Texas advocates take risks to get harm reduction tools to drug users

Texans looking for assist for substance use can name the Substance Abuse and Mental Health Services Administration’s free help line at 800-662-4357. They may also entry providers accessible of their area by means of the Texas Health and Human Services website.

Editor’s word: This story incorporates express language.

HOUSTON — Thirty minutes earlier than a punk present this summer season, Claudia Dambra arrange a desk and taped to it a tablecloth she had hand-painted with broad, white brushstrokes. The banner learn, “PUNK NOT DEATH.”

As folks flooded into the Houston music venue, Dambra stacked on prime of the desk a number of bins of overdose reversal remedy that she was freely giving. But beneath, she quietly took inventory of a distinct sort of stock — clear syringes to assist forestall the unfold of ailments amongst drug users.

Dambra is aware of she has to be discreet concerning the syringes. Unlike overdose reversal remedy, it’s unlawful in Texas to carry or trade drug-using provides like used syringes and pipes, in addition to fentanyl testing strips. Some of the folks Dambra meets at venues are afraid to ask for the provides in public, so she meets them within the rest room. She tells them to save her quantity.

“I’m living in a world where organizations are operating very much underground,” Dambra stated. “It’s very, very dangerous to be a drug user here. And the fact is, a lot of people are in dire straits right now as a result of the pandemic.”

Through her personal expertise with substance use dysfunction, Dambra has examined the effectiveness of a public well being technique referred to as harm reduction, which incorporates freely giving sterile syringes to scale back the destructive well being outcomes of dependancy. It may help forestall overdoses, reduce the unfold of illness and put drug users in a greater place to hunt down therapy.

Research has proven harm reduction is one of the most effective tools to assist individuals who use medicine, and advocates say such packages are wanted greater than ever. But state-run harm reduction packages don’t exist in Texas, and the Legislature has beforehand batted down efforts to decriminalize the possession and distribution of provides for drug use and drug testing. To keep away from felony prices, Texans who use medicine will typically keep away from getting sterile provides and reuse the pipes and needles they’ve.

“The criminalization and the general thought of criminalization is causing people to hurt themselves. It’s causing them to not seek help if they need it. It’s causing them to think that this is what they deserve,” Dambra stated. “When you’re living your life in fear of even having a sterile syringe or sterile pipe, your quality of life is just so low.”

Advocates like Dambra aren’t ready for adjustments within the regulation. They function harm reduction packages throughout the state within the shadows, recurrently freely giving these provides to drug users and risking hefty fines and incarceration.

It’s a matter of life and dying, Dambra stated.

Harm reduction is a science-based practice that acknowledges that persons are typically unable or unwilling to instantly abstain from drug use. It emerged within the Eighties out of the AIDS epidemic and facilitated early intervention amongst drug users. Rather than forestall drug use, harm reduction insurance policies guarantee individuals who use medicine stay alive and as healthy as possible till they’re prepared for therapy.

A means to assist 

Dambra had been attempting to get sober when she moved again to her residence state of Texas from New York in the summertime of 2021. But the method of recovering from substance use disorder will not be at all times linear. In her first six months in Houston, between unpacking bins and serving to her household, Dambra used amphetamines, ketamine and artificial opioids closely.

Dambra didn’t know the place to go for clear syringes, so she reused needles. She couldn’t take a look at her medicine to assist her decide the efficiency of the substances she was utilizing. Without harm reduction tools, Dambra routinely contracted bacterial diseases like cotton fever, which is derived from injection drug use and characterised by pores and skin lesions, swelling and hives. She overdosed 10 instances whereas the nation was below lockdown due to the coronavirus pandemic. She stopped caring whether or not she lived or died.

Dambra ultimately discovered the Houston Harm Reduction Alliance on-line, a neighborhood nonprofit that helps drug users, and began routinely accessing clear syringes by means of them. Her well being began to enhance, which helped her pull out of what had appeared like a downward spiral: If she stopped getting sick, perhaps she may additionally cease utilizing medicine.

“Through my personal accessibility to harm reduction practices, I was able to slowly regain self worth and slowly regain manageability of my life,” stated Dambra, who ultimately went to two inpatient packages within the state and has been sober for eight months. “Being able to use harm reduction supplies … you are in a position to gain hope, you are in a position to imagine a better life for yourself.”

Harm reduction consists of distributing sterile syringes, pipes and drug-checking tools like fentanyl testing strips and emphasizes prevention and reversal of overdoses. Clean syringes, for example, decrease the transmission of viral ailments like Hepatitis C, according to a study from the Yale University School of Medicine. Drug testing helps users determine the efficiency of medicine and forestall an unintended overdose.

