Not every kind of addiction gets the “disease” treatment.
Now that Americans have finally come to grips with the fact that addiction is a disease and requires treatment, business is brisk in the modern recovery industry. Seems we’ve come a long way since addiction was classified as a mental disorder and sufferers were locked up in “asylums.” But while addicts are no longer viewed with moral indignation, at least not in the middle class—whose progressive perspective parallels an unprecedented spike in prescription pill abuse—the addiction-as-disease model still doesn’t extend to include poor people getting their opiate fix the old-school way, shooting heroin.
“I know there’s a lot of stigma about injection users,” says Yaya Liem, Prevention Point Philadelphia’s Syringe Exchange coordinator, while working out of an RV set up on a recent afternoon at 11th and Indiana Ave. in North Philadelphia. “People all have an opinion on what a heroin user is like, but to be honest they are some of the most real and honest people that I’ve ever met,” he says. “They just come by a hard way of life.”
Liem may not be like the typical interventionist you see on TV, or like the one PW profiled at the beginning of this series, but he’s the only help some addicts will likely ever encounter. Liem prolongs life by providing IV drug users with clean needles—along with HIV tests and referrals for training, counseling and treatment.
“It’s a very complicated process to get into treatment, especially if you’re homeless and don’t have some stability in your life,” explains Liem. His work is less about snuffing out the addiction and more about enabling disenfranchised IV drug users to live safer, healthier lives. So the 29-year-old travels throughout the inner city to distribute kits containing new needles, syringes, cookers, bleach, alcohol wipes and Band-Aids in exchange for used needles. Condoms, sitting in a bucket between the driver’s and passenger’s seat, are handed out on request.
A Haverford College grad with an English degree, Liem is a long way from his childhood home in the Philly burbs. The flak he says his parents sometimes get from friends over his work reflects the rift between worlds—between social classes. “They go, ‘I can’t believe you raised Yaya to work with heroin users.’ My parents think it’s great. It’s definitely been the most fulfilling work I’ve had. Before I was doing harm reduction work full-time, I was working for a multimillion-dollar company running their sales department ... but it just didn’t feel right.”
All afternoon Liem hangs inside near the RV’s door as clients arrive carrying used needles stuffed into soda bottles and wrapped in plastic grocery bags. Everyone who comes by does so with a hearty friendliness, and Liem responds in kind, throwing around “hon” and “no worries” and slips of Spanish with Latino clients. Women wave and call out “have a good day” on their way back home—pockets full of condoms and needles and bleach kits. Liem cheerfully repeats exchange instructions for each client: “Just drop it on in and I’ll push it.” Then the ritual: A client drops a baggie on top of the small garbage bin placed outside the door, then Liem shoves it down with a wood dowel, ensuring no one gets stuck with the needles. Liem is all about making sure no one gets stuck—with needles, with HIV, with Hepatitis C, with infected abscesses.
Prevention Point advocates the “harm reduction model” of social services. In the sex health sector, that means giving out condoms to reduce disease. In addiction services, it means giving out needles and other paraphernalia to help reduce disease and other harm from sharing or injecting dirty needles.
“Instead of being abstinence-only and telling everyone they should quit, we’re developing a trust. If you’re not ready or not in the position where you can quit right now, then how can we make what you’re doing safer?” says Liem. “The ultimate goal of any syringe exchange program is to make sure you’re still alive when you’re ready to quit.” After each exchange, Liem punches basic information about the transaction into a portable machine the size of a thick paperback. The machine records the client’s ID number via a program-issued card, how many people they are bringing in needles for and the number of needles brought in, the number received. You have to bring in dirty needles to exchange for sterile ones. One client exchanged for 150 needles. “Have you seen a needle that’s been used? After three to six times, it looks like a Christmas tree when it’s blown up; it’s all barbed and the needle’s bent backwards, and it hurts,” says Liem.
