In 2021, recorded drug deaths in America tragically surpassed 100,000. That’s more than every American soldier killed in action since World War II – including in Vietnam, Korea, both Iraq wars and Afghanistan – put together. According to the CDC, there were 100,306 fatal overdoses, three quarters of which were from opiates, 64% from fentanyls.

As experts and politicians proclaim that ‘something must be done’, there’s one crucial voice being left out – that of the users themselves. Like colonial subjects, those most closely affected are being shut out of the conversation. But while they’re not usually granted a say, they’ve actually led the charge for reform in North America and beyond.

Although there was activism before, the movement as we know it was born in the HIV epidemic. It first appeared among needle-injectors in New York City in the mid-late seventies. They called it “junkie pneumonia”. No-one knew what was causing these mysterious fevers and weight loss. Even when it was recognised as HIV, the epidemic among smackheads took a backseat in the public arena to the epidemic amongst gays (who much more publicly accepted, even then). Groups such as ACT UP (the AIDS Coalition To Unleash Power) were formed.

“It was clear to a lot of people like me who were injecting drugs at the time that we needed sort of an ACT UP for people with addiction,” said Maia Szalavitz, author of the book Undoing Drugs, a history of harm reduction. “And because addiction is so criminalized in the United States, it was really, really difficult to organize. And we were very lucky that there were some gay, intravenous drug users who had more resources and were more active.”

Maia was herself a veteran of New York City’s heroin scene in the 1980s.

“I was addicted to heroin and cocaine and injecting them at was what was probably the worst time in history to take that up, because HIV was rampant and half of the injectors in New York were already positive,” she said. “At the time, there was no treatment and it was universally pretty much universally fatal.”

Such was the ignorance that behind a brick in the alleyway behind Mabuhay Gardens punk club in San Francisco lay a syringe with instructions for user to shoot up then put the needle back to share the love.

Like most others back then, Maia didn’t know she was at risk. She recalls one time heading over to a friends’ house to score. As he went out, his girlfriend, who was visiting from San Francisco, taught her to clean her needles. You shouldn’t share, she said, but if you are you should rinse them with bleach.

“She pretty much saved my life,” Maia said.

That was her intro to harm reduction. Needle exchanges (giving away fresh syringes to shoot up so as not to spread disease) were outlawed at the time on the grounds of it “encouraging junkies”, so a movement began from San Francisco urging users to clean up after themselves. But activists challenged the laws against needle exchange, too.

“In New York we had a big case where John Parker, who is a former injecting drug user, was going up and down the East Coast and getting himself arrested in various places to try to fight these laws,” Maia recalled. “And so he joined up with ACT UP, the famed gay activists, and they convinced the judge that what they were doing was indeed medically necessary: they were saving lives, and the law was preventing them from saving lives. It was a really quite dramatic trial, which I was very lucky to get to attend, and they won.”

“All of that is you know, a necessary response to the war on drugs,” journalist Travis Lupick explained. “Needle exchange and naloxone are not things that should require grassroots activism and guerrilla tactics, but they do because of America’s puritanical attitude, and even the healthcare establishments’ response rooted in in the war on drugs, which has forced harm reduction to operate as grassroots movements.”

It may seem strange now but naloxone, the lifesaving antidote to bring someone back from an overdose of heroin or fentanyl, was once so heavily restricted that activists had to smuggle it from overseas.

Invented in 1961 by a doctor searching for a cure for constipation, the Lazarus effect appears only once you’ve overdosed: normally, opioids bind themselves to receptors in your brain and in an overdose, make you stop breathing, but naloxone gets in the way and blocks them. The bad side is it plunges you into instant withdrawal, which isn’t pleasant. Taken on its own, naloxone is completely inert, non-toxic and non-addictive, but at first it was only available in hospitals and ambulances thanks to the usual panic of enabling druggies.

Enter Dan Bigg. True to his name, Dan was a big guy with a big personality who loved dogs. He was also an active heroin user. From the mid-nineties, Big Dan began persuading Chicago physicians to prescribe it to him and his pals to start making it available on the street; if that didn’t work, he secretly smuggled it from India.

“In 1996 after he lost one of his friends to an overdose, he decided that he was going to be the one who brought naloxone to the masses. And indeed he did,” Maia said. “So he first distributed it locally in Chicago, and then he went around the country with his big sack of naloxone and trained people to use it and to set up their own programs, teaching them how to save lives. Literally thousands of people alive today owe their lives to him.”

