Conflict over the opioid crisis

For people who begin working with Christopher Abert at the harm-reduction organization New York Recovery Alliance, there is plenty of information to master: how to administer Narcan in the case of an overdose, mitigate potential for hepatitis C or HIV/AIDS, and properly dispose of syringes.

While these details are all important, that knowledge pales in comparison to a single concept: “Above all, treat them with kindness, like you will be the last human interaction they might have. Because you might be,” Abert says.

Abert is executive director of NYRA, which uses direct action and advocacy to shift resources and power to people who use drugs, and a board member of Recovery All Ways, which offers recovery support to those affected by mental illness, homelessness and substance use disorder, or SUD.

Unlike other harm-reduction programs, both organizations are unique in being peer-led–an approach at odds with traditional solutions to the opioid problem. All members currently use or previously used drugs.

From two decades of chaotic drug use and another 20 years of advocacy, Abert personally knows just how true that is. He has been called away from outreach events to emergency situations where someone could not be resuscitated. Once back at outreach, he might take a few quiet moments, but he returns to help the next impacted individual.

“We offer a safe space where we can walk beside each other and navigate this fucked-up world,” Abert says. “We can make our love ungovernable.”

The opioid crisis is not stopping, so neither can he.

Unstoppable crisis

Over the past four years, the Monroe County Heroin Task Force has recorded 3,750 overdoses, 17 percent of which were fatal. While overdose cases over this period have been trending downward, monthly fatal cases have remained relatively consistent. 

Opioid burden, a metric used by the state Department of Health to summarize outpatient emergency department visits, hospital discharges, and opioid overdose deaths per 100,000 people, showed Monroe County to be in the highest quartile in the state, recently available data show. Within the county, the opioid burden is highest in the north and northeastern areas of Rochester, with ZIP code 14621, where NYRA and RAW hold weekly outreach, among those sections most burdened.

While the opioid crisis continues, peer-led organizations like NYRA and RAW see clear solutions through further engagement with impacted individuals. Their approach, however, is in direct conflict with historical and current government strategy toward the issue of drugs.

This conflict of philosophies was brought into focus in the most recent standoff at a homeless encampment at Loomis Street. While city officials have claimed there has been a refusal of service and a danger to public safety, members of NYRA and RAW see their attitudes dehumanizing toward people suffering from SUD and a “death by a thousand paper cuts” tactic for removing vulnerable people.

Peer-led approach 

NYRA and RAW both were launched a couple of years ago by outreach workers in an effort to help those they saw as being abandoned by the system.

“It’s one thing to escape a house on fire, it’s another thing to run back in with water,” Abert puts it.

He supports a number of potential measures, including decriminalizing drug use, increasing fentanyl testing resources, syringe distribution, expanded methadone clinics, and supervised consumption sites. All have studies proving their effectiveness, he says.

For example, public syringe disposal or exchange programs have been shown to reduce, not increase, litter. A review of the 1,500 reported global cases of needlestick injuries in 2015 found only five cases of resulting blood-borne viral infections, all of which were hepatitis B or C, and a 2018 study found safe consumption sites to reduce the risk of disease transmission and frequent visitors adopted safer injection practices afterward.

However, officials dealing with the opioid crisis still make statements that, in Abert’s view, place the blame on people with SUD and engage in erasing an already vulnerable population.

“We have families who live here, we have children who live here. We don’t want it. We’re not going to have it. I don’t know where you’re going to do your drugs, but you’re not going to do them here,” City Councilmember Michael Patterson said after trees were cut down in the Loomis Street area.

“To me the safe injection sites are just giving people free rein with no consequences. Why would they want to get help if they know they can safely use somewhere?” says Monroe County Sheriff’s Deputy Michael Fatava, head of the county heroin task force.

“You can’t put a value on a life, I get that. A life is a life,” adds Fatava. “But we have to at some point backtrack and see people are committing crimes left and right to feed addiction.”

