International Overdose Awareness Day

It goes without saying that this International Overdose Awareness Day is different than recent years, an outlier even among the years of outliers that make up the overdose crisis. Overdose Awareness Day typically calls for recognition between other more festive end-of-summer events, cookouts and back-to-school preparations, and asks us to remember those we’ve lost, those who are not here to celebrate, those whose futures were already determined. Many of the ways we’ve found to mark Overdose Awareness Day—marches, candle-lit vigils, local get-togethers that seek to not only honor the lost but celebrate the “survivors and revivers”—are less available this year, and the sense of community that these events foster may feel hard to come by. This is especially difficult when community is the cornerstone: Overdose Awareness Day is powerful because it connects people made vulnerable and isolated through stigma, shame, and criminalization, to create space where people can come together in grief and gratitude and know that they are not alone. This year, Overdose Awareness Day comes after months of rising overdoses compounded and complicated by the COVID-19 pandemic: the United States has seen double-digit increases in unintentional overdose deaths during every month of the shutdown.

While significant for people who use drugs, loved ones, advocates, and service providers, IOAD also functions as an appeal to broader society: our pain is like your pain, our grief is like your grief, and it deserves solemn recognition. But the tables have turned somewhat, and perhaps this year it is more fitting to say, “your pain is like our pain.” At the beginning of the pandemic, drug user advocates, harm reductionists, and people living with HIV expressed hurt, frustration, and resentment over the comparative government responses to these public health crises. Swift action to declare an emergency, direct large-scale resources, and call for public cooperation suggested that political leadership took this crisis more seriously than others because its victims could not be wholly written off as marginal or morally suspect. However, during the past several months, the response began to look more familiar. Racial inequities are glaring in impact and resources, with cruel, particular damage to low-wage workers and people without health insurance. Communities are isolated, steeped in misinformation and trauma. Prevention and response have become politicized, more representative of identity than evidence. Specialized healthcare services are limited, and costly and burdensome to access. States and municipalities are, again, forced to reassign staff, redirect funding, halt programs. A growing string of previous global health priorities, including malaria, tuberculosis, polio, HIV, sexually transmitted infections, viral hepatitis, and now overdose, are rebounding with increases in occurrence as vaccination, harm reduction, and treatment programs are limited. Efforts to address the pandemic are fragmented and lack coordination. This devolution in response has been more surprising for some than others, shocking while deaths rise and political will dwindles. The problems are systemic, the harms systematic. Your pain is like our pain.

We recognized it again when people all over the country and world rose in righteous and desperate protest over the police murder of George Floyd in late May. NASTAD and the harm reduction community stand in fierce solidarity with the Movement for Black Lives and recommit to upholding not only Black life and livelihood but Black safety, Black wellbeing, Black joy, growth, and leadership. Criminalization of people who use drugs, principally through the War on Drugs, has always functioned as a racist and classist tool of social control, sacrificing communities of color, families, jobs, and healthcare in favor of mass incarceration, private prisons, and entrenched political and economic power. Its targets—people who use drugs, people who sell drugs, people suspected of having been in close proximity to drugs, their families and loved ones—are doubly silenced with contempt that challenges their humanity, ability to love, and deservingness of care. As harm reductionists, we recognize the processes of dehumanization that allow an officer to kneel on a man’s neck for over eight minutes, a police squad to kill a woman asleep in her home.1 When tallying police-involved deaths, do we count those who died from opioid overdose because responding officers objected to carrying naloxone? How do we estimate the avoidable and deadly infections that may have been prevented by sterile supply access, were it not for decades of law enforcement or political opposition? Can we quantify the suffering of people forced through painful detox when jails deny appropriate medication? Who is responsible for post-release deaths, when members of our community are thrust back into the world, traumatized, without ID, without medications, and without regard? How should we distinguish the various, complex, and deeply personal harms perpetrated by and through the public servants tasked with our protection?

In this moment of social, political, and economic upheaval, we reestablish harm reduction’s transformational, liberatory, and abolitionist goals, and affirm the leadership of people who use drugs and people who do sex work in these movements. Harm reduction has always been an intersectional struggle. This International Overdose Awareness Day, despite our isolation, we can extend the reach of our community and stand in solidarity with all people pausing in grief and responding to both recent and long-standing harms. Forward together. Not one step back.

1Emboldened by a “no-knock” warrant, a technique developed for drug-related charges.