By minimizing overdoses and the unfold of infectious ailments, harm reduction may also scale back the monetary burden of destructive well being outcomes on each drug users and well being care suppliers. In 2017, substance use disorder cost emergency departments and inpatient settings throughout the nation greater than $13 billion.

Harm reduction packages have helped put individuals who use medicine on the trail to therapy. Those who take part typically see harm reduction advocates as their first level of contact for medical referrals when they’re prepared to search therapy. Advocates may determine folks experiencing withdrawal signs and proactively supply therapy, stated Dr. Brian Hurley, the president of American Society of Addiction Medicine.

“It becomes an avenue through which … the addiction treatment sector (becomes) accessible to the community,” stated Hurley, an dependancy doctor primarily based in California. “When somebody indicates that they could use help with opioid withdrawal or when somebody is interested in a referral to medical services … that community-based organization has now a connection to the person who previously would have been disconnected.”

According to a Seattle and King County public health department study, syringe service program individuals are 5 instances extra probably to begin therapy than those that don’t.

Dambra is now attempting to arrange the primary above-ground syringe service program in Houston that gives a constant supply of unpolluted provides to drug users within the space.

“They can trust that there’s at least one other person … that actually does give a shit even if it’s just in these really basic ways,” she stated. “Knowing that there’s somebody who cares about your life and your quality of life gives you the opportunity to care about your own.”

And as overdose deaths within the state reached new heights in the course of the pandemic, advocates and researchers say there has by no means been extra of a necessity for entry to harm reduction provides.

An overdose disaster

On a Monday in May 2021, Cassandra Saldivar dropped off her 2-year-old son, Ace, along with her mom, Patricia Hammad. That night was supposed to be a brief break from the pressures of elevating a baby in the course of the pandemic.

But it was the final time Ace and Hammad would see Saldivar. Late into the evening, Hammad bought a name from the native hospital, the place she realized Saldivar had died from an unintended overdose. A toxicology take a look at later revealed Saldivar had taken anxiousness remedy laced with fentanyl, an artificial opioid that’s cheaper however way more potent than morphine.

“I didn’t know they were lacing pills until that telephone call that happened to our family,” Hammad stated.

Saldivar had been experiencing anxiousness about payments piling up and about discovering a job in the course of the pandemic. She had arrange an appointment with a psychological well being counselor, however she missed it. Two weeks later, she tried to self-medicate with anti-anxiety remedy that turned out to be counterfeit.

Hammad is now elevating Ace. Every day, she factors to photos of Saldivar hung up round the home. “Who’s that?” she’ll ask Ace. She doesn’t need him to overlook his mother, although Ace understands that Saldivar gained’t come again to decide him up. If you ask, he’ll inform you his mommy is within the sky, sleeping.

From April 2021 to April 2022, 4,839 Texans died of a drug-related overdose, in accordance to estimates from the U.S. Centers for Disease Control and Prevention. It’s a soar in fatalities by 63.4% over the past three years. The variety of drug-related fatalities is probably going far increased than reported figures as a result of solely the state’s 15 most populated counties recurrently conduct toxicology assessments to determine the function of medicine in any dying; the opposite 239 counties typically forgo them because of financial restraints.

In the face of psychological well being points spurred by loneliness, fears and uncertainty, extra Texans began or elevated substance use in the course of the COVID-19 pandemic — all whereas entry to therapy was disrupted and the provision of medicine available in the market grew to become deadlier.

As amenities closed due to the lockdown in the course of the pandemic, substance use therapy grew to become tougher to entry, together with methadone clinics and help teams. Some therapy facilities throughout the state restricted their hours or shut down altogether. It exacerbated the present limitations to psychological well being care within the state: Texas ranked worst within the nation in entry to psychological well being care, in accordance to a Mental Health Care America report primarily based on 2019 knowledge.

The pandemic additionally disrupted the panorama of drug use. Some folks couldn’t get involved with their common drug sellers and turned to unfamiliar sources, amplifying the risks. Others began utilizing medicine alone. Many of them couldn’t entry sterile provides or take a look at once they had been utilizing medicine.

In addition, the drug provide has been quickly altering, which has led to extra deadly outcomes. Criminal drug networks have flooded the market with fentanyl. In the final decade, distributors and sellers have been reducing heroin, methamphetamine and prescription capsules like Xanax with fentanyl to maximize earnings.

