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Current Events The Volunteer State

Suspected Novel Psychoactive Substance Outbreak in Northwest Tennessee — Fatal Opioid Overdose Risk Increases Thanks to Coronavirus

I live in Northwest Tennessee, also known as Region 6N by the state (at least as far as Regional Overdose Prevention Specialist jurisdiction is concerned), a nine-county region home to about 254,000 people. 2014 — that’s when I moved here. It’s also when I picked up opioids as my drug of choice. I’ve been using illicit opioids, both heroin and diverted prescription opioids, regularly since then.

Although now I’m “in recovery,” I’m still in touch with people who use opioids around here. I give out syringes, naloxone, fentanyl test strips, and the like. I educate people about safe drug use practices. I inform law enforcement and members of the public about relevant issues and the gospel of harm reduction.

I read countless articles and social media posts about how the novel coronavirus pandemic would disrupt the drug trade. Nothing, really, changed around here. Until now.

A week-and-a-half ago, I came across a report of some strong heroin. People I know claim this stout stuff acts like normal heroin, but another (often strong) wave kicks in anywhere from a few minutes to over an hour later — even if they inject it intravenously.

I came across this same stuff again just five days after my first encounter with it. People around me say they’ve had this stuff before, maybe even as far back as a few months or years ago. But it’s in supply now. If you’re buying opioids, whether it be heroin, diverted prescription opioids, or counterfeit opioid painkiller tablets, there’s a chance you come across this stuff.

I know it’s in Jackson, too, which isn’t technically in Northwest Tennessee — it’s central West Tennessee.

I was told by a regional medical/public health official there were nine fatal overdoses in Northwest TN in the past month. I was also told by a fellow opioid user that there were three fatal overdoses on Mother’s Day weekend alone. I don’t know if these three are included in the nine since the second report came from an unofficial, anecdotal source.

Unfortunately, I don’t know what’s in this heroin. It could also be in counterfeit pain pills around here, if not elsewhere, but I don’t know. I haven’t heard reports of this stuff in Knoxville, Nashville, or North Carolina from sources in these areas.

I think a novel psychoactive substance (NPS) is being cut into heroin because of supply chain issues thanks to the novel coronavirus pandemic. But we don’t know what that NPS is yet. It could be a fentanyl analogue. It could be something like U-47700. But I don’t know. It’s definitely an opioid, that’s for sure.

My purpose in writing this is to sound the alarm and tell people who use drugs, specifically opioids, to be careful. But how, exactly, can you be careful while using this drug — whatever the hell it is?

Advice for Using Opioids During This Time

These tips are gathered from real-world experience with harm reduction in mind. The following tips aren’t necessarily true for all opioids — again, they’re written with this batch of whatever-the-fuck-it-is in mind.

Take It Super Duper Slow

Like I said, this stuff takes anywhere from a few minutes to over an hour to fully kick in. You should always use test doses (called test shots if you’re injecting), but especially with what’s going around right now. Although it’s tempting to use a larger dose at first or even a few minutes after doing a test shot, refrain yourself from dosing again for at least an hour, if not longer.

I know this is difficult. Plus, it’s not practical to assume everyone will take this precaution. A test dose might not be enough to bring someone out of hellish opioid withdrawal. Also, being careful isn’t always synonymous with having fun — I understand the rush this stuff brings is nothing short of sensational.

Cook It First

You can’t do this unless you inject — well, you can, but most snorters don’t want to dissolve their drugs in water; plus, most people aren’t willing to boof, or rectally administer, opioids, even though it’s the next-best route of administration after injecting with roughly 60% bioavailability — but “cooking” your dope refers to heating it up wth a lighter just to the point of boiling (some prefer to heat it to a boil, some don’t) once you dissolve the drugs into water.

Rumor has it that cooking this stuff makes it potentially safer by helping the other active drug(s) kick in faster. If possible, even if you only snort or boof, cook your opioids before using them (I wouldn’t cook pills, but, then again, I wouldn’t recommend injecting or otherwise using pharmaceuticals other than directed, which is usually orally). Here’s how to do just that:

  1. Dissolve some of your drugs (this is possible with other water-soluble drugs, not just opioids) in water. I recommend using less than one milliliter of water, as well as using metal “cookers” as shown below. A metal spoon will work just fine, too.
  2. Mix the drugs until they dissolve. Sometimes, like with black tar heroin, they might not dissolve without heat. Here in Northwest Tennessee, though, powdered heroin that readily dissolves in water is the norm.
  3. Hold a lighter under the cooker just until it boils. The boiling point is reached as soon as you begin seeing bubbles form. You should see black scum forming at the top of the solution. These are likely impurities, if not one or more of the novel psychoactive substances (or one or more of their byproducts), that you don’t want to be consuming anyway. Keep in mind you want to avoid boiling because opioids could be destroyed. Nobody wants that. At least not me.
  4. Use cotton or a wheel filter (good luck finding those; they are available online, just kinda pricey) to draw the solution into a hypodermic syringe or an oral syringe — hell, a turkey baster, if you can’t get either of those. You can get oral syringes from pharmacies without prescriptions. Go ask any pharmacy (I’ve had success at Walmart) for an oral syringe, they’ll usually give one to you for free. You can buy hypodermic syringes online from medical/diabetes supply shops without syringes — I’d recommend pharmacies, but most here aren’t willing to sell needles without prescriptions.
  5. Most people don’t store injection drug solutions for long, as they usually cook just enough for one dose. If you do decide to store an opioid solution, I recommend keeping it in a refrigerator.

Know How to Spot It

Check out these pictures an anonymous source took of this batch. These were taken just a few days ago, around Wednesday, June 10th.

Here’s what the “black scum” looks like after cooking.

Remember how I said the color of the uncooked solution is often darker? Here’s what that solution looks like before being heated. Note the color of the solution is darker than after it’s been heated.

Unweighed amount of heroin (likely ~0.25 grams) dissolved in ~130 units of water.

Although the cooked solution is visible in the first picture above, here’s what the cooked, filtered solution looks like. There doesn’t seem to be much difference in the filtered and unfiltered solution after it’s cooked.

Roughly one-quarter gram (0.25 g) dissolved in ~1.3 mL (130 units) of water after being heated and filtered.

But what does the dope itself look like?

Slightly less than one-half gram of this batch wrapped inside its original packaging.

Here’s what the stuff looks like outside of plastic.

Roughly one-quarter gram (~0.25 g) inside a “cooker.”

This stuff is said to taste just like any other batch of heroin and wasn’t sweet like fentanyl-cut batches sometimes are. Keep in mind that you can’t reasonably identify drugs just by their appearance, though it is important to know what this stuff could look like and how it might behave.

If you come across any opioids that share some or all of these chracteristics, contact me and/or other drug-involved persons, ranging from dealers, fellow users, family members, prevention coalitions, law enforcement agencies (reporting the presence of drug trends to law enforcement ain’t snitchin’), syringe services programs, medication-assisted treatment program administrators and physicians, addiction treatment providers. Don’t do anything that might incriminate you, but there are plenty of ways to go about sharing drug reports without getting yourself or others in trouble.

Getting Naloxone

If you live in Northwest Tennessee and need naloxone (Narcan), contact Region 6N Regional Overdose Prevention Specialist (ROPS) Melesa Lassiter at (731) 819-7603 or melesa@martinhousing.org. You can also contact Martin Housing Authority if you’re around Martin at (731) 587-3186 or the Weakley County Prevention Coalition at (731) 514-7951 or weakleyprevention@gmail.com.

If you live elsewhere in Tennessee, use this to find your region’s ROPS, along with their phone numbers and emails.

Categories
Harm Reduction The Volunteer State

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.

Categories
Harm Reduction The Volunteer State

Syringe Services Programs in Tennessee

Syringe exchanges, known as Syringe Services Programs (SSP) by the Tennessee Department of Health, aren’t very common in Tennessee. There are two in West Tennessee, one in Middle Tennessee, and three in East Tennessee.

According to the state’s Allison Wilhelm, as of April 21, 2020, there are seven current SSP sites — two in Memphis, two in Nashville, and three in East Tennessee (Chattanooga, Johnson City, and Knoxville). 

Memphis

The Memphis Area Prevention Coalition’s Safe Point operates each Wednesday from 2:00 to 4:00 p.m. It can be found at 28 N. Claybrook Street in Memphis, Tennessee. 

A Betor Way is also in Memphis, though at 1571 Sycamore View Road. It operates every Friday from 6:00 to 9:00 p.m.

Although it’s not an SSP, the Shelby County Health Department operates a Needle Disposal Program. Visit 814 Jefferson Ave.’s Central Laboratory, found in Room 258, between 8:00 a.m. and 4:30 p.m. to get a sharps container and to turn in used syringes. Note that, unlike every other SSP listed here, Shelby County Health Department charges a “minimal fee” for its syringe disposal services.

Nashville

Nashville is only home to one SSP, Street Works, which ran for years on an underground, illegal basis before earning an official title as one of the Volunteer State’s few Syringe Services Programs. In Madison, on 907 Gallatin Pike, Street Works operates from Monday to Friday from 9:00 a.m. to 5:00 p.m.

You can also call (615) 779-4840 for more information. 

Note: I claimed there were two SSPs in Nashville. According to the Tennessee Department of Health, both of which are operated by Street Works. One is located in Nashville at 101 Old Trail Court, the other at 907 Gallatin Pike in Madison. I don’t know the difference between these two locations — call Street Works at the aforementioned phone number to learn more.

East Tennessee

East Tennessee is home to three SSPs, two of which are run by Cempa Community Care, the other by Choice Health Network.

Chattanooga

Chattanooga’s SSP is run by Cempa and can be found at 1042 East 3rd St. It operates from 8:00 a.m. to 5:00 p.m. on Monday, Tuesday, and Thursday; an additional hour in the evenings on Tuesdays; and closes early on Fridays at 12:30 p.m.

