As part of the Art for Justice project, we have included local openers representing organizations in Tucson and Southern Arizona that are working to address issues around mass incarceration. We are proud to continue including these local organizations in a digital format. Our next Art for Justice reading is on Thursday, February 18 at 6 PM with poets Raquel Salas Rivera, Sin á Tes Souhaits, and Vanessa Angélica Villarreal. Click here to learn more. You can watch this event live on YouTube and Facebook.
Editor’s Note: The below interview was edited for length and clarity.
About Sonoran Prevention Works:
Sonoran Prevention Works is a grassroots group working to reduce vulnerabilities faced by individuals and communities impacted by drug use in Arizona. SPW utilizes a harm reduction framework to educate Arizonans on overdose response, HIV and Hepatitis C prevention, and stigma. SPW provides capacity-building assistance and trainings to individuals and service organizations who interface with people who use drugs. We recognize drug use as a public health concern that impacts everybody, and we utilize a framework of equity and evidence-based practices to intervene on preventable risks.
About Executive Director Haley Coles:
Haley Coles is a die-hard Arizonan committed to achieving health equity among people impacted by drug use and drug policy. Her personal experience with chaotic drug use and the devastatingly preventable loss of people she loved informs her personal mission to make meaningful structural change for a more just and healthy Arizona. She is the Vice Chair of the Aunt Rita’s Foundation board, is an alumna of the Robert Wood Johnson Foundation’s Culture of Health Leaders program, received the 2018 Leadership in Advocacy Award from CABHP, and has provided consultation for the National Association of State and Territorial AIDS Directors and the CDC.
Poetry Center: Your work aims to reduce harm and address stigma around drug use. What are the specific challenges we face in Arizona around these issues?
Haley Coles: Arizona’s drug policy laws are archaic. Arizona notoriously underfunds public health, so our practices—just general public health practices—are pretty behind. So, it’s no surprise that our drug policies are as well. There’s been a worldwide and national wave of changing how communities treat people who use drugs and how we view drug use. Arizona just hasn’t gotten onboard with that. So that means that evidence-based practices such as syringe service programs, supervised consumption sites, not incarcerating people for their drug use, and not withholding basic human services to people who use drugs—Arizona’s not doing any of that.
So that’s part of the landscape. I think us being a border state changes the narrative a little bit. In some ways, I think that Arizona officials believe that it’s their duty to protect the entire country from substances by keeping our border militarized. So it’s not just stigma toward people who use drugs and not just misunderstanding of people who use drugs, it’s also a kind of paternalistic desire to protect people who are viewed as helpless.
PC: Are there any initiatives or proposals currently being considered by Arizona lawmakers that would create change? What are some things you’re seeing on a national level that are hopeful?
HC: At the state level, 2021 will be our fourth year running syringe service programs legislation in Arizona so that people can access sterile syringes, so that we can build relationships with people who use drugs who aren’t accessing other resources because of very real stigma that they experience. Right now, it’s a felony to give someone a syringe if they’re going to use drugs. This bill would change that. And we’re really hopeful that this will be the year that it will pass.
Nationally, so… in Europe and in Canada there have been supervised consumption sites as well as heroin-assisted treatment for quite a long time, and the U.S. and Arizona are pretty far behind. There are some communities across the country such as Philadelphia, who have moved forward with allowing supervised consumption sites. If someone is going to use anyway, if they don’t have a place to use, they’re going to do it in public. So, this gives them a place to do it where there is medical supervision. I know that the California legislature passed a bill a couple of years ago, but it was vetoed.
There’s movement in other communities across the country to allow these programs. I haven’t heard anybody in the country talking about heroin-assisted treatment, which is shown to be even more effective than other medications used for opioid use disorder like methadone and buprenorphine, but I think that’s something to look forward for.
PC: Can you explain a little bit about what heroin-assisted treatment is?
HC: Medications for opioid use disorder are methadone and buprenorphine, as well as naltrexone, but there’s not a lot of evidence behind that one. Essentially, people take these medications on a regular basis to kind of calm the opioid receptors in the brain that are experiencing withdrawals and cravings for opioids.