By 2012 thanks to Bigg’s activism, naloxone was freely available in Illinois without a prescription, but still not at the federal level. The FDA held hearings on whether it should be available over-the-counter. One of the witnesses was Joy Fishman, the second wife of pharmaceutical researcher Jack Fishman, who literally invented naloxone; her son from previous marriage had fatally overdosed and she didn’t even know her husband invented the antidote.

Meanwhile in the run-down Downtown Eastside neighborhood of Vancouver, overdoses tripled in the early nineties, and by 1997 a quarter of the injecting population was infected with HIV. That same year, VANDU took their first action. They installed 1,000 wooden crosses in a park, each representing one of their dead friends.

VANDU, or the Vancouver Area Network of Drug Users, wasn’t the first dopers’ alliance. In 1981 the RotterdamJunkiebond (Junkie Union) founded by Nico Adriaans started giving out free needles in response to the hepatitis outbreak. Other cities in Holland and Germany followed their lead.

Whereas other movements struggled to find funding and there were several cases where admirable efforts collapsed under the weight of their leaders’ own addictions, VANDU was an exception. They offered participants a small stipend (3 Canadian dollars) to turn up to meetings. This kept them going where other organisations did not. Come for the money, stay for the cause. Their command structure was a board of 25, because you never know who will turn up alive to the next meeting or not. And because Vancouver is a relatively small city with easy access to officials, they could show up to council meetings carrying coffins or dressed as ghouls to draw attention to their plight.

“It wasn’t easy, you know,” said Travis, who initially got his start in narco-journalism reporting for a newspaper in his hometown of Vancouver.

“It was 10 years of marching in the streets and occupying the city hall. Drug users in Vancouver got together and formed VANDU. And this is a group of street-entrenched, often homeless people got together in a park and said, you know, we want to be involved in in how Vancouver responds to addiction. And that was 1997. Two decades later, that organization is still around, has successfully gained a seat at the table, and has a loud voice in how Vancouver and Canada responds to the overdose crisis.”

VANDU’s campaigning finally paid off. Insite, Canada’s first safe injection site, opened in 2003, despite Americans pressuring them not to. You could smoke crack or shoot up under medical supervision in booths, and get help to find housing or kick the habit entirely. From 1998-2008, deadly ODs halved in Vancouver.

While on tour promoting his first book about the crisis in Vancouver, Travis met the protagonists of his next book. Light Up The Night follows two women, Jess Tilley and Louise Vincent, as they save others, fight for change and struggle with their own addictions. Both were committed to mental homes by their parents as teenagers, and later experienced the harshness with which society deals with so-called “junkies”; even doctors and nurses supposedly sworn to the Hippocratic Oath. At one stage, Louise couldn’t get prescribed painkillers after being injured in a hit-and-run and eventually, her leg had to be amputated.

“Because she was viewed as an ‘addict’, she didn’t receive adequate pain treatment,” Travis explained.

“And so what did she do? She found painkillers on the streets, she self-medicated. And she’s running around with this badly broken leg, and that leads to a chaotic addiction and kind of pushes her into a spiral. And that’s not something that she had to experience. Similar things that happened to Jess Tilley: she suffered an assault and she was treated horribly at the hospital, so she said to herself, ‘there’s no way that I’m going to go through what I’ve experienced again with the police.’ America’s primary response to the overdose crisis is not saving lives, it is hurting people.”

There’s a common belief, even among doctors, that druggies deserve what’s coming to them, so it’s unsurprising they hesitate seeking medical care. There’s a mutual distrust between doctors and their patients: patients treated disrespectfully are unlikely to trust doctors and so act in an uncooperative manner. Meanwhile, fear of arrest leads female drug users to avoid reporting crimes and abuse, including rape. Female drug addicts aren’t always believed when say they’ve been raped – it’s assumed they’ve just been catching tricks. Because they’re so hated in society, drug addicts can internalise some of this hatred and self-loathing.

According to NIDA, addiction is defined by compulsive chemical thrill-seeking in spite of negative consequences – so why are our policies still punitive?

Recreational chemistry enthusiasts are often considered unreliable liars. Former users are OK because it’s in the past, the folly of youth. But it’s still a stigma for those who continue using, even among harm reduction communities, so many keep quiet. That’s why it’s important that those still using have a space to be themselves – after all, it’s they who can reach out to people who don’t wanna be found.

