But it was not until I spent a year shadowing Tim Nolan and his harm reduction peers that I began to see what successful addiction care might look like.
Across the nation, harm reduction services look vastly different in rural towns and counties than in, say, New York City, which authorized the nation’s first official supervised-consumption sites last fall. Many rural Americans make do with a hodgepodge treatment landscape that depends entirely on the efforts of individuals. And yet this type of care has been proved time and again to work, and the federal government must take heed if it hopes to truly curb overdose deaths.
Mr. Nolan thanked Sammy for opening up. “That’s how we’re going to work together,” he said. The next day he would call in a prescription of low-cost buprenorphine for his new patient. (Sammy was uninsured, partly because North Carolina is one of 12 non-Medicaid expansion states.) But right now, Mr. Nolan needed his new patient to understand two things:
First, you can get better.
Second, and maybe even more important: “Don’t disappear.”
That meant that Mr. Nolan expected to see Sammy the following week, even if he relapsed. If Sammy’s vehicle broke down and he couldn’t make it to McDonald’s, Mr. Nolan would drive to him.
If Sammy no longer had a home address — a reality for so many addicted Americans — Mr. Nolan was fully prepared to meet him under a bridge, in a tent encampment or in another parking lot of his choosing, as he did for many patients, a practice experts call low-barrier or low-threshold.
Success, as I came to understand it, could be boiled down to two simple edicts: hope and help.
Mr. Nolan volunteers for the Olive Branch Ministry, an organization based in Hickory, NC, and co-founded by the Rev. Michelle Mathis, a nondenominational Christian minister, and her wife, Karen Lowe. “Ten syringes fit nicely in a box of Nature Valley granola when you take out a few bars,” said Ms. Mathis, who has a floral tattoo on her forearm with the words “Acta non verba” — which is Latin, she told me , for “Do shit. Don’t just talk about it.”
Operating the nation’s first queer, biracial, faith-based harm reduction organization, the couple began their work in 2009, seven years before the state legalized needle exchange, under the auspices of a food pantry they ran out of the back of their pickup truck.
Back then, they covertly added sterile syringes, condoms, and wound-care kits to the boxes of dry goods they gave out. They tucked in business cards, too, with only a phone number and the ministry’s name, so that if disapproving relatives discovered the cards, they’d think: How nice, they’re going to church.