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Harm reduction expert: NC can and must do better in attacking drug crisis

[1]
Robert Childs

reporting [2]on the opioid crisis [3] in North Carolina, a few names come up a lot. Robert Childs, executive director of the North Carolina Harm Reduction Coalition [4], is one of them.

With staff in Raleigh, Wilmington, Fayetteville, Durham, Greensboro and Greenville, the coalition is respected by active drug users, those in recovery, people working in rehabilitation, law enforcement and politicians on both sides of the aisle. That’s no small accomplishment for a group working on politically fraught issues for people with drug problems like syringe exchange, overdose prevention and pre-arrest diversion programs, such as Law Enforcement Assisted Diversion (LEAD) [5].

One of the keys to Childs’ success: he carefully avoids making a partisan issue of dealing with drug use and its effects. He’s willing to work with people of all political stripes to help accomplish the coalition’s goals.

“I’m not a fan of much of either party, but I am willing to work with both” Childs said in an interview last week.

“What we talk about is meeting people where they’re at,” Childs said. “So for some people it’s going to be a fiscal issue. For some it’s going to be a religious issue or a moral issue. For some people it’s going to be about law enforcement and safety – reducing crime. For a lot of people it’s going to be ‘I know Joe who is my neighbor – his kid is dependent on opioids from a skateboarding injury.’”

From wherever someone’s concern comes, Childs said, there’s a strong argument for harm reduction – a philosophical approach that seeks to help people involved in risky or illegal behavior without judgment. It’s about reducing health risks through things like condom distribution, providing sterile syringes and medication to help prevent overdoses and curb opioid dependence.

“We fully acknowledge that we as a society are never going to stop all drug use,” Childs said. “There isn’t a society that doesn’t use drugs. If we know that, we need to work on a system that fully acknowledges that and work with people to have healthier outcomes.”

Some drug users aren’t ready or able to stop using, Childs said, but that doesn’t mean we shouldn’t do everything we can to help prevent serious consequences like HIV transmission, hepatitis or deadly or debilitating overdoses. Those who are willing to stop using are more likely to accept help getting into treatment from those who meet them where they are at, Childs said – not those who help conditionally or with judgmental caveats.

“Every single human deserves access to quality health care, quality treatment and harm reduction,” Childs said. “Their circumstances shouldn’t matter.”

It’s something Childs believes deeply – but it’s also proven to work and to be cost effective [6].

“An HIV infection can cost $600,000 to treat in pure medical costs,” Childs said. “But we can prevent infections for a very small amount of money. An overdose can cost $17,000 to treat. But we can prevent overdoses for a fraction of that.”

Similarly, Childs said simply jailing drug users rather than offering harm reduction strategies, social services and treatment is an expensive, failing strategy.

That’s something Childs has seen firsthand – first as a mental health crisis social worker and then, after getting a master’s degree in public health, in his work with drug users. Before coming to North Carolina in 2009, Childs worked in Oregon and New Hampshire as a social worker and health educator and was program director for the harm reduction program Positive Health Project in New York City.

“I saw people who were prescribed drugs to deal with mental health problems and then would self-medicate to feel normal on the side,” Childs said. “They would use a light amount or meth or something else so they could feel normal enough to do something like go shopping for groceries. And a lot of people who use drugs have had some kind of trauma growing up or they have depression and they’re really self-medicating. And when I saw that criminalized, when I saw them put in jail and having to deal with having records – I have a problem with that. Why aren’t we getting them help rather than putting them in jail?”

Looking at drug use as primarily a law enforcement problem rather than a public health crisis creates a vicious circle, Childs said.

“If we continuously arrest people and give them records, they can’t get work due to their criminal record,” Childs said. “How do they pay to support themselves? They can’t even get a job at McDonalds. How do you expect them to get out of the game? That has been massive as a barrier.”

Childs applauds pre-arrest diversion programs that have gotten off the ground in the state, like those in Fayetteville and Wilmington, and those starting soon in Brunswick County, Statesville and Waynesville. But a lot more are needed, he said.

“You’ll hear most police and sheriffs now say, ‘We can’t arrest our way out of this.’” Childs said. “So we need to promote that model. I really applaud the jurisdictions that have stepped up to do that.”

The pre-arrest diversion programs the coalition supports don’t insist on abstinence from drugs, Childs said.

“Relapse is expected,” Childs said. “Expecting them to be totally abstinent is setting them up to fail.”

The current opioid crisis in the state has gotten a lot of attention and that has led to some long overdue and positive changes, like legalizing syringe exchange. But like many who have worked closely with drug users for years, Childs said that has a lot to do with demographics – and race, specifically.

“Opiates are a big problem right now, but we’ve seen this before with crack,” Childs said. “I think anybody who doesn’t acknowledge that the reason we’re seeing change is because of who is being impacted – they’re way off base. Race definitely plays a very big part.”

When the drug problem went from majority minority populations in cities to white people in suburbs and rural areas, people in power began paying more attention, Childs said.

That’s led to some positive changes –legalized syringe exchange, the passage of a Good [7]Samaritan law [7], community based naloxone programming – including medical standing orders [8] for naloxone and the STOP Act.

But a lot more needs to be done, Childs said – and as a state, we have to properly fund things we know are working.

“We need to increase the amount of syringe exchanges that exist and actually fund them,” Childs said. “We know we’re seeing injection drug use throughout the entire state, but there hasn’t been investment throughout the entire state for these programs.”

Childs’ group does the most syringe exchanges in Wilmington, Raleigh, Durham, Goldsboro and partners with groups in Greensboro, Hickory and Dare County. In Wilmington – a city with a population of just over 117,000 – it has already given out 133,431 syringes this year and collected 105,310 over the past year.

Childs said his group’s programs are funded through national initiatives like the Elton John Foundation and MAC AIDS Fund.

“We need investment from North Carolina,” Childs said. “Right now we do a lot of begging around the country for help.”

While the recently passed state budget did improve funding for the state’s Controlled Substances Reporting System [9] and funneled $10 million in federal grants to treatment services, it was well under what Gov. Roy Cooper called for in his suggested budget and only about half of what was called for in the bipartisan Strengthen Opioid Misuse Prevention (STOP) Act [10].

A lack of funding hurts low income people most, Childs said – like those who face waiting lists for detox and drug treatment.

“When someone needs to go, when they’re ready to go, we need to be able to get them in then and there,” Childs said. “If the only detox in town costs $25,000, who can afford that? If the free or discount programs don’t provide transportation, how do they get there?”

There should also be more investment in programs that provide methadone and buprenorphine, Childs said – proven methods for treating opioid dependence.

“These are not the most popular programs for people to contribute to,” Childs said. “Most people don’t want to donate to syringe exchange programs, for example. We’re not a popular thing to contribute to. People like funding other things – like helping people who are in treatment. And that’s a very deserving cause. But all those people use drugs at some point. And what’s there to help them then? If they come out with HIV, with Hep C, a history of overdosing and hospital debt, with a record – there are so many barriers for them to have success.”

Preventing those barriers – and fighting the stigma associated with drug use that prevents better drug policy – is hard work, Childs said.

“We’ve found that people are fivefold more likely to go to drug treatment if they live in a community that has a syringe exchange,” Childs said. “Because they feel too stigmatized in every other social service environment.”

So that stigma is preventing what we say we want,” Childs said. “We have to recognize that.”