The Exclusion of Poor Whites by Harm Reductionists

Taken from the Centers for Disease Control and Prevention.

Read more like this at Tennessee Harm Reduction.

Harm reduction, per the Harm Reduction Coalition (HRC), is “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.” It’s “also a movement for social justice built on a believe in, and respect for, the rights of people who use drugs.”

In my three years practicing harm reduction, I’ve found that many others also interested in the movement conflate other, non-drug-user-specific social equity efforts with harm reduction. And that’s fine, as long as it doesn’t impede upon helping what or whom should matter most — helping people who use drugs like me.

Unfortunately, in my opinion, fellow harm reductionists have excluded advocating for Poor Whites, people like me who are disproportionately harmed by both the “racialized drug policies” the Drug Policy Alliance seeks to reduce the harms of and by drug use itself.

The Centers for Disease Control and Prevention (CDC) published “Jurisdictions Determined to be Experiencing or At-risk of Significant Increases in Hepatitis Infection or an HIV Outbreak Due to Injection Drug Use Following CDC Consultation” in 2018. Put simply, it identifies the top 220 most vulnerable counties in terms of HIV or HCV (hepatitis C) outbreaks across the United States.

Among those 220 counties is an eight-county cluster in Middle and West Tennessee that includes Benton, Hardin, Humphreys, Lawrence, Lewis, McNairy, Perry, and Wayne Counties. I’m from one of those counties, Lewis County, which also happens to be among just two counties in Middle Tennessee that are considered part of Appalachia by the Appalachian Regional Commission, a federal-state partnership created by Congress a long time ago “to bring the region into socioeconomic parity with the rest of the nation.”

The majority of people in these eight counties are White, with White people making up anywhere from 92% to 97% of each county’s population. For clarity, I found these statistics on each county’s Wikipedia page, all of which were directly pulled from the United States Census Bureau’s American FactFinder tool.

I’m from Lewis County, specifically its county seat, Hohenwald — and, yes, it’s very much a “hole in the wall.” I left Hohenwald when I was 19, though I spent the first four years of my nine-plus years as a near-daily drug user there.

Half of my childhood and adolescence was spent around my super-problematic drug user of a mother. Most of my time in high school was spent hanging out with other people who used drugs.

Among my closest “friends” — most of them didn’t turn out to be true friends, but rather “drug buddies,” people who usually don’t have too much in common with each other outside of their drug use — were people who have since found themselves in prison on 12-year bids, on six-year-long state probation stints, and otherwise inextricably entangled with drugs and the problems they oh-so-frequently cause.

None of these eight counties are served by syringe services programs (SSP), entities that exist in Memphis, Nashville, and throughout East Tennessee that dispose of used syringes, provide injection drug users with clean works, provide participants with personalized recovery-oriented consultations, and much more.

Outside of the often-exclusionary 12-step programs, rehabs running on long-outdated best practices, and wholly-unhelpful probation offices that act nearly exclusively as profit centers, there are no resources for drug users in this area. This holds true for the vast majority of rural Tennessee, including where I live now, in Northwest Tennessee.

In Lewis County, for example, the demand for opioids is so ridiculously high that the price of street-sourced oxycodone is $2/milligram or damn close to it — that’s the price for everybody, not just people who are poorly-connected in the area — and it’s been this way for some time. Just know that, as someone who grew up around drugs, who’s faced so very many problems related to my own drug use, and who was very much “in the mix” when he lived in the area, drugs are bad here.

Harm reduction’s first major application came in 1985, when several early harm reductionists came together from across the United States to stop the spread of HIV/AIDS among gay people, most of whom were injection drug users.

This trio of intersecting socioeconomic factors were all very much directly related to drug use.

Since then, many practitioners and supporters of harm reduction have considered “harm reduction” as equal parts helping drug users and advancing social justice efforts. However, many social equity efforts that are currently supported by modern American harm reductionists aren’t inherently related to drug use.

