Here Is the Introduction/Talk About Safer Injection I Planned to Give in Portland And

Here is the introduction/talk about safer injection I planned to give in Portland and didn’t get to.

Thanks for coming! My name is Terry Morris. I am really happy to be here.

How many people here- if you wouldn't mind, raising your hand, are at this conference for the first time? How many people have been to a conference once? Twice? Three times? How many folks here work at needle exchanges? How many folks are already talking with participants about safer injection? Anybody here ever sometimes feel inadequate or less informed than you would want to be when having those conversations than you’d like? Anybody here ever struggle with being uncomfortable talking about this stuff sometimes?

I went to my first needle exchange conference in 2001 and came to my first national harm reduction conference in 2002. These conferences are incredible opportunities to meet awesome people and borrow/steal great ideas. There are amazing people in this movement. There are amazing people in this room. On this panel. It is great to be here- with you all.

So, I have this slideshow that I would like to offer you if it could be of use- it is online at www.tspsf.com and if you want me to email it to you so you can edit and change it to suit your needs I would love to send it to you. If you would like to look at it and help me out by making suggestions for improving it- that would be great to.

The slideshow is basically a collection of images and information gathered from websites, organizations, books and people. The harm reduction coalition, Chicago recovery alliance, SFNE/Homeless youth alliance, harm reduction therapy center, Seattle king county health department, tweaker.org, exchange tools from the UK, Edith Springer, Alex Kral, urban health study, Mona Bennett, Fred Johnson, and people at the exchanges in Atlanta and San Francisco who have taught me.

So please take the slideshow- take what you find useful, ignore anything that is not helpful to you. I have used it to invite people to have conversations about injecting.

It can spark conversations about the circulatory system and anatomy, injection technique, the supplies exchanges give out, vein care, abscesses, Hepatitis and HIV prevention, self care, how people learned to inject. It can invite conversation about people's relationship with drugs, managing substance use, managing a run, relationships and dynamics between people around injecting, conversations about the details of an injecting experience- from what your day was like- what your body was like- what you went through that day to get the drugs you will be using, what you did to find yourself the time and setting to do that injection, who you were with, what your plans are for that trip/high, how people get introduced to injecting- their thoughts and feelings about initiating others, peoples experiences with overdose, and alternatives to injecting from choosing another route to substitution therapy.

The slideshow can be used as a group facilitation/workshop tool, one on one, or you can email it to people or give them the link to the website so they can use it as a self guided tool. I have used it to chat people up in alleys and storefronts at exchanges on a laptop or printed out- at indoor needle exchange sites, in vans parked in alleys, and at the AIDS foundation in big rooms for groups from one person to twenty or so people.

So, none of this information is really from me. I sure didn't generate it- I have learned from and borrowed brilliant ideas from many of the amazing people in this movement, from websites, books, podcasts, videos, movies and I learn on a daily basis when I am working- from my teachers in the community-people who use drugs.

Last week in preparation for this talk I walked down to the exchange to ask exchangers what they thought I should say about safer injecting. I asked a few people about where they got their information about safer injection, where they did their learning about it. I noticed a young man, young, good looking, well dressed- coming in with a bunch of big sharps containers and said hello. I told him I was coming to this conference and was wondering if he wouldn't mind talking with me for a few minutes about how people learn about safer injecting and vein care.

ABOUT THE YOUNG GUY I TALKED TO AT THE EXCHANGE:

He told me about himself: during his freshman year of high school he decided he wanted to try every drug out there. He tried weed. He tried cocaine. He tried valium. He tried a number of pills. One day he tired oxycontin. He loved it. When he described it he said “with oxy I was at ease. My worries, doubts concerns- were eased” and he said he could focus on what’s at hand.

The OC experience taught him some things he found valuable about all the worrying he was doing- all the fretting-and how it was basically useless- what he learned getting high- that teaching bled into other parts of life- he found himself mentally more relaxed when he was sober- all that worrying was gone. The downside- the bad part of oxycontin for him- was that the depression he struggled with increased 10x. So there is an AND between those two- not a BUT. We are sort of conditioned to frame things like “this is good- BUT- this is bad” where what might be a more helpful way to frame it is “this is good- AND- this part is bad” Both can be true at the same time- without de-valuing the other.

I asked him HOW DID HE LEARN ABOUT INJECTING: He learned the safety aspects from the internet. “When I decided I wanted to inject I researched on the web.” I asked, “Where did you find helpful information? What sites?” He told me thefix.com was good, readit.com/opiates and recommended opiophile.com an online forum for opiate users.

I asked “What have your experience been like coming down here to the exchange?” He said, “Well, I feel awkward- I feel detached from everyone else who comes in. I mean, I am from _____ (a very wealthy neighborhood in SF) I am a student at ______(a prestigious university) I am successful in school. I am an achiever. I feel really different from most of the people that come here. With that my experiences have been really positive. The people here are always friendly.”

I asked what suggestions he would make for us to improve how we do what we do at the site…. Well I don’t have any big suggestions, but….He pointed out the posted flyer-the Warning about the reformulated Opana ER pill that is dangerous. He let me know that the picture of the pill on the flyer is wrong- the new formula with the E on the front is the one that has been causing problems. The pills shown on the flyer are the old version.

