"This is Ohio" Excerpt: A New Way of Thinking About Addiction

A Mother: August 2019

It’s a busy summer morning in a grassy lot at East Main and Buena Vista streets in Newark. A tent is set up in the shade of a sprawling mulberry tree; a scrawny hackberry and a silver maple linger just behind. Some folks call these trash trees, but they are resilient wonders, pushing up through hardscrabble urban dirt and concrete, willing themselves into existence.

These trees give ample respite to the unsheltered who gather at this corner, where a group of mostly women have set up every Saturday since January 2018. The group members offer food—always hot dogs, sometimes fried bologna sandwiches, chips, cookies, fruit when available—and clothing, which hangs on portable racks, lies folded neatly on tables, or is stuffed helter-skelter in bags below. They also offer brown paper bags—harm-reduction kits—containing sterile syringes and the drug naloxone (known by its trade name Narcan), used to reverse opioid overdoses.

Every Saturday, between 75 and 100 people who are homeless and underserved in this Licking County community come to the empty corner lot, which muds up in the spring and is now overgrown with crabgrass and knee-high weeds in the corners. The group under the tent is Newark Homeless Outreach, the brainchild of Trish Perry and Jen Kanagy, two fiercely independent and engaged women who saw a gap and raced to fill it. Jen is a nurse by trade, and Trish works as a transportation manager at one of the many local distribution centers, though her real passion is advocating for people with substance use disorder. Every Saturday they’re here at the corner, despite the vagaries of Ohio weather.

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Trish, with her brunette hair and bright but slightly crooked smile, walks over when she sees me and, before saying hello, launches into a report about overdoses and complains about the lack of a sanctioned syringe exchange program in Licking County. In Ohio, a syringe exchange must have the approval of the county board of health. Because Licking County’s board has not sanctioned her work, she could be risking arrest. But for Trish, the safety of the people who come to the corner is the most important thing. She never imagined this as a part of her work at the corner, but then she saw the need and wanted to “meet people where they’re at, but not leave them there,” as many harm reduction advocates say.

A woman approaches Trish. The woman is maybe in her 60s, her hair is askew, and she’s wearing glasses that barely hide the tears welling up in her eyes. Trish puts her arm around her, and the woman whispers about her daughter’s drug use. I catch pieces of their conversation.

“I don’t have anyone to talk to. I wish I could get her some help,” she tells Trish. “I wish I could do something.”

Trish knows how it feels to have a child you cannot save, one you worry over at three in the morning. So Trish is here, looking after others, providing a space where people feel safe—she’s doing the thing that she wishes she could have done for her son Billy, who has struggled with addiction.

Last year, 70,980 people died in the United States from a drug overdose, a staggering and unnecessary loss. Since 2000, the accidental overdose rate in Ohio has more than tripled, and overdose deaths are the leading cause of injury death, surpassing car crashes, for Ohioans under the age of 55.

Trish doesn’t want Billy to become a statistic.

A Son: Spring 2018

In his modest trailer in Newark, Billy McCall stares through a mostly curtained window to the street. His long hair is pulled back in a ponytail and smooshed down by a beanie. He’s fresh out of jail, and on Vivitrol (the brand name for naltrexone), which blocks the effects of opiates, and he is hoping that this time, sobriety sticks. He admits he’s not used to how sober he is feeling right now—it makes him anxious.

Billy has struggled with substance use disorder for years. His use is intertwined with his short list of crimes that led to probation violations and more complications. He’s been to prison twice and jail often enough. Inevitably, it’s just more traumatic experiences that don’t address the underlying problems. And now he’s overwhelmed by probation—the fear that if he slips, he’ll go back to jail again. He has to call every day to see if he is going to be tested. He checks outside the window again. “I’m paranoid looking out my window thinking they’re just going to show up here.”

He’s not alone. One of the central narratives of the current overdose crisis is that there has been a softer touch than during the crack epidemic of the ’80s and ’90s. There is some truth to that. It’s hard to imagine, now, how many lives racist drug policies have destroyed—all the families disrupted, all the men and women killed, all the human beings imprisoned. Now, there is a growing push for criminal justice reform in Ohio. Senate Bill 3, for example, reclassifies some drug possession charges—if possession is for personal use—to misdemeanors.