There are some people, though, where the medications just don’t work for them for a multitude of reasons, so in other countries scientists have formulated diacetylmorphine, which is heroin, but it’s produced in a lab, is controlled, and people who have opioid use disorder take that in prescribed doses. The benefit to it is that they know what’s in the drug, so they’re not going to be overdosing from too high of a dose or from contaminants like fentanyl. It is for people who have “failed out” of other medications.
The alternative is that they’re just going to buy heroin on the street and be considered a criminal. Whereas if they’re able to take heroin that has been prescribed to them, they aren’t committing a crime.
PC: The Art for Justice project is focused on mass incarceration in the United States—two topics that overlap significantly. Can you talk a bit about how drug use and incarceration are intertwined?
HC: I don’t think it’s necessarily just drug use that’s intertwined with mass incarceration—it’s drug policy. We know that more people are incarcerated for drug-related offenses than any other offense. That can include people who aren’t using drugs but who may be transporting drugs, who may be selling drugs, who may be in the vicinity of drugs. And there’s a long history of drug policy being used as a weapon against communities of color, in particular African American communities.
I think it’s just looking at those drug policies in general because we do start to hear lawmakers say, “Oh, we don’t want to incarcerate people if they have a ‘drug problem.’” And that’s nice, but A) Not everyone has a drug problem. Lots of people use illegal drugs and don’t have a problem with it. Are we also going to extend them that same courtesy of not incarcerating them if they’re just doing it for fun and they aren’t dependent? And B) By saying that, we’re saying that we do still want to incarcerate people who are transporting drugs, selling drugs, or are around drugs.
And we know that the majority of those folks are drug-dependent themselves or don’t have other viable economic opportunities. It makes a lot of sense why people choose to do that. We know that if you have a felony, are undocumented, or have certain disabilities, it’s incredibly difficult to get a job that is going to be meaningful and is going to pay you a living wage. The issue (of selling, transporting, etc.) is an economic issue.
A lot of times when people talk about how bad drugs are, they talk about it in terms of “drugs are bad because they can kill you” and “drugs are bad because they can make you sick.” And it’s not necessarily linear like that. Drugs don’t have to kill you; drugs don’t have to make you sick. If people know what is in drugs, people know exactly how much they’re taking, if people can cut the drugs with things like Vitamin C, then it seriously reduces the risk. It doesn’t completely get rid of the risk. Even in a heavily controlled environment, there can still be some risk associated with drug use, but I think it’s really important to separate those things out. Drugs don’t necessarily equal death and illness.
That’s also not ignoring the real and sometimes tragic impacts of drug use. Even if it’s not overdose and illness, people who are dependent on drugs and don’t want to be—that can feel really powerless. I’m not trying to minimize that whatsoever, but we need to talk about this in a nuanced way. Lots of people use drugs. Some of them are legal, some of them are not. Some drugs are safer than others. Some methods of ingestion are safer than others. And we all have very different reasons for using those drugs and different relationships with the drugs.
PC: At the Poetry Center, we’ve invited poets to write about their experiences with incarceration and the U.S. carceral system. How do you think language affects the way we view drug use and harm reduction?
HC: Oh my gosh, it’s huge. I don’t have to tell you, and probably the people reading the blog, that language creates reality. A lot of the ways we refer to people who use drugs and drugs in general is a language of criminalization, it’s a language of blame and of deficiency. When I was talking about needing to separate the drug itself from the effects that sometimes occur, that’s all about how we talk about it. A drug itself doesn’t have inherent value. It depends who is using it, how they’re using it, the circumstances of their use, where and when they’re using it. It’s really important that if somebody is using drugs to acknowledge that we don’t know how they’re using it, we don’t know their relationship to it.
Calling somebody a drug addict is presuming a lot. What does addiction mean? That’s not even a term that’s used in the DSM [standard classification used by mental health professionals] anymore. So, if we don’t know the person’s relationship to the drug, we should call them a person who uses drugs rather than a drug user or a drug addict. By using that person-first language we’re humanizing people, we’re saying you are a person and you engage in a certain thing rather than your behavior defines who you are. People who use drugs are also people who are parents, people who are employees, people who are employers, students, artists.
