Sociologist Erving Goffman’s 1963 book, Stigma: Notes on the Management of Spoiled Identity, was considered groundbreaking work for its time, and continues to be relevant today. The English word “stigma” stems from the Greek stizein, meaning “to tattoo.” Goffman describes how stigma, for the ancient Greeks, was explicit and visual. A stigma was a bodily evident sign to indicate someone was of low status, disgraced, or for whatever reason best for respectable people to avoid. For instance, a person might be physically branded as a slave.

By establishing their distance from the stigmatized group, dominant groups benefit from an elevated sense of self and status. As with the ancient Greeks, the more visible and obvious the stigma, the more powerful and inescapable it becomes. Throughout human history, physical markers have enabled conquest and subjugation. These can be imposed on the stigmatized group, such as forcing Jewish people to wear the yellow star of David in Nazi Germany. Other people are born stigmatized, such as with systemic racism, which degrades people’s humanity based on phenotype or skin pigmentation.

The physical effects of certain drug use can also be used to reinforce stigma. As one harm reduction outreach worker described to Filter, “It was really hard for me to re-enter the workforce, even with the nicest clothing, still having track marks and all this other baggage that you can see.”

Like prestige symbols, stigma symbols offer a shortcut for establishing hierarchical position. A flashy car, impressive job title and expensive clothes suggest success and worth. On the other hand, being branded a drug user provokes fear, shame, judgment and the threat of prison. As Sarah Wakeman, medical director for Substance Use Disorder at Mass General Brigham in Boston, told Filter, much of it boils down to “The very fact that we criminalize certain types of drug use. The whole point of criminalizing something is to increase the stigma of that action.”

The imposition of stigma inherently devalues a person’s humanity. The “drug user” label suggests that they can be routinely subjected to a multitude of discriminations. As Goffman explains, “By definition, of course, we believe the person with a stigma is not quite human … On this assumption we exercise varieties of discrimination, through which we effectively, if often unthinkingly, reduce his life chances.”

“We have bars which are perfectly socially acceptable … then criminalize people who need a safe space to use other types of substances.”

Stigmatization of drug use is used as grounds to deny people’s rights to housing, employment, education, health care and more. Societal shaming promotes riskier, isolated drug use while diminishing access to critical harm reduction resources and treatment—literally costing lives.

Drug use stigma is contextual. Moral judgement of drug users is often hypocritical, as well as discriminatory. People often make ethical allowances to justify their own methods for getting buzzed.

“I think there’s still this intense othering of people who use certain types of drugs and this notion of a distinct us versus them,” Dr. Wakeman said. “You know, there are those people who inject drugs, for example, or those people are different than us who use alcohol. Just think about the conversation around overdose prevention sites or supervised consumption spaces. We have bars which are perfectly socially acceptable for the people who are making the laws and policies that then criminalize people who need a safe space to use other types of substances.”

More privileged people can confine their drug use to private spaces, while maintaining conventional lifestyles and careers. They are more likely to avoid the risks of poverty, criminalization, and limited access to safe supplies that result in physical markers of poor health, lack of nutrition and subsequent damage to their appearance. “We don’t have the same degree of stigma, or even outright hatred that you can see towards certain communities of people who use drugs. That is connected to a long history of racism in the United States and how that has driven a lot of decisions around drug policy,” Dr. Wakeman said.

Jarringly, the more disadvantaged the person—living in public housing, perhaps, or on the streets—the more likely they are to be placed in a position where their drug use is made visible and subjected to the most stigma. Terrell Jones, the outreach and advocacy program manager at New York Harm Reduction Educators and a long-time harm reduction leader, told Filter that the hardships of the COVID pandemic have exacerbated the problem. “Stigma is at an all-time high because of the increase of drug use due to social and economic factors, where people have started using more and it’s more and more public drug use that people are experiencing,” Jones said. “People are walking around with their kids and seeing injection drug use and it hurts.”

