Opioids, Overdose, Abstinence—A Historically Deadly Combination

Editor’s Note: Today’s post comes from contributing editor Brooks Hudson, a PhD student in history at Southern Illinois University.

We have told ourselves the “opioid crisis” is an exception to past drug scares. In the past century, the narrative goes, we relied on law enforcement and punishment to curb widescale drug use, but our country now has turned over a new leaf—one centered on public health and compassion. Had it not been for Purdue Pharma, a uniquely bad actor, the spread of addiction and overdose deaths would have never occurred.

None of this is true. Rhetorically, yes, smart politicians now deemphasize the punishment aspect in public speeches. But law enforcement plays a greater role than ever before in regulating the use of drugs—from the zealous policing of some people who use illegal drugs to expansive prescription monitoring programs and from the detailed cataloging of the dosage of Americans’ medications to DEA to threats to doctors who fail to obey their dictates. Such strict and exacting regulations often leave elderly patients and patients with chronic pain out in the cold unable to secure necessary drugs. Yet, at the same time, prohibitionist drug control measures have also done little to stop the proliferation of black-market drugs.

Far from being a deviation, this has long been the norm and with often devastating results. Regardless of your thoughts about current events, this post will let us look back and travel to the past to try to clarify why overdose deaths continue to increase now despite a dramatic recent decrease in opioid prescriptions. And why this situation unlikely to change under current conditions. For about the last century, the United States government has abided by a philosophy that seems to prioritize drug abstinence and the strict policing of drug use at the expense of saving lives. To investigate this continuity, I will briefly examine two episodes: a 1930s critique of an early version of the war on drugs and the government’s opposition to needle exchanges during the AIDS epidemic of the 1980s.

Points Hudson Title Card Opioids
Left: A 10 milligram OxyContin pill. Source: Wikimedia Foundation.

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The Instruments of Darkness Tell Us Truths: A History of Heather Edney & The Santa Cruz Needle Exchange

Editor’s Note: Today’s post in honor of Women’s History Month comes from Greg Ellis. Ellis and Heather Edney are currently writing an insider’s account about Edney’s early pioneering needle exchange work in Santa Cruz during the AIDS epidemic prior to the advent of protease inhibitors. Edney’s innovative ideas about harm reduction flourished in a male-dominated field and changed the face of modern healthcare and recovery. The memoir will be an imprint of Anthology Press.

junkphood - How to Spot a Coke OD
How to Spot a Coke OD, from the “Coked-Up Puffs” edition of junkphood, artwork by Brooke Lober, 1995. Image courtesy of Heather Edney

But ‘tis strange and oftentimes, to
win us to our harm, the instruments
of darkness tell us truths, win us with
honest trifles, to betray’s in deepest consequence.

—Macbeth act 1, sc. 3, l. 124-8

There is a simple principle in the field of harm reduction that drug users are the experts on using drugs. But what exactly does that mean? Strong governmental and institutional pressures to uphold systemic standards and anti-drug laws frequently foster mistrust between drug users and social service providers.

In her soon-to-be-published memoir and harm reduction manifesto, titled Sucking Dick for Syringes, long-time harm reduction activist Heather Edney recounts the history that led her to bridge the divide from the shooting gallery to the boardroom. Edney, who was instrumental in building the pioneering Santa Cruz Needle Exchange Program (SCNEP) in the 1990s, writes about the intersection of drugs, sex, and running an illegal syringe exchange. Her innovative risk reduction modalities ultimately created some of the most revolutionary and lasting changes during the infancy of the field. Her ideas and techniques have saved countless limbs from infection and loss, prevented unknown numbers of seroconversions, and introduced the concept of holistic healthcare to marginalized and criminalized populations.

Heather Edney operated in the world of drugs for much of her young life before landing in Santa Cruz, California, at the age of 19—where she learned about the fledgling needle exchange program run by a dedicated group of volunteers. Edney employed the skill set developed from a childhood of sexual trauma and familial dysfunction, quickly rising to a leadership position and ultimately creating an internationally renowned needle exchange model.

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