Johnson City

The Tri-Cities’ area’s sole SSP, also known as the Syringe Trade and Education Program of Tennessee (STEP TN), is found at 615 North State of Franklin St. in Johnson City and runs Monday to Friday from 8:30 a.m. to 4:30 p.m., though is closed for lunch from 11:45 a.m. to 12:45 p.m.

Knoxville

Operated by Choice Health Network, Knoxville’s SSP is found at 701 N. Cherry St. and operates for two hours on Monday and Thursday, from 1:00 p.m. to 3:00 p.m.

Since publication, someone from Choice Health Network told me these times and this address are wrong. They asked me to include their phone number — (865) 208-7356.

Rural Areas

As of now, unfortunately, there aren’t any syringe services programs in rural Tennessee. This leaves most of Tennessee’s injection drug users shit outta luck.

I recommend visiting pharmacies — try independent ones — for syringes, though you may get turned down. If this doesn’t work, try out diabetes or medical supply websites or the free mail-based supply distributor NEXT Distro.

Categories
Harm Reduction Recovery The Volunteer State

What Do Tennessee’s Regional Overdose Prevention Specialists (ROPS) Do?

Nestled deep inside the Bible Belt, Tennessee is big on tradition and conservative values. As you might imagine, harm reduction — reducing harm done to and experienced by drug users — isn’t very big here.

Here’s a good rule of thumb — the more left-leaning a state is, the more likely existing harm reduction infrastructure can be found there (e.g., California, New York). Places like Tennessee don’t have much in place; we’ve got at least six state-recognized Syringe Services Programs, at least one county health department-run syringe disposal program, and 21 Regional Overdose Prevention Specialists (ROPS).

Billboard from the Tennessee Department of Mental Health & Substance
Tennessee billboard promoting free naloxone.

ROPS are employed by the Tennessee Department of Mental Health & Substance Abuse Services to hold regular naloxone trainings and distribute the life-saving drug. Although the Volunteer State certainly isn’t the only government to employ people acting in such roles, Tennessee is unique in its use of “Regional Overdose Prevention Specialists” as a title.

Man holding a single unit of Narcan naloxone nasal spray still in its packaging.
Man holding Narcan (naloxone) nasal spray.

The Background of ROPS

In late 2017, the Tennessee Department of Mental Health & Substance Abuse Services released its “TN Save a Life Program.” Ostensibly, this four-pronged program was rolled out due to the rash of opioid use and resulting opioid-related deaths that initially broke out some 10 to 15 years prior.

The TN Save a Life Program was designed to deal with fallout from the opioid epidemic and consists of the following components:

  • The so-called “Project ECHO,” a project with Vanderbilt University touting the end goal of helping clinics, hospitals, and emergency rooms beef up access to medication-assisted treatment programs, a.k.a. opioid replacement therapy, through the provision of telemedicine services.
  • The creation of “regionally-specific resource guides.”
  • The staffing of 20 “Regional Overdose Prevention Specialists” throughout 13 regions within the Volunteer State. These people hailed from a variety of backgrounds, including “recovery, paramedics, and Certified Peer Recovery Specialists,” taken directly from the DMHSAS’s website. Now, there are 21 ROPS.
  • A state-wide media campaign.

Who Do ROPS Serve?

This comes from the same website mentioned above: ROPS primarily tend to first responders, entities that provide treatment and recovery services or community-oriented resources, and people considered at risk of overdose — including their family members and friends.

These aren’t the only beneficiaries of ROPS — “all interested community members” can be trained in responding to opioid overdose with naloxone.

Regional Overdose Prevention Specialists hold training sessions across the region they’re assigned to. There are 13 regions in terms of ROPS distribution. Northwest Tennessee, a nine-county area home to 254,000 people, is labeled Region 6N.

What Do Trainings Consist of?

Just as there are three primary audiences, there are three main topics that ROPS’ training events cover:

  • Raising public awareness for facts about the opioid crisis and the trends that currently define it, how addition works, and best practices for administering naloxone.
  • Attempting to nip drug-related stigma in the bud.
  • Spreading knowledge of harm reduction, why it’s important, and defining what the practice consists of.

A Real-World Example of a Regional Overdose Prevention Specialist

Melesa Lassiter, Region 6N's Regional Overdose Prevention Specialist, running a naloxone training seminar in Humboldt, Gibson County, Tennessee.
Melesa Lassiter holding a naloxone training event in Humboldt, Tennessee, on Oct. 2, 2018.

Melesa Lassiter has served as Region 6N’s Regional Overdose Prevention Specialist since Oct. 2017. She’s part of the Weakley County Prevention Coalition (WCPC), which oversees her role as ROPS.

Although WCPC engages in prevention-based drug use efforts, thanks to Ms. Lassiter’s status as ROPS, she stands out as one of the only prevention coalition employees in Northwest Tennessee to be active in harm reduction — even though naloxone distribution is the lowest-hanging fruit on the harm reduction tree, we very well can consider it “harm reduction.”

Via a local public housing authority office, Martin Housing Authority, name-brand Narcan is made available for pickup. She also holds naloxone training events, including specialized sessions designed just for law enforcement, among other intended audiences.

By no means are these all the things ROPS engage in, though everything mentioned here collectively acts as the meat-and-potatoes of their job duties. What each individual Regional Overdose Prevention Specialist does will vary based on the organizations that oversee their duties for the state.

Ms. Lassiter, for example, may be more likely than the average ROPS to carry out prevention-based programming at local schools — such messaging is a major focus of local prevention coalitions like Weakley County Prevention Coalition.

In Full Disclosure — Do ROPS Fall Short of Their Intended Goals?

Regional Overdose Prevention Specialists, due to the town hall-style nature of their trainings, often fail to reach the most disadvantaged regular drug users (e.g., injection opioid users). This isn’t to say they completely fail to train these people or meet them where they’re at with naloxone, though. As ROPS continue to make a name for themselves across the Volunteer State, more injection opioid users, for example, will come to perceive these state-sanctioned harm reductionists as legitimate and worthwhile.

Much like anywhere, people here — especially long-term, often-problematic drug users like me — exhibit discretion in assessing new or otherwise-too-good-to-be-true opportunities. I think the average level of discretion exhibited by the most disadvantaged drug user here in Northwest Tennessee is higher than average, nationally-speaking, that is.

People can be surprisingly unwilling to open themselves up to offers of free safe drug use supplies. One time, I visited an area of West Tennessee that was populated by a relative fuckton of people experiencing homelessness to have my help refused by all but one person despite the fact I shot heroin in front of them!

Here in Northwest Tennessee, for example, the overwhelming majority of locals who’ve received syringes, naloxone, and other harm reduction supplies from me weren’t aware of ROPS when I first met them — since then, little has changed.

The most disadvantaged people who use drugs — those who are cordoned off from society — are unlikely to trust opportunities like opioid overdose response training or free naloxone because people here aren’t used to having others provide them safe drug use supplies.

To reach these objectively-worse-off, often-problematic drug users is by continuing to advocate for harm reduction and the fair treatment of drug users.

In places like rural West and Middle Tennessee, where there’s little interest in drug user advocacy, activating drug users, illicit drug retailers, and laypeople alike as grassroots harm reductionists is arguably our best tool.

In Closing

All considered, Regional Overdose Prevention Specialists are a valuable resource in improving the treatment of drug users. Although they only pluck the harm reduction tree’s lowest-hanging fruit — naloxone distribution and training — I think we’ll look back at ROPS as being pioneers of modern-day harm reduction here in the Volunteer State.

Categories
From Personal Experience Harm Reduction The Volunteer State

Understanding Syringe Access in Rural Middle and West Tennessee

West Tennessee, a 21-county area home to roughly 1.56 million people over 10,650 squre miles, is home to two Syringe Services Programs (SSP). In comparison, Middle Tennessee is home to 41 counties, 2.68 million people, 17,009 square miles, and a lone SSP; East Tennessee, home to the most SSPs of any single Grand Division (3), holds 13,558 square miles with 2.4 million people.*

Outside of these two SSPs, which happen to be in the far southwestern extreme of West Tennessee, there’s essentially nothing good for drug users in terms of treatment programs, syringe access, or softer drug policies. I live about 125 miles from Memphis and 145 miles from Nashville — both are roughly two-and-a-half hour drives. No matter where you are in Northwest Tennessee, you’re at least, give or take a few minutes, an hour-and-a-half’s drive from your starting location to Memphis or Nashville.

It’s like this — if you aren’t already in Nashville or Memphis, you’re probably not participating in any of Tennessee’s recognized Syringe Services Programs. Even people inside those cities sometimes find it difficult to visit the physical locations where services are provided to participants; in other words, both Nashville and Memphis are all but havens for syringe access.

Here’s One Resource We Do Have — But It Sure Ain’t Syringe Access

The Tennessee Department of Health established the role of Regional Overdose Prevention Specialist in Oct. 2017. Currently, there are 21 Regional Overdose Prevention Specialists (ROPS) across 13 districts. ROPS are hold town hall-style naloxone trainings and distribute the lifesaving drug for free. According to the Volunteer State, ROPS primarily target three audiences:

  • First responders.
  • Entities that provide community-based resources, addiction recovery services, or treatment.
  • People who’re most likely to experience overdose, including their friends and family members.
Multi-color map of Tennessee broken down into counties. Each color represents one of 13 areas that the Tennessee Department of Health's Regional Overdose Prevention Specialists (ROPS) are assigned to.
Districts assigned to the state’s 21 ROPS. I’m in Region 6N.

From what I understand, a significant portion of attendees tend to attend ROPS training events to satisfy continuing education requirements. None of the 35 to 75 people I’ve given syringes, naloxone, and other harm reduction supplies to in my time as a practicing harm reductionist — virtually all of whom were long-term, often-problematic drug users; in other words, the most generally-disadvantaged drug users — have been familiar with Regional Overdose Prevention Specialists.

I’ve talked to some ROPS, all of whom admitted that they largely failed to reach regular often-illicit opioid users who are at high risk of overdose, as well as people who they’re close with. Yes, they inevitably reach some people at risk of experiencing opioid overdose, but not nearly enough.