“People disrespected me, dehumanized me, mocked me, and put me into a deeper hole of my drug use.”

For the most vulnerable, their drug use is transformed into the defining aspect of who they are. They are subjected to dehumanizing labels. Unlike stigmas placed on people who are, for instance, disabled or suffering from an illness, drug-use stigmas—in common with those around sex work, weight or gender non-conformity—often result from perceptions of a moral failing, indulgent behavior or depravity.

“People disrespected me, dehumanized me, mocked me, and put me into a deeper hole of my drug use,” Jones said. “The community needs to understand how much of a part they play. Instead of putting people down, give them some kind of resource. That goes a long way. This person is a human being. People act like drug users come from another world, like aliens, outcasts … people where something went wrong.”

Stigma damages trust and access to effective care for people who use drugs in medical settings, creating further risk. “Doctors and nurses are humans and members of society,” Dr. Wakeman said. “They’ve been influenced by the same societal stigma that laypeople have, particularly because learning about drug use and addiction and harm reduction is generally not a part of our medical training or hasn’t been to date … I think there sometimes is cognitive dissonance for health care providers in that they’ve been taught that drug use is bad. Often it’s actually the policies around drug use that cause the most harm. But I think in people’s minds, there’s this notion that drug use is harmful to your health, so if someone is engaging in that behavior, they must not value their health.”

“Reframing that narrative,” she continued, “is, ‘Actually people who use drugs have not forfeited their human rights, including their right to the best possible health care.’”

Stigmas even follow people into treatment and recovery programs, where expectation of total abstinence dominates and people who “relapse”—or even who use certain medications, like methadone—are judged harshly or deliberately excluded from services and support. “The narrative was so strong that if you’re not abstinent, and not abstinent in this way with this kind of program model, you are still perceived as less than,” one former participant told Filter.

Harm reduction at its core is a strategy against stigma. Giving people the space and freedom to manage their own health without judgment or coercion is a core component. Harm reduction is not just a strategy to minimize the risks of drug use, but a philosophy for self-care and community care that promotes compassion, openness and practical knowledge that can improve and save lives.

But harm reduction is also dismissed by abstinence-only believers who label its practices as permissive or “enabling.” Before we can shift the general population’s stigmatization of drug use, perhaps we need to dismantle the exclusion and shaming within the drug treatment and recovery community, which pushes people out of the services and support that could help them stabilize or save their lives.

After a year of reporting on the overdose crisis for Vox, journalist German Lopez declared that stigma against drug use is “the single biggest reason America is failing in its response to the opioid epidemic.” Overdose claimed over 100,0000 lives in the US in 2021. These were deaths that could have been prevented, by naloxone, methadone, buprenorphine, drug checking services and safe consumption sites, among other resources.

Stephen Hamill is vice president for policy advocacy and communication at Vital Strategies, a public health nonprofit. Earlier this year, Vital Strategies launched the first national advertising campaign to raise awareness about harm reduction as a remedy for the US overdose crisis (full disclosure: I served as a communications advisor for the campaign). “As long as people see this issue as something that doesn’t affect them, it will never gain political priority,” Hamill told Filter. “You will continue to see NIMBYism around putting services in every community because they feel like, People like me don’t need a needle exchange. We don’t need safe supplies or drug testing kits. It’s those bad people who are going to benefit.”

Humanizing those “other” people was a core strategy of the Vital Strategies campaign to subvert the stigmas that create obstacles for harm reduction programs. It featured the stories of people who use or have used drugs, presenting them as human beings who are loved, and who are contributing to their communities as harm reduction workers.

Dr. Wakeman also described a program to challenge stigma in hospital settings, whereby patients who use drugs volunteer to return to the hospital and visit with the staff where they were hospitalized. “I think that can be incredibly humanizing because people who work in hospitals and emergency rooms in particular often only encounter folks in a moment of crisis,” she said. “They may see someone when they’re in the throes of active withdrawal or after an overdose … it can be really powerful to just connect with the person outside of that to see them in their normal clothes and see them as a sister or a father or just a human being, essentially.”

