By: Daniela Muhleisen
First Church Shelter, SIFMA Now!, and the Harvard Global Mental Health Coalition hosted the 2017 Mitch Snyder Lecture, an opioid awareness event for Harvard College students and members of the Cambridge community. The Mitch Snyder Lecture memorializes Mitch Snyder, longtime advocate for people experiencing homelessness in the nation who died in 1990. The event included keynote speakers with legal and medical experience working as champions to change policy and treatment options for those living with Substance Use Disorders (SUDs) and was followed by a community discussion surrounding next steps for local and national-level advocacy, education, and policy change.
Dr. Kimberly Sue and Corey Davis were the keynote speakers at the 2017 Mitch Snyder Lecture. Dr. Sue is a sociocultural anthropologist and physician who studies the intersection of mental health policy, addiction policy, and drug treatment as well as access to health and treatment in the US prison system. She has conducted ethnographic research on Massachusetts women enrolled in a community-based suboxone treatment program as they transition from life in prison after their release. Corey Davis is an attorney at NHeLP’s Los Angeles Office who has received the International AIDS Society’s Young Investigator Award and currently works to improve access to health and Medicaid in an ever-challenging national health landscape.
Both Dr. Sue and Corey Davis spoke largely of their own experiences – and hardships – working within a system where access to treatment for individuals living with SUDs is limited, costly, and stigmatized. The first obstacle, of course, is the “illegal” label attached to drug use which has led to the unregulated introduction of fentanyl in heroin, leading to yet another spike in fatal overdoses. The stigma that is attached to “illegal” substance use is just as prevalent; while most people will agree that something must be done about the epidemic, “not in my backyard” is too often repeated when the state attempts to open new treatment facilities for those with SUDs. Education – even in the medical field – is also limited, and where education does exist, differences in policy opinions often stifle the ability for medical institutions to affect change amidst a growing epidemic. On top of all of these challenges, the Trump administration and the fight against the ACA makes the issue a legal battle as well.
So where is the hope for changing the gaps in access to SUD treatment? Dr. Kim and Corey Davis highlighted alternatives that would simultaneously help reduce stigma, the transmission of disease, and overdose death. For example, Dr. Sue referenced the incredible initiatives for harm reduction in Vancouver, Canada which include supervised injection facilities that allow persons to use safely and under supervision. Individuals using these facilities are exempted from prosecution under Canadian drug laws, and they are able to inject safely and off the streets; in the case of overdose, community workers and nurses at the sites can administer Nalaxone. A peer-reviewed study from 2009 confirmed the benefits of safe injection sites in Vancouver; of the 273 witness overdoses, none resulted in death. Moreover, over 2,000 individuals between 2004 and 2005 received referrals for counseling support. Perhaps most importantly, 75% of users reported that they injected more safely since using the sites, and this safety also translated to feelings of safety by users, specifically women who the female injection sites to be refuges from the vulnerability that they face when they use on the streets.
However, in Massachusetts, the picture is more bleak. The Chapter 55 Overdose Report, a study by Massachusetts Department of Public Health released this August, found that there were almost 2,000 confirmed opioid‐related deaths in Massachusetts by May 2016. Nonfatal overdoses in the state have increased 200% between 2011 and 2015. More daunting, however, is the fact that the chance of overdose is 30 times higher for those experiencing homelessness, and for those with a history of incarceration, the overdose rate is 120 times higher. While the opioid epidemic may finally be on the agenda of public discussion, those who are most affected by the epidemic are often those forced to suffer the burden of our siloed health system.
Safe injection sites are a proven measure that lead to violence prevention for substance users and those living with SUDs, providing a haven for vulnerable populations living on the streets. Moreover, these places provide users with a place to use without needing to fear federal drug laws, thus reducing sentences that only advance the criminalization of substance use and substance use disorders.
Of course, safe injection sites, harm reduction, and decriminalization of substance use disorders are only the first step in an upward battle against this epidemic. Education and community awareness is just as vital. This is a public health crisis; as community members, we should be doing all that we can to educate ourselves, to reduce stigma, and to help reduce overdoses. Police officers should not be the only ones trained to administer Naloxone. This is a step that we all can take.
The First Church Shelter, SIFMA Now!, and the Harvard Global Mental Health Coalition plan to partner again to host a Narcan training for Harvard College students and the Cambridge community in mid or late January.