Do Pharmacies Play a Role in Syringe Access?

In rural Middle and West Tennessee, if not elsewhere in the Volunteer State, injection drug users like me primarily get their syringes in black-market fashion. Pharmacies are given legal discretion to sell syringes without prescriptions, even if they feel that the sharps they sell will be used for injecting illicit drugs.

However, in actuality, very few pharmacists sell syringes without prescriptions. The relatively few active injection drug users who’ve tried buying syringes from pharmacies aren’t likely to keep asking pharmacists to sell them syringes; rather, it often feels like pharmacists are sworn enemies of people who use drugs.

I’ve heard that pharmacists in bigger cities are more willing to dispense syringes without prescriptions, though I don’t know this from experience.

Either way, it’s safe to say that pharmacies don’t play a role in expanding syringe access. Thanks to most local pharmacists’ unwillingness to provide injection drug users access to clean syringes, they actually do a good job of keeping disease transmission, likelihood to continue injecting drugs, and likelihood to not seek out drug treatment high.

But Seriously — What Resources for Drug Users Are Here?

We’ve got outdated, non-evidence-based drug rehabs, often-exclusionary 12-step programs, probation and parole, and drug courts, as well as medication-assisted treatment programs — though there’s just 19 physicians prescribing buprenorphine for opioid use disorder and two methadone clinics in Northwest Tennessee, a nine-county area that’s home to 254,000 people.

Outside of that, we’ve got absolutely nothing for drug users like me.

More About Sharps on the Black Market

As I’ve already mentioned, most sharps that local injection drug users source are from the black market. What does the “black market” for syringes consist of, exactly? The more popular sources of sharps are:

  • Fellow drug users, typically taking the form of injection drug users.
  • Illicit drug dealers.
  • Most importantly, family members who have prescriptions for syringes.

Drug Users Benefit From Performing Services for Fellow Drug Users

Due to drug laws, participants in illicit drug markets often face scarcity. Since a local market’s illicit drug vendors can’t openly offer their services, few end-users in any given area are familiar with all the dealers worth their salt there — buyers have a seller-finding problem.

Sometimes, end-users rely on fellow end-users to act as middlemen. End-users aren’t likely to give up their connections for two reasons: (1) dealers may not be comfortable with taking on new clients and (2) leveraging a relatively valuable connection by prospective middlemen. The nature of the black market makes opportunities scarce — that’s what ultimately makes these connections with dealers not always easy to come by and, therefore, valuable.

Family members seem more trustworthy than other sources of syringes. However, due to the nature of the black market, you can’t ever be sure family-sourced sharps have never been used. Still, I’d feel safer trusting a family source than a fellow user or dealer.

One time, I drove a well-connected fellow drug user to source drugs. She wouldn’t have been able to get there otherwise. Even though I regularly give her harm reduction supplies (e.g., syringes, naloxone, tourniquets) and she knew she would have still secured my transportation, whether she’s got a clean syringe to spare or not.

I understand she was incentivized and may have felt pressured to procure a syringe for me. What if I were less likely to turn to her as a middleman in the future as a result of her not giving me a clean syringe?

I’d asked her for a syringe upon getting the drugs, to which she obliged. Just before injecting, I found the barrel to contain a little bit of what looked like water.

Syringes never have liquid in them unless they’ve been used. At least never in my experience as a regular injection drug user.

Fortunately, because I’ve secured syringes and company from a free, mail-based harm reduction supply distributor for a year-and-a-half or two years now, I’ve never needed to hit the black market for sharps. I can only imagine how much more risk I could’ve faced without my long-time, super-safe supply source.

Dealers Aren’t Likely to Offer Syringes to Buyers

Now, I don’t know what things are like where you are, but dealers offering syringes, naloxone, and other drug-using supplies isn’t a thing here.

While I’ve provided two low-level dealers with syringes, naloxone, and company, they didn’t start a market trend where competitors felt forced to offer these same supplies.

If syringe access was better here, I feel like dealers here would more likely stock syringes for sale or as complements to the illicit drugs they sell.

It should go without saying, but dealers would be more likely to stock harm reduction supplies if we had better harm reduction infrastructure here.

The best shot we, as advocates of drug users, have at implementing this infrastructure is to become active in doing things that effectively promote harm reduction-positive ideas in a grassroots, self-motivated, lone-wolf manner.

Understanding Syringe Laws in Tennessee

Tennessee Code Annotated § 40-7-124 grants immunity to people who inform police they’re in possession of syringes or sharp objects that could be considered drug paraphernalia (a violation of T.C.A. § 39-17-425) from getting charged with or prosecuted for Possession of Drug Paraphernalia for those syringes or sharp objects.

Despite the fact this law came into being in 2015, it’s alarming that many law enforcement officers aren’t aware of the law. I’m sure many agencies across the Volunteer State do a great job of educating their members.

However, if law enforcement agencies here were on top of things, I wouldn’t have been arrested for Possession of Drug Paraphernalia for syringes despite the protection afforded to me by T.C.A. § 40-7-124, which I’ve seen nicknamed as the “Needle Possession Officer Awareness” law. What’s worse is that the syringes, albeit used, didn’t test positive for drug residue. I also didn’t admit to using them for illicit drugs. From what I understand, the syringes shouldn’t have been construed as drug paraphernalia based on T.C.A. § 39-17-425.

I’m not an attorney, but I’m intimately familiar with these two laws pretty well — I’d hope anybody else who’s been charged with and prosecuted for Possession of Drug Paraphernalia three times would be, too.

Lastly, I know many officers aren’t familiar with differentiating low-gauge, intramuscular-use syringes from their high-gauge counterparts that are common among injection drug users.

The former, usually ranging from 21 to 25 gauge, is included in naloxone kits.

Again, even though syringes themselves not used for illegal drugs aren’t illegal, people found in possession of naloxone kits containing IM-use syringes are liable to face unfair treatment from law enforcement, including ultimately getting charged with Possession of Drug Paraphernalia even though such a charge would be unfounded.

A local resident who I’ve given naloxone kits told me he’d been pulled over with at least one naloxone kit in his vehicle’s glovebox.

He told me the police asked to search his vehicle. In doing so, they found the naloxone kit and scrutinized him for the (albeit clean, unused) syringe it contained.

While it’s certainly possible to fight unfounded criminal charges in court, many residents of the Volunteer State, especially people living in rural areas and who are particularly-disadvantaged drug users, are unable to post bail or afford private legal representation.

They often prematurely, unnecessarily plead guilty to charges they’ve been accused of, even if defendants are confident they don’t deserve some or all of them.

I’ve been in that same situation. At the time of arrest, I was already on probation and arraigned 6 days out from my next scheduled report date. In court, I was told it’d take at least two weeks to be appointed a public defender and get back in court. Unable to post bail or hire a private attorney, I was forced to plead guilty — if I waited in jail, I could still end up getting charged, resulting in two potential violations since I wouldn’t have showed up on time; if I pled guilty, I could get violated because I caught a criminal charge, the cardinal sin of any probationary agreements.

What Can We Do for Syringe Access in Tennessee?

Tough question.

You can source clean syringes, naloxone, and other harm reduction supplies, then distribute them to illicit drug dealers and injection drug users.

You can try to inform in-state pharmacists of the benefits of selling syringes without prescriptions to suspected or potential injection drug users.

You can tell others about the state of syringe access in Tennessee and encourage them to support safe syringe disposal sites, syringe services programs, and the like.

I’m sure there are other ways you can advocate for improved syringe access in the Volunteer State, but I’m drawing blank. Whether you get engaged in syringe access advocacy or not, at least you’re now better informed about syringe access in rural Tennessee.

*Note that, since no official Tennessee Department of Health information regarding the number or location of Syringe Services Programs, there’s no way to be entirely sure of how many SSPs are up and running right now.

Categories
Drug User Advocacy From Personal Experience The Volunteer State

How Current Tennessee Laws Affect Drug Users

Without laws, uncivil action would permeate society. Laws are essential to maintaining order. Few of us would be willing to live somewhere that doesn’t have laws or an active law enforcement presence. 

Worn wooden gavel resting on a wood surface.
Wesley Tingey

Unfortunately, across the United States, existing laws unfairly treat people who use drugs. This is especially true in Tennessee — take syringe laws in Tennessee, for example. Further, law enforcement might not enforce more recent laws that treat people who use drugs more favorably. 

Here are several ways that Tennessee laws and law enforcement officers hurt Tennesseans who use drugs

Some Officers Just Aren’t Up to Speed

Here in Tennessee, we have a law known as T.C.A. § 40-7-124. It was codified — or written into law, in other words — in 2015. For pronunciation’s sake, that’s Tennessee Code Annotated, Title 40, Chapter 7, Section 124. 

The law doesn’t have an official nickname, though you may find it referred to as “Needle Possession Officer Awareness” — for ease of understanding, we’ll refer to it as the Needle Possession Officer Awareness law. 

Put simply, if someone gets apprehended by law enforcement and informs officers that they’re in possession of syringes or sharp objects before they’re searched, they can’t be charged with possession of drug paraphernalia, a violation of T.C.A. § 39-17-425, a Class A misdemeanor punishable by as much as one year in jail and $2,500 in fines.

This is one of the most common criminal charges Tennesseans receive — possession of drug paraphernalia, a violation of T.C.A. § 39-17-425. Law enforcement officers (LEO) are informed of these laws, as well as what constitutes evidence to actually charge people with criminal violations.

LEO are always on the lookout for syringes and sharp objects, as needlestick injuries can potentially lead to the transmission of blood-borne diseases like HIV or HCV (hepatitis C). 

People who inject drugs in Tennessee know all too well that being found in possession of syringes can land them in jail. As such, they’re incentivized to keep quiet about being in possession of syringes. Why, after all, would someone tell on themselves, potentially landing themselves in jail, on probation, or with expensive fines to pay?

This is a problem that LEO routinely face. 

This is the reason why the Needle Possession Officer Awareness law was written into state law by legislators in 2015. Their number one goal was to protect the police officers, deputies, and other LEO who protect civilians from criminals and maintain civility throughout Tennessee. 