“We do need more non-stigmatized people with courage enough to acknowledge our own drug use.”

Another approach, most prominently advocated by Dr. Carl Hart, a neuroscientist, noted author and psychology professor at Columbia University, calls for privileged drug users to put skin in the game by publicly outing their own drug use.

Admittedly, the ability to keep one’s drug use private is a benefit of privilege. It’s a tough ask to let go of that benefit and risk the curse of stigma. Yet we do need more non-stigmatized people with courage enough to acknowledge our own drug use. Whether it’s caffeine, nicotine, alcohol, mushrooms, marijuana or opioids, just about all of us have consumed substances that alter our consciousness. Being open and honest with ourselves might not only make us better, more compassionate and less judgmental people, it could also improve our own health.

If we look to comparable campaigns to end stigma—for instance, around HIV, mental health and sexual orientation—the template we need looks like a web of all of the above. We need to draw attention to the human cost of stigma, the people whose lives were cut short and their grieving loved ones. We need the statistics that demonstrate what compassionate and non-judgmental care can accomplish. We also need the stories of people living fulfilling lives, after using drugs or while still using them, that transcend stigma. We need to challenge the use of dehumanizing language and labels that reinforce discrimination—such as the word “clean,” which suggests that people who use drugs are “dirty.” We need to hold the media accountable for their role in perpetuating drug-use myths and stereotypes.

As Hamill said, “Stigma can be a way of disassociating yourself from the risk. It’s like that’s something that wouldn’t happen to someone like me, that happens to these other people who have bad behaviors, or they’re bad types of people.”

To change this, we need to be willing to let go of the hollow sense of status that labeling and judging others may give us. Perhaps if we can learn to acknowledge that our own shit indeed does stink, we can avoid constantly stepping in it. 

Screenshot of Terrell Jones in Vital Strategies’ “Harm Reduction Saves Lives” advertising campaign

The post Stigmatizing Drug Use Is Killing Us, But Why Is It So Hard to Stop? appeared first on Filter.

A comparable dilemma was faced by the LGBTQ community in particular, recalled Daniel Wolfe, after activists and health professionals urgently mobilized to curb the HIV/AIDS crisis that developed in the 1980s. Wolfe is the director of the Open Society Institute’s International Harm Reduction Development Program, and he, like many leaders of today’s harm reduction movement, became an activist at that time.

“Whether it’s talking about injecting drugs or oral sex between men whose serostatus is unknown, we’re negotiating questions of risk and pleasure,” Wolfe told Filter. “I think that is really at the center of some of the questions about harm reduction, which is how do you diminish the risk and hold on to the pleasure, and how do you talk to people about that in some way that they can relate to?”

Monique Tula, the executive director of the National Harm Reduction Coalition, acknowledges that there is no universal definition of harm reduction, even if her organization upholds certain principles. “Generally speaking, it’s the practice of advising people how to mitigate risk in real time in real-world conditions,” she said. “So no fear-based public health campaigns that fail to provide people with practical solutions to really complex situations. Demanding that somebody wears a condom or just says no doesn’t work for everyone. And it fails to recognize the lived experience of people who’ve often spent decades navigating risk and personal trauma.”

Because harm reduction is often associated with specific public health policies, public discourse around it often loses sight of the bigger philosophical vision.

Harm reduction at its core is about challenging stigma. It means respecting people for their whole selves and lived experiences while avoiding judgment. It prioritizes people whose identities are marginalized by society, and who are therefore especially vulnerable.

“Harm reduction is more than just a package of interventions,” said Judy Chang, executive director of INPUD (International Network of People who Use Drugs). “Harm reduction is linked to social justice and human rights, as a movement for radical love and acceptance.”

