Jane, 52, is a long-term sex worker and often-problematic drug user. She preferred cocaine for some two decades, drifting in and out of jail, rehab, and places to stay along the way. Now, she uses heroin to treat her chronic pain. I believe the unfortunately-illicit opioid satisfies her nearly-lifelong craving for stimulants, although she still uses meth from time to time to scratch that proverbial itch.
Jane, a tried-and-true oldhead, distributes more safe drug use supplies throughout Northwest Tennessee and Jackson-Madison County than likely anybody. Well, I’m sure her numbers are behind Northwest Tennessee’s sole Regional Overdose Prevention Specialist — who only distributes naloxone, might I add — but she’s up there.
How did Jane, a “community guide,” become a leading figure in drug-related public health here in rural West Tennessee, yet still not be employed, commended, or even recognized for her contributions?
The answer lies in the intersection of Tennessee’s painfully-slow response to the opioid epidemic and its unusually-harsh criminal justice-social services alliance. Oh, and the fact that rural communities in the Volunteer State still don’t have a single syringe exchange. Y’know, problems with community buy-in and stuff like that.
Introducing the Community Guide
Other harm reductionists and public health officials have long aligned with well-connected sex work/drug-involved people like Jane to further distribute safe drug supplies and, thus, reduce transmission of blood-borne diseases like hepatitis C and HIV, encourage drug-involved people to improve their lives, and all that good stuff.
Yet, I haven’t seen anybody define the role that Jane plays here in Northwest Tennessee. Or anywhere else. I think “community guide” is a fitting term because, although Jane might not have the glowing reputation of a mayor or city council member, she’s super-integrated in Northwest Tennessee’s sex work/drug-related underworld.
Tennessee, as well as every other government or government-related entity in the realm of public health, needs to begin using — hell, not “using,” but employing — people like Jane as community guides to start reaching the most deprived members of society, those that the criminal justice-social services alliance has done nothing but harm.