Personally, I’ve been arrested for possessing drug paraphernalia, specifically syringes, even though T.C.A. § 40-7-124, the Needle Possession Officer Awareness law, should have protected me. I informed the deputy that pulled me over that I had syringes in my vehicle before I got searched and everything. Despite this, I got sent to jail for a night and had my vehicle impounded. Unable to afford bail or an attorney, I was forced to plead guilty, which resulted in me being put on probation, more commonly known as “11/29.” The probation costs are something like $700. The impound fee was about $250. I also put my loved ones through stress they didn’t deserve as a result.

Are all law enforcement officers here in Tennessee unaware of the Needle Possession Officer Awareness law? Surely not. However, the deputies that arrested me in September — referring to the incident above — weren’t aware. I’ve got a personal friend who works in law enforcement in Southern Middle Tennessee who wasn’t aware. 

I think it’s safe to say that countless other members of law enforcement across the Volunteer State also aren’t aware of this law. 

That doesn’t mean that they’re bad at their jobs, that we should launch a full-scale protest against them, etc. What it does mean is that we should strive to educate deputies, officers, and other members of law enforcement throughout Tennessee about T.C.A.§ 40-7-124. We should educate our friends and family members about this discrepancy, too. The more people who know about this, the more likely Tennessee law enforcement agencies will get on the proverbial ball and educate their employees about the Needle Possession Officer Awareness law and how to enforce it. 

Tennesseans Aren’t Incentivized to Get Medical Help for Drug Overdoses

I’m a long-term drug user and a lifelong resident of Tennessee. Having used regularly for about a decade now, I’ve heard countless stories of people not getting medical attention for others who experience drug overdoses. 

Why didn’t these people help their friends, acquaintances, or fellow community members seek medical help for suspected drug overdoses?

One reason rang true throughout all of these anecdotes: people were afraid of getting in legal trouble. 

Here in Tennessee, T.C.A. § 63-1-156, known by some as “Overdose Prosecution Immunity,” provides some protection to people who seek medical help for a suspected drug overdose, whether it be themselves or someone else. If you want to discuss this law with others, it’s pronounced as Tennessee Code Annotated, Title 63, Chapter 1, Section 156, for the record. Also, for simplicity’s sake, we’ll be referring to this law as the Overdose Prosecution Immunity law from here on out. 

I won’t be explaining the law in full. If you want to check it out yourself, here’s a link

It’s true that the Overdose Prosecution Immunity law does defend Tennesseans from legal trouble if they seek medical assistance for a drug overdose. This can’t be argued. However, the issue with the current iteration of this law is that it’s far too limited in scope. In other words, it doesn’t provide enough protection for Tennesseans who want to do the right thing by seeking help for people who are thought to be experiencing a drug overdose. 

Here’s what this law does: anybody who (A) calls 911, law enforcement, or a poison control center for or (B) assists someone in contacting these entities for or (C) directly provides care to someone who is thought to be experiencing a drug overdose “shall not be arrested, charged, or prosecuted for a drug violation.” They also won’t violate parole, probation, or any restraining orders or orders of protection in doing so. 

To be more specific about the term “drug violations,” Tennesseans are only protected against being charged with the Class A misdemeanors of possession of a controlled substance (T.C.A. § 39-17-418) and possession of drug paraphernalia (T.C.A. § 39-17-425). If people are found with a larger amount of a drug than what constitutes personal use, or simple possession, in other words, they’re not protected by the Overdose Prosecution Immunity Law. 

Here’s the Problem With This Law

Legislators did Tennesseans, in general, and Tennesseans who use drugs a favor by writing this law into state law books. However, they fell short in only allowing this law to protect people who are seeking help for the first time. 

To be fair, I understand why legislators made it this way. As a long-term drug user myself, I very much understand that drug use is risky. I’ve experienced opioid overdose at least three times, each instance of which could have killed me. Fortunately, I was given naloxone (Narcan) two of these times. Even though others might think that I “would have learned my lesson” after just one overdose, let alone three, people who use drugs and struggle with problem drug use or addiction often aren’t dissuaded from further drug use by an overdose. 

I know that I didn’t stop using after overdose. Few other people who use drugs stop immediately after they overdose and never use drugs again. 

I understand that legislators in the Tennessee General Assembly, where our state lawmakers meet, felt that giving people more than one “get out of jail free card” would encourage people who use drugs to keep using if they didn’t enact a strict limit on how many times Tennesseans would be provided legal protection by the Overdose Prosecution Immunity law.

Unfortunately, this just encourages Tennesseans to not seek medical assistance for people who are thought to be experiencing drug overdose. It also encourages them to not provide any help themselves, such as administer naloxone, the life-saving opioid overdose antidote. 

In the eyes of many people who use drugs here in Tennessee, the best thing they can do is get as far away from someone who is thought to be experiencing drug overdose.

Many Tennesseans Struggle to Afford Bail or Hire Attorneys — Here’s Why This Is an Issue

Law enforcement officers are incentivized to arrest people. It generates money for the jurisdictions they work in and may make the agencies they work for look better, thus finding themselves more likely to be awarded grants or otherwise favorable treatment. 

People charged with crimes who don’t plead guilty routinely experience better outcomes than those who do. Economically-challenged people are more likely to experience worse outcomes in court, getting longer jail sentences, more fines levied against them, longer probation time, and other unfavorable outcomes. 

The reason money sets low-income people back is because they can’t afford bail or to hire a private attorney. People who can afford private attorneys frequently experience better legal outcomes than people who are appointed public defenders by courts. People who can afford bail can better prepare themselves for court. 

Many Tennesseans are poor and can’t afford bail or to hire a private attorney. These people end up staying in jail longer after arrest. Their better-off, more wealthy counterparts are able to post bail just hours after being jailed, allowing them to return to their jobs, families, and lives nearly instantaneously. 

Here’s an example of how this comes into play. 

When I was jailed in September for possession of drug paraphernalia — again, even though the Needle Possession Officer Awareness law should have protected me from criminal charges — I felt forced to plead guilty the next day in court because I was on probation at the time and had to check in with my probation officer for a regularly-scheduled monthly meeting, like always. Waiting to be appointed a public defender by the court would have taken at least two weeks, I was told, causing me to not be able to report on time and likely ending badly for me. 

I also wanted to get back to work as soon as possible, as I can’t afford to miss work. As such, I pled guilty as soon as I possibly could, even though I knew I didn’t break the law and that T.C.A. § 40-7-124, the Needle Possession Officer Awareness law, would protect me from prosecution. 

This problem isn’t unique to me. Countless thousands of Tennesseans plead guilty to criminal charges they’ve been given, whether or not they’re actually guilty, to return to their normal lives as quickly as possible. 

Putting Everything Together

These aren’t the only ways that contemporary Tennessee laws and law enforcement officers unfairly influence people who use drugs. However, these three things are major problems that Tennesseans currently face.

Categories
Drug User Advocacy Harm Reduction The Volunteer State

What Can You Do to Advocate for Harm Reduction and Drug Policy Reform Here in Tennessee?

If you’re reading this, chances have it you probably support harm reduction or drug policy reform, if not both. While you likely wish things were different, there’s only one way to actively accelerate social change other than the inevitable passage of time — advocacy. 

Google defines “advocacy” as “public support for or recommendation of a particular cause or policy.” Here’s one example of harm reduction advocacy: creating a brochure that explains the basics of harm reduction, describes examples of it, and tells readers why adopting harm reduction-friendly practices is a good idea; after printing the brochure out, copies are distributed to laypeople throughout the distributor’s local community. 

There are countless forms of harm reduction and drug policy reform advocacy. Few are objectively better than one another, though all have unique pros and cons. As such, all forms of advocacy can be better than others depending on how they’re being used — I think advocates should always be situationally sensitive.

Local News Agencies Are Valuable

Keep an eye on local news agencies’ most recent releases. You should keep tabs on at least several local news agencies, preferably those in and around your current area of residence. Subscribing to at least a few elsewhere is also a good idea.

When you find articles or broadcasts that favor the progression of harm reduction and drug policy either on a national level here in the United States, a state level, or even a local level, try reaching out to these agencies and identify whether you think they had a positive or negative effect on advancing harm reduction or drug policy. 

To define what I mean by “negative,” negative pieces include those that sensationalize drugs, spread misinformation about them, or damage our collective cause to advance harm reduction and drug policy reform.

Whether you’re looking to (reinforce/punish) the publication of harm reduction-(positive/negative) or drug policy reform-(positive/negative) pieces, you should always seek help from other advocates who you’re connected with. When one of your advocacy group’s members locates a piece that one of you wants to reply to, each of you should write a letter to the news agency in question for added effectiveness. 

The person who initially floated this idea to me said it may prove useful to send multiple replies from different identities. Of course, this isn’t illegal, but could very well contribute positively to our cause. Only you can determine if doing so is within your ethical boundaries — honestly, I’m still on the fence about it.

Coming Out as a Person Who Uses Drugs

Although sexuality and drug use are two entirely different things, just as people can out themselves as bisexual — I, too, am a member of the Alphabet Gang — widely outing oneself as a drug user can prove similarly difficult. Of course, there are many downsides to outing yourself as a drug user. If we all out ourselves as persons who use drugs (PWUD) — not that any such widespread, preplanned coordination would be feasible — the stigma associated with drug use is likely to start fading away. 

However, you should understand that everything you do will reflect on the other few people who have come out as PWUD. These people have already risked outcast, relationships, criminal justice problems, work opportunities, friendships, and much more. 

As such, you shouldn’t come out as a PWUD if you’re not in a good place to do so. Soon enough, fortunately, the stigma surrounding drug use won’t be as strong. The more people who do decide to come out as PWUD will make coming out easier, so, by coming out, we’re helping drug users as a whole.

This should go without saying, but you’ll be less likely to make others look bad if you’re responsible, well thought-out, maintain employment, and so on. 

Again — if you decide to do this, make sure you won’t make others look bad in the process. 

