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New York City Moves To Expand Availability Of Naloxone

In the wake of a rising death toll in the opioid overdose epidemic, New York City Mayor Bill de Blasio has announced a plan to make the overdose antidote, naloxone, more readily accessible.

Naloxone, an opioid antagonist also known under the brand name Narcan, will be available for around $50 over the counter at Rite Aid and independent drug stores in the city, according to Newsday.

De Blasio and other city officials announced the change in a press conference on Monday.

According to city data, opioid-related overdose deaths have increased by 56% since 2010. “The deaths are what we all struggle to avoid … but that’s just the tip of the iceberg,” said de Blasio. “For every death, there are literally hundreds who struggle with addiction.”

City Health Commissioner Dr. Mary T. Bassett echoed that sentiment. “In order to recover, you need to stay alive,” she said.

Technically, naloxone is still a prescription medication, but because Bassett announced a citywide standing order to dispense the drug—something Baltimore did earlier this year—it is available over the counter.

Last year, New York City Police Commissioner William Bratton announced that he planned to have the city’s entire force trained and equipped with naloxone. And New York Attorney General Eric Schneiderman announced a statewide program to fund more naloxone for police departments statewide.

In addition to making naloxone more available to the public, the city will spend $750,000 to distribute naloxone kits to New York City drug prevention programs. On a similar note, the city announced plans to train 1,000 more medical professionals to prescribe buprenorphine, a drug that is used for opioid replacement therapy.

At the press conference, 21-year-old James Brenker of Staten Island spoke in support of the initiative. He said that his own life was saved by naloxone when he overdosed on heroin and oxycodone.

“I felt like no one cared. I know a lot of addicts feel that way,” he said.

This story was originally published on The Fix.

Johann Hari on Billie Holiday, Harry Anslinger, and the War on Drugs

On Wednesday – the same day that New York approved emergency access to medical marijuana – New York City activists gathered in a Chelsea loft to hear Johann Hari, author of Chasing the Scream: The First and Last Days of the War on Drugs, explain why the drug war hasn’t worked.

He began, though, not by talking about the modern drug war, but by telling a story that started more than three decades earlier.  

“In 1939 seven blocks away from where we are now,” Hari said, “Billie Holiday walked on stage in a hotel where she wasn’t even allowed to walk through the front door. And she sang a song. It was called ‘Strange Fruit.’”

That was “the musical starting gun for the civil right movement,” but at the time it attracted unwanted attention from one Harry Anslinger.

For more than three decades, Anslinger was the head of the Federal Bureau of Narcotics. He was the man responsible for waging the war on drugs before it was called the war on drugs.

According to Hari, he had a “really intense hatred” of drug addicts and of African Americans — and Holiday was both.

The same night the rising jazz great sang “Strange Fruit,” Hari said, Holiday got a warning from Anslinger: Stop singing that song.

But Holliday didn’t stop, and Anslinger stayed true to his threat.

He hired someone to follow her and, in 1947, the singer was arrested on drug charges and sentenced to 18 months in prison. After her release, she couldn’t get the license she needed to perform in places that sold alcohol.

“This is what we are doing to addicts all over the world,” Hari said. “We are putting barriers between them and their ability to reconnect.”

Holiday started using again and by the late 1950s, years of drug and alcohol abuse took their toll: She was diagnosed with liver cancer.

Johann Hari in 2011, via Wikimedia Commons

Hospitalized in 1959, she was arrested and handcuffed to her deathbed when cops raided her hospital room. She died, but Hari doesn’t think Anslinger — who later became an opiate addict himself — came out on top.

“Right now people all over the world are listening to Billie Holiday and they’re feeling stronger and nobody fucking remembers Harry Anslinger,” he said.

That’s not entirely true, though. As Hari recounted, at least one person remembers Anslinger: Maricopa County Sheriff Joe Arpaio.

In the course of his research, Hari visited Maricopa County — and found a picture of Anslinger hanging on the notorious sheriff’s wall.

In that same visit, Hari passed a chain gang of female Maricopa County inmates digging graves, wearing shirts the read “I Am a Drug Addict” and trying to ignore the jeers from passersby.

According to Hari, that’s the exact opposite of how addiction should be addressed, because it’s based on a misunderstanding about how addiction works in the first place.

