Hope, struggle and harm reduction in 'This is Ohio'
In This is Ohio: The Overdose Crisis and the Front Lines of a New America, author and Denison University professor Jack Shuler takes readers on the same eye-opening journey he took with the women and men involved in grassroots efforts to combat addiction and deadly overdoses in Newark, Ohio, near where Shuler lives.
At the beginning of that journey, which began in 2016, Shuler admits he was a bit naive, even as someone who had previously worked on issues of poverty and homelessness.
“I was with someone who was introducing me to some of the issues in the community, and they took me to a train yard in Newark. And my community guide was like, ‘I know that people live inside these cars that are parked here. And over there in the woods is where there's a camp.’ And I was kind of shocked. I know there's some homeless camps in Columbus and big cities. But here? In a train yard? In 2016?” Shuler said. “Then I went home and I looked at Zillow, and the woods where people are living are like 5 miles from a house that costs $600,000. I know most people understand that. But when you’ve stood in the place and you've seen the thing, it changes things. So from that point forward, I was like, 'I need to know more about this. I need to know what's going on here. And we need to talk about this.'”
At the time, Shuler also thought about addiction and recovery in a certain way, which was mostly tied to a general familiarity with 12-step groups. But as the book progresses, he learns more about harm reduction, an approach to addiction and substance use disorder that prioritizes saving lives. That education arrives via countless hours spent with the compelling people of Newark who make up the heart and soul of This is Ohio.
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Shuler dedicates the book to “the ones who keep showing up,” and he took a similar approach in his reporting, showing up again and again to meetings and informal gatherings and one-on-one conversations in order to learn more about the people and the issues.
“It’s just being around them enough that you get to know their personality. You get to know the things that make them who they are beyond their story of overdose or addiction or their activism,” Shuler said. “All these people in the book taught me that if you're going to make change, it can sometimes be really boring. It's just a lot of meetings. … But you have to do that. You have to just show up constantly. And when you show up constantly, the people get to know you and you become familiar and they trust you and they're willing to open up to you, because hopefully they know that I have the best intentions to tell their story the best I can and do them the most justice. … A lot of them are part of my life now, and I think that my life is richer because of it.”
One organization prominently featured in the book is the Newark Think Tank on Poverty, a grassroots group that formed in 2014 and is made up of people who are struggling with poverty or previously struggled. “There's a scene in the book where all the people from the Think Tank and from the [Newark Homeless Outreach], they all go and speak at the city council meeting. And it's really powerful to see people and to hear from people who have experienced homelessness — to hear their stories in the public sphere, in places where we don't normally expect to hear them,” said Shuler, who emphasizes throughout the book the importance of hearing directly from those most affected by poverty, homelessness and addiction issues.
Shuler also takes time in the book to draw attention to terminology and the ways in which we talk about and frame addiction. The title of the book, for instance, doesn’t refer to an “opioid epidemic” or even an “addiction crisis.” It’s an “overdose crisis.”
“If we call it the ‘opioid crisis’ or an ‘opioid epidemic,’ then the focus is on all the pills and the pain clinics and all these things that don't exist anymore, really. That's not the issue. Right now, the issue is that there is a drug supply throughout this country that for some reason, especially here in Ohio, is tainted. It has fentanyl and carfentanil in it, and it's causing people to overdose and die. And it's not just from people who are purchasing opioids; it's from people who are purchasing stimulants,” Shuler said. “The first thing that we have to do is we have to try to save lives, and we do that through better access to naloxone (also known as Narcan), access to fentanyl testing strips and even having a conversation about safe consumption sites, which probably will scare a lot of people.”
In a later scene in This is Ohio, Shuler visits Vancouver, Canada, home to North America’s first safe, legal injection site, Insite, where, Shuler notes, no one has ever died of an overdose. Since the overdose crisis in Vancouver escalated, activists also set up other safe injection locations, known as overdose prevention sites (OPSs).
“There's oxygen on hand and there's naloxone at the ready, and nobody dies. That's the thing. We can't help people deal with whatever underlying issues are leading them to or causing substance use disorder or opioid misuse if they’re dead,” Shuler said. “I don't think we're doing enough in the United States to actually help people. And we haven't done enough, in part, because we haven't listened enough to people who use drugs.”
That trip to Canada lit a fire underneath Shuler. “Seeing how angry the activists were there, I thought, ‘We need some anger here. We need to be really pissed off about this,’” Shuler said. “It’s great to go after Big Pharma. I think that's awesome. Let's do that. But let's don't spend all our time doing that and forget the fact that people are currently dying now. We need to address the fact that they're dying right now.”
Despite that frustration, and despite the intimate window into the lives of people struggling with addiction and who’ve lost loved ones to overdoses, This is Ohio isn’t a depressing book. It’s a portrait of men and women who, instead of waiting for seats at the table, made their own tables and pulled up their own chairs and began working for change in Newark, Ohio. And for Shuler, those conversations haven’t stopped.
“I was on a call today about naloxone. It was a bunch of churches who were talking about setting up naloxone distributions, and someone on the call said, ‘There's nothing more pro-life than naloxone.’ And it’s like, ‘Yeah!’” Shuler said. “There are ways to talk about these things that can reach people where they're at.”