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Tending to those on the frontline



For the Gazette
Monday, August 27, 2018

I’ve been working in the field of harm reduction for more than a decade, most recently at Tapestry. I’ve never experienced losses like the ones we’ve seen in recent years. In short, we are trying to control a crisis within a crisis — and it’s taking a toll on those in the field.

Tapestry runs a Syringe Access Program in all four western Massachusetts counties. Its main goal is to save lives, and our approach is known as “low-threshold,” which means if people are not ready to seek treatment, we work with them to decrease the chances they and people they know will die of a fatal overdose as they begin to move toward healing.

Even with the many efforts in our community to fight the epidemic, our region is in the midst of an alarming uptick in fatal and non-fatal opiate overdoses. In Hampshire County from January to the end of June, 23 people died of opioid related deaths, compared to seven for the same period in 2017, according to numbers compiled by the state police.

Meanwhile, statistics are equally grim at the state level. According to the National Institute on Drug Abuse, Massachusetts has the sixth highest opioid overdose death rate in the country, at 29.7 percent per 100,000 people. In terms of raw numbers: in 2015, there were 1,684 opioid overdose deaths statewide, compared to 2,149 in 2016. In 2017, there were 2,016 opioid overdose deaths, according to numbers posted on the Mass.gov website. For Hampshire County, those numbers are: 16 in 2015; 36 in 2016 and 28 in 2017. With 23 deaths so far this year, it appears 2018 will outpace last year.

We want to stop these trends, but there are many reasons why that’s a tall order. Fentanyl, the deadly synthetic opioid increasingly added to street heroin, makes drugs more lethal and unpredictable than ever. Those working in harm reduction are likely to encounter a person overdosing as a common occurrence.

In early May, for example, there were four non-fatal overdoses in downtown Northampton within a few hours of each other. In March, Ludlow saw eight non-fatal overdoses and two overdose fatalities over a two-day period. These numbers represent only the people for whom somebody summoned help via 911. We will never know the real number of people who experienced non-fatal overdoses, but we believe it is significantly higher.

The opioid epidemic has affected me personally as well. Over the past three years, I have lost eight close friends and family members to overdose. That includes a period in 2015 when, in a span of three months, three loved ones died.

One day, when I told a coworker about these losses, she said my grief reminded her of her time in San Francisco during the height of the AIDS epidemic in the 1980s. Her description of the heaviness she felt losing so many people she loved in a short timeframe hit home for me. Since then, I’ve come to understand that trauma and grief bonds people in ways that other experiences do not.

It is heartening to see that staff in the field handle these crises in ways that can only be described as courageous and admirable. We celebrate our successes. Tapestry’s programs in 2007 provided 342 doses of Narcan to people at the highest risk of witnessing or experiencing an overdose. This year alone, we have given out close to 4,000 kits which contain two doses each. (It’s helpful to have two doses on hand because first responders are finding it can take two doses to effectively reverse an overdose.)

Still, the increases in fatal overdoses show that we need to do more for those at highest risk and the people who work closely with them. These repeated losses take a toll emotionally, physically and mentally on people working in the field. Support is an ambiguous term often thrown around in many different contexts. As a loved one who has lost so many to overdoses, I’ve found I do not always know what I need or how to ask for it. As assistant director for drug user health at Tapestry, I know there is no formula to support people.

There are responses that help, and as we continue to experience these losses, we will continue to learn. As colleagues, we must acknowledge the grief, make time for it and create a healing atmosphere for people whose work involves so much death. If overdose trends continue the trajectory of recent years, the close involvement of our staff will only increase as well.

In my role as a supervisor of people doing this work, I believe one of my duties is to be present for them. It is not always easy for people who are grieving to reach out for what they need, especially in a workplace. This, to me, is a cue that all of us must do the reaching. When we see peers, colleagues and friends struggling, we need to check in. We never really know what that kind of attention can do for someone.

International Overdose Awareness Day will be marked in many places around the world on Friday. In Northampton we’ll do so Tuesday. This is a day devoted to reflecting on the many lives lost to overdose deaths. For me, it is important to remember these lives whose deaths, I believe, were preventable. It’s also a time to reflect on the lives saved by the efforts of people working in harm reduction. Overdose Awareness Day gives me fuel to keep on with the work and reminds me that there is still so much more work to do.

Tapestry, Hampshire HOPE, HRH413, a grassroots, street outreach harm reduction advocacy group, and others involved in the opioid crisis will be in Pulaski Park in Northampton beginning at 2 p.m. We’ll have resource tables, onsite Narcan trainings and an art exhibit in the afternoon. At 6, there will be a candlelight vigil to reflect on the memories of those who have died from overdose. We invite everyone to join us.

The next day, we’ll all get back to work. We know this work never stops.

Jill Shanahan, Assistant Director for Drug User Health at Tapestry, is a member of the Hampshire HOPE coalition. She is one of several individuals who contribute to a monthly column in this space about local efforts underway to address the opioid epidemic.