There’s an assumption that heroin causes heroin addiction which means that forced sobriety is the solution, Hari said.

He doesn’t think that’s accurate, though.

Early addiction experiments showed that a rat put in a cage with a bottle of drug-laced water and a bottle of regular water would quickly become a drug addict, Hari said. That seemed to reinforce the idea that the drugs were the problem.

In the 1970’s, Bruce Alexander tried a different experiment. He gave the rats the tools for happy, fulfilling rat lives instead of putting them in rat solitary confinement. They had the drug water and the regular water, but they also had toys and — most importantly — rat friends.

“It’s basically heaven for rats. It’s called Rat Park,” Hari said.

“This is the fascinating thing: In Rat Park, they don’t like the drug water. They almost never use it. None of them ever use it compulsively, none of them ever overdose.”

Addiction, Hari said, is not about drugs; it’s about the cage.

“We’ve got to change the cage, we’re living in a shitty cage,” he said.

Hari believes that, like the rats, humans need to bond with the others in their cage.

“But when you can’t do that because you’re traumatized, or isolated or beaten down by life, you will bond or connect with something that gives you some sense of meaning [and] that might be heroin,” Hari said.

“For 100 years we have been singing war songs about addicts … we should have been singing love songs to them all along,” he said.

Out for Good: An Overview of Reentry Efforts in Tompkins County

Every year, close to 700,000 people are released from jails and prisons in the United States. More than 700 of them are released from the jail right here in Tompkins County.

Those individuals are “reentering citizens,” and, as criminal justice reform moves into the national spotlight, reentry is just one aspect of reform that is gaining steam locally. Reentering citizens can face an array of challenges, including finding a job when they have a criminal record, securing housing without any savings, and transportation to meeting parole and probation requirements.

José Peliot of Civic Ensemble

Ten years ago, there was relatively little to speak of in the way of reentry efforts in Tompkins County. Now there’s a smattering of local groups dedicating resources to everything from college preparation to acting, all in the name of reentry.

Reentry Subcommittee

One big player in local reentry efforts could be the county government. In its current iteration the 2016 budget includes $100,000 in target contingency funds to support a reentry program, the specifics of which will be worked out as the year progresses. The decision to fund reentry support was based on recommendations from the Criminal Justice and Alternatives to Incarceration Board’s Reentry Subcommittee.

The county’s current interest in looking at reentry grew out of the jail expansion. In addition to prompting the creation of the Jail Alternatives Task Force, the decision to install seven more jail beds eventually led to the creation of the Reentry Subcommittee in early 2015.

The group was charged with the tasks of developing recommendations for a reentry program, identifying funding sources to implement those recommendations, and developing tools to track recidivism and program efficacy.

“Why are we talking about reentry? I think everyone’s pretty aware that there’s a revolving door syndrome,” Patricia Buechel, subcommittee co-chair and county probation director, told the county legislature during an Oct. 6 presentation on the group’s recommendations.

To understand who exactly is part of the reentering population, Buechel—along with co-chair Deborah Dietrich and CJATI Chair Suzi Cook—offered up some data from the county jail.

In 2014 the jail had a total of 794 inmates, 68 percent of whom were unsentenced. The jail population is relatively young—64 percent were under 33 years old—and 80 percent male.

Although the jail population is mostly white—72 percent—African Americans are significantly over-represented. While 23 percent of the jail population is black, according to the Tompkins County Health Department’s most recent county health assessment, only 4 percent of the county population is black.

Since 2008 the jail has had a limited reentry program in place. It began as a pilot project, but it doesn’t actually get any specific funding.

Teheran Forest of Civic Ensemble

In a nutshell, the reentry program helps inmates complete Department of Social Services (DSS) applications, offers transport to DSS for an intake appointment, and provides assessments for other needs. However, the current program is only available to a small fraction of the jail population.

To be eligible, inmates must be sentenced and have at least 45 days left to serve. They can’t be on parole or probation after their release, they can’t have participated in the reentry program previously, and they must be planning to stay in Tompkins County.

As a result of those restrictions, only 14 percent of sentenced inmates—143 people—have gone through the program since it was created seven years ago.