As a end result, folks typically have no idea what substances they’re utilizing, which may flip into “a recipe for accidental overdose,” stated Claire Zagorski, this system coordinator for the Pharmacy Addictions Research and Medicine Program at The University of Texas at Austin College of Pharmacy.

“We’re seeing this really broad proliferation of substances in the drug supply,” Zagorski stated. “And every time there’s a change and a shift, that’s a learning curve.”

Hammad stated she needs the state to intervene to cease the hemorrhage of loss throughout Texas. If Saldivar had had entry to a fentanyl testing strip, it could have helped her determine the drug she overdosed on as counterfeit.

“What I wish [the state] would do is take it more seriously because there’s a lot of kids dying,” Hammad stated. “Fentanyl is wiping out a generation.”

But in Texas, not everybody believes that freely giving testing kits or sterile provides is the easiest way to assist drug users.

A skeptical state 

Despite the scientific proof, critics consider harm reduction tools allow and encourage drug use.

U.S. Sen. Ted Cruz, R-Texas, has overtly criticized harm reduction as a observe.

“You want to fight for minority communities? Get the kids off crack. Don’t give them crack pipes,” he stated on his podcast, “Verdict,” earlier this yr.

Research has proven that people experiencing poverty and marginalization are more vulnerable to substance use disorders and that the distribution of unpolluted pipes is an inexpensive means to scale back illness transmission amongst drug users.

Harm reduction supporters in Texas have sought to decriminalize these tools for years and failed. During the 2021 legislative session, a bill sponsored by state Rep. Jasmine Crockett, D-Dallas, aimed to take away felony penalties for possessing drug paraphernalia in Texas. Though the invoice handed out of committee with bipartisan help, it by no means got here up for a vote by the Texas House.

Gov. Greg Abbott has favored bolstering border safety as an answer to the overdose disaster over harm reduction initiatives. Citing lethal medicine which might be transported throughout the border, he lately directed the Department of Public Safety to step up its efforts to crack down on Mexican drug cartels. Abbott has additionally repeatedly blamed overdoses on the Biden administration’s border insurance policies.

In a September letter to the heads of state agencies, Abbott stated the “federal government’s unwillingness to take border security seriously” has contributed to overdose deaths. But in a uncommon second, he additionally signaled an openness to insurance policies past policing.

“The efforts of DPS are noteworthy and commendable, but law enforcement alone cannot be expected to end this crisis,” Abbott wrote, asking businesses to suggest different initiatives to lower fentanyl deaths in Texas for subsequent yr’s legislative session.

Naloxone, an overdose reversal remedy, is the one harm reduction device that Abbott has overtly supported, although its provide is dwindling. The federally funded state program for naloxone has run out, whereas the worth of the remedy is growing.

Advocates aren’t optimistic that the state’s strategy to harm reduction will change. And so long as most harm reduction tools are unlawful, they need to proceed to make cautious calculations about what provides to carry and the place to give them away.

A dangerous endeavor

Kirby Jack spends Friday nights in downtown Dallas bar hopping, leaving plastic baggies they packed by hand subsequent to rest room sinks. Jack hopes that the kits — which comprise fentanyl testing strips, sterile water, cookers used to put together medicine and foam filters — will make their means to individuals who use medicine and assist them keep wholesome and protected.

But Jack gained’t stick round to know; they’ve to transfer rapidly. Carrying drug paraphernalia like fentanyl testing strips is prohibited in Texas, so if police are anticipated to be at a venue, Jack gained’t go.

Possession of drug paraphernalia — gadgets used to devour unlawful substances that may embody fentanyl testing strips, used syringes and pipes and different harm reduction provides — is codified as a Class C misdemeanor in Texas and is punishable by a most wonderful of $500. If there’s proof of an intent to promote or distribute drug paraphernalia, an individual may be charged with a Class A misdemeanor, which is punishable by up to a yr in jail, a wonderful of up to $4,000 or each.

Law enforcement businesses throughout the state are inconsistent in how they crack down on possession and distribution of drug paraphernalia. Advocates say officers in rural areas have a tendency to ship harsher penalties in contrast to city areas.

In Williamson County, paramedic Daniel Sledge stated he’s seen some cops arrest residents over drug paraphernalia, with rural areas doling out harsher punishments. Others confiscate provides and let residents off with a warning, he stated. Meanwhile, Houston district attorneys have instructed native organizers they don’t seem to be actively attempting to prosecute actions which might be associated to harm reduction.