But the old drug war playbook hasn’t been entirely abandoned, and some prosecutors have adopted a decidedly tough-on-crime approach—through the usual charges around possession and trafficking, as well as “drug induced homicide” laws.

Several years ago, Billy and his girlfriend, Michelle, bought some heroin together and shot up in her car, in the parking lot of a Columbus-area Nordstrom. He remembers telling her that if she stopped breathing he was going to dial 911. She did. Then he, too, lost consciousness and remembers waking up and being surrounded by paramedics.

His girlfriend died, and Trish got Billy into treatment in Pike County. It was a fraught time—dealing with his girlfriend’s death—and three weeks in, he bought some black tar (a crudely processed form of heroin) off someone inside, locked himself in the bathroom and shot up. He woke up in the hospital, and a sheriff’s deputy told him he was being charged with “abuse of harmful intoxicants,” a first-degree misdemeanor under Ohio law.

“This has been a whole trip for my mom, too,” Billy says. “She’s evolved a lot through it. At first, she would just get angry about stuff; she would just shut me out, tough love. I’d see anger in her eyes, and she wouldn’t want anything to do with me. Now, when I look at her, when I’m using and stuff, I can tell that she’s just scared she’s not going to see me again. She ain’t angry. She ain’t mad. … She’s more sad than scared.”

The Good Fight: Fall 2018–Spring 2019

In journals Billy kept while in treatment during the summer of 2018, it’s clear that he was in need of nonjudgmental love and acceptance, if not from others, then from himself. He marked off each day, to measure either his sobriety or his stay in treatment. And he describes his choices in black-and-white terms: sobriety or using, life or death. He’s severe at times, criticizing himself, remembering Michelle especially, and feeling shame that he lived and she did not. “No amount of guilt,” Billy writes, “can solve the past.”

On the day that Billy gets out of treatment, he attends a public information session and forum at the Licking County Library about syringe exchange programs organized by Dennis Cauchon, a Granville resident and formerUSA Today journalist turned harm reduction advocate. Billy’s hair is cut short (he donated the ponytail to Locks of Love). He looks like a new man. He tells me he’s ready to help push for a syringe exchange.

Dennis’ goal—and now Billy’s—is to set up a Licking County SSP, or syringe service program, which differs from a one-for-one exchange program in that it’s not always based on how many needles you bring in. An SSP is, more specifically, a distribution site for sterile needles as well as a point of contact between people who use drugs and health professionals. In some cases, it’s the only contact they have.

SSPs help reduce needlestick injuries (accidental punctures) and the spread of infectious diseases (hepatitis C and HIV). They save taxpayers money. SSPs are also a place to build relationships with people who use drugs, to offer health care, to distribute naloxone, and, maybe, to open a door to treatment. At an SSP, a person who uses drugs can get help with injuries they might have as a result of injecting drugs—abscesses, needles in their arms. They can also learn how to safely inject, how to use alcohol to prevent infections, how to use a fentanyl test strip, or how to administer naloxone. An SSP, Billy says, is really about building relationships.

Over the next few months, Billy emerges as a devoted advocate for the SSP cause. Dennis and Billy meet with local agencies, network with politicians. Billy attends every health department board meeting he can—he even sends Christmas cards to all the board members. “As a community, we need to face this issue with addiction head-on,” he tells members of the Newark City Council in December. “There’s no one answer to the problem. A syringe exchange is just one element to it. Some people say it’s enabling drug use. I can answer that many different ways. We think of it as prevention, not permission.”

So does Trish. She is worried about the health of the people coming to the corner and decides to do something about it. Now, on Saturdays at the corner, people are learning through the grapevine that there is a lady handing out “clean works”: brown paper bags filled with condoms, Band-Aids, Neosporin, vitamin C packs, tie-offs, fentanyl test strips, cotton balls, heroin cookers and sterile syringes.

It seems inevitable that Licking County will get a syringe program. The commissioner of the health department, a quiet but self-assured man with years of experience named Joe Ebel, is on board—as are other folks working at the health department. They understand what is at stake and can see the rising number of hep C cases, not just in Licking County but also around the state.