Despite its limited scope, there are some indications the reentry program may be working. The most recent Bureau of Justice Statistics study in 2005 found that more than 50 percent of state prisoners recidivate. Though there isn’t recidivism data for the county jail overall, reentry participants are reincarcerated about 35 percent of the time, according to the subcommittee report. However, that number only measures returns to the Tompkins County Jail and thus commitments to other county jails aren’t included.

Although the subcommittee expressed optimism about the program’s low recidivism rate, it’s hard to make significant conclusions from such limited data.

To improve and expand the program’s outcome, the subcommittee offered a number of recommendations (including better data collection). Some highlights of the 16-page report include:

Hire two full-time reentry coordinators to create discharge plans, identify needs pre-release, and provide follow-up in the community.

Create transitional housing in the city, staffed by a resident advisor. About 50 percent of inmates said they were unsure of their housing upon release. Transitional housing, the subcommittee notes in its report, “would provide a supportive atmosphere for those high risk inmates leaving the jail who have no or inappropriate housing.”

Implement more jail programming, possibly at off-site locations. Educational opportunities, college orientation programs, money management, and addiction treatment programs were all identified as options that could help provide inmates with better tools for the real world after their release.

Consider “Ban the Box” legislation at both the county and city level, in order to reduce barriers to employment by removing questions about criminal background from job applications.

Create a van service to help reentering citizens in rural areas get to appointments and jobs.

Create a mentoring program. The report notes, “Lack of emotional support upon release from incarceration is an identified issue for those leaving both the prison system and the Tompkins County Jail.”

Improve the process for getting identification post-release. Some reentering citizens struggle with finding the necessary documentation to get state ID. The report notes that the Department of Motor Vehicles has agreed to accept enhanced sheriff’s ID cards—which could be given to reentry program inmates—for points toward proving identity for a license.

The legislature, at the urging of Legislator Martha Robertson (D-Dryden), began by tackling the first of those suggestions in this year’s budget, but there are other groups already in place and working to address some of the remaining recommendations.

Mary Bogan College Initiative

“The thing about reentry is it’s a cloth, and every single person who offers support is a thread in that cloth,” said Benay Rubenstein.

Rubenstein, an energetic woman with decades of experience working in prison college programs, wants to add another thread to Tompkins County’s cloth.

That’s why she created the Mary Bogan College Initiative (MCBI). Funded by private donations, MCBI is intended to “provide a bridge-to-college program for the entire reentry community here in Tompkins County.” Basically, that means helping current and former inmates figure out how to navigate the college application and preparation process.

Starting in October, Rubenstein and volunteer academic counselor Laura Komor began meeting with groups inside and outside the jail to provide academic counseling services.

Rubenstein said that Ray Bunce, the jail captain, has offered eager support.

Benay Rubenstein of the Mary Bogan College Initiative

“Number one, he’s going to be posting our information in the dormitories in the jail, and we’re asking that anyone who’s interested in having a meeting with an academic counselor put in a request to meet for one-on-one appointments,” she said. “Then when they come home we can take the next step, which would be college prep courses or remedial work. Or, if a person is ready to apply, it could be assistance with applications, financial aid, dealing with outstanding loans, and dealing with the special application process for people with felonies.”

The program is named after a long-time New York State Department of Corrections and Community Supervision employee who passed away in 2011.

MCBI’s seed funding came from one of Bogan’s close friends, Park Foundation Board of Trustees President Adelaide Gomer. Rubenstein hopes to find other sources to grow that seed funding into a tree.

“At the moment the MBCI project is running on a shoestring budget, although I’m giving it my all in the hopes that more funding will follow,” she said.

Rubenstein said that once there are additional funds in line, there is a possibility that the program could expand to other counties. Eventually, it could lead to more jobs for reentering citizens.

“My plan is to hire formerly incarcerated people to staff this program as soon as possible,” she added. “Also, volunteers are welcome. There is much to do, including outreach, academic instruction and tutoring, building a website, and on and on.”

Cornell Cooperative Extension

It’s not just community groups and the county government that have become involved in reentry efforts—the Big Red behemoth up the hill has stepped on board too.

Cornell is already home to the Cornell Prison Education Program, which seeks to provide a college education for state prisoners, but now the university is expanding its efforts, as the Cornell Cooperative Extension is housing a part-time reentry specialist position.