Advocates say they’re at all times teetering on a skinny authorized line and liable to falling on the mistaken facet of an officer’s judgment. But they are saying the chance is a essential one.

“If I get arrested, I’m going to chalk it up to the game,” stated Jack, who is thought within the Dallas space because the Santa Claus of harm reduction. “Because the people deserve these resources. Because in other states, harm reduction is built into public health programs — we deserve to have that same access. And because I love people who use drugs and I want them to be safe.”

Casey Malish, the director of outreach on the Houston Harm Reduction Alliance, understands the risks he takes each time he hundreds alcohol wipes, syringes, sterile water, cotton balls and tourniquets in his automotive.

“You can’t always play by the law’s rules when it comes to saving people’s lives,” he stated.

Malish compares the $500 wonderful for possession to an unnecessarily costly parking ticket. However, he and the alliance do restrict their harm reduction operations to keep away from the extra severe Class A misdemeanor prices. The Houston Harm Reduction Alliance hasn’t launched a syringe entry program, Malish famous, as a result of used syringes may function proof for distribution of drug paraphernalia. His voice wavered with uncertainty as he stated it — nothing is absolute within the authorized grey space the place harm reduction advocates function.

The Houston Harm Reduction Alliance and different comparable packages are additionally restricted within the dimension of the operations they will run. As lengthy as legal guidelines round drug paraphernalia cease harm reduction from being built-in into the general public well being care system, advocates are sometimes scrambling to discover funding.

The Houston Harm Reduction Alliance doesn’t have the funds to function full time or purchase a van. Jack works full time as an organizer with the group North Texas Rural Resilience however struggles to discover the funds to import provides from out of state and pay expensive delivery charges.

And but, the demand is excessive. At one distribution in downtown Dallas in August, Jack introduced lots of of protected use provides and ran out in 20 minutes.

“They deserve better”

Advocates say the criminalization of harm reduction tools may also contribute to poorer well being outcomes for drug users, who are sometimes hesitant to hunt down provides overtly.

“They’re definitely not going to risk persecution to jump through these hoops and just hope to God that a cop is not going to show up on the other end,” Dambra stated. “People are hurting themselves in so many ways physically and mentally by using unsafe supplies and dirty supplies. They deserve better.”

And arrests over drug paraphernalia can disrupt therapy as a result of remedy for substance use problems, equivalent to methadone, is tough to entry in prisons, stated Sledge, who has been a paramedic specializing in substance use dysfunction for greater than a decade. He works with drug users who survive an overdose to join them with therapy choices, different medical providers and social help.

“When an arrest happens and somebody is dependent on opioids, they go to jail and they get very, very sick in jail,” Sledge stated, referring to withdrawal signs. “Even if that person is on methadone already, it’s extremely hard to access [that medication] in the jail.”

One research in North Carolina discovered that within the two weeks after their launch, lately incarcerated folks had been about 40 times more likely to die from an overdose than the final inhabitants.

The confiscation of provides for protected drug use will also be problematic, Sledge stated, significantly for people who find themselves experiencing withdrawal signs and are looking for reduction. When protected use provides are taken away, drug users will reuse or share provides, growing the chance of infectious ailments, he stated.

When Houston resident Crystal Salinas was utilizing medicine, she would take a look at them as typically as she may. People round her have died as a result of they used medicine laced with fentanyl.

But this yr, Salinas stopped carrying the fentanyl testing strips in her automotive. She was beginning to get sober, and she or he was afraid of getting pulled over by a patrol officer.

“They say everything’s bigger in Texas,” Salinas stated. “You don’t want to mess with Texas. You don’t want to mess with the Texas law.”

Salinas nonetheless retains the testing strips at residence in case different folks want them. She stated if pharmacies can take a look at the make-up of prescription capsules, drug users and their households ought to have the ability to get the identical assets.

“Why is that resource a bad tool? People are still going to use, and that’s been hard to accept, but it is what it is,” Salinas stated. “Texas is so against helping the addict. I don’t know why. I don’t know.”

This article is revealed as a part of the Mental Health Parity Collaborative, a nationwide partnership between The Texas Tribune and The Carter Center’s Rosalynn Carter Fellowships for Mental Health Journalism and different newsrooms all through the U.S.

Disclosure: University of Texas at Austin has been a monetary supporter of The Texas Tribune, a nonprofit, nonpartisan news group that’s funded partly by donations from members, foundations and company sponsors. Financial supporters play no function within the Tribune’s journalism. Find an entire list of them here.