Realistically speaking, I know at least some drug users would take initiative, but those people would likely be of a more-responsible, go-getter nature. In other words, getting the people who most frequently and most intensively make us look bad — for the record, I’ve made us, as drug users, look bad countless times — would prove difficult, likely rendering our efforts better channeled via another effort.

Befriend or Get to Know the Following People and Places

Some people and entities are inherently more drug-friendly than other people and entities. These include law enforcement agencies, law enforcement officers, correctional officers, wardens, jails, drug rehabilitation facilities, prevention coalitions, churches, libraries, health departments, public defenders, parole boards, etc. 

By cultivating relationships with these people and places, you’ll generally be in a better position than most people to influence them. 

Understand you’ll get further with those who are already more drug-friendly or drug user-friendly. Still, I’d argue that our collective efforts would be better spent in areas that are more drug-averse or drug user-averse.

Never Spend Time Trying to Change Others’ Minds on Social Media

This is self-explanatory. Arguing with others doesn’t get you far, especially on social media. This is because people on social media are often set in their ways regarding hot-button issues like abortion, gun control, or how society treats drug use. 

Trying to advance your cause by attempting to persuade these people either wastes your time and gets you nowhere or results in people thinking worse about your cause. 

The unconventional measures that harm reduction-friendly policies propose don’t seem like good ideas upon first glance. Because social media doesn’t lend itself to answering complex, multi-faceted questions — or even hearing them out in the first place — spending time trying to change others’ minds, especially on social media, isn’t a good idea.

If you do try to attempt this, your posts should be placed in highly-visible areas, must be easy to understand, must be non-argumentative, and must not be placed in communities that are inherently or largely against such ideas already — sharing posts in more moderate areas may be a better use of your time.

Ultimately, the only reasons why I post on social media about harm reduction or drugs in general is to expand my network, relentlessly self-promote my writing, or boost my chances of finding gainful employment in this harm reduction space. I believe that posting to social media with the goal of changing others’ minds is nothing short of a waste of time.

Activating Drug Dealers by Giving Them Harm Reduction Supplies

Many people who use illicit opioids via injection, for example, like myself would much rather be able to source syringes from the same place they purchase their opioids of choice from than having to visit syringe exchanges, pharmacies, or — what often happens in rural Tennessee, where I am — elsewhere on the black market. 

Syringe, likely used, found on the ground with the plunger pulled roughly halfway back. The syringe itself is empty.
Syringe litter

Dealers who offer clean syringes to customers, whether it be for free or not, can cultivate and maintain a competitive advantage.

In areas where clean, free syringes are available, dealers aren’t likely to source syringes in an above-ground, legal manner. Rather, they’re more likely to accept syringes from below-ground resources, such as from one of their customers, for example. This is something I’ve done, myself.

Activating drug dealers by providing them with syringes, naloxone, and other harm reduction supplies is a good way to advocate for harm reduction because:

People who activate dealers in this way should also educate them, if possible, about the basics of harm reduction. Ideally, these aforementioned activators should provide dealers with hard copies of educational material in the form of brochures, pamphlets, or even single, printed-off, black-and-white sheets of basic harm reduction information.

In my experience, dealers aren’t as interested in learning about harm reduction as they are the prospect of building a competitive advantage. I’m not saying dealers are heartless, soulless criminals — I just think humans are more interested in capitalizing on opportunities that benefit them in the now rather than advancing abstract ideologies and the very-potential benefits that may come from them.

Also, even if dealers you come across are interested in the ideology of harm reduction, let alone adopting it and practicing it, they should be — at least I’d hope any business-minded person would be — averse to supporting something that would ideally cut them out of contention (i.e., harm reductionists generally support safe supply, which involves things like allowing doctors to prescribe pharmaceutical-quality heroin; this would unarguably harm any illicit drug market’s bottom line).

In Conclusion

Advocating for causes is time-consuming and often frustrating. Further, many people don’t advocate in effective ways. One of the number-one ways that people think is an effective way to be an advocate is by posting on social media. In most cases, this is simply ineffective, if not wholly counterproductive. 

These aren’t the only ways to advocate for harm reduction or drug policy reform. However, these five methods are all solid means of advancing our cause as harm reductionists or drug policy reformers — if not both.

Categories
Drug User Advocacy Harm Reduction The Volunteer State

Why I Support Safe Syringe Disposal in Tennessee

One of my few hobbies is picking up litter around my community. I’ll go litter-picking, as I call it, anywhere from once a month to three or four times a week. In just the past year, I’ve found used syringes in my small, rural area on at least five occasions.

After posting about my most recent run-in with irresponsibly thrown-out used sharps on Facebook in November, a local resident commented and claimed they, too, found a used syringe less than a mile away from me.

Although the potential of catching diseases like HIV or hepatitis C via needlestick injuries is low, nobody wants to come into contact with errantly-discarded used syringes.

Why Don’t We Increase Police Presence and Clamp Down on Prosecuting Syringe Possession?

This is a common response from people who I’ve told this story to. Small-town Martin, Tennessee, a low-key college town with great public schools, is a great place to grow up, say residents. Every local resident I’ve told about my run-ins with used syringes is baffled.

They usually respond by sharing sentiments that wholeheartedly disapprove of drug use. After all, people who inject drugs (PWID) know what they’re getting into ahead of time. Why tolerate such tomfoolery?

Police Are Already Harsh on People with Syringes

Police are already unforgiving of people found in possession of syringes. Judges aren’t fond of these “criminals,” either. Possession of syringes without a prescription often results in criminal charges.

Here are two recent, local examples of how law enforcement typically isn’t fond of people found in possession of syringes.

Example #1

A young, 25-year-old who lives in Martin named Zack — that’s not his real name, of course — got pulled over about a year ago here in Martin. A naloxone kit I’d given Zack was in his truck’s glovebox. The officer(s) found the naloxone kit and immediately thought the packaged, unopened, 25-gauge syringe was intended for injecting drugs. This kit, which included the syringe, two vials of naloxone, and a sheet of instructions, was in a bag clearly decorated with a large, white sticker that read “Intramuscular Naloxone Kit.”

Zack was not in possession of drugs at the time he was stopped. He also wasn’t under the influence of any drugs. Fortunately, he wasn’t arrested on any criminal charges.

It surprised me that the presiding police officers weren’t aware that 25-gauge, Luer-Lok, 3-mL syringes are almost never, ever used by injection drug users.

Example #2

In September 2019, I was pulled over by a sheriff’s deputy for speeding in Madison County, about an hour south of Martin. The deputy asked to search the vehicle. I refused. Before a K9 was called to the scene, I informed that deputy that I was in possession of syringes. I said nothing else and was not in possession of drugs or other paraphernalia.

The K9 alerted to drugs that weren’t there, giving the deputy and his crew probable cause to search the vehicle. Only the syringes I reported were found.

T.C.A. 40–7–124, a 2015 law, prevents Tennesseans from getting charged with possession of drug paraphernalia, a Class A misdemeanor punishable by a year in jail and a $2,500 fine, if they inform law enforcement that they’re in possession of sharps that have been used as drug paraphernalia prior to getting searched.

Further, syringes that haven’t been used as drug paraphernalia cannot be construed as evidence for charging someone with possession of drug paraphernalia, a violation of T.C.A. 39–17–425.

No matter what, I shouldn’t have been charged with possession of drug paraphernalia.

Here’s Why Criminalizing Syringe Possession and Use Won’t Work

Why do people throw syringes on the ground? Why don’t they properly dispose of them like self-respecting human beings? Here’s why:

  • Injection drug users (IDU) are scared of catching criminal charges from syringe possession.
  • IDUs have nowhere to legally or safely dispose of used syringes in Tennessee outside of the six syringe services programs (SSP) recognized by the state. The closest SSP to Martin is over 130 miles away. The next closest SSP is over 145 miles away.
  • People who inject drugs (PWID) around here haven’t been educated about how to safely dispose of syringes. The most appropriate, 100% free option is to dispose of used syringes in a 2-liter bottle, empty laundry detergent bottle, etc. The bottles should then be marked as “biohazard,” “sharps,” or “syringes.” It’s also a good idea to secure the top with tape once full.
  • PWID are scared of coworkers, loved ones, friends, and even fellow drug users finding out about their injection drug habit.

Benefits of Instituting Safe Syringe Disposal Locations

Social isolation is closely tied to problem drug use. PWID are more likely to seek treatment and have better long-term outcomes when they have closer ties to their communities.

Improves local residents’ relationships with the communities they live in.

Reduces criminal charges incurred by drug users, the majority of whom aren’t violent.

Many people in active addiction struggle from mental health problems that need to be dealt with via evidence-based mental health treatment providers. By creating areas in which IDU feel safe, they’re more likely to be interested in, seek out, and ultimately enroll in treatment.

Prescription Drug Take Back Day is an event held annually throughout Tennessee. These events are often manned by law enforcement officers, public health workers (e.g., physicians, nurses), and social services employees (e.g., counselors). By accepting used syringes at these events, PWID would: grow closer to the community; feel better about themselves since community leaders are accepting of them, even in active addiction; be more likely to seek out help from law enforcement, social services, and public health sectors; and encourage PWID to be more trusting of resources provided by cities, counties, and the state.

What Can We Do to Hasten the Adoption of Safe Syringe Disposal Locations?

Here are several things everybody can do to effectively encourage politicians, stakeholders, and laypeople alike to support the adoption of safe syringe disposal locations:

  • Talk to people you know in person — not on social media — about potentially crossing paths with used syringes in unexpected places (e.g., public bathrooms, sidewalks).
  • Write, call, and talk to local judges, police chiefs, sheriffs, state representatives and senators, health departments, and prevention coalitions about the benefits of safe syringe disposal locations.
  • Get involved with community-based organizations and local meetings such as those held by chambers of commerce and city boards. Befriend people who regularly attend them and share your ideas with them in a friendly, open-minded, understanding, well-researched manner.
  • Find brochures and pamphlets about syringe exchanges, for example, online or from harm reduction peer educators like myself, print them out, and distribute them to laypeople in your community — even if you don’t know them personally.
  • Connect with entities that deal with addiction treatment and drug use prevention such as rehabs and prevention coalitions. Share your ideas, such as expanding syringe access, with them.