Different narratives

Statements like that frustrate Abert and, in his view, represent a narrative that has stalled any significant harm-reduction programs in the local government.

“This idea that there’s a open-air drug market (at Loomis) is so crazy to me. This thing of, ‘We shouldn’t give them Narcan’, ‘They should just say no.’ All that’s the result of years of vilifying and dehumanizing people who use drugs. That’s not meeting people where they’re at,” Abert says, referencing a core principle of RAW.

He points to the long history of drug enforcement, which has roots as far back as 19th century anti-immigrant policies against Mexicans with marijuana and Chinese “coolie laws” with opium. Abert also points to the now-famous quote by John Ehrlichman, a Nixon-era White House counsel, who said the war on drugs was really about disrupting political enemies in the Black and leftist communities.

This clarity of purpose and attention to de-stigmatization is why Abert believes NYRA and RAW are different from other harm-reduction organizations.

“Imagine the difference when all of the people on your board have been personally affected,” Abert says. “Take that amount of money given to (the war on drugs)—that $1 trillion—and give it to people who were actually impacted by drug use. Imagine the people we could have saved. It’s clear the war on drugs was a failure. You can’t arrest your way out of this problem.”

A mix of tactics

As one of those on the side of law enforcement, Fatava also knows the opioid crisis is a complex issue with no easy solution. With work experience with the Drug Enforcement Agency and U.S. Marshals, he sees a connection between drugs and crime from increased rates of larceny and violence from people suffering from SUD or dealers. However, Fatava also believes constant arrests will not solve this issue.

“If you want help, we’re not going to arrest you. We’ve been promoting that for years,” Fatava says. “Someone like that, who does want help—I have yet to have someone refuse to ride with me because I’m a cop.”

He thinks the task force’s three focuses are an acknowledgement of that complexity: enforcement, but also education and outreach.

“Monroe County is extremely rich in resources. Each one of these treatment providers is like a storefront at a strip mall and the customer is a person battling addiction,” he says.

Among the task force partners are Delphi Rise Open Access Program, Helio Health, Villa of Hope, ROCovery Fitness, S.O.A.R.S., Mission Recovery and Hope, Veterans Outreach Center, and fellow county government organization IMPACT: Improving Addiction Coordination Team.

In July of this year, IMPACT expanded its efforts to reduce opioid addiction and overdose-related deaths by making naloxone more readily available in cabinets located at community sites and businesses. At the time, the county government said IMPACT had distributed over 3,500 doses of naloxone but more were needed.

“They do amazing work once the customer is there, but if the customer isn’t going to the business, they can’t sell the goods and fix the people,” Fatava says. “(Law enforcement) are not the experts, we don’t know how to treat these problems. We’re like the taxi that takes a person who needs help to a place where they can get help.

“If people aren’t willing to get treatment or help, they’re going to continue on committing crimes and potentially dying,” he adds.

Since starting the task force in 2018, the sheriff’s department has tried to follow up where they can with overdose victims to be that conduit between the people in need and the service providers. Fatava says the success rate has varied over the four years and is more case by case than a clear trend.

On the ground with NYRA and RAW, however, the effect of law enforcement providing resources feels less like a taxi and more like “shock and awe” tactics.

“They sent about 30 to 40 people one day to ‘offer services,’” RAW member Gary Harding says about a recent incident at the Loomis Street encampment. “This consisted of a police tactical box truck, a trauma unit, a fully staffed fire engine, an AMR ambulance, a bobcat, DSS, PCHO, the FIT Team, the IMPACT Team, many unmarked police cars, many armed police officers, and a slew of other city and county vehicles.”

The large number of people caused the park area to scatter, which was repeated later when trees from the Loomis lot were taken down in October. Public officials interpret those actions as a refusal of treatment. However, NYRA and RAW members as well as people living in the encampment see that as a misinterpretation.

