Reflections from an overdose prevention practicum placement
Submission to The Social Lens: A Social Work Action Blog by Kristi Pinderi
I am sitting in the van – the harm reduction station – while outside it is raining. The weather is astonishingly unpredictable: windy and rainy one moment, sunny and hot the next. We have opened one picnic tent, some chairs, two black tables and a small coffee station. Inside the van we keep some food and water stored inside an icebox. Two service users are under the effect of the substances after smoking ‘down.’ We call ‘down’ any suppressant opioid like fentanyl or heroin. When inhaled (or smoked) we record it in our forms as “Down (S)”; when injected we write it as “Down (I)” and we write down the time.
When crystal meth is used, we record it as “Side (S)” when smoked, or “Side (I)” when injected. In case of an overdose, this information becomes crucial. Back in the van, during an unbearably slow day, I cannot ignore the “elephant in the room”: this practicum feels nothing like what I expected. I realize that for this practicum to work for me, I need to deconstruct my thinking, especially about my role and about service users. This blog entry is about how I initiated that process and the choices I made.
Unique service users vs. visits on the site: Overcoming the trap
First, I was faced with a surprising indicator when I was told that the site has recorded over 3,000 visits since it opened. That number, though, represented the totality of visits, not the total number of unique service users. I wondered whether that was a way to convince the donor about the importance of the project. For some time, I was not comfortable with it. If a service user approaches the van and asks for a harm reduction supply, we record it as one visit. If, moments later, the same user comes back and asks for something to eat or drink, we record it again as another visit.
One day I recorded my own data, and I replaced the number of visits with the number of visitors. I then tried to add whatever demographic information was available, and I wondered whether there was a pattern in those demographics. I soon noticed that there was indeed a pattern: the “pattern” was that there was no real pattern!
What became clear to me was that by replacing the visits with the visitors, I was trying to satisfy my need to anchor social issues into a set of numbers, something that reflects a thinking pattern that originates from our education system that imposes certain analytical schemes on us. I became aware that in trying to anchor the issue to the numbers, we risk relativizing the issue, hiding it, and making it less relevant. Because numbers can be relative as they are understood in relation to several political, social and environmental contexts, so does become the issue itself.
On the other hand, by shifting the indicators from the unique visitors into the number of visits, we focus our understanding on the needs instead, and not on the number of people, something that goes hand in hand with the attempts to decriminalize substance users. This is crucial if we want to stop the cycle of harm for both the individual and the society.
The “they will never change” trap
I see those two service users sleeping, I think that this might be their life for the rest of their time, and I feel sorry for them. But this is another neocolonial trap in my thinking that probably originates from the historical and deep-rooted “tough on crime” narrative. While I can credit myself as being progressive, that does not make me immune from systemic propaganda. This is a mental trap that misleads us to think “they will never change,” “there isn’t much we can do,” or “we need to focus on the systemic level.” It becomes clear to me that this thinking is neither compassionate nor just, so I decide to actively engage myself with a different approach.
In this reflexive process I remind myself that people have always taken drugs, including ones found in nature. For some people the use of drugs is also a way they choose to medicate themselves. Sticking to the prejudice that “they will never change” is another way of criminalizing them. As a fellow student with lived experience told me, “For those struggling with substance use disorder, their disease is criminalized too.” This is thus a continuation of the punitive response that we as society are taught to have. Then my role becomes clearer: I am here to offer support and to reduce any harm.
The “You have to do something” trap
Another expectation that often becomes a barrier in my thinking is the one that requires to put myself in a position where it is expected from me to always do something. But sometimes – like most of the time I am in my practicum – what is required is simply to be with, instead of to do something for our service users, a tension beautifully described by Gorman (1995).
There comes M., an old man who lives in his camper and uses our harm reduction site. It’s difficult to understand what M. tells you, as his accent is mixed with some speech disorder. Yet I stand with him, as I struggle to understand what he says to me. Nevertheless, I attend to him, nodding my head, smiling, or mimicking his laugh. I don’t understand most of what he says to me, yet I know he appreciates my listening, and he comes every day to chat with me. I am doing what he needs the most: I am being with him.
Here is another service user. After she has smoked “down,” she approaches me and she tells me her stories. I hear about her work in a health setting. I hear about many forms of rejection she has experienced in life. I hear about the fire that destroyed her house. She speaks to me about her life before. She talks to me about her children, and she becomes emotional. There is nothing she wants me to do for her. She appreciates the opportunity of me being with her. She calls me “honey” because I resemble her son. Some of her stories sound contradictory and are often absurd, but that is not the issue. What counts in those moments is that I offer to actively listen to her. There is also a sense of stability for them knowing that we will go there again the next day. Not only to do something for them, but most importantly to be there with them.
References
Gorman, J. (1995). BEING AND DOING Practicing a Secret Profession. Reflections: Narratives of Professional Helping, 1(1), 35-40.
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