But because harm reduction is often associated with specific public health policies—such as providing resources like sterile syringes and naloxone, establishing safe spaces for drug use, or increasing access to safer alternatives from methadone to nicotine vapes—public discourse around it often loses sight of that bigger philosophical vision.

Drug policy reform advocates’ messaging has sometimes unwittingly contributed to this. For example, phrases like “treatment instead of incarceration” may be effective in getting public officials and media to buy into certain programs, but also sit uncomfortably with deeper aspects of harm reduction.

“I think people understand the immediate need for harm reduction. I’m not always clear if people get the underlying tenets of self-determination and choice,” said Kassandra Frederique, executive director of the Drug Policy Alliance (DPA). “Some of our arguments, and some of the ways that we win politically, are about, you know, we get syringes because they help with blood-borne diseases? We have syringe exchanges, so there won’t be syringes in our parks. We need safer consumption spaces, so we don’t see the person using heroin. And all those things can be true. But they’re not the driving reason why we do these things. The driving reason why we do these things is because we’re trying to create a world that recognizes that people use drugs.”

The myth of a drug-free world has created generations of discriminatory and misguided policies that persecute people who use drugs, instead of working towards the pragmatic and constructive goal of developing a more functional societal relationship with drugs. Harm reduction, in contrast, accepts the reality that people will always consume various psychoactive substances to achieve pleasure and relieve pain.

Fifty years after President Nixon declared a “War on Drugs,” the consensus that it is time for a different approach has never been stronger. The term “harm reduction” is popping up in more mainstream conversations and even government strategies, especially in light of the ongoing overdose crisis in the US. However, harm reduction programs continue to face backlash and opposition, often emerging from the absolutist goal of abstinence.

“What harm reduction confronts is an abstinence-only ideology that puts abstinence on a pedestal higher than life itself,” said veteran drug policy reform advocate Ethan Nadelmann, founder of DPA.

This is perhaps the biggest challenge in harm reduction: how to forge ground to work effectively while constantly butting up against an ideology that sees drug use as inherently bad, and opposes any intervention that prevents an addicted person from hitting the absolute “rock bottom” deemed necessary to force change.

Harm reduction says no one needs a “rock bottom.” Although it encourages tools to address chaotic drug use, it doesn’t see people’s struggles within a vacuum. Someone’s problematic drug use is likely to be a symptom of a stressful, challenging or trauma-filled life. Empowering a person to be well is the goal, and abstinence is not the only way to get there.

From a harm reduction perspective, a person is defined by how they show up in the world, and not by labels or what they put into their body. “You don’t call somebody dirty or clean or you don’t say they’re a dope fiend or a crackhead,” said Dinah Ortiz, vice chair of North Carolina Survivors Union, Jails Action Committee member at the New York Women’s Foundation, and a harm reduction expert specializing in mothers who use drugs. “These types of phrases alienate and stigmatize people. You want people to be seen as human beings … Drug use is not the only thing that I am or that I do. I’m a parent. I am a grandmother. I’m a professional. There are so many other things that I am.”

That larger purpose entails building connection. And it is this that might make harm reduction exactly the right vision to help guide recovery from the pandemic.

What is truly powerful about harm reduction is it does not aim to be prescriptive or to force people into boxes. It provides a framework for transformative relationships, and it does not only have to be about drugs. Harm reduction in its bigger form is the fundamental recognition that humanity is broad and inclusive, and that every human being has inherent worth and dignity.

That larger purpose entails building connection, bringing people in instead of pushing them out. And it is this—beyond using analogies between face masks and condoms, syringe access and vaccines, to raise public awareness—that might make harm reduction exactly the right vision to help guide recovery from the COVID-19 pandemic. Our communities are looking for ways to rebuild connections, and to help people calculate risks, while treating each other with compassion and empathy.