The terminology and language that we use changes over time, too. It continues to change for the better. For instance, medication for opioid use disorder is mostly known as medication-assisted treatment. But the science that’s been coming out lately shows that the medication is the treatment. Even without therapy the medication is the thing that helps people get through their opioid dependence. So now people are starting to call them medications for opioid use disorder.
Also: opioid use disorder. That is a diagnosable condition. But if you aren’t a doctor and somebody hasn’t told you that they have that diagnosis, then what business do you have saying someone has an opioid use disorder? There’s just an incredible amount of nuance to drug use and people’s relationships to drugs and the way that we describe it. Changing that can help to challenge stigma.
PC: How has your work changed while in the midst of a pandemic?
HC: Before COVID, we were doing some drug user organizing. We were working with people who use drugs, most of whom were unhoused. We did some community-based participatory research where this community designed what they want to see in their community, which was essentially about how they experience different service providers. What’s our experience when we go to try to get healthcare, with the housing system, with first responders. And then people from this union, we called it a “users union” or a community health advisory committee, then went out and surveyed their peers. From that we found a lot of great information that we already knew, but it’s important to have that data, and we were coming up with a plan in response. What area are we going to focus on, who are the targets, what’s the leverage we have, what do we want to see done differently?
When the pandemic occurred, all kinds of people were thrown into absolute chaos, including people who are unhoused or unstably housed and people who are dependent on drugs. We lost all that momentum. Especially with people who are unhoused, we had been able to engage with them a lot in person, and it was no longer safe for us to be doing those in-person meetings. We learned a lot, and people who were part of the organizing also learned a lot and got a lot out of the experience. I do hope that after the pandemic we’ll be able to continue. But that was one of the biggest losses.
Another issue: it’s expected that over 100,000 people will have died of overdose in 2020, nationally, and the year before I think it was around 78,000. Any “wins” that had occurred throughout the nation that had occurred in stopping overdose deaths are all gone. Being in a pandemic is stressful. It’s isolating, it’s alienating, people are losing their jobs, loved ones, feeling out of control. Some people turn to drugs who may not have been using before, or they may not have been using in a chaotic way. People have been mixing drugs or using in a way that is different from how they previously used, which really increases overdose risk. That’s been really, really scary and awful to see and we have been trying to mitigate that. We’ve been distributing naloxone, or Narcan, for the past four years. We do a lot of that through other organizations and through outreach. We’re continuing to distribute the medication, but we rolled out a mail-order naloxone program so people from all over the state can just request it by mail rather than needing to come in somewhere or needing staff to go somewhere for a delivery. So we’re trying to keep people safe that way.
We also put a pause on our HIV and Hepatitis C testing as well as some of our in-depth peer support and navigation so we could really focus our efforts just on outreach. We had people who didn’t have access to food anymore; food banks were empty. We had people who were not able to get medical supplies, so for the past six months now we have really focused our efforts on getting survival supplies out to people to keep them safe. We’re finally at a point now where we can roll out the testing and peer support again, but we need more capacity to do that because the outreach needs are still there.
PC: When folks are made aware of the issues around mass incarceration, they often want to help but may not know where to start. What are some steps people can take to get involved from home with Sonoran Prevention works?
HC: We will, in the next couple of months, in March or April, be launching a page on our website where people can sign up to volunteer. We’re going to have a lot of different ways for people to be involved, and we’ll only be providing ways people can be involved safely. Until then, we can use support for our syringe service programs legislation, and people can just contact us directly if they want to know more. Calling and writing to elected officials in the state legislature in support of this bill really makes a difference. There are probably also going to be some bills this session that work against freeing people from mass incarceration, so it’s going to be important that elected officials are hearing from their constituents that these bills are harmful to their communities. For anything policy or law-related, I’d love for people to get in touch with us. Additionally, as a boots-on-the-ground nonprofit, we depend on financial support from our communities. Doing this kind of work costs money – the supplies, postage, and travel gets expensive when you’re doing it on the scale we are. All donations are tax-deductible, and can be used toward state taxes as well. People can donate at spwaz.org/donate, and people can reach out to me directly at firstname.lastname@example.org for other ways to get involved.