Dopesick - Beth Macy Page 0,96

test strips so users could gauge the potency of the drugs before they used them, then take smaller doses, avoid using alone, and have naloxone at the ready in case of overdose.

In San Francisco, Seattle, Philadelphia, and even Greensboro, North Carolina, drug-user unions were working to combat the stigma of addiction and advocate for harm reduction, pushing for wider naloxone distribution and needle exchanges, and even negotiating with drug dealers when batches of fentanyl entered the local supply. “Our goal is to end the drug war and to hold treatment providers accountable,” said Louise Vincent, who runs a Greensboro needle exchange paid for by state and private funds. “When you pay fifty thousand dollars for treatment and rehab, I believe you should get the gold standard of care,” including MAT, she said. She also argued for stricter regulations of “cash-cow Suboxone clinics.”

But there is still only one treatment bed available for every five people trying to get into rehab, and at a cost far beyond the financial reach of most heroin users. And for all the treatment money paid by people like Tess’s octogenarian grandfather, rehab isn’t standardized, nor does it often dovetail with what science says is the gold standard for opioid treatment: medication-assisted therapies. (Only about a third of all U.S. treatment centers allow MAT.)

“It’s really going to take doctors standing up for this, and it’s going to take going against the very vocal twelve-step recovery community, which is most at odds with the work the harm-reduction movement is trying to do,” said Vincent, a recovering heroin user who pays $480 a month, cash, for daily methadone maintenance.

In Baltimore, where the overdose death rate was six times the national average (and where much of Roanoke’s heroin supply originates), the health department has long deployed a needle-exchange RV to heroin hot spots six days a week, offering disease testing in addition to clean needles, naloxone training, wound care for injection abscesses, and prenatal care. The initiative is credited with reducing needle-injected HIV instances from 64 to 8 percent. Conservative then–Indiana governor Mike Pence responded, albeit reluctantly, to the 2015 Scott County HIV outbreak that infected 175 people with a limited needle exchange.

In San Francisco, recovering heroin user and certified addiction specialist Tracey Helton Mitchell launched her own renegade harm-reduction movement in 2003 by mailing out free packages of clean needles and naloxone vials. In the opioid-minded Reddit forum where she became known as the Heroine of Heroin, Mitchell still shared counseling and intervention strategies, answering some fifty emails a day.

She continues to receive calls from frantic users in large swatches of the country eager for clean needles, information, and naloxone. “We’re in the absolute dark ages in most of this country for syringe exchange,” she told me, describing users with worn needles broken off in their arms, or people who reuse needles found in the gutters and then sharpened with matchbooks. “We’re years behind catching up, and the drug deaths haven’t even peaked yet.”

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And yet the ideological gulf I witnessed between the criminal justice establishment and families like Tess’s seemed to grow wider by the day. Kevin Coffman, a drug task force member who’d worked the Ronnie Jones case, told me he firmly believed we could end the opioid epidemic with a single stroke of Trump’s pen: imprison heroin users for life the third time they got caught with the drug, and that would have a chilling effect on remaining users, who would logically, he believed, give up their drugs.

We were sitting in the same room where Coffman and Bill Metcalf had mapped out Jones’s heroin ring. It was next to the kitchen, where a trump–pence sticker was pasted on the refrigerator door. Not only did the detective have zero empathy for the addicted, but he also lacked any scientific understanding of the morphine molecule’s pull.

Nor did some of my dear friends, longtime members of AA, who remain staunchly opposed to harm reduction and MAT for those working its twelve-step program. “There’s a reason why some people think NA and AA are cults,” said Mitchell, who used methadone, needle-exchange programs, and a secular support program called LifeRing to treat her heroin addiction. “They can’t take in any other information because it throws a different light on their own personal recovery.”

As Trump-appointed attorney general Jeff Sessions said in March 2017: “We need to say, as Nancy Reagan said, ‘Just say no.’ backed health care it.”

Two months later, the Trump administration proposed gutting the office of the White House drug czar,