“I do think that people will hear a message that they can easily adapt to,” said Ifetayo Harvey, founder of the People of Color Psychedelic Collective, noting the debilitating and even life-threatening impacts of isolation. “As opposed to saying, ‘Don’t have any contact with folks, just stay inside all day long,’ saying ‘If you decide to go to the park with your friend, this is how much risk it is. Wear a mask and distance, versus going to a restaurant. Indoors is different…’ Breaking down those scenarios gives people the agency to choose: This is how much I’m willing to risk.”

Advocating for an expansive COVID-inclusive harm reduction vision might seem more of a nice-to-have than a must-have priority. According to the CDC, there was a 29 percent increase in fatal overdoses in 2020 from the previous year, and, if current trends continue, drug overdose will soon kill more Americans every day than COVID-19. Meanwhile, life-saving harm reduction programs are under constant threat.

However, a core part of harm reduction philosophy is interconnectedness. No crisis exists in isolation. Since trauma and loneliness are often contributing factors to risky drug use, what do we think the months and years ahead might look like? And what about the rush to have a good time that comes along with opening up? Even people who don’t identify as “drug users” but consume alcohol, can benefit from common-sense harm reduction messages like go slow, be conscious of the dangers of mixing substances, drink water and remain mindful of risks to others.

Shira Hassan, a longtime activist for sex workers, LGBTQ youth and harm reduction, spoke about applying harm reduction principles to safer hugging during the pandemic, especially with people who are immune compromised, who are elders or who are unvaccinated. “Well, you can be back-to-back or have energetic hugs, or what if everyone masks and your faces are turned away from each other and the hug is less than 10 seconds?” she asked. “We’ve been having sweet and tender conversations about that, and I think in some ways, talking about COVID has made harm reduction more accessible for people who never think of it as personally related to them. A hug itself is not a high-risk behavior. In the same way that framing sex work as a high-risk behavior ignores all of the ways that sex work is care work and sex workers protect themselves, and that community has supported and cared for each other—while at the same time taking care of the biggest threat of all, which is criminalization and policing.”

“We have gotten so bad at disagreeing. We fight each other, and we tear each other down … I think we need to take better ownership of our own brokenness.”

Another urgent harm reduction message at this time, including to new audiences, is simply to accept and support one another, despite our inevitable missteps and imperfections.

Louise Vincent is a leader with the national Urban Survivors Union and North Carolina Survivors Union, promoting harm reduction and supporting drug users in a very politically contentious context. She hopes the harm reduction philosophy can help transcend the many judgments and labels that keep us apart.

“We truly are scared to talk to people who don’t totally agree with us,” she said. “Our news is full of the people who agree with us and [that’s how] we surround ourselves. We have gotten so bad at disagreeing. We fight each other, and we tear each other down… I think we need to take better ownership of our own brokenness, our own inability to understand, and our own confusions. There’s something really powerful about taking ownership of all of our brokenness and all of our beauty, all at the same time.”

Photograph by Mehmet Turgut Kirkgoz on Unsplash

The Influence Foundation, which operates Filter, has received a restricted grant from the Open Society Insititute to support promotions relating to the film Liquid Handcuffs. The Influence Foundation previously received a restricted grant from DPA to support a Drug War Journalism Diversity Fellowship.

The post Can the Pandemic Usher in a New Age of Harm Reduction Awareness?  appeared first on Filter.

There are many situations where a police presence might cause more harm than good. When you call the police in the US, you should recognize that there is a possibility that they will kill someone—and that this possibility will be three times greater for a Black person than a white person. In eight US states, the rate of police killing Black men is even higher than the national murder rate.

What can we do as individuals to make a difference in this moment, while we are advocating for systemic change?

Solving this problem will require major systemic change and a rethinking of what public safety means, and to whom. One of the most fundamental ways that we can reduce police interactions is to make fewer things criminal. Drug use, drug harms and addiction, for instance, are public health concerns. Decriminalizing drug use, as Portugal did in 2001, would take away the basis for a good deal of police involvement in the lives of people who would be much better served by health information, harm reduction guidance and resources, counseling, treatment available on demand, and therapy. Transformative justice strategies and non-policing models for public safety also deserve urgent consideration.