Lisa Ellin—who has also been involved in Civic Ensemble’s project (see below)—is currently filling that position. While many of the other reentry efforts underway focus on life after jail, Ellin is focusing on life in prison.

Right now, she’s running parenting classes at state prisons in order to help men learn how to maintain and rebuild family relationships upon their release.

“The research shows that family connections and family involvement in reentry is critical,” Ellin said. “What I’m doing is helping to develop tools and skills with these men so they can play a powerful role in their child[ren]’s lives.”

Ellin said she also works on alternatives to violence programs and hopes to expand offerings to other facilities, possibly including the county jail.

Civic Ensemble

“What the arts can do is give a glimpse of another way,” said Sarah Chalmers, Civic Ensemble’s director of civic engagement. “In theatre there’s no wrong answer.”

There are right answers, though, and last spring Civic Ensemble embarked on a project to help former inmates find them. The eight-week playwriting class culminated with a series of plays—all penned by reentering citizens—offered up to the community for free.

After a successful set of performances and positive community feedback, Civic Ensemble has decided to do it again. In early 2016 they’ll be offering a second theatre reentry playwriting class.

As they did last spring, Civic Ensemble will offer a stipend to anyone who completes the class and transportation will be available to anyone who needs it. The class meets twice a week, and Chalmers said—in addition to providing positive growth experience and resume material—the class can create a sense of place that reentering citizens often need.

“Someone who’s been told you can’t or you’re not good enough or you’re not a full member of our community, they now have a place where they are valued without question,” she said. “With this program, people have someplace to go, where they’re expected to be. They’re getting paid, they have community and people who are excited to see them and care about them. They work together, and by the end of the eight weeks they’re helping each other finish their plays.”

Ultimate Reentry Opportunity

The idea for the URO came about in late 2013, according to one of the organization’s founders, Schelley Nunn.

“The reason why this all came about,” Nunn said, “is because there were some serious issues around reentry. A lot of what we know is anecdotal information; it’s been a little difficult getting statistical data.

“We know of people who are opting to go back to jail because it’s just so difficult to be out here,” she said.

In addition to Nunn, Audrey Cooper and Fabina Colon are at the helm of the grant-funded project, which is affiliated with the Multicultural Resource Center (MRC). One of the key aspects of URO’s problem-solving approach is the “collective impact model.”

“It’s really an approach that is used to solve large-scale social issues,” Nunn said. “It goes a step further than collaboration; it brings key organizations and individuals together so they can work outside of the silos that exist when we operate in our own vacuums. It’s a model that has been used internationally with great success.”

So far, the group has begun their work by holding meetings with stakeholders involved in all aspects of a reentering citizen’s life. That has included representatives from fields including mental health, education, probation, and more.

Also, URO plans to start a mentoring program for newly released members of the community.

Colon said that within the next year, they expect to hire one position to coordinate the volunteer mentoring program and another two positions to facilitate working groups for reentry stakeholders.

“There are definitely gaps here in Tompkins County and Ithaca that are pretty serious,” Colon said. “I think that we have a lot of work to do.”

This piece originally appeared in the Ithaca Times. 

Safe Injection Facilities: Out of Harm’s Way

Damien Trimingham was a bright kid. He was well-liked and a successful athlete. He came from a good family. He did not seem destined for a life of addiction— and indeed he wasn’t.

At just 22, Damien died of a heroin overdose.

The police did not notify his worried family for three days.

That was in February of 1997, and now almost two decades later, his father Tony, a psychotherapist, has become a leading voice in harm reduction.

On Sept. 30, he recounted his son’s story to a crowd of more than 200 at “Out of Harm’s Way,” a panel discussion in Manhattan.

“It was, of course, a shock even though we knew that death was a possibility with heroin use,” he said. At the time of his death, Damien was trying to stay clean. His father said, “That’s one of the ironies of heroin use, that the people who die are often the ones trying to give it up.”

He continued, “I was to find out later that no one has ever died in an injection center anywhere around the world, even though there are many overdoses.”

That’s when Tony latched onto the idea of safe injection facilities (SIFs). Although they aren’t legal in the United States (yet), there are around 100 SIFs operating around the world, in places like Canada, Spain, Germany, Holland, and Norway.

