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Stories from the field | A community-led response to the overdose crisis in the USA

In this video, Louise Vincent from Urban Survivors’ Union talks about her daily reality, fighting the overdose crisis in North Carolina, USA
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My name is Louise Vincent, and I’ve worked in harm reduction for the last 20 years, I’ve been practicing harm reduction for over 20 years and I’ve been using drugs most of my life. So abstinence based programming and treatment for me started around the age of 13, and it started with wilderness camps being abandoned by my family. Tough love approaches, you know, everything that people could do to disconnect you and to make you feel alienated and broken. And if we could if we could break people down, if we could if we could scare people bad enough, if we could scare them straight, if we could force them.
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Through fear and pain to change their ways, and that’s most of what I’ve been subjected to my entire life and most of what we see people subjected to here in the United States and certainly here in the southern United States is far more conservative politically. And really, it’s taken from 2016 to get serious service programs legalized. And even community naloxone came pretty late.
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I got involved with harm reduction probably at around the age of twenty eight. Forty five now. And I got involved. Because I was getting involved with of them, this gave me the ability to have a life that I wanted, this gave me the ability to have.
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The same chance as everybody else, right? So I went to college, graduated college, went to graduate graduate school, got to MPH, became an executive director of a harm reduction program.
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So I see those things as successes, but by any you know, if someone else was looking through the lens of sobriety or an abstinence based world, then I have not been successful at all. So I guess we have to decide where we sit in this in this framework and and what is success.
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It is not the chemical contents of my pee that should define me, it is in fact my behavior. And it is not for you to try to figure out whether I’m using. Right.
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So let’s talk about the problem of overdose in the United States. How serious is this problem? What are we dealing with? What’s actually happening? Right. It’s serious, right? We have got an enormous crisis here in the United States, a crisis from which I don’t think we give enough attention to what we’re dealing with as a poison drug supply and a synthetic drug crisis. So we’ve got synthetic drugs that are stronger than we’ve ever seen. We call them heroin, even though it’s not heroin, it’s fentanyl and analogs of fentanyl and other synthetic drugs that never made it to market.
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Small kernels of, you know, what would be considered a kernel of sugar is enough to kill you, people cannot wrap their mind around the small amount of drugs that it takes to actually kill someone. So it used to be that you basically, in order to die from heroin, you know, we talk our interventions were don’t mix drugs. Benzodiazepine and opioids are dangerous. Now, that’s not you know, that’s not enough. We’re talking about fentanyl is enough to kill you on your you know, the first time you use it, whether you’re injecting it, snorting and it does it, you know, a very tiny, minuscule amount is enough to kill you. So our answer to this has been naloxone and community based naloxone.
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Thank God for it.
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It was illegal to give people naloxone. And that’s because naloxone was a prescription drug, and so we had to fight really hard to legalize naloxone, people did not want to call 911 when they were terrified. So we had to pass legislation and we called that legislation Good Samaritan legislation. And that was, if you call 911 one because of an overdose, you will not go to jail. Right. And you won’t go to jail if you have drugs on you. Small amounts of drugs on you.
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We understood or the world understood that you were calling to save a life and the determination is basically life is more important than arresting someone. Most people believe that life is valuable and most people believe that life is more valuable than arresting people for small amounts of drugs. So we were able to pass Good Samaritan legislation and it was doing such a good job. Until recently, we passed a death by distribution law, which basically said, if you are involved in giving someone drugs and they die, you can be charged with murder. And. If you have to worry about whether you’re going to be charged with murder. You’re not going to call nine one period. You’re not going to do it.
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And so. Here we are again at the crossroads of we’ve got to push and the pull, we’ve got one hand trying to help people that use drugs. We’ve got another hand trying to arrest people that use drugs. We’ve got criminalization versus public health, both pulling in two different directions and smashing into each other and undoing each other.
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What is community naloxone look like in our program? Well, you know, our program is made up of about a thousand. I’m looking here at our program data and so we have about nine hundred ninety eight unique participants last year that we saw. And about 400 of those participants were new participants. We distributed around thirty five hundred vials of naloxone. And of those 35 vials of naloxone, we saw we saw sixteen hundred plus reversals. And those are just the ones that people reported. So that’s sixteen hundred. Lives saved. That’s huge, that’s huge, that’s sixteen hundred people that are here today because of community action in Greensboro, North Carolina, and to just pause with that, I think is really important.
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Sixteen hundred people that would be dead without community naloxone. How powerful. What a powerful what a powerful intervention. And it’s so good for people that use drugs because they can be involved in the life saving process. They can they can assist helping people stay alive and being part of the solution.
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We distributed five hundred and fourteen thousand syringes with about a 60 percent return rate. So we are working really hard here in Greensboro. And this program was illegal up until 2016. So we’ve only been legal for a couple of years and now we operated underground for a lot of years. But it is so different being able to operate legally than it was being an illegal program and having to. Having to always be secretive and and being arrested for doing this work, we are not able to have safe, safe consumption spaces and it is so important. It’s so important.
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So we provide safe bathrooms and we have a safe bathroom policy, which basically says people can come in and use our bathroom. We check on them every three minutes. We have we have we’re able to have an intercom on the door and we’re able to get in. And if you don’t respond to our voice, we. Hello or you OK? Are you back there? You know, we knock on the door if no response, we go in and we reverse the overdose. Many times people pull up in front of the office, overdosed. So we have Ambu bags. We are ready to go at any moment.
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Last year, I believe we reversed around 11 or 12 overdoses here on site and there was zero deaths. So we’ve had zero deaths here. I want to emphasize today. That the overdose crisis is going to get considerably worse as we move forward because we continue to ignore. Evidence we’ve got to treat it with dignity and respect. We’ve got to treat people as though their rights matter. I mean, harm reduction, the big H, the big are human rights. Harm reduction is more than a public health intervention. It’s more than naloxone. It’s more than a syringe service programs. It is about racial justice. It’s about social justice. It’s about human rights. It’s about community resilience.
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And it’s about keeping drug users at the forefront of decision making and engaged in employment at every level of service provision. Thanks.

We will conclude the public health dimension topic with the real-world experiences from Louise Vincent. Louise talks about the devastating overdose crisis in the USA. She gives us insight into the daily work of her organisation, fully run by and for the community of people who use drugs.

Such community led initiatives will be further spotlighted throughout this course and we will dive deeper in the community involvement in the second topic of the next week: “The community at the heart of the response”.

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Drug Use and Harm Reduction

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