But what can we do as individuals to make a difference in this moment, while we are advocating for systemic change? We can start shifting the dynamic by adopting alternative practices to calling the police in crisis situations, including those that involve drugs or mental health issues. Here are four ideas to start.

Prepare and Train

It’s valuable to have CPR training, to know the instructions to help someone choking on food in a restaurant, and to follow the rules to safely evacuate an airplane. Similarly, we can all benefit from training on how to respond to mental health and drug use emergencies. Mental Health First Aid (MHFA) helps people become better prepared to assist someone experiencing a mental health or drug-related crisis. The training involves recognizing warning signs and learning to provide helpful intervention.

Almost 4 million people worldwide have attended an MHFA course. A meta-analysis study published in 2014 that reviewed all published evaluation articles on the MHFA Program concluded that the training increases participants’ knowledge of mental health problems, decreases their negative attitudes, and increases supportive behaviors toward individuals with mental health problems.

The MHFA course is available internationally and throughout the US.

Damien Johnson, owner of No Grease Barber School in Charlotte, North Carolina, brought the MHFA training to his business because he saw how often mental health issues impacted his clients. Johnson said, “As men, they don’t readily share these struggles, but when they sit down in a barber chair, it’s a safe place where they feel comfortable telling it all.” The MHFA course is available internationally and throughout the US and will soon be provided in an online format.

Similarly, learning what to do in the event of an overdose is vital. Opioid overdose deaths can be prevented with the timely administering of the antagonist drug naloxone. In 2018, US Surgeon General Jerome Adams issued an advisory supporting the use of naloxone, and said “Knowing how to use naloxone and keeping it within reach can save a life.” Many first responders and police departments have become equipped with the drug and have been trained to use it; however, fear of police might inhibit drug users from calling for help. And naloxone should be administered as quickly as possible.

Learning how to use naloxone is practical emergency preparedness and may reduce the need to involve police, although it is always best practice to seek urgent medical attention in the event of an overdose. Proper use of naloxone requires little training, and in most states people can request it at pharmacies without a prescription.

Build a Health and Safety Contact List

Ideally, and hopefully someday soon, there would be a readily available alternate emergency number to call in crisis situations, reaching social services responders who can be safer and more effective than police. In the meantime, we can build our own local contact lists to be used in times of crises.

Suicide prevention hotlines, county mental health departments and homelessness services are examples of such resources. Community groups in your area may already have already created a helpful list, such as this one from MPD 150 in Minneapolis. If not, you can take the initiative and draw up your own contact list of health and safety resources. You might share it with members of your community, such as local social media groups, your neighbors, your religious community, or anywhere else you can think of for distribution in your personal network.

“Your pod people may not be your closest people. Your pod people are people that you can rely on and can turn to in times of crisis.”

Another idea is to create a pod map to identify designated people in your life that can call upon for help in times of trouble. “Pod,” is a term coined by the Bay Area Transformative Justice Collective (BATJC) to refer to people who would turn to each other for support around violent, harmful and abusive experiences, whether as survivors, bystanders or people who have done harm.

As Mia Mingus from BATJC described, “Your pod people may not be your closest people. Your pod people are people that you can rely on and can turn to in times of crisis, in times of emergency, in times of violence. Sometimes that can be your bestie, but sometimes it’s not. Sometimes maybe it’s a coworker that you’re not as close to, but you know if you needed them, they would show up for you.” The approach reflects a shift towards looking to localized, non-law enforcement approaches to community safety, and personalized support systems.

Check Yourself

Police are not good at calming mental health crisis situations. In 2015, the Washington Post conducted the first tally of officer-involved shooting deaths involving people with mental illness. It showed that across the US, at least 25 percent of people who were shot and killed by police officers suffered from acute mental illness at the time of their death. In most cases, the police officers who shot them were not responding to reports of a crime. According to the Post, “More often, the police officers were called by relatives, neighbors, or other bystanders worried that a mentally fragile person was behaving erratically… And in many cases, officers responded with tactics that quickly made a volatile situation even more dangerous.”