“Jess Tilley a long time ago founded and continues to participate with the New England User’s Union, which organizes drug users around the US northeast, and then Louise Vincent is doing something similar out of her hometown of Greensboro, North Carolina,” Travis said, “and that’s how I got to know them. But then I found out they’re working side by side to lead this new national organization, the Urban Survivors Union, which is uniting drug users across the country, taking the overdose crisis to Washington, DC.”

The Urban Survivors Union (USU) was founded in 2009 in Seattle by Shilo Jama after a friend OD’d next to him while they were asleep in a squat hiding from the cops. The USU grew, networked with drug users around the country, and laid out clear goals: legalise syringe exchanges across all states, ease access to methadone, end the war on drugs. By 2019, it had chapters in 20 different cities. Over time, it incorporated sex workers as well and adapted it’s strategies accordingly.

Meanwhile, the opioid crisis was picking up pace, with the much more potent fentanyl creeping into packets of heroin. It was this that led to the death of Dan Bigg in 2018. When he passed away he was alone, with no-one to administer naloxone to him, the Lazarus drug he’d given to so many. Hundreds joined a march in his honour in New Orleans, holding up candles in memory of him and the tens of thousands of other Americans who passed away or deprived of their liberty. Both Jesse and Louise gave speeches.

That same year, the USU charted a formal document titled Do Not Prosecute (DNP), based on a Do Not Resuscitate (DNR) order, aimed at police, family, friends and prosecutors, that they don’t want their dealers or those sharing drugs with them taken to prison over their deaths. Dozens of states have drug-induced homicide laws on the books, which means that drug-related deaths and overdoses are treated as homicides, from manslaughter to first-degree murder, and those who supplied the lethal dose (usually friends and family, not El Chapo or Stringer Bell types) are held responsible.

“When you talk about dealers, the perception is a scary guy standing in the shadows in a dark alley, but that’s not usually who a dealer is,” Travis explained. “Louise has known some of her dealers for more than twenty years. So has Jess. These are not scary people standing in alleys, they’re their friends, struggling with their own issues and addictions, and they do not want people to die. They’re struggling with the fentanyl problem the same way that everybody else is. I understand the logic behind going after a dealer, but I think that is not what the majority of drug users want.”

Travis has included an example of such a form in his book’s appendix and while it’s less legally binding than a handshake, the USU hopes it might inform friends’ and families’ response to a death.

From a young coke and heroin addict, Maia now a columnist at the New York Times, bringing harm reduction into the mainstream. And even in the recent controversy over crack pipes, in which Republicans whipped up a moral panic over the federal government’s funding for “safe smoking supplies”, she sees progress.

“But the fact that it’s a controversy, rather than everybody gets on-board with banning, it immediately shows how far we’ve come,” she said. “I mean, the fact that Joe Biden is supporting harm reduction at all, given his role as one of the leading drug warriors, is astonishing. We have come a long way on naloxone, and New York just opened a safe injection site….”

Canada has come a long way too, and last year in Travis’ old stomping grounds of Vancouver, a demonstration held by a renegade team of activists, the Drug User Liberation Front, handed out free doses of coke, heroin and meth, bought in bulk over the darkweb and tested for fentanyl. Though it’s technically trafficking, the Vancouver PD said it sometimes overlooks illegal activity during protests. But it’s still a long way to go until legalisation, or “safe supply” as it’s known by activists.

Until then, VANDU and the USU will keep fighting.

“It’s going to be challenging – the war on drugs is still deeply entrenched in America and deeply popular, not only among conservative politicians, but the general population,” Travis summarised. “A majority of people might say that they want addiction treated as a healthcare issue, but they’re still in favour of locking people up. This powerful, long-held, deeply-entrenched ideology that drug user activists are coming up against, that’s going to be difficult. Stigma is so deeply rooted in America that it’s subconscious, it’s everywhere. And so, gaining a voice for drug users is going to be challenging. But members of the Urban Survivors Union are now in more than twenty cities, and that number continues to grow. And you know, these are incredibly impressive, intelligent, capable people who are organizing and taking power for themselves, and I think are going to really change things.”

Niko Vorobyov is a government-certified (convicted) drug dealer and the author of the book Dopeworld. Tweets @Lemmiwinks_III

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