Observations of the Traveling Junkie

While my introduction frequently changes, the narrative remains the same.

“Hi my name is Tracey Helton Mitchell. I have a Bachelor’s Degree in Business, a Master’s Degree in Public Administration. I also used to stick needles in my neck.” I hear a few gasps from the audience. The story of a young female college student from the suburbs who gets hooked on heroin resonates with the crowd. I have come to Boston as a “national expert” when it wasn’t so long ago that I spent my evenings nodding out between the two shopping carts I called home. There would be 40 more minutes of questions, answers, and vocalized frustrations on all of our parts.

While my introduction frequently changes, the narrative remains the same. Twenty years ago in July, I started my first volunteer gig for an agency that served sex workers who had histories of both trauma and problematic drug use. I started as a peer counselor putting out food at groups and listening to stories from women not unlike myself. I had escaped the streets at just the right time. San Francisco was in the middle of an overdose crisis. There were 183 deaths in 1999, a substantial number for the city then but a fraction of what some cities of a similar size are seeing today. The city began to assemble interested parties from a variety of disciplines and backgrounds to work on potential solutions. These included doctors, nurses, EMTs, public health officials, advocates, outreach workers, law enforcement, and mostly importantly people who had formerly or were currently using drugs. In short order, it was determined educators were needed to teach drug education and overdose prevention to the community at large.

Today we are dealing with similar issues on a national scale. On my whirlwind trip to the East Coast, I spoke with a federal judge, a head of probation, a group of incarcerated women, a group of medical professionals, and a group of college students. Three states, two meetings, and three presentations in two days. I spoke to roughly 250 people. These diverse groups are united in their common struggle to find solutions to the opioid crisis. The jails are overcrowded with low level offenders. Emergency rooms are frequented by desperate people with addiction-related medical issues. Friends and loved ones feel as if they are losing the battle to help the person close to them who is using drugs. To these audiences, I am the junkie unicorn. I am a person who not only used drugs but escaped a lifestyle that is proving fatal to so many.

These settings are all very different but the sentiment is the same: what can we do to “fix” the problem. The federal criminal system government is starting to look into alternative sentencing with the fairly recent addition of federal drug courts and allowing probationers to be on MAT (depending on the rules of the jurisdiction). The county jails are working with educators and advocates to provide drug education and relapse prevention for inmates while they are incarcerated. In addition, some jails are providing naloxone upon exit as a form of overdose prevention. Medical providers are working with patient and community advocates to get information to the community about tainted batches of drugs, treatment options, and links to services from the emergency department. In colleges, students are working to educate each other about the increasing risks of fentanyl in the U.S. drug supply. In all these settings, there was an overwhelming feeling of frustration and sadness. Everyone, it seemed, had lost or nearly lost a loved one to addiction. Despite the differences in profession, each person had gotten involved in their work to help their community.

My recommendations have been consistent: first and foremost, everyone should have access to free or affordable naloxone. The first step in making any real change to slow the tide of the opioid epidemic is reducing the mortality rates. While I strongly agree with the surgeon general and the recommendation that everyone should carry naloxone, this announcement is almost too little too late. He has also announced support for syringe exchanges. It is refreshing to see common sense public health policies are gaining traction.

Secondly, there is a widespread call for expansion of low barrier treatment options. This should include MAT and/or evidence based rehabilitation centers. My visit was met with a groundswell of support for more options when it comes to self help services. 12-step is frequently the only game in town for people seeking no cost help for addiction. There was interest in coaching and tech tools that provide relapse prevention support. The incarcerated women I spoke with particularly felt that tech-related support should be implemented on a broader scale, pointing out that in today’s world “even the homeless have phones.” Last but certainly not least, there is a huge need for jobs that pay a living wage, mental health services, safe housing, and a healthy dose of human connection.

When I leaned back in my seat on the plane on my way home, I began to reflect on all the different people I met in my days away from my family. For the first time in a long time, I felt hopeful instead of hopeless. To see such a diverse set of individuals focused on solutions means that our efforts are no longer in a vacuum, just like the early efforts in San Francisco where there is now currently one of the lowest rates of fatal overdoses in the nation. I never got to meet with the Trump administration staffers who originally invited me, but it’s likely that they won’t be the people who will make the significant policies needed for us to create and sustain change. Instead, it will be local efforts, regional efforts, and efforts spearheaded by people who were once drug users that will make the real difference.

Change, because it is incremental, can be so slow that we may not always see the progress. But we should not lose momentum or hope: the wheels are already turning. I look forward to seeing the evolution of the next generation of activism and advocacy.