"Something they will actually enjoy" - Jason Farrell, Harm Reduction Consultant

Initiator of one of the first needle exchange programs in the US, founder of the one-stop-shop centre for the intravenously addicted in one site, originator media campaigns to popularize needle exchange. It is at a conference in Sofia that we talked to the expert, mostly engaged lately in consulting work, who recently changed headquarters from New York to Amsterdam.

Magyar Narancs: Whom do you offer consultancy?

Jason Farrell: Normally, it is NGO-s who demand assistance in setting up and popularizing needle exchange programs and the activities related to establishing drop-in centres. This might involve technical preparations, developing the infrastructure and the strategy, training employees, and frequently includes convincing local authorities and raising awareness for them. The last time, however, it was not NGO-s, but the Thai government who asked me to help them develop their new harm reduction program.

MN: Surely that has its difficulties. The Thai government is not exactly known for its liberal drugs policies.

JF: Well, not indeed. In Thailand, you can have sex with a fourteen year old and get away with it, but might risk execution simply for getting high. Nevertheless, the dramatic spread of AIDS led to the introduction of a needle exchange program. The government realised that irrespective of matter their attitude to people with drug issues, this is the most efficient way of stopping the disease. Naturally, the local harm reduction program still suffers form childhood inflictions: just recently they came up with the idea, for example, of relying on the army to force drug addicts into so-called abstinence camps. They think that people will just give up the addiction at a gunpoint. At least they now seem to be warming up to the idea that giving methadone and clear needles to people with a dependency serves not only the addicts but the rest of society as well.

MN: What is in it for the rest of us?

JF: First of all, there is the financial aspect. I managed to help many people, even those with a strong rightist outlook realise that needle exchange programs are cost efficient indeed. Every AIDS patient will cost taxpayers a lot of money, since the state has to pay for the medicine, the medical coverage, the examinations and so forth. In the US, this roughly means about 100-150 thousand dollars yearly – for the rest of the patient’s life. This equals, more or less, the yearly budget of an NGO running a needle exchange program. These programs thus do not “just” save human lives, but save a lot of money as well. This is something politicians will understand.

MN: You have worked all around the world. What kind of differences have you encountered?

JF: Every country is at a different level. The US is still a novice in the harm reduction field. The Netherlands was among the first to start such a programme, while in Thailand they are only starting one. Even if they have peculiar views on the methodology concerned… But really, the differences are not that great. In the US, there are still states where you can get a life sentence for using drugs. Or, for example, if stimulant traces are found in the blood of a pregnant woman seeking treatment, she will be jailed and the baby given to a foster family after birth. For this reason, many people just won’t see the doctor even when they need to. In many places they wouldn’t even support the use of condoms. That is why I moved from the States to Europe; I’ve just got fed up with the ultra-conservative population with their right-wing views. They think that by preaching that you should not take drugs, their job is done.

MN: What exactly is a "one-stop-shop" centre?

JF: It is a place where an addict will get all the medical and social help they need. They can come in, sit down, watch TV, have something to eat, can talk to a counsellor or a psychiatrist, get clean needles and of course HIV and hepatitis screening is provided – without it being compulsory for them to do so! The point is they have access to all the services in one site; it is rather like a mall for the addict. I started the first centre like that in New York. Back then, they would not provide care for people with drug issues unless they proved they had been clear for a certain period. Thus it was especially important for them to have a place where they could get the care needed and be treated as human beings at the same time.

MN: Not only the centre, but the needle exhange program referred to as the Positive Health Project was among the first.

JF: Yes, ours was one of the first programs that got the green light in the US. When we started, exchanging needles was still a criminal offence. Some of my colleagues even got arrested. Then by 1992 we managed to get the law changed in the state of New York. Decision makers realised this is the best way to protect people.

MN: Many will say that such programs and centres actually support drug abuse, even make people turn to drugs.

JF: That is not the way things work. An addict will not give up drugs just because they do not receive care or support. Those with a severe dependency are not happy and do wish to break the circle. The real question is what alternative options they have. What will the addict get for breaking the habit? They take drugs so that they can support life. If you take that away from them, you need to offer something in return. Something they will actually enjoy.

MN: So what can you offer an addict in exchange for giving up drugs?

JF: Learning opportunities for one. Most people in the needle exchange programs, you know, do not have a college degree. They are mostly in their 30s and 40s with a history of abuse going back 15 to 20 years. They have not had a job for most of their lives, which tends to make “normal life” something of threat in their eyes. That is why you need to help them in learning a trade – even at a time when they are still addicted. I might be on drugs, but if there is something in life I can actually enjoy doing, I will tend to inject less so that I can go turn up at the course.