I’ve been to two drug-related conferences now, the International Drug Policy Reform Conference in Nov. 2019 and the 2020 HepConnect Meeting in March 2019. Both of them involved panels and sessions that touched on social equity efforts, even if they weren’t directly related to drug use themselves. None of them mentioned Poor Whites.

Since I started using Twitter in Dec. 2019 to connect with other harm reductionists, I’ve noticed that many of my fellow harm reductionists support other social equity efforts. Most people who support harm reduction are largely-left-leaning, which I fear has resulted in the wide-ranging adoption of non-drug-user-specific causes by supporters of harm reduction. Oh, by the way, none of them — not that I’ve seen, anyways — have mentioned Poor Whites.

I don’t know how long the conflation of other social equity efforts with harm reduction has been going on, but I fear that anti-White sentiments, especially anti-Poor White sentiments, have been injected into pro-other-social-equity-efforts along the way. And, for the record, by “other” social equity efforts, I mean those that don’t directly relate to drug users like me.

As you might imagine, rural Tennessee is home to largely-right-leaning people. Making people aware of harm reduction in the first place is difficult enough, let alone getting them to adopt harm reduction-positive ideologies.

But what if I were tasked with pushing harm reduction in conjunction with other social equity efforts — can you imagine how difficult that would be?

I think this is especially important to frame from the perspective of people who live in rural Tennessee, those who currently have absolutely zero worthwhile, effective resources to help them — not them, but us.

I’m the only harm reductionist I know of practicing in Northwest Tennessee — hell, in rural West or Middle Tennessee! The presence of harm reduction-related penetration and presence of programs or resources that help drug users like me is one par with one another — there’s an embarrassing lack of both here.

I know it’s difficult for people to understand things they’ve never experienced themselves. As the majority of harm reduction supporters and practitioners live in largely-left-leaning areas or subscribe to largely-left-leaning ideologies themselves, it’s difficult to establish common ground with them on the basis of Poor Whites having long been excluded from harm reduction, or any effort to help drug users, for that matter.

I’m not throwing shade on any social equity efforts. I think it’s important to get everyone on a more-or-less equal platform. I’m actually a fan of any efforts that take privilege or otherwise-improved socioeconomic standing away from any better-off Whites — or any class of people, which, at least here in the United States, largely happens to be better-off White people — because they’ll hopefully, at least, result in Poor Whites like me being better off as a result. Also, of course, I support them because I’m a rational human being — whether or not they help Poor Whites, as long as they’re bringing social equity to society at large.

What I am trying to do is bring awareness to the plight of Poor Whites, especially as it relates to the opioid epidemic and the rash of non-opioid-drug-use that has plagued, does plague, and will plague areas like rural Tennessee for years to come. Specifically, I want other harm reductionists to start thinking about things that could help harm reductionists who operate in largely-right-leaning areas like me, especially in Appalachia or elsewhere in the rural Southeast.

I don’t want Poor Whites, especially those in places like rural Tennessee, to be mentioned among the likes of other social justice efforts. I’d rather socioeconomic predeterminants to be removed from the equation entirely — I just want my fellow long-term, often-problematic drug users to get the resources, programs, and other help we so desperately need.

I know a fellow harm reductionist living in East Tennessee who has been helping drug users like us for several years longer than me. He/she/they — I don’t want to give up his/her/their identity, hence the non-specification of the pronouns they use — has told me several times that he’s/she’s/they’re scared of bringing up the issues that Poor Whites in Appalachia, rural Tennessee, and elsewhere face out of being shunned from the greater harm reduction community.

Considering that largely-left-leaning people preach inclusivity, this doesn’t make sense. As a lifelong Poor White, he has/she has/they have — like me — faced issues that better-off Whites are much less likely to face.

However, I very much agree with that fellow, East Tennessean harm reductionist that, if he/she/they were to even bring up what I’m touching on here, that he/she/they might not receive grant funding for his/her/their organization, might not be involved in any ongoing or future harm reduction-related efforts, or otherwise be welcomed by the modern American harm reduction realm’s membership.

Long-term drug user, writer, practicing harm reductionist. Lifelong resident of rural Tennessee. Director of Tennessee Harm Reduction.