Past experiences with the system for them may have already proven to be a timely and costly endeavor. Unlike in other countries such as Norway, periods of housing insecurity, such as couch surfing or staying intermittently at a hotel, are not considered, which is an unrealistic depiction of homelessness and makes people wait longer for help, Abert says.

Similarly, benefits are often attached to detox programs, zero-tolerance drug use, or dropped if an individual is “sanctioned” or banned, which can happen for missing appointments, refusing to open a public assistance case, or physical altercations. Four years ago, a report from Nazareth College found that while Monroe County’s sanction rate used to be low, it recently grew to one of the highest in the state.

If any of those factors are broken, people have to start over at square one. Returning to chaotic drug use or being sanctioned by a shelter can mean years of effort to get back to that same point of service again.

“The people living at Loomis are survivors of childhood neglect and abuse. Of poverty and racism. Many are non-gender conforming. They are queer. They are BIPOC and poor white people. And they are just looking for space to exist that doesn’t retraumatize and further abuse them,” Abert says.

“Folks living there desperately want help, but our system has failed them. And then those overseeing the system, like (Rochester Corporation Counsel) Linda Kingsley or Mike Patterson, blame them for not engaging in the broken, traumatizing system, misrepresenting them as dangerous drug addicts hell bent on their next fix,” he continues. “It’s repulsive.”

‘We’re all failing’

The people left behind in the system often have mental health issues, past early trauma, suffer from SUD and are unhoused. All these factors make it difficult for them to get appropriate services in a system that seems set against them, not to mention backlogged and lacking personnel and support.

According to figures from the National Alliance to End Homelessness, between 2007 and 2020, the unhoused population in Monroe County grew by 33 percent overall and by 340 percent for unsheltered individuals alone, causing issues in shelter capacity, which was further exacerbated by the COVID-19 pandemic.

Although the House of Mercy recently reopened its doors, in theory alleviating some of those issues, those in NYRA and RAW, as well as individuals living at the Loomis encampment, say it is much more difficult in reality. Instead, Abert favors a new fair housing system.

“Housing specifically designed for those hundred or so folks who (Person Centered Housing Options) can’t house, who can’t get into the shelters because they’re banned, or don’t feel safe, because they were retraumatized because they were misgendered or abused at the services, or they’re scared because someone was murdered there,” he says, describing the approach he supports. “You find those hundred people you literally can’t house anywhere else, and you create a low barrier/high retention supported ‘Housing First’ option for them. Make a super low barrier to get in and an incredibly high barrier to get kicked out of.”

With that in place, the area would see a sharp decline in overdose and fatal overdose cases, he contends.

Early this week, the city government indicated with a sweep that it is moving to shut down the Loomis camp by installing fences and planning to arrest those who trespass afterward.

“The bottom line is if you go there and look around, there are needles everywhere. There are women who leave that site under—what we can only assume—are sex trafficking to pay for their drugs circumstances,” said Kingsley in a statement.

Five residents chose to move to Peace Village, a city-sanctioned encampment, but, according to one RAW member, the PCHO staff was not prepared for new residents and only one half-shed was open. They also saved two tents and belongings for residents who were not on site at the time.

In a joint statement, allies of NYRA and RAW—social advocacy groups VOCAL-NY and Citizens Action—decried the actions taken: 

“Unhoused people do not have any form of protection against sudden and violent eviction and the seizure of their property. Forced ‘sweeps’ of encampments threaten their survival and put people at unnecessary risk, without reducing homelessness or addressing the problems that cause it.

“The use of Rochester’s police force to harass and criminalize unhoused residents and the people attempting to support them, is unconscionable.”

“(The Loomis sweep) isn’t going to change anything,” says Harding. “All it’s going to do is put vulnerable people in further danger.”

RAW plans to continue its normal outreach session on Sunday. It just won’t be at Loomis anymore.

Jacob Schermerhorn is a Rochester Beacon contributing writer. The Beacon welcomes comments from readers who adhere to our comment policy including use of their full, real name.