By Lawrence Grandpre
Now that Baltimore has won its lawsuit against opioid distributors, it is important to understand the narratives around how Baltimore got here in order to maximize this opportunity to address addiction and overdose.Â
Last year, when a story hit The New York Times stating Baltimore has the highest fatal overdose rate in the country, a narrative spread that Baltimore City lawmakers, too distracted by focusing on murder rates, were to blame, as they failed to listen to experts and do best practices in harm reduction.
These stories build upon long-standing narratives in the harm reduction space, that Black elected officials, and by proxy the Black community, are too conservative and blind to the evidence to be trusted with decision-making power over responses to overdoses. This narrative must be combated to address overdoses and maximize the unique opportunity that the city’s recent opioid settlements present.
The rise of overdose deaths has little to do with perceived conservatives or lack of focus in the Black community. The rise of fentanyl, which is far more potent than heroin, meant that traditional public health responses like naloxone were not enough to address overdose. Indeed, a recent study showed the best practices of public health-centered harm reduction failed to show a significant decrease in fatal overdoses.
In reality, Baltimore’s biggest risk in addressing fatal overdoses is listening exclusively to expertise from institutions like Johns Hopkins and relying too heavily on elite decision-makers at the cost of grassroots knowledge.
In a recent press conference, Baltimore City Mayor Brandon M. Scott unveiled his plans on how to spend the hundreds of millions of dollars the city will receive in opioid settlement payments. While there is a community oversight board, the structures of elite decision-making place the community at a disadvantage when a multibillion-dollar institution like Hopkins gives knowledge on highly scientific issues like addiction. This means there is a power imbalance that requires we not only rely on the individuals on the advisory board with lived experience to anchor the communities’ engagement with this process. The city needs to prioritize democratic control over resources and strengthen community involvement to ensure that the funds are directed towards what the community views as addressing the harm caused by the opioid epidemic.
Grassroots responses from the Black community to addiction focus on spiritual and political interventions that challenge the systems of anti-Blackness, which push some in our community to seek escape from an oppressive reality through substance use. Organizations like Self Determined Recover use the lessons of African-centered theorists, combined with spoken word therapy, to address the injected oppression which has driven opioid use in Baltimore. Activists in the 70s at Lincoln Detox in New York used acupuncture as part of a holistic addiction treatment system. They engaged in political education and addressed addiction as righteous indignation around oppression turned inward against the individual, seeing political engagement as part of the solution to addiction. Despite the evidence being mixed, recent evidence adds support for the effectiveness of acupuncture in treating drug dependency. However, in a webinar with folks who worked at Lincoln Detox, participants said that political education was the most effective part of their addiction treatment. These are precisely the sort of treatments denigrated as not being “evidence-based” in the traditional public health system.
Some of the greatest successes attributed to harm reduction have been an extension of grassroots spiritual work of community health workers on the ground. In Harlem, there is an overdose prevention site called On Point, where individuals who use street drugs can get them tested and use them in a supervised and safe manner. They have never had a fatal overdose. However, what is less discussed is the critical role addiction treatment and acupuncturists directly tied to the legacy of Lincoln Detox have been to this organization. Despite this dual approach, it is the public health and overdose prevention work that is often held up as the solution to overdose.
In America, given political opposition, we’ve struggled to open two overdose prevention centers. If we take On Point NYC’s number and assume each site sees 200 users a day, with 25,000 potential clients in Baltimore, it would take over 100 overdose prevention centers to oversee every dose of street drugs. It is not anti-harm reduction to say Overdose Prevention Sites alone are unlikely to address the overdose epidemic.
From the Hopkins police force to gentrification, Black Baltimoreans have seen Hopkins fail abysmally at community engagement and empowerment. The city health department has given extreme deference to Hopkins, meaning the rise in overdoses has happened on their watch. Given Hopkins’ history, there is concern that including folks with lived experience with addiction risks doing more to create an illusion of legitimacy than to empower community. The community will not accept only a seat at a table Hopkins has built. We are demanding the resources and space to design for ourselves solutions to the overdose epidemic.
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