Oftentimes, when people try to advocate for causes via the Internet, other people aren’t willing to listen. Neutral parties and opponents alike are likely to argue with proponents of adopting safe syringe disposal locations, ultimately causing rifts between those who do support the idea and advocates’ target audience members.

The best way to avoid this is to simply avoid using the Internet to spread this cause. It’s okay to organize advocacy efforts with like-minded advocates using the ‘net, as well as to perform research. Otherwise, avoid using the Internet, especially social media!

Categories
From Personal Experience Harm Reduction The Volunteer State

Solutions to Northwest Tennessee’s Area-Specific Challenges

Note: Since the publication of this article, I’ve been made aware of two Syringe Services Programs in West Tennessee. Both are in Memphis — A Betor Way and the Memphis Area Prevention Coalition’s SafePoint.

Northwest Tennessee (NWTN) is home to just as many drug users as anywhere else, though not nearly as many — if any — resources that other places have. Unfortunately, however, rural Tennesseans who use drugs, especially our injection drug users — note that I’ve been an injection drug user for about three years — largely suffer from a statewide lack of resources, among other issues, that lead to things like poor quality of life, shorter life expectancies, and so on.

This article is a follow-up to “Area-Specific Challenges in Northwest Tennessee,” an article I published in mid-November 2019 on my website, Northwest Tennessee Harm Reduction.

Note that this doesn’t contain all possible or appropriate solutions to the issues I posed in the aforementioned piece — which also isn’t a comprehensive guide to the area-specific challenges that we face here, though they apply to all of rural Tennessee, if not the entirety of the Volunteer State — though it certainly does cover several major points.

An Aside

I assume all readers don’t know my personal history, though you can find it over at “Who Am I?,” another page on my website. I speak from the perspective of a long-term drug user who has spent the entirety of his life in rural Tennessee. I grew up in Southern Middle Tennessee’s Hohenwald, which is very much a hole in the wall, lived in Knoxville for all of four months, and have been in Martin — that’s in Northwest Tennessee — since May 2014.

I have used drugs nearly every day since Dec. 2011. Opioids have been my drug of choice since roughly June 2014. Like so many others, I used opioid painkillers at first — though I didn’t use them for pain, only recreation at first and later as self-medication for mental health purposes — that I purchased off the street. Some 3.5 years ago, I turned to heroin as a cheaper alternative. Between 2.5 and 3 years ago, I first injected heroin. I am now on Suboxone to satisfy my opioid dependency and have been since mid-September 2019.

I’ve been active in harm reduction for anywhere from 2 to 3 years now. I do this work for free and hope to eventually become gainfully employed in this field — I’d love it if I could satisfy this aspiration while living in rural Tennessee, preferably West Tennessee or Southern Middle Tennessee, the two portions of Tennessee that I believe are currently most underserved by government agencies, non-profit organizations, and community groups that help long-term drug users.

For what it’s worth, I’m low-income and always have been. I say this not because I think it makes me special, but because I very much understand the issues my fellow long-term drug users here in Tennessee also face.

Why Just Northwest Tennessee and Southern Middle Tennessee?

I mention these areas because I’ve lived and used drugs in these areas personally. I don’t want to speak on what I don’t know.

East Tennessee is filled with programs like syringe exchanges, also called syringe services programs by the state’s Department of Health. Nashville has at least one such program. There have been talks about Memphis getting such a program, but there is not such an operation — at least not yet — to my knowledge.

Look at a map if you need to, but Northwest Tennessee (NWTN) and Southern Middle Tennessee (SMT) are farther away from large cities and other areas that already have a relatively greater support system for drug users. The entirety of West Tennessee also fits this bill, except for Memphis, found in the southwestern extreme of the state. As such, and non-Memphis West Tennessee and Southern Middle Tennessee are more “stranded” than any other regions of the state.

Again, what follows largely applies to the entirety of Tennessee.

If you live outside of NWTN or SMT, the following information still is relevant to you.

Solutions

1. Improving Trust and Reducing Discretion Exercised by Underserved Persons

Discretion, for the record, includes everything people do to avoid confrontation, keep from hurting themselves, and unveiling confidential information.

People don’t trust “the system” because it’s failed to protect underserved populations for so very long. Drug users can’t be honest about their substance use with law enforcement officers in fear of catching criminal charges, going to jail, potentially losing their jobs, and being separated from their families. People of color are less likely to be able to afford healthcare, including mental health treatment, even though politicians often swear to help these people; if they are able to afford it, they’re more likely to be discriminated against by treatment providers and therefore less likely to be honest with them about whatever issues they’re currently facing.

There are countless other examples of how people don’t trust the system. Here are two more specific examples.

In my efforts to distribute syringes, naloxone kits, and other harm reduction supplies throughout Northwest Tennessee, plenty of people have thought I’m either an undercover police officer or a confidential informant. People in the national harm reduction community have thought the same. I’m not a cop, a confidential informant, or otherwise working with law enforcement — I never have been any of these, either.

People are sometimes unwilling to trust me, for example, for a few reasons. No harm reduction infrastructure exists here and what I do seems totally out of the ordinary. When people note things are unordinary or out of place, they’re trained to not trust those things out of a sense of self-preservation.

For these reasons, as well as several others, people are unlikely to trust social services workers, first responders, or law enforcement, even though these very people are often employed to protect them.

Time for another example. Meet Josh, a totally fictional resident of rural Tennessee. He works, but struggles to support his wife and child. Josh lacks reliable transportation. Due to his manual-labor job, Josh’s chronic pain is constantly acting up, causing him to source opioid painkillers from family members and friends. He also suffers from an anxiety disorder. Josh has no insurance and can’t afford to visit a doctor.

A local church offers to pay for mental health treatment on Josh’s behalf so he can seek help for his anxiety disorder. However, once he’s there, he quickly realizes he can’t be honest to the counselor or prescriber about his opioid use. Even though mental health professionals are supposed to be able to be trusted by patients, Josh can’t be honest.

If Josh could be honest, he could better receive the help he needs and stop self-medicating. He’d be less likely to turn to substance use thanks to having his anxiety disorder under control, too. This example illustrates yet another “trust” problem that’s all too common.

So, how can we improve trust and limit the barrier of discretion between drug users and the social services-criminal justice alliance in rural Tennessee?

Here’s the Solution

This is a multi-faceted problem. Due to the complexity of this solution, I’ll try to keep my explanation concise.

Part 1A — Law Enforcement and Drug Users Need to Have a Better Relationship

First, law enforcement officers need to establish trust with drug users.

Another example. In September, I was pulled over by law enforcement for speeding. Probable cause for a search was established by a K9 alerting on my vehicle, despite the fact I didn’t have drugs. Before I was searched, I informed the officer I was in possession of syringes. Despite the fact I spoke up, I was still charged with being in possession of drug paraphernalia.

T.C.A. § 40–7–124 is a law that prevents people in possession of syringes or sharp objects that have been used as drug paraphernalia from getting charged with or prosecuted for a violation of T.C.A. § 39–17–425, a.k.a. possession of drug paraphernalia, as long as the person being searched speaks up and tells the officer they’re in possession of such objects before a search is conducted.

Despite this, I was still charged with possession of drug paraphernalia. The officer obviously wasn’t aware of this law, even though it’s been around since no later than 2015.

People, particularly drug users, don’t trust law enforcement for this very reason — they’ll send your ass to jail in a heartbeat!

Here’s what I propose: law enforcement officers shouldn’t be able to charge anybody in possession of drugs or drug paraphernalia with criminal charges as long as they’re honest about it. Why? Doing so promotes bonding between the long-underserved population of drug users and law enforcement. Ultimately, this leads to things like greater long-term drug treatment outcomes and an ability to better solve crimes.

Ever heard of the whole “protect and serve” thing? Police could better protect and serve our society if drug users like me could actually trust them and be honest.

Educating law enforcement about laws such as T.C.A. § 40–7–124 would improve the relationship between drug users and police officers. A few more possible solutions include changing legislation so that honest, upfront drug users who come clean to law enforcement officers about being in possession of drugs or drug paraphernalia shouldn’t be given criminal charges, giving people who find themselves in trouble more options to seek out substance use treatment where appropriate, and getting law enforcement involved in distributing naloxone.

Part 1B — Promoting Alternatives to Criminal Punishment Used by Social Services Professionals

Second, social services-criminal justice alliance professionals should eschew traditional punishments for substance use in favor of evidence-based alternatives that improve the long-term outcomes of substance use disorder treamtent.

For example, who in their right mind would tell their probation officer they recently relapsed or otherwise used drugs? People go to jail for this stuff.

Here’s another example. Assume a couple gets arrested for child abuse. Although nobody wants parents to be using drugs, it’s unavoidable — some parents will have drug problems. The couple’s home is visited by a Department of Child Services representative who performs a test for methamphetamine residue in the home. The representative finds meth residue on a window in the parents’ bedroom, where their child is never allowed. No drug paraphernalia or drugs was accessible to the child.

This is actually a reason why parents get charged with child abuse.

These social services workers should be less willing to turn to the criminal justice system in dealing with clients’ substance use problems. There should be more government funding for committing people in the above two examples — as well as anybody else who deals with the social services system in any way, not just these two manners — to evidence-based substance use disorder treatment.

One last example. Opioids have been my primary drug of choice for nearly 6 years now. I turned to heroin in mid-2016, which is much more dangerous than pharmaceutical opioids due to its unregulated nature. Heroin users don’t know what their batches contain or, even if they did, the amount of heroin, fentanyl, or other drugs they contain. This makes it very easy to overdose from heroin — this ideology also spills over to counterfeit opioid tablets, which are already common all over the country. They usually contain fentanyl, a highly-potent opioid that has little threshold between the amount required to (A) make users feel high and satisfy their withdrawal symptoms and (B) cause overdose.