It is important to think about how bias might play into your perception of risk.

But we’ve also witnessed many incidents of people calling the police on Black people for pretty much anything. A 2017 study of a private message board in a predominantly white neighborhood in Austin, Texas found that residents contacted the police in 60 percent of the “suspicious persons” instances involving Black people, compared to only 10 percent of those involving white people. In an October 2018 HuffPost poll of 1,000 adults, 28 percent of Black respondents reported previously having had the police called on them because of their race or ethnicity, compared with 4 percent for white respondents.

When deciding whether to involve the police, it is important to think about how bias might play into your perception of risk. Are you assuming things about someone because of their race or appearance? If the person were white, or did not appear poor, would police involvement be your first instinct? If someone is behaving erratically, do they really pose enough threat that arrest, detention, and the possibility that the person might die in police custody feel like the only viable solution? If they looked different, would you be more inclined to think that they might be suffering from a medical condition, rather than assuming that they are intoxicated or dangerous? If you are a business owner or employee, or if there is a property offense or theft involved, can you simply report the damages to your insurance company, and/or remove or ban the person? If it is necessary to file a police report, might you consider doing it at the police station, rather than calling police to the scene?

Organize

Individual actions combined with collective actions produce social change. There are inspirational examples of communities banding together with a collective commitment to supporting safety through internal systems of accountability, collaboration, transformative justice and reduced dependence upon law enforcement.

These include the “Harm Free Zone” in Durham, North Carolina, and the Audre Lorde Project’s Safe OUTside the System (SOS) Collective in Brooklyn, New York. There are many innovative and thoughtful community-based solutions put forth in a book released earlier this year called Beyond Survival: Strategies and Stories from the Transformative Justice Movement.

“It’s important to say that oppressed communities have been addressing violence without police for generations because of the history of police in our communities,” Ejeris Dixon, editor of Beyond Survival and co-founder of SOS Collective, told Filter. “We just need to go one generation back to find community-based safety systems within Black communities that have been displaced. It’s not like we’re reimagining a whole new way of doing things, but what if we had the resources and could frame it from a liberatory framework?”

One of the nation’s longest-running community-based alternatives to the police is CAHOOTS—Crisis Assistance Helping Out On The Streets—started by The White Bird Clinic in Eugene, Oregon 31 years ago. CAHOOTS is a free, 24/7 community service where, instead of police, a medic and a mental health worker are dispatched for calls such as welfare checks or potential overdoses. As described in a Mother Jones profile, “The CAHOOTS system relies on trauma-informed de-escalation and harm reduction, which reduces calls to police, averts harmful arrest-release-repeat cycles, and prevents violent police encounters.”

In 2017, CAHOOTS answered 17 percent of the Eugene Police Department’s overall call volume, and according to the White Bird Clinic, the program saved the city, on average, $8.5 million each year from 2014-2017. Less than 1 percent of the 24,000 calls fielded by CAHOOTS last year required police involvement. CAHOOTS has inspired similar programs in other cities, including the Denver Alliance for Street Health Response (DASHR), Mobile Assistance Community Responders of Oakland (MACRO) and Portland Street Response in Oregon.

We all must change our relationship with the concept of public safety.

Ultimately, we need a redirection of resources and incentives away from punishment and towards human rights, public health and social good. But whether the revolution in policing comes swiftly or develops in stages, it’s not only law enforcement that needs to change.

We all must change our relationship with the concept of public safety. We must rethink what we each of us can do to shift the dynamic away from racism and fear and towards restorative healing, fairness, and a more just society. As Mia Mingus said, “We need the small to be able to fight the big. In this country at least, we need 300-plus million people doing the small things.”

Photo by freestocks on Unsplash

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