MN: This sounds all jolly good. But does it in fact work anywhere?

JF: Yes, it does. Many social workers and counsellors, you see, are former addicts. Many studies in psychotherapy prove that people who take up a job tend to feel better, have a better self image, think better of themselves, with their confidence improving and use less of the substance. This is where it all begins. There is also evidence for the fact that people in needle exchange programs will also use less drugs than others. For the single reason that they can regularly go to this place where they will be treated with respect, where they can see that they could work as counsellors, social workers or volunteers.

MN: You have been around for a long time, working in many countries. In your perception, have people’s attitudes changed?

JF: Of course everybody would rather that nobody used drugs. But most people today are willing to understand that not everybody will stop intoxicating themselves just because they know they should. So while they are using the stuff, we should help them stay alive, remain healthy so that they can reach the point where they can at least entertain the thought of going clear. Most people will only use hard drugs for a couple of years and stop in their 30s and 40s, or at least switch to lighter stuff. We help them not to get fatal diseases while they spend their time taking intravenous drugs. Returning to the issue of people’s attitudes, with drugs it is just like with new years’ pledges: most people who decide to stop smoking, for example, will manage to go clean for a week or two and then they lose the determination and light up again. The same way, most drug addicts want to stop, but after a certain period of abstinence the old habit will easily take over. This is something people can identify with.

MN: Still, nicotine and heroine are hardly in the same league…

JF: Not indeed, but that doesn’t mean it is not the same kind of fight when you want to give up either. On the other hand, just because you’re a smoker, you'll still have access to medical coverage, can have a job, a house, a life. Most heroine addict could not tell you the same about themselves. The point is that we do not want the addict to get sick and spread disease. My job is about the health business, it is not about addiction care. Still, I do support anyone who wishes to quit, but my task is about teaching you, if you're and addict, to see what risks your life entails, and how you can avoid them. If you want to use drugs, go ahead and do it, the choice is yours. For my part, I will tell you about the advantages and drawbacks of your choice, what the risks are, and how you can stay alive in the meantime.

MN: Don’t you grow tired?

JF: Of course I do. There is a lot of shit that goes with this job, especially if you work out there in the streets or as an assistant in a centre. It is not exactly a heart-warming experience to talk to prostitutes all day, see people fall apart and die. I have lost many a friend and client over the years. It comes with the job. The burnout rate is high, and many assistants will get hooked on drugs or kick the bottle. I have even seen assistants with no previous history of drugs, who tried them out of curiosity, but lacked the experience and took an overdose. Those who work in this profession will also have to learn how to take care of themselves just as they need to learn about caring for others.

MN: Why did you start this kind of work in the first place?

JF: When I was young, I played in a band. It was all going rather well and when we got a record deal, we absolutely went crazy with joy and got hooked on heroine. In the end, nothing came out of the deal itself, but I managed to stay an addict for years. I could personally experience the stigmatisation, the discrimination, the bad treatment. Then in 1990 I turned out that to be an HIV positive, and realised there’s nobody to help me. That is when I started training so that I could help people how to take care of themselves.

MN: You surprised me there... in the sense that you seem to be perfectly healthy…

JF: I do indeed. I have been taking what they call “the cocktail” for AIDS patients. But exactly, that is the key feature of the disease. There’s no way for you to see it! That’s the most frightening thing about AIDS: people think it is accompanied by visible traits and that when you get infected, you’ll look like Tom Hanks in Philadelphia, which is just not the case anymore. If I had not told you myself, you’d have no idea I was infected. And there are people who just won’t tell you. Those in their twenties now grew up with the “cocktail” around, and they are not scared of the disease anymore since they cannot sea what it does to you. How it destroys people physically until it murders them. Just what a horrid and disgusting disease this is. People keep getting laid with no protection whatsoever, and they’re like, even if they get the disease, they will go on the pill, no big deal.

MN: How does one become a heroine addict?

JF: Everybody has a story to tell. The main thing about it is that it just feels good. Most people think they can keep it under control, and end up addicted. When they realise this, they can still decide which way to go. Some people will stop immediately, while others continue. One’s self-image and family background can make a huge difference. Psychiatrists say those with a history of trauma or victims of child abuse will have a higher rate of ending up as addicts. At the same time, I’ve known drug users coming from model families with a happy childhood. There is no single overriding reason. The thing is, they just use the stuff and that’s about it.

Zsófia Iványi