Cannabis has been shown to be a powerful tool in promoting long-term treatment outcomes in people like me, long-term sufferers of opioid use disorder. Although cannabis can certainly be misused, it’s silly that probation officers widely violate probationees for testing positive for cannabis, particularly where cannabis use helps people stay clean from other drugs that are typically more dangerous than cannabis, such as opioids.

Part 1C — Healthcare Providers Should Be More Accepting of Drug Use

Healthcare providers shouldn’t be forced to fire patients who test positive for drugs of abuse or otherwise admit to using illicit or unprescribed drugs.

For example, let’s say I relapse on illicit opioids. If I tell my buprenorphine prescriber that I’ve relapsed, he’s likely to fire me from the program. That leaves me without a legitimate source of Suboxone, a drug that’s helping me avoid using heroin; quite literally, I face death every time I use heroin. Although we’d like opioid users in these situations to refrain from relapsing, is it really a good idea to have such a low-tolerance view toward accepting recovering patients’ slip-ups?

I should note that, while the prescriber has some discretion in choosing whether he fires me or not, the state outlines rigid guidelines for buprenorphine prescribers in Tennessee that prevents them from keeping patients who’ve relapsed too many times.

Another example. Simone is prescribed a controlled substance (e.g. Xanax, Norco, Percocet, gabapentin) from a physician. The physician is required to provide drug screens on at least a quarterly basis, if not every month.

Physicians face serious scrutiny from regulators if they don’t fire people like Simone if they test positive for illegal drugs like meth, cocaine, cannabis, or other drugs that aren’t prescribed to them.

Let’s say Simone is prescribed Percocet for a serious, debilitating spine injury. She tests positive for cannabis according to a urine drug screen performed by her prescriber. Simone is now refused a prescription by the physician.

Every physician is different. Some allow a few slip-ups from such patients, while others have no-tolerance policies.

One thing’s for sure, however — prescribers shouldn’t be forced to stop rendering services to patients who slip up like Simone did. This is especially true with cannabis, an effective pain reliever that’s already been legalized for at least medical use by more than 30 states.

Part 1D — Doing Things That Help Drug Users

This might seem obvious, but it’s the most important thing that can be done to address regional area-specific challenges—actually doing things that help drug users.

These things can be carried out by non-profit organizations, government agencies, groups of like-minded people, or even individuals.

Here’s a quick anecdote: I pick up litter around Martin regularly, and I’ve done so in a few other local communities. In the past month, for example, I’ve picked up 3 syringes and had one other person in my neighborhood tell me they found a syringe littered near their home. In total, I’ve found syringes on 5 occasions on my own; with that other person’s report, that makes 6 total instances of used syringes being improperly discarded in my immediate vicinity.

I’ve talked to a few neighbors about this and the reaction is always the same — surprise; concern.

I always tell them that injection drug users are incentivized to throw used syringes on the ground because of law enforcement or not wanting family members, friends, or coworkers to know that they inject drugs. I follow this by telling them that injection drug users, such as myself, don’t have anywhere to dispose of used syringes around here.

This holds true for the entirety of West Tennessee outside of Shelby County, in the far southwestern extreme of the state, that is, as the Shelby County Health Department offers syringe disposal services for a small fee.

Even in cities that have such programs, injection drug users still improperly dispose of used syringes.

  • We need gas stations to start putting sharps containers in their bathrooms. Doing this won’t welcome injection drug users to start shooting up there freely — we’re already using public bathrooms to do this! At least help us and everybody else on this planet, not to mention animals, stay safe by buying a sharps container for a few dollars and placing it in public bathrooms. This holds true for all other facilities that welcome the public: Walmart, other grocery stores, Family Dollar, Dollar General, restaurants, and so on.
  • Health departments and/or non-profit organizations and government agencies need to begin offering services that syringe services programs do, such as collecting others’ used syringes, referring drug users to evidence-based substance use disorder treatment providers, and distributing supplies that keep drug users safe (e.g. fresh syringes, clean tooters, alcohol swabs, tourniquets).
  • Lifting federal regulations on buprenorphine prescribing. Like I’ve talked about in “Suboxone Is Too Hard to Get,” SAMHSA, the Substance Abuse and Mental Health Services Administration, a federal government agency, only allows physicians who specialize in addiction medicine, undergo specialized training, and pay hefty licensure fees to prescribe buprenorphine (Suboxone, Subutex) as an opioid replacement. Thanks to this legislation, the nine-county region that is Northwest Tennessee, home to some 254,000 people, only has 19 buprenorphine prescribers — and a whopping 2 methadone clinics, each of which is located at the westernmost and easternmost ends of Northwest Tennessee in hella inconvenient form.
  • Requiring pharmacies to sell syringes to adults. Although I’m not a fan of authoritative governments and excessive market regulation, pharmacies throughout Tennessee, especially rural Tennessee, widely refuse to sell syringes to customers without insulin prescriptions. This encourages injection drug users like me to purchase syringes off the black market at best and share used syringes at worst. Revoking pharmacists’ ability to exercise discretion in choosing who they sell syringes to would increase access to clean syringes throughout all of Tennessee, especially chronically-underserved areas like Northwest Tennessee.

The more we do these things, the more likely people, particulary underserved drug users, will trust “the system.”

2. Educating Drug Users About Harm Reduction

I can’t speak for the entire drug-using population of Tennessee when I say this. However, here in Northwest Tennessee, drug users aren’t aware of things like the existence of naloxone (Narcan), where to find clean syringes in a legal manner, how to properly respond to opioid overdoses, or the recent state laws designed to protect drug users.

I’m dead-ass serious when I say that most drug users I’ve come across don’t know what naloxone is.

Even daily injection opioid users, who really, really, so very badly need naloxone largely don’t know what naloxone is. It’s not like they just don’t know where to get it; they don’t even know about it in the first place!

Here’s the Solution

Part 2 — Educate Drug Users, in Particular, About Harm Reduction

Like I mentioned earlier, even though the state has hired 20 Regional Overdose Prevention Specialists to promote harm reduction, reduce stigma, and boost public awareness of things like naloxone administration and how addiction actually works — these are the three things the state’s Department of Mental Health & Substance Abuse Services claims to do via its ROPS — they largely fail to reach people who actually are at risk of opioid overdose and other drug users.

This isn’t an empirical fact. Rather, it’s just my experience. Remember how I talked about people aren’t willing to trust “the system,” let alone people?

We need to do a better job of educating drug users, especially those who are most at risk of serious injury or death stemming from drug use (i.e. homeless populations, people of color, low-income individuals, those with lengthy criminal histories) about harm reduction.

Yes, both society and the greater cause of advancing harm reduction and improving the lives of people suffering from substance use disorder benefit from educating the general public about harm reduction.

However, long-term injection drug users and other underserved, problem drug users are harder to reach than run-of-the-mill drug users. After all, the majority of people are drug users, which includes cannabis, alcohol, and tobacco.

  • We need to reach these people and tell them about naloxone and how to use it, as well as provide them with Narcan or generic naloxone kits.
  • Educate them about how to properly inject drugs.
  • Inform people like me about what blood-borne diseases (e.g. HIV, Hepatitis C[HCV]) are and how they spread. Make clear how diseases can spread through sharing paraphernalia such as syringes or tooters. Provide safe, feasible options for drug users to stay safe while using drugs without having to incur additional costs or losing any of their drugs in the process.
  • Tell drug users why they should care about harm reduction. Getting end-users of drugs to adopt harm-reduction-related ideologies is the single most effective way to get them to practice it.
  • Most importantly, we need to know where to obtain harm reduction supplies. This includes the mail-based national distribution organization NEXT Distro, based in New York, diabetes and medical supply websites that sell things like syringes without prescriptions at low costs, and potential in-state distributors such as syringe services programs — if and when they’re implemented in currently-underserved areas like NWTN or SMT.

A Summary

Despite the fact I only labeled the above solutions as Part 1 and Part 2, there are actually five main solutions for addressing the area-specific challenges that drug users face here in Northwest Tennessee — remember, these solutions largely hold true for the entirety of the Volunteer State.

If you couldn’t be bothered to read the body of this article, that’s okay! Here’s a summary of the five solutions I proposed above.

These five solutions are summarized below, with the first paragraph representing Part 1A, the second paragraph representing Part 1B, and so on. The fifth paragraph represents Part 2.

Drug users and law enforcement need to have a better relationship. Law enforcement is directly responsible for improving this relationship. Benefits include officers having access to more information because more community members would be willing to proffer leads or direct evidence and improving long-term substance use disorder treatment outcomes.

Social services-criminal justice alliance professionals include probation and parole officers, judges, child custody social workers, and sheriffs, among others. These people are often keen on turning directly to traditional punishments (i.e. incarceration, strict drug court program enrollment) in dealing with substance use disorder. Members of the social services-criminal justice alliance should adopt other, more humane, evidence-based means of addressing substance use problems, including criminal charges that result from drunken behavior and parolees simply failing drug tests for illicit (or legal, in some cases) drugs.

Healthcare providers, whether because of personal preference, employer requirements, laws, or regulatory scrutiny, are too keen on discontinuing treatment as the result of patients’ unprescribed use of illicit (and sometimes legal) drugs. This even extends to treating long-term, dependent opioid users with buprenorphine, such as here in Tennessee, where prescribers aren’t allowed to tolerate many relapses and are forced to fire patients, leaving them without a legal source of reliable pharmaceutical opioids. Prescribers should ultimately be more accepting of patients’ consumption of unprescribed and/or illicit substances, ranging from primary care physicians, to mental health practitioners, to addiction medicine specialists.

It sounds silly, but we need to actually start rendering services that reduce harm to drug users, repealing existing legislation that works against the best interest of people suffering from substance use disorder, enacting new legislation that favors these persons’ lifelong treatment outcomes, and so on. This includes things like retail businesses adopting the use of sharps containers in their bathrooms, removing SAMHSA’s strict red tape around buprenorphine prescribing for opioid use disorder, and having non-profit organizations and/or health departments render services to local communities such as collecting used syringes, distributing clean ones at no cost, and referring problem drug users who seek help to evidence-based treatment providers.