After Billy speaks at a Board of Health meeting in February 2019, he texts to tell me that it went well. And then the board goes into an executive session and afterward votes 8–0 (with two members not in attendance) to oppose any syringe program in Licking County. A vote is not on the agenda, there was no public discussion of the proposal, and Billy wasn’t notified they were going to vote, even though he was at the meeting. At the time, 22 of Ohio’s 88 counties have SSPs in place already, and Licking County’s board of health may be the first in the state to vote against an exchange in recent years.

A month later, in the parking lot in front of the Licking County Department of Health, about a dozen or so people are hanging out before a meeting of the Board of Health. There’s a positive buzz in the setting March sun. Trish’s friends from OhioCAN (Change Addiction Now) in Canton are here, as well as dozens of local supporters. Reporters from local papers, along with a couple of TV crews from Columbus, are already getting a story.

A reporter from Spectrum News 1 asks Billy if he’ll go on camera. Billy tells him how he attended board of health meetings for months asking for support for an SSP, how the board voted in executive session without public discussion and without listing it on their agenda, how they have yet to explain their decision, and how he is here today to seek answers and hopefully change some minds.

“If they’d paid attention to the research and science and all the counties that have done this,” Billy says, “it’s a no-brainer. … It’s easier for them to say ‘no comment’ than to say, ‘We’ve made a decision based on scientific fact and we’ve decided to go against it.’”

Billy is clearly fired up, and the reporter asks him why. “I’m a 10-year IV drug user,” Billy answers. “Been in recovery for over a year now. During the 10 years of using, I contracted hepatitis C. I’ve had abscesses that almost took my life. I’ve been hospitalized for endocarditis. A small thing like a 12-cent syringe could have prevented a lot of that. What we’ve been doing for so long with the war on drugs is not working. In fact, it’s cultivating addiction. We gotta start looking at other pieces to the puzzle. There’s no one fix to the opioid crisis in America.”

During the meeting, board members are silent as Billy, Dennis, Trish and others demand an explanation for the syringe decision. Board of Health president Neisha Grubaugh issues a statement that doesn’t respond to questions but just says the board appreciates the comments and that the health department is committed to disease prevention, offers hep A vaccines, gives out free naloxone and educates “the public about the dangers of opioid abuse.”

A few days after the health department protest, Trish goes with her grandson Ethan, his wife, and Billy down to Myrtle Beach, South Carolina. She takes this trip every year, but this is the first time she has ever taken Billy. So many times in the past he couldn’t do it, wouldn’t do it, or simply made their vacations next to impossible. One time they were driving to Kentucky’s Newport Aquarium, on the other side of the river from Cincinnati. They made it to I-70 before Trish had to turn around and bring him back. She and the others continued the trip, but Billy messaged them the whole time that he was going to kill himself.

But now, throughout this week in Myrtle Beach, Trish posts photo after photo on social media of Billy and his son, Ethan. Billy in the ocean, blue sky. Billy in the pool with Ethan. Smiling.

Heartache and Hope: Fall 2019–Summer 2020

It’s 8 a.m. on a Saturday, and her apartment door is wide open, her rusted-out red Ford Ranger backed up to it. Inside, boxes cover the floors and couches, any flat surface of the cramped room. Resting on top of a large orange Rubbermaid water cooler is a copy of the Narcotics Anonymous “basic text”—the comprehensive book aimed at people seeking recovery. I can smell the coffee. Family photos, with a young, smiling Billy, frame a flat-screen TV set to a classic rock music station blaring Jimi Hendrix’s “Little Wing.”

About 50 brown paper bags are opened up and scattered about the room. It’s hard to tell what the system is or even if there is a system. I don’t ask. I just watch as Trish moves and talks. She goes to a box, picks up a handful of something, and walks around dropping supplies into bags. She stuffs harm-reduction items into paper bags, which she then staples shut. Supplies are donated or come out of her pocket—but she can barely keep up with demand. Trish is also distributing a lot of naloxone these days.

There is support for naloxone, though maybe not as much as there could be—but it’s still not always getting to the people who need it the most. People who use drugs have been harmed by the criminal justice system and by health care, making even low-barrier online access, as exists in Licking County, a tough sell. It’s a lot easier for some folks to walk up to Trish at the corner, fill out the paperwork (required for many free naloxone distribution sites) and walk away.