This young man did research. And he made a plan with a group of his friends that also wanted to try injecting. They made agreements with each other- they wouldn't share any injection equipment. If any of them when off the chain- and got really too into drugs they would tell that kids parents. They all agreed. They stockpiled backup opiate pills so that if one of the circle of friends had to make a choice between doing something crazy and stupid to get money to buy drugs- this person could have an OC so they wouldn't have to go out and do something sketchy. The group also kept suboxone and narcan handy- they all share a script- one of them has a pain management doctor that he could get OCs from- the idea with the group of friends was “if you ever are considering doing a shady thing for dope you can get an oxy off a friend.”

WHEN I ASKED THE YOUNG MAN about his experiences injecting, how his veins were- he said he had a really hard time injecting and it would take him 20 or 30 minutes to get in a vein. It was frustrating- bloody. And he actually finds himself snorting heroin (he has a good connect) or choosing to swallow a pill more often than not now. Which he was happy with. So I didn't jump in to LETS HELP YOU GET REALLY GOOD at INJECTING so you don’t have to be a bloody mess. I took a step back- respecting his ambivalence about it. Turns out he was returning syringes and picking up for his dealer so he would get a free sack of dope. The syringes weren’t for personal use.

He talked about the stigma around injecting- this is secret stuff. His parents and non using friends have no idea he is using right now. They say things to him about how great it is to see him over drugs-and not using anymore- how healthy he looks etc. and he laughs because he knows he is using and their observations are funny to him. He has to keep it hidden.

When he talked about his DEPRESSION he explained he has dealt with it throughout his teen years. Part of his experimentation with drugs was partly a search to feel less bad. When someone gave him an OC and he took it he loved it.

My conversation with this young man illustrates a few really important things-

people are resourceful,

people anticipate and address problems they might face in very creative ways,

people care about each other,

people are thoughtful and have a lot of self awareness about their relationship with drugs, their mental health, and themselves and take steps to tend to it,

money and self esteem, and family and friendship, and connections to others, and hopes for the future, and resources and a sense of belonging sure can't hurt! they are protective.

people are motivated to take care of themselves.

drugs give things are helpful AND drugs can be harmful. (depression)

Drugs can be teachers- the teachings can have implications that impact our lives- not fretting and freaking out about things- being more relaxed in daily life.

YOUNG INJECTORS are not a monolithic group. They are unique and diverse individuals just like everyone else. When this young men talked about other young people he met at his dealers- he saw them as reckless- not willing to listen to anyone else- and taking a lot of chances- because they are young and think they are invincible.

Learning to inject can be a really rough and messy trial and error experience.

And peoples decision to become proficient at injecting can be very related to how they think they will be able to manage their drug use. This young man gave me the message that he had kind of given up on injecting and chosen to snort or take pills instead. This decision was in part a strategy to continue to keep his drug use manageable.

People think about and take care of the prevention of blood borne viruses!

People often have to lie to their friends and family about drug use. it is a secret. the stigma on it is massive.

People coming to the exchange are often picking up supplies for OTHERS.

While I was talking to this young man I did some noticing… what I was feeling listening to him, what were my impulses, my urges talking to this young man:

What was I struggling with while we talked? Even though I did a buttload of drugs as a kid and wouldn't have listened to anyone tell me otherwise- as a grown middle aged lady these days- if I am honest- generally- I struggle when young people come in to the exchange. it’s my shit. I want to protect them. I want to tell them what to do. Part of me doesn't want them to be shooting drugs.

I worried about his future

I worried about his depression.

I worried about him overdosing and his mom (who i made up in my head) his mom (who has no idea he is using) finding him in his room.

I wanted to help this kid get better technique while i was listening to him talk about the bloody trials and tribulations he was experiencing trying to get a hit when i asked about how his injection sites were- were they sore- did they hurt- any scarring or marks. But when I listened- that might not have been on his agenda. So I had to let it go on mine. He didn't ask.

Recognition that this young man didn't learn from us he is self taught. Our role as syringe providers-to him- we are a spot to get supplies- a friendly exchange- we might NEVER meet his friends, his dealer, the young people he sees at his dealers house.

USER TO USER information, support, and advice is the BEST stuff there is!!! SOME PEOPLE WILL NEVER EVER EVER COME INTO AN EXCHANGE::: what can you do to make it easy for people to get supplies- as many as they need- how can you foster secondary exchange and let people in the community know you value and appreciate their efforts? How can you help people share information between each other to support safer injection?

At an exchange you won't be able to offer what could happen between people using together. Its different to be able to access works at a kitchen table- at a friend’s house, and shoot the shit while you are picking up works (maybe you are fixing up)- in a relaxed comfortable non clinical, (depending) non chaotic place/ relaxed comfortable place to get information, raise concerns, get info and advice.

The best innovations and ideas come from people who use drugs- we can learn a lot from people who come to our services.

If you invite someone at the exchange to sit and talk- OFTEN they DO have TIME and THEY DO WANT TO and they DO APPRECIATE that YOU WANT TO LEARN ABOUT THEM and HOW THEY ARE DOING. Sometimes we assume people want in and out service- and we can miss opportunities engage people in conversation.

I began volunteering with the Atlanta Harm Reduction Center in 2001. The Atlanta Harm Reduction Center is Georgia's only syringe exchange program- Georgia has insanely restrictive syringe access laws- no pharmacy sales without a prescription- and no okay from the local health jurisdiction to do it legally. So in Atlanta when you hand someone a ten pack- you are breaking the law. At one of our sites off duty police officers were paid by local merchants to patrol the neighborhood. It was a gentrifying stretch of blocks that used to be a very busy sex work stroll. The cops would park across the street. They would come over to our outreach van. We hid the syringes in the back seat and put them under bagels in bags when we handed them out.