The idea is that SIFs provide a safer environment for injection drug users. Staff are available to teach safe injection practices and clean syringes are free for the taking. Crucially, there’s also naloxone available to treat overdoses immediately, without any fatalities.

Predictably, SIFs tend to face some initial resistance, but in Australia, Tony was instrumental in turning the tide of public opinion.

The year that Damien died, the Australian government proposed a heroin prescription program, but ultimately the prime minister vetoed it. But the time seemed ripe for harm reduction and so Tony took action. He wrote a letter to the local paper, describing his son’s death and explaining how unnecessary it was. The paper published his piece on the front page, and it sparked debate.

After four years of lobbying and advocating, Tony said, “We got our injection facility, thank goodness.” He added, “It was a hard road because there were opponents.”

Overall, though, he said it’s often apathy and not opposition that is the toughest obstacle. “Most of the general public don’t really care,” he said. “They’re not pro, they’re not against. It doesn’t affect them.”

Like Australia, Germany has safe injection sites, and another of the panelists—former Frankfurt drug czar Werner Schneider—documented the history of his city’s harm reduction efforts. Frankfurt began exploring harm reduction in earnest in the 1990s in response to a significant uptick in heroin use. That exploratory work quickly led to the creation of a safe injection facility.

Schneider said, “The most important result of this program was a tremendous reduction of drug-use related death cases.” Simultaneously, the city witnessed a decrease in criminality and also a decrease in public concern about drug use as a major citywide problem.

Like Frankfurt, Vancouver experienced a ballooning heroin problem in the ’90s. Canadian Senator Larry Campbell—a former law enforcement officer who was also the mayor of Vancouver—told the crowd that as overdose deaths skyrocketed, so did HIV and incarceration rates.

After a decade as a cop and two as a coroner, Campbell got tired of watching the bodies pile up, and so in 2002 he ran for mayor.

“I ran on the platform that I would open a supervised injection site in Vancouver,” he said.

He did that, but keeping open North America’s only safe injection facility, Insite for Community Safety, was a struggle. Although the federal government initially offered the program a three-year legal exemption, once that initial approval expired, Insite had to sue to keep its doors open.

Campbell said that SIFs are a crucial part of the shift from punishing addicts to treating addiction as a medical problem.

“Addiction is a medical disease. Addiction is not a criminal offense. No one starts out life saying, ‘You know what, I think I’ll be an addict,’” he said.

“You can address this as a humanitarian gesture, a humanitarian idea, that we’re all people … but I recognize that there are those who don’t move from a humanitarian end but from an economic end.” That works, too, though, because Campbell explained that safe injection facilities can save on welfare, police and prison costs.

“So whether you believe in humanitarianism or economy,” he concluded, “this is an idea that works. It’s good, and it’s time.”

Liz Evans, a nurse who works with Insite, concurred. She said that Insite is estimated to have saved $14 million in 10 years. “Over 2 million injections have taken place and not one has resulted in death,” she said.

Over time, the community has come to accept the program. Evans said that the last poll taken showed that 76% of Vancouver residents supported the safe injection site.

By bringing users off the streets, it has created a better environment with less public injection around the facility but also, she said, the presence of a safe injection facility seems to encourage people to get help. “If you’ve just come to Insite once, you’re 33% more likely to come to detox or treatment,” she said.

Evans pleaded for “peace” in the War on Drugs and said, “The controversy today should not be around where … a safe injection facility makes sense. The controversy today should be over how we have allowed the status quo to persist for such a long time.”

She added, “In Vancouver, drug users will tell you that Insite is a symbol of care. This is a humane space where we are able to reverse a pattern of exclusion.”

The panelists—and moderator Amy Goodman of Democracy Now!—drew an enthusiastic crowd, and the evening was punctuated regularly by bursts of applause. (One comment that drew particularly raucous support was a question Tony posed to the crowd: “Who in here supports safe injection facilities?”)

Although many audience members came from in and around New York City, some traveled much farther, with four- and five-hour drives from Binghamton and points north.

One of those longer commuters was John Barry, the executive director of an upstate New York syringe exchange called the Southern Tier Aids Program (STAP).

“We need one of these,” he said.

He acknowledged that growing political will and legal support for SIFs could be difficult, but he didn’t see it as impossible: “I think the dominoes have to fall in the right order.”

This story was originally published on The Fix.