Sheila Vakharia PhD MSW Profile picture
Sep 29, 2020 15 tweets 4 min read Read on X
Really powerful piece in the New York Times today about the intersection of the overdose crisis and #COVID19. Some thoughts and observations in a thread below: nytimes.com/2020/09/29/hea…
1) I actually LOVED the title of the piece - "The Drug Became His Friend."

As a harm reductionist, I spend a lot of time talking abt the fact that drugs work. They WORK. They meet physical needs, emotional needs, spiritual needs, so many others. We need to be reminded of this.
2) Harm reductionists spend a lot of time trying to create space to talk about how and why drugs work for people. The role they play. The purpose. The meaning. "Don't take away what you can't replace" is a mantra we use a lot. And focusing on abstinence negates this process.
3) Common narratives focus only on drug harms. Frame drug use unidimensionally as self-destructive and damaging. Not as a form of self-care and coping. So many of us can't hear this because it scares us. We're afraid of going there. We're told we shouldn't.
4) The problem is that we take away a drug or force someone to give it up before we've built an understanding of the role it played and built a skill set of replacement strategies. We take away your armor then send you to war.
5) I'll skip now to the most striking part of this article for me- THE VISUALS. Note the bright skies. The color. The beauty. The family. The community. The framed photo. The mundane. The simple domesticity of life.
6) A few years ago I had to attend a panel discussion entitled "A Tale of Two Crises: Reading images of a social epidemic." (I found the recording here and highly recommend you leave it on the background/bookmark: icp.org/browse/archive…)
7) Panelists included photographer Jeffrey Stockbridge, Kalah Siegal a NYC journalist, Michael Shaw a visual journalism expert, and moderated by the inimitable Dr. Helena Hansen (whose name you should all know as a pioneer of challenging the 'whiteness' of the OD crisis)
8) I livetweeted it so you can read my thoughts and get glimpses of images/slides here:
9) This piece and the imagery of white rural America made me think of a lot of what Michael Shaw discussed as the clear contrast between how the current overdose crisis is depicted vs. heroin in the 80s and crack in the 90s.
10) "Photos are almost always shot in color rather than the starker black and white. We typically see daytime or well-lit indoor photos, as opposed to night action on seedy streets or dark alleys. There is minimal engagement with courts, jail, or the police..." -Shaw
11) "And there is a stress on domesticity. The photos often are shot at a home, the spaces mostly tidy or pulled together. Bedroom portraits are common. Opioid stories typically stress the bonds and commitment of family, extended family, and community." - Shaw
12) You can read his excellent piece that his panel discussion was based upon here (and where the above quote is from): cjr.org/criticism/opio…
13) At a time when overdose deaths are spiking across the country, in both rural and urban centers, and when racial disparities in overdose deaths are CLOSING, in some cases have SWITCHED ,so that we have cities/states with Black or Latinx OD rates higher than whites. THIS is it?
FIN.

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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!
Image
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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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