Sheila Vakharia PhD MSW Profile picture
Jun 25, 2020 19 tweets 4 min read Read on X
Dr. Buer sharing that sexual and physical violence occur in rural communities, unlike the myths that may make it seem that they are exempt. She also includes police violence and violence of systems, incl Child Welfare, Soc Services, Healthcare, and Housing. #DrugResearchersRT
Dr. Buer now discussing that lack of employment remains a challenge, especially for people with records or without college degrees- maybe not even available in the entire county. #DrugResearchersRT
Dr. Buer dispelling the myth that housing would be cheaper in rural communities - perhaps owning might be for some, but renting can be costly, and Section 8 housing may be limited or otherwise unavailable (the last 2 being urban challenges too).
Dr. Buer now explaining that childcare may be completely unavailable in your town/county, so family care may be only option. In addition, more of these communities are healthcare deserts with limited providers, hospitals, and methadone/bupe provider may be hours away.
"Appalachia being shrouded in blame because of their geography." They are often seen in contrast to suburban centers as being "unregulated and incomprehensible." Despite economic and racial diversity, constructions of whiteness and poverty can be damaging. -Dr. Buer
"When Appalachia as a place is seen as a problem, the only solution presented by insiders and outsiders is to leave. That can mean leaving family land, family connections, and family care work. Also assumes that their lives will automatically 'get better.'" - Dr. Buer
Women in her study who left but carried the stigma of drug use AND their hometowns, they saw that maybe leaving wouldn't help and maybe they were better off staying at home.
And leaving would never protect them from sexism, classism, drug user stigma, and other structures and systems that pervade all communities.
She is highlighting that while many of these challenges are similar for those regardless of rural/urban status, she wants to reiterate that 1) confidentiality and privacy is a distinct challenge. One good strategy in rural areas is using secondary exchange to increase access.
2) Court-ordered treatment program structure also require people to attend self-help groups and this is a challenge when some communities don't have them at all, or only have Bible-based groups. This reduces choice and makes court-ordered programs require Bible programming
3) Court-ordered treatment programs also end up forcing people without transportation to "jail" because they don't have reliable access to bring them to programs that might be hours away.
Now Buer crediting Black women leadership for starting conversations about abolishing jails/prisons and defunding the police because they are relevant in white rural communities too since they lose community funding and it gets allocated to carceral systems too.
She also highlights that defunding police can still be harmful if funding goes to social workers and other systems that have policing-type powers that control and punish communities and people.
Buer highlighting that while we are overregulating individuals, we are underregulating exploitative industries in rural communities - this includes the pharmaceutical industries, pay day loans, occupational safety, and substance use disorder treatment. Where is the money going?
And how can we funnel money away from "industrial treament" towards ham reduction in these communities?
Buer acknowledging that white supremacy is clearly an issue in rural communities and in the country more broadly. White supremacy being behind deciding who is expendible, and this being exemplified in our Drug War and also in patriarchal systems and structures impacting women.
Buer also speaking about how this is connected to an overregulation of pregnancy- connecting to Drug War, misogyny, and white supremacy as well. Shouting out @NAPW and @SisterSong_WOC for their efforts here.
Sorry this thread died - I was moderating the Q & A. I'll share the recording when it's available!

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More from @MyHarmReduction

Sep 21, 2023
Thrilled to be here at the @MethadoneLib conference!

Great turnout in the room and I’m sure we have plenty folks logged in remotely representing so many diverse groups and regions!

We all share a commitment to #FreeMethadone!
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We are listening to an infuriating clip from @National_usu ‘s podcast Naturally Noncompliant to hear from people about their experiences and why we need to #FreeMethadone.

Follow and tune in podcasts.apple.com/us/podcast/nat…
@National_usu Moving onto our first panel with a fantastic lineup of speakers- @suenlw @DrChinazoOASAS Paul Joudrey @highway_dave and Kelly Knight!

#FreeMethadone Image
Read 6 tweets
May 10, 2023
People often ask, "What about treatment?" "Why aren't they in treatment?" when talking people with addictions or other mental health diagnoses.

We talk about treatment as some magical black box- people walk in sick and then walk out "better," improved, stabilized, asymptomatic.
But the reality is that treatment is slow and time-consuming.

Change does not happen overnight; it may not look how you expect.

The first days, weeks can be challenging. You settle in. You meet the counselors- some are great, some are terrible. You may not speak right away
Sure, there are lovely, warm. caring counselors. But there are shaming, blaming, harmful counselors too.

They may recognize you from the last time- some will welcome you back. Others will tell you, "I told you so."

There may be familiar faces in group therapy too. Good and bad.
Read 12 tweets
May 3, 2023
New CDC report on OD trends in US 2016 to 2021 🧵

- The US fentanyl-involved OD death rate is 21.6 per 100,000, a rate that more than TRIPLED in just 5 yrs
- Methamphetamine-involved OD death rate more than quadrupled,
- Cocaine rate more than doubled

🔗cdc.gov/nchs/data/vsrr… Image
- Meanwhile the rate of heroin-involved OD remained relatively stable during the 5 year period,
- Oxycodone-involved OD rate decreased by 20+%

**At this point, any talk of the overdose crisis without acknowledging prevalent stimulant use misses the mark
Gender disparities in overdose deaths remain so that men have significantly higher rates of overdose for all drugs compared to women.

Meanwhile middle-aged adults (aged 25-44) have incredibly high overdose death rates involving fentanyl Image
Read 8 tweets
Mar 8, 2023
Watching @CNN and @andersoncooper talking about the overdose crisis. They are talking about two tragic cases of young people who died of overdose with their grieving family members.

Both overdoses were with counterfeit pills. (1/?)
In first story, the young person thought it was a Percocet. When he was overdosing, a friend was deterred from calling 911 for fear of law enforcement.

In second story, the young man ODd while talking to his girlfriend on the phone but she didn’t know signs of him overdosing.
While they are talking about the need for more awareness of fentanyl adulteration, recognizing overdose, and naloxone access—tougher laws and prosecutions are also being proposed by family. They worry that felony charges for the dealer and 4 years in prison are not enough.
Read 28 tweets
Feb 25, 2023
Many people do not realize the difference between these terms and that they actually mean different things:

Decriminalization =/= Legalization =/= Regulation

These are three different things.

And only 1 of them ensures a known, tested, and monitored drug supply for all users.
1) Decriminalization simply means that possession is no longer a criminal offense.

You cannot get arrested, booked, finger printed.

No potential jail time.

Nothing on your record when you get a background check.

You may owe a fine. You may be diverted to a case worker.
+ You may be able to waive that fine if you complete a health assessment or see a dissuasion panel.

However, your drugs may be seized.

And, if they aren't seized, your drugs could still be adulterated or unsafe.

You may not know exactly what is in them.
Read 9 tweets
Nov 22, 2022
Learning from Dr. Joseph D'Orazio that xylazine is being detected in over 90% of tested heroin and fentanyl samples in Philadelphia.

Screenshot below shows that it's also prevalent in overdose victims - xylazine + fentanyl positive in 100% of those who died in 2020.
Also, Philadelphia seeing a notable trend of decreased benzodiazepine-involved overdose deaths while xylazine-involved overdose deaths are rising.
This slide shows that xylazine overdose response must prioritize airway management so they can breathe and keep in the recovery position.

Administering naloxone still important since opioids often still on board, yet may appear as a "narcan resistant OD" due to xylazine
Read 7 tweets

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