I was addicted to fentanyl. Here’s what we should be doing about it.

A former fentanyl addict writes about her experiences and the policies she believes will best help others

Madeleine Sweet

April 10, 2023

It’s Dec. 23, 2021, the day before Christmas Eve. My mother wears an expression mixed with fear, anticipation, and relief. It rained the night before and I am carrying the only possessions I have left to my name : a little roller bag, packed with mildewed clothes and various half-empty toiletries from the volunteer crew that would occasionally push their Radio Flyer wagons through the little tent city under a bridge.

I knew I looked bad  —  I hadn’t slept well, the rain kept leaking through the tent. My jeans were caked in mud and my hands were dirt-stained. There was a just-barely-healed abrasion near the corner of my mouth where I had been smacked, hard, across the face. Not to mention, I hadn’t showered in … a while. My appearance told a story of despair — the despair that had encircled every facet of my life.

My mom grabbed me and held me. Tears streamed down my face.

“I’m sorry, mom,” I cried. “I’m so, so sorry.”

And I meant it. I had tried, again and again, to get clean to no avail. I was addicted to fentanyl — deadly, illicit fentanyl — and I knew in my bones exactly what that made me: a no-good junkie. A homeless parasite. I did not deserve recovery or happiness. The fallout from my addiction was immense, and my family was left strewn in the wreckage. I felt a deep and abiding sense of shame, a hurt so profound it defies articulation.

Good-hearted people in yellow vests marked with the word “VOLUNTEER” would venture down to the trail that was dotted with makeshift structures and deteriorating tents. They would bring Narcan and granola bars. They would try, again and again, to throw us life rafts, and I would bat them away. “We can help,” they would offer. “There are groups and rehabs and doctors who will see you.”

We took the Narcan and the water bottles but left the offers.

I have salient memories of my time on the streets, bursts of euphoria punctuated by intense anguish. One moment, I am upright, foil in one hand, torch in the other. The next moment — I wake up to the blinding light of day on a park bench. I am dopesick and hungry, and for the first time since I was a child, I cried out in public. From the depths of my soul, I emitted a wail of unmitigated heartbreak.

Then, on a warm night in October, I took what’s known as a “hot shot” — a term used to describe an IV rig filled with too much or a stronger batch of a substance, in this case, fentanyl — and went limp. I stopped breathing and my lips turned blue. I had overdosed. Miraculously, a bunch of homeless addicts living in abject poverty in a tent on a trail by the San Lorenzo River had enough Narcan, the lifesaving antidote I needed, readily available to bring me back from the brink of nonexistence.

At times, the conversation about policy surrounding addiction loses its essential humane tenor. In lieu of statistics and abstract policy, it’s important to remember that we deal in human currency. The life I lived in active addiction was not pretty; it wasn’t a dignified existence. Nonetheless, and by the skin of my teeth, I made it out the other side.

I am writing this op-ed to defend harm reduction policy. As someone whose life was undoubtedly saved by these policies, I feel I am especially apt to address the critiques this approach has faced of late.

In December, the Tenderloin Center, an unofficial safe injection site in San Francisco, closed its doors, and overdoses have increased in the months since. For critics who claim there’s no direct correlation, one can at the very least note that January 2023  — the first full month since the closure of the Tenderloin Center — saw the most overdose deaths of any month since January 2020, which is when data first became available. The National Institutes of Health concluded in a study that “[safe consumption sites] are associated with lower overdose mortality,” and “67% fewer ambulance calls for treating overdoses.”

Though I write this with the intention of providing a humane perspective into this issue, it can’t be understated that statistical evidence supports the benefits of these policies: A 2014 review of supervised injection services demonstrated that these sites fulfill their objectives — in that they reduce overdoses and increase access to life-saving health services — and they do so all without increasing drug use or drug trafficking.

Initiatives like safe injection sites do not enable nor encourage people to use drugs. As someone who has lived as a drug addict and benefited from harm reduction policies similar to safe injection sites — such as needle exchanges and access to naloxone, which can reverse opioid overdoses —  I can say confidently I never once predicated my use of drugs on the accessibility of life-saving measures. Not even once. Drug use is a compulsive behavior on behalf of drug addicts, and we, as a society, have two choices: We can either make space in our hearts and minds for drug addicts to endure their sickness with a modicum of safety and dignity, or we can let them die in throngs laboring under the mistaken belief that reducing the harm inherent in their compulsion equates to encouraging the addiction.

The people who came down to the trail and dispensed Narcan, granola bars and goodwill — those strangers had shown me love and compassion. Indeed, they had loved me until I got well enough to love myself. That show of humanity saved my life. Without ready access to Narcan, I would cease to exist. My parents would have buried their oldest child.

I have a simple question: What’s that worth?

Even if you can’t get behind the idea of saving someone’s life, and care only about getting addicts out of public view, listen to the evidence that demonstrates that safe injection sites achieve that aim. A study in Vancouver, Canada, showed that safe injection sites actually reduced the prevalence of public drug use in the surrounding area.

As Peter Davidson, a researcher specializing in harm reduction at UC San Diego, pointed out in a 2018 NPR article, “If there had been unintended consequences, I suspect that would have been picked up by now.” A prevailing theme for adversaries of proactive harm reduction policy is rooted in fear about the message it sends to young people and to impressionable members of our society. It’s fueled by a sense of disquietude — that if we destigmatize addiction (in particular, opioid addiction) we are tacitly endorsing it. A common analogy is used with regard to tobacco and nicotine: We stigmatized the use of tobacco and nicotine, we make it illegal or at the very least actively discourage it, and now tobacco use has decreased.

