for Tennessee and the Rest of the South?

I’ll be the first to tell you — I don’t know. While I know what Tennesseans don’t like, I’m not well-versed in Christian literature, values, or culture, which seem to be supported by the overwhelming majority of the Volunteer State’s residents.

People who understand these values and, by extension, how to frame harm reduction-positive messaging are vital to our efforts. Here in Tennessee, specifically, we don’t have any networks of harm reductionists or others who are interested in harm reduction-like things. I’ve looked through countless resources online with magnifying glasses and fine-toothed combs and have uncovered very few contacts.

For example, I went to the HepConnect Grantee Meeting in Raleigh, North Carolina, in March 2020 and met several Tennesseans who are active in harm reduction — not just interested in it — and have been for longer than me. I know there are several dozen others out there, too, if not more, but I just don’t know how to get a hold of them.

So, admittedly, it’s not like we Tennesseans have our shit together when it comes to harm reduction. We just — of course, I can’t speak for everybody in saying this, but every Tennessean harm reductionist who I’ve talked to largely agrees with these general sentiments — feel that we’ll need to modify the “harm reduction” that has worked for states like New York and California or countries like Canada and Portugal in order to effectively roll out harm reduction infrastructure in the Volunteer State.

Going Forward

If I haven’t already made this clear, I don’t have the answers for building harm reduction infrastructure in Tennessee.

However, I do know that we grassroots harm reductionists — many of whom, like me, are people who actively use drugs or are former long-term, often-problematic drug users — need to hop to action before the state does.

Right now, if you’re an active drug user, you can’t work as a Regional Overdose Prevention Specialist. From what a ROPS has told me, you’ve got to have something like a couple years’ clean time from regular drug use in order to hold the position. That person said regular drug users wouldn’t be able to work for the state in any capacity, unfortunately.

We’ve seen countless manifestations of seemingly-drug-user-oriented organizations that don’t hire active drug users or involve them in decision-making processes and, as a direct result, fail to do things that best help active drug users, especially “long-term, often-problematic drug users,” as I call them.

There will come a time when harm reduction goes mainstream. If we haven’t positioned ourselves well enough by then, I worry that the best interests of us active drug users won’t be kept in mind.

By Daniel Garrett

I'm a self-employed writer, long-term drug user, and resident of rural Tennessee. Find me on Twitter at @DanielGarrettHR or email me at danpgarr@ut.utm.edu.

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