Lastly, we should educate end-users of drugs about harm reduction. Simply educating the public about it isn’t enough. Despite the efforts of Regional Overdose Prevention Specialists in Tennessee, people paid by the state to distribute naloxone and reduce drug-related stigma, people who are most affected by drug use such as me are largely glossed over by the efforts of ROPS. ROPS fail to reach drug users themselves due to the population’s lack of trust in social support systems and their use of discretion. We need to develop and carry out new approaches to educating these people about harm reduction.

Putting It All Together

Yeah, this article is pretty long. There’s a lot of information to take in. I can hardly digest YouTube videos that are just a few minutes long, let alone articles that are 4,000-plus words long, like this one — hell, I usually can’t be bothered to read them in the first place, am I right?

And, again, this is by no means a complete aggregation of all the solutions to addressing Northwest Tennessee’s area-specific challenges.

There is no single way to address these area-specific challenges. To effectively, speedily integrate harm reduction — and not just grabbing the low-hanging fruit that is distributing naloxone — into Tennessean society, we need to explore all five of these avenues at minimum.

So, what can you take away from this?

We need drug users and law enforcement to get along. We need to develop and regularly use alternatives to criminal punishment to address problem drug use. Healthcare providers need to be more lenient in dealing with substance use. We need to actually do things that help drug users, like implement places for injection drug users to dispose of syringes without the threat of being slapped with criminal charges. Lastly, drug users, particularly those who are most damaged by how we currently deal with drugs as a society, need to be educated about harm reduction.

Also, existing members of the harm reduction community need to be active in laying down harm-reduction-related infrastructure in barren places like Northwest Tennessee. We’re not being helped by hardly anybody who knows what they’re doing!

Why haven’t people who get paid to do this — unlike me, unfortunately — in well-established areas such as California or New York focused their efforts on places like Northwest Tennessee or Southern Middle Tennessee?

I don’t know. But I sure hope this changes.

Even if I never get paid to do this for a living, even if I never have a part in implementing harm reduction on a large scale here in Tennessee, I sure hope some group, some organization, some government agency, or somebody makes change here and makes change quickly.

Categories
From Personal Experience Recovery The Volunteer State

Suboxone Is Too Difficult to Get

We’re in the midst of an opioid epidemic here in the United States. It’s worse here in Northwest Tennessee than most places across the country — not the worst, but it’s certainly not great.

There are a few central reasons why opioid use here is so likely to result in overdose, if not death. First off, the lack of regulation in the market means batches of opioids can’t be screened for contents or purity. Put simply, opioid users, like me, don’t know what we’re using.

Second, there’s a lack of resources necessary to healthy, fulfilling lives here in rural Tennessee. Many of us struggle to even find transportation to get to mental health practitioners or physicians, let alone pay for them in the first place.

Third, although this fits into the “resources” problem mentioned above, it’s difficult for long-term, dependent opioid users to seek out and secure opioid replacement treatment, also called medication-assisted treatment (MAT), in the form of buprenorphine (Suboxone, Subutex) or methadone.

A Personal Aside

I am a long-term drug user. Opioids have been by primary drug of choice since, give or take a month, June 2014. Not for pain — just ‘cause they’re hella fun. #ItsLit

But seriously, drug use isn’t cool. #ItsNotLit I self-medicated depression and anxiety with opioids before opioid dependency caused — well, worsened is the proper term — mental health issues on its own accord.

I began injecting heroin about two, maybe two-and-a-half or three years ago. I first snorted heroin for a few months or a year prior to graduating to injection drug use. I moved from street-sourced pharmaceutical opioid tablets to heroin, and later from sniffing heroin to injecting the drug, for cost’s sake.

Earlier this year, after an arrest, I was tired of the legal issues associated with illicit drug use. Thus, I sought out treatment at a buprenorphine prescriber in Jackson. I went as far as Jackson, an hour or more away from me, because there aren’t many prescribers in Northwest Tennessee. More on that below.

Things That Make It Difficult for Opioid Users to Get on Suboxone or Methadone

This article solely focuses on the area-specific challenges that plague long-term illicit opioid users such as myself here in Northwest Tennessee, though these issues aren’t just specific to Northwest Tennessee — they’re rampant all over rural Tennessee, if not the entirety of the state.

Due to the fact that the federal government upholds excessive regulation around buprenorphine prescribing, these things also hold true throughout the United States.

Cost

I’m not particularly a fan of airing my personal information out into the ether, but I want everyone to know just how expensive Suboxone really is.

The prescriber I go to charges $275 monthly for just one visit. The physician prescribes 28 days’ worth of Suboxone for that price. If you go weekly, it’s $100 per week. Everybody at this clinic has to start off going weekly for at least 6 weeks.

These excessive costs make it difficult for people to get their foot in the door — and $275 isn’t on the higher end, either; once people do gain entry to medication-assisted treatment programs, they’re still going to get their heads busted by facilities that specialize in opioid replacement therapy.

56 generic Suboxone films cost $388 at the pharmacy I go to. They don’t take discount cards. I don’t have insurance. None of the 11 health insurance plans I was offered by Healthcare.gov this year covered Suboxone.

Right now, it costs $663 per 28 days. It initially set me back $788 per 28 days.

Like, fuck — might as well stick to heroin!

Pharmacies Aren’t Willing to Fill

Pharmacies don’t like filling prescriptions for controlled substances.

Especially for Suboxone.

The idea is that people on Suboxone and other controlled substances are more likely to abuse their medications than run-of-the-mill medications and pester pharmacies for early fills and cause a scene.

Is this true? No idea. On the surface level, I totally understand the merits behind this ideology. Is it right? No.

The pharmacy I use is an hour away from my house. It’s a small mom-and-pop pharmacy that doesn’t take discount cards. I’m forced to pay cash. At least I get treated like a human, though.

I tried to fill at Walgreens in that city, but they said since I didn’t live there, they weren’t willing to fill. My prescriber is a quarter-mile — a five-minute walk — away from that Walgreens. Whatever.

I tried to fill at a CVS where I live, but the pharmacist said they were at capacity for buprenorphine prescriptions, meaning they couldn’t welcome any more. That’s a lie. There’s no such thing as an upper limit of Suboxone prescriptions — or any prescriptions — that a pharmacy can fill. Whatever.

I tried Walmart. They said they’re not licensed to dispense buprenorphine. That’s a lie. “While qualified practitioners are required to have waivers to prescribe or dispense buprenorphine under the Drug Addiction Treatment Act of 2000 (DATA 2000), pharmacists and pharmacies are not required to have any credentials for dispensing these medications beyond those for other Schedule III medications,” SAMHSA’s official website says. Whatever.

I tried the closest Walgreens to where I live. They don’t stock buprenorphine. Whatever.

Is it their responsibility to fill my prescription? Not at all. I shouldn’t have gotten myself into this situation in the first place. I should eschew drug use in favor of a better life.

All long-term opioid users should do the same — stop using drugs — unless given a prescription for chronic pain or something. However, this doesn’t work, in practice.

SAMHSA Limits the Number of Prescribers Who Can Legally Prescribe Suboxone

I’m not going into the specific limitations that SAMHSA, the Substance Abuse and Mental Health Service Administration, places on buprenorphine prescribers.

Just know that there’s a reason why less than 4% of all licensed physicians in the United States are able to prescribe Suboxone to chronic, dependent opioid users. That reason is SAMHSA.

Yeah, I get it — what if doctors started misprescribing Suboxone? I get it.

However, one thing’s for sure: not helping the already-underserved populations of people suffering from opioid use disorder by making buprenorphine and methadone, the two go-to opioid replacement drugs, widely available harms us. Family members, friends, and communities lose people to the opioid epidemic left and right, especially in rural Tennessee.

Statistics About This Lack of Prescribers

In the nine-county area that makes up Northwest Tennessee, there are about 254,000 people. There are only 19 buprenorphine prescribers licensed to prescribe Suboxone or Subutex for opioid use disorder.

Fucking awesome.

The United States Department of Health and Human Services designates certain parts of the United States as “federal shortage areas,” which, obviously, have shortages of health professionals based on various criteria.

7 of NWTN’s 9 counties have medically underserved populations (MUP) in terms of primary care physicians. The other 2 are medically underserved areas (MUA). MUA refers to the entire county’s geographic area, whereas MUP refers to the people in the area. To make it simple, all of the counties here don’t have enough doctors.

9 of NWTN’s 9 counties are considered to have a shortage of federal mental health professionals and are deemed “Whole County Geographic” shortages. That means no matter where you live in NWTN, the entirety of this region has a shortage of federal mental health professionals.

What You Can Take Away From This

Suboxone and Subutex both contain buprenorphine, a long-lasting, relatively safe opioid that satisfies long-term, physically-dependent opioid users’ brains’ opioid receptors. That means no withdrawal symptoms, physical or mental.

When I didn’t have opioids over the past 3+ years, when my opioid use really started to progress, I laid around, did next to nothing, and my depression and anxiety symptoms worsened.

Now, since I started Suboxone in mid-September, I haven’t felt depressed at all. I don’t have to worry about overdosing because I don’t use heroin. I don’t have to worry about the legal issues associated with illicit drug use.

Other long-term opioid users largely report the same: their mental health improves and stabilizes, they don’t have to live highly-dangerous lifestyles with short life expectancies, and they don’t have to worry about the legal issues arising from daily drug use.

We need to make buprenorphine and methadone more widely available. The single most effective means of doing this would be severely loosening the existing regulations supported by SAMHSA.

As more practitioners could prescribe buprenorphine, the cost of getting a Suboxone prescription would decrease big time. Filling the prescription would still cost a lot, but as demand for Suboxone increases and stigma associated with Suboxone users decreases — a direct result of loosening government regulation on buprenorphine prescribing — I feel that costs incurred by end-users of Suboxone would drop.