Harm Reduction’s Odd Couple

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George Warren, a retired physician in Charleston, South Carolina, is probably the last person on Earth one would expect to operate a syringe exchange, especially one that is not explicitly legal. But you’d better believe it. Straight-laced and polite to a fault, this mild-mannered grandfather is the unlikely catalyst behind South Carolina’s first and only outreach program to injection drug users. In pursuit of a public health program to lower disease rates among drug users, George has endured more doors slammed in his face than he cares to count, sat through nail-biting sessions with law enforcement, and overcome a host of obstacles, not the first of which is that he hasn’t the faintest idea where to find injection drug users.

As George himself is the first to admit, “If you gave me a truckload of syringes, I wouldn’t know what to do with them.”

But George Warren knows that syringe exchange works. As a physician, he is more than familiar with the scourge of diseases such as HIV and hepatitis C that spread through shared syringes. He is well-versed in the scientific literature that demonstrates the benefits of programs that exchange used syringes for sterile ones: significant decreases in HIV, hepatitis C, and drug overdose among people who inject drugs; fewer syringes discarded in public places; fewer needle-stick injuries to law enforcement and the public; significant increases in the number of users referred to drug treatment; and no uptick in drug use or crime.

When George first began his crusade in 2011, his efforts were met with hostility, though he did manage to cobble together a loose coalition of ministers concerned with public health. Within a couple of years, they had laid all the groundwork, secured permission from local law enforcement, and accessed syringes, but one major problem remained—who to give them to?

Charleston has a booming population of injection drug users. Like the rest of the country, injection drug use is thriving on account of a rise in heroin use, and so is HIV, hepatitis C and every other blood-borne disease that results when people can’t access sterile syringes. But this retired physician and his reverend compatriots were far removed from the underground world of injection drug use. Ironically, it looked as if all their hard work would stall for lack of contact with the very population they wished to serve. By 2014, George had almost given up. Then one email from a young woman named Julie changed everything.

Julie Walworth is everything that George Warren is not: young, energetic, head-strong, talkative, a woman with many years of experience as an injection drug user under her belt. Drama trails her like a cloud of perfume and tales of her chaotic life cause one’s jaw to drop to the floor.

In 2012, anyone stepping into the New Orleans apartment Julie shared with her then-boyfriend, Billy, would confront a floor littered with beer cans and used syringes, a sagging gray couch, and strangers who drifted in-and-out in a drug-induced haze. But all that changed in 2013 in the form of a most unlikely savior—reality TV.

In 2013, Billy was featured on a reality TV show called Drugs, Inc. A diabetic, Billy couldn’t even buy syringes to inject insulin because his dark, unkept hair and jerky movements caused pharmacists to turn him away. It was the film crew of Drugs, Inc. who, upon witnessing the squalid conditions that Julie and Billy called home, suggested that the couple visit a local harm reduction program where they could be connected to a variety of social services, including an underground syringe exchange program.

Julie credits that program with changing her life. “We cleaned up in so many ways through that program,” she says. “We brought sharps containers into the house and starting paying attention to general cleanliness and how we lived. It wasn’t just that we finally had access to clean needles and no longer had a 100 dirty rigs around the house. It was the first time a social service program had ever treated us with decency.”

The couple eventually broke up and Julie moved to South Carolina, where, a year later, she married. Her new husband was also an injection drug user, who, due to lack of access to sterile syringes, re-used his old needles until they were dull and painful. Julie went looking for a harm reduction program in South Carolina to help him, but search after search turned up nothing but an email address in an online database. She sent off a message. George Warren called her back.

Three weeks after that first email exchange, Julie began handing out the first sterile syringes in Charleston, South Carolina, and soon after, in Columbia. George procured an entire pallet of syringes. Julie now connects them to people who need them. It is the perfect pairing of a most unlikely duo. Julie affectionately describes George as “fuddy-duddy” and admits that she sees him as a mentor. George credits Julie with being the vital link between “do-gooders and the drug world.” He also said he was impressed with her motivation.

“At the time, her husband was trying to get clean,” he says. “Julie thought that if he saw the positive work she was doing in harm reduction, it would be helpful to his recovery.”

But just months after their program was off to a promising start, something happened that threatened to capsize the whole operation. In December 2014, Julie received an anonymous phone call from someone who said he had found her husband, alive but suffering an acute drug overdose, dumped on the side of the road. A frantic Julie drove to the site and tried to revive him with mouth-to-mouth resuscitation. First responders arrived and paramedics whisked her husband off to the hospital while police detained Julie for questioning.

“They only cared about where [my husband’s] car was,” she says, still bitter at the memory. “They kept me there for an hour and even searched my car before they finally let me go to the hospital. But by the time I got there it was already too late.”

A couple of tragic ironies surrounded her husband’s death. The first was that he had completed drug treatment only days prior. Due to the period of sobriety, his tolerance for opiates was likely much lower than normal. It is extremely common for people to overdose soon after leaving a detox or treatment center, yet shockingly few treatment centers embrace the idea of educating their clients about drug overdose prevention or equipping them with a medicine that can reverse a drug overdose, naloxone.

The other irony is that very day someone had mailed Julie a package of naloxone, specifically to have on hand in case her husband relapsed. It arrived two days too late.

After her husband’s death, Julie redoubled her efforts to reach out to people who use drugs. “Some people discouraged me from doing harm reduction work after he died,” she says. “But this is when I need to do the most work. I don’t want anyone else to go through what I have been through.”

Julie is particularly keen on passing overdose prevention laws to protect people who call 911 to report an overdose from prosecution for some drug charges and to expand access to naloxone. In the spring of 2015, she and George testified in front of the House Judiciary Subcommittee of the South Carolina General Assembly in favor of House Bill 3083, which, among other things, protects people who prescribe, dispense or administer naloxone from liability. The law was enacted on June 3, 2015. It does not, however, allow naloxone to be distributed by community organizations (neighboring North Carolina and Georgia have flourishing programs that have saved over 800 lives), nor does it protect people who call 911 to report an overdose from legal repercussions. Julie believes that had these laws been in place, her husband might have lived.

“We need a 911 Good Samaritan law in South Carolina,” she says. “Maybe then people will stop dumping bodies.”

She and George, along with a coalition of other motivated South Carolinians, plan to push for a 911 Good Samaritan law next year. George is also working to renew his prescriber’s license so that he can write prescriptions for naloxone. They may be an odd couple, but they are an effective one. And right now, they are an answer to many prayers.

Tessie Castillo is the Advocacy and Communications Coordinator at the North Carolina Harm Reduction Coalition. She writes a regular column for The Huffington Post on overdose prevention, drugs, sex work, HIV/AIDS, law enforcement safety and health. She last wrote about sexism in the drug war.