Outside the RV, a man bent forward at the waist is raking the top part of a broken plastic hairbrush through a long grey curtain of hair. “Someone tried to rip my hair out last night trying to steal my diamond dust,” he says, spreading his fingers through the knots. No one seems surprised by the story. Two young volunteers—a pretty girl bundled up in a scarf and coat offering cookies and a guy with a stethoscope slung around his neck—offer casual camaraderie, shake their heads. Liem feels a kinship with the population he serves. “I have my own history, too. I was doing a lot of drugs when I was a teenager and through my college years. I wish somebody had told me that this existed back then, you know?”
The program, funded mostly through the Philadelphia Health Department’s Office of Addiction Services, claims that 98 percent of the needles given out are returned. Prevention Point enrolled 1,600 new clients last year, and made about 600 documented referrals to treatment—though Liem emphasizes that treatment referral isn’t the yardstick of success.
Studies show that needle exchange programs are effective. Before Prevention Point opened their operation in Philly, 47 percent of newly infected HIV patients were intravenous drug users. Now it’s projected to be down to about 18 percent. From a financial perspective, the strategy is a sound public health initiative: Liem points out that treating a person with HIV or Hepatitis C for a lifetime costs hundreds of thousands of dollars, while each syringe costs only eight cents. Even so, such programs are still restricted on moral (read: political) grounds. Federal legislation enacted in 1989 that prohibited the use of federal funds for needle exchange programs is still intact, even 11 years after then-Secretary of Health and Human Services Donna Shalala acknowledged that such programs inhibit the spread of HIV and do not promote drug use in 1998. “People have such a phobia about syringes, that’s what makes it really hard,” says Liem. “It makes it really difficult to operate.”
Though President Obama promised to lift the ban during primary elections, it remains in effect. However, House Democrats announced in July that they would seek a ban lift in 2010. But the new legislation is choked with so many restrictions about where such programs could open—how close to schools, community centers and so on—that even if it passed as is, Prevention Point has only been able to find one spot in all of Philadelphia where it could legally operate: smack dab in the center of the Schuylkill River. “People would literally have to swim to us with their syringes,” says Liem, exasperated.
Liem is especially flustered because even though he intelligently slings stats and elegantly explains the financial logic of needle exchange programs, it’s clear he’s working more for the people than the issue.
“When I started doing this work, every client I met, client is such a stale word—every person I met, they were literally shocked that I would give them a hug or shake their hand,” says Liem. “I think it was because they have been dehumanized and told over and over again by society that they’re dirty. When somebody goes into treatment, they call it getting clean. So it’s like, what were you before?”
He makes it a point to never say junkies or addicts, only clients or participants. He respects them, even admires them.
“It’s actually a really tight-knit community,” says Liem. “A lot of us, we see each other every single day, or at least once a week.”
On request, Prevention Point trains clients in life-saving breathing techniques—basically CPR without the chest compressions—to use in case of an overdose. It also has a doctor on staff to provide prescriptions for Naloxone, a drug that can reverse the effects of an opiate or morphine overdose.
“A lot of participants now sort of work as outreach workers for us,” says Liem. Some clients use their Naloxone in the shooting galleries (abandoned buildings used for selling and shooting dope). “I hear stories all the time about people, they come in and refill on their Naloxone because they’ve saved five different peoples’ lives.”
Liem tells the story of a client who came running into their building this summer, looking for help for a friend who overdosed across the street. “She was somebody who really looked out for other people,” says Liem.
While they saved that guy’s life that day, Liem just found out that the woman overdosed last weekend.
“We hear two sides to the story all the time. We hear one side, society, saying, ‘these people have been written off, their life isn’t worth saving’ and all that kind of stuff,” says Liem. “We also see people every day who are saving each other’s lives and helping each other when they can.”
The mobile RV is all the office Liem needs. He says it’s a calling.
“I look at my life and the life of my clients,” says Liem. “I can’t say I come from the same situation they do, but I know a little bit about it. At the end of the day, we’re all just people.” ■
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