Yet, opioid abuse and especially IV opioid use is already severely stigmatized. It’s highly discouraged — and rightfully so. The analogy is a false equivocation, and either way, it’s still perfectly legal for consenting adults to buy nicotine. For a stigmatization to be effective or meaningful, the behavior or product in question needs to have been normalized in the first place. IV opioid consumption will never be normalized, and harm reduction policies do not normalize addiction. These policies only address addiction as the unfortunate phenomenon it is.

To those who believe San Francisco’s problem is uniquely acute, I have some news for you: This type of addiction exists in every city in the country. The difference is that ours isn’t entirely hidden in back alleys and under bridges. San Francisco is a city that looks our most vulnerable in the eyes. According to data collected by the American Addiction Centers in 2021, San Francisco is actually among the least drug-addicted cities in the country. Another study from 2020 also pointed out that California, as a whole, is not considered a “problem area” when it comes to drug abuse. I don’t say this to diminish the problem we are facing, because it is colossal. I say this because I often see detractors posting video after video to Twitter showcasing the despair-lined streets of the Tenderloin, as though that is a meaningful response to people’s suffering. It seems like a thinly veiled attempt to invoke revulsion in lieu of sound reasoning. It’s like despair porn: it is gratuitous and does nothing to address the underlying issues.

Furthermore, the following dichotomy is presented: On one hand, detractors are saying, “Look at this horror and destruction, this obscene display of inhumanity,” and with the other hand they suggest that somehow that same phenomenon is going to lure impressionable citizens to do the same. Which is it? Abject revulsion or an appealing life path?

After years of trying in vain to tread water, I finally accepted a life raft. It would have been easy to discount me as a hopeless dope fiend, but on that cloudy December afternoon, I did the impossible (or at the very least, statistically improbable) and I chose to go into detox. I was terrified because I knew just how sick I was going to become. At the same time, I was desperate for my nightmare to end. My parents took me to the hospital, where I spent two weeks writhing in pain as the poison seeped out of my pores. I was despondent and broken, but amazingly, I was alive. And now, with the benefit of hindsight, I can see it was far and above the best Christmas present I could have ever received — another chance at life.

Frankly, I would not agree to enter detox until I was told that a path had been cleared for me to return that did not involve incarceration. My struggle with addiction spans nearly a decade of my life, beginning around the same time I graduated law school in 2014. I had been arrested in 2017 for a low-level drug offense and after completing drug court, I was sentenced to probation. I was, in fact, still on probation during my last relapse. Luckily, a probation officer empathized with my mother’s plight and assured her that they would not lock me up if I agreed to detox and rehab. 

If we, as a society, continue to envision addiction as a moral failing that warrants punishment, we will always struggle to address the problem. Tougher drug laws will not stop people from using or selling drugs. If that worked, we would have already solved the problem — because that is how we have always treated it. We need to try something different, and we must approach this issue from a place of love and compassion.

I sympathize with the desire to force people to do what’s best for them. Mayor London Breed has recently pushed for changes in state law that would make it easier to compel people into mental health or substance abuse treatment programs. In cases of severe mental illness, a case can be made for compelling treatment by way of the courts. In terms of addiction, though, my own personal experience tells me that the fear of incarceration can only get you so far — eventually, staying clean has to be a decision to make a better life. It is impossible to compel that decision for another.

Take it from a native Midwesterner, San Francisco is a special place. For the most part, our local government addresses these problems from a place of genuine compassion. We have pioneered laws aimed at enabling people like me to have a meaningful shot at gainful employment. Nonprofit organizations like Urban Alchemy engage with homeless and addicted people where they’re at and connect folks to important resources. We value deescalation and alternatives to incarceration and erring on the side of nonviolence. The list goes on and on. I lead a life I probably could not lead anywhere else, and for that, I am so grateful.

Today, everything is different. Not to brag, but I live indoors. I have my own apartment in the city I love. I have a rewarding career where I get to help people. I have family and friends whom I don’t disappoint or frighten anymore. I am a model citizen. I don’t even smoke cigarettes anymore. Surviving my ordeal has enabled me to create a purposeful life. If not for harm reduction policies such as the wide distribution of Narcan, I would have been left to die, and none of this would have come to fruition. I implore you to consider the gravity of that. What is that worth?

According to a recent study, up to 75% of addicts are able to find true long-term recovery. That’s a staggeringly hopeful statistic, but we need to work to ensure that as many of us as possible have the chance to get there. Given the prevalence of my deadly and potent drug of choice, it is of the utmost importance that we implement policy that will save addicts’ lives while they find their way to recovery. As Harvard professor Dr. David Eddie puts it, “Nobody recovered from addiction dead. My feeling is if we can keep people alive long enough, we know eventually the majority get recovery.” I am living, breathing proof of that.

Now, back to the day before Christmas Eve, 2021, the last day I ever used a drug, by the way. Picture this moment: a mother, holding tightly to her weeping daughter, both in silent prayer for a brighter tomorrow. That day was the beginning of a new life that very nearly never happened. Take it from me, we are all capable of overcoming great odds.

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