Trish remains frustrated by the lack of movement on harm reduction in Newark and in Licking County, but she persists on this sunny morning. She says she tells anyone who will listen about the corner and about naloxone. At a recent work meeting, she explained what harm reduction is to her managers. Were they surprised or confused? She says she couldn’t tell. Some more politically astute folks have said she should start by seeking changes on the Board of Health, but that frustrates Trish. She wants change now, and she acts with a zeal that irritates some.

“People don’t like what I have to say about Newark sometimes,” she says, and then gets distracted by her cat, who comes into the room, begs to go outside, but immediately turns around. “Make up your mind,” she says. She keeps working while talking about local politics, her job, the complicated new online system for visiting inmates at the county jail, a mother who just found out her son is using heroin—she’s going to meet her for coffee tomorrow. She says she feels supported, despite the busyness of her days, the frantic nature of her life. Her family supports the work she’s doing. They get it. Some of them have gone down this road themselves, so they support not only her but also Billy. After almost 11 months of not using, Billy started again and ended up back in prison.

“Looking back, you see all the signs. But at the time”—she pauses to staple a bag shut—“I didn’t see the signs.” She says that there were a lot of half-truths, a lot of hiding, and, on her part, a lot of confusion. “I’ve heard every story from Billy. It used to embarrass me, but now I don’t care. In the beginning, everybody has that—they care what people think.”

Trish gathers all the bags and puts them into boxes and carries them into the truck. Then she starts moving other boxes—clothing mostly—and putting them into the truck. A large cooler, random bags of food, more boxes. She checks her email on a computer in the corner. She keeps moving.

On Nov. 5, 2019, Trish’s underground syringe access program is brought out into the light by a short video posted online by CNN. Shortly afterward, stories run inThe Newark Advocate andThe Columbus Dispatch. After this media coverage, Licking County’s health department stops supplying Trish with naloxone to distribute at the corner. Trish is worried about the consequences for her, though she knows that if the police do go after her, she will have a moral victory. She was more worried that this decision will limit access to naloxone in the county—especially among people who use drugs.

But then folks start donating supplies to Trish—in part because of the CNN story, in part because of the decision to no longer give her naloxone. One night she comes home from work to a box full of Neosporin on her doorstep. A note attached reads: “For the harm-reduction kits.”

And then the coronavirus pandemic spreads across the globe, a fierce, uncompromising shadow. On March 20, the day after flash flooding destroys roads and homes throughout Licking County, the Department of Health announces the first case of COVID-19 in the county. Sorrow on top of sorrow. The pandemic is revealing gaps in our safety net and our health care system—things that the folks on the front lines of the overdose crisis have shouted about for years.

For some people, the pandemic has exacerbated isolation, disruption and dislocation—and this has made life more complicated for people with substance use disorder. Now more people could be using alone or using again after not using for some time. Overdose rates appear to be on the rise. Licking County’s neighbor Franklin County has reported a 50 percent increase in overdoses in the first months of 2020 compared to 2019 and significant spikes during the pandemic.

Billy is released from prison just before Christmas 2019 and sent to a halfway house in Lancaster but eventually leaves. He is sent back to prison. As this magazine is to go to print, Billy is scheduled to get out on Aug. 14. He says he’s ready to continue to advocate for change. Right now he’s thinking about the people protesting the death of George Floyd and Breonna Taylor. “It’s not the first time that it’s happened,” he tells me on a phone call from prison in late July. He asks his mom to order a T-shirt that reads, “Who’s policing the police?”

For her part, Trish is still going to the corner. Food is being handed out in paper bags, everyone is asked to stand 6 feet apart in a line as they move from table to table, and all the volunteers are wearing masks and gloves. Harm reduction kits are running out quickly every Saturday. Despite the controversy following the CNN video, Trish continues to distribute sterile syringes.

In July, she learns that the man who owns the corner lot has to sell it, and she’s in the process of buying the property through her nonprofit partner, OhioCAN, and raising money to cover taxes and (she hopes) put a building on the lot. With a building, she wouldn’t have to keep everything in her small apartment. Besides, she asks, laughing, “You know how much stuff I forget every Saturday morning?”

It would be another step, she says, in her effort to fill the gaps, to meet people where they’re at. 

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This story is adapted from "This Is Ohio" by Jack Shuler, about grassroots activists on the front lines of the overdose crisis in Licking County. The book was published in September by Counterpoint Press, counterpointpress.com.