“They Want Us Dead”: An illegal OPS, Jan. 2020
Back in 2020, I hid behind an abandoned building in East Baltimore with three guys who all used heroin together as they tested their drugs, injected them, and made sure they were there for each other in case any of them overdosed.
It was about 8 a.m. in the middle of January 2020, sunny but cold, and “D”—Black, in his late 30s, without a home, and requesting anonymity for obvious reasons—held court behind a vacant rowhouse. D saw to it that he and his friends were as safe as possible—he’s more fastidious and more experienced than the others. Heroin had been part of his life for about 20 years.
“I’ve been using off and on,” D told me. “Mostly on.”
In case anybody did overdose, D was ready with naloxone, the medicine that blocks the effects of opioids and reverses overdose. He gripped the small nasal spray bottles of Narcanand got less jokey with me: “Lifesavers, man,” he said.
Overdoses have been increasing for years now because the drug supply has been poisoned with fentanyl, a synthetic opioid that has leaked into street drugs, making them unpredictable and lethal. You just don’t know what you’re getting. For the most part, the response to this lethal phenomenon has amounted to the all-too-typical declaration of an “opioid crisis,” mostly focused on addiction and treatment.
For D, who does not want to stop using heroin, just about any kind of large-scale service aimed at people who use drugs is pretty much useless as far as he’s concerned: “I don’t need a bed and I don’t need treatment,” he said.
What D needs is a safe place to use drugs and to be treated with dignity and respect. Until that day comes, he’ll be here, holed up behind a bent and crumbling building propped up by some two-by-fours, trying to keep himself and others alive. Most mornings back then, D and his friends looked out for one another because they understood that they were most likely to overdose when they used alone. If no one’s there with you, no one’s there to save you.
“I’m a lifeguard,” D said. “We’re all like lifeguards for each other.”
You know it’s fentanyl because there’s no waiting for it to hit you.
“It’s a little too good sometimes,” D said.
The threat of overdose feels omnipresent now.
“You think about it and you don’t,” he said. “Everybody tries not to think about dying.”
The first question D asks when he gets a hold of some heroin is: “Is it good?” The next question is: “How good is it?” Then he wonders, “Is it safe?” He has some sense of how safe it is because he tested it. With cookers and strips given out by organizations such as the Baltimore Harm Reduction Coalition, he tests his drugs. He mixes heroin with clean—or clean-ish—water, puts it in the cooker, and mixes some more. Then he dips the end of the testing strip into the heroin-and-water mix and waits about 30 seconds. If the strip shows a single line, there’s fentanyl in it. If there are two lines, there’s no fentanyl.
Simply knowing fentanyl’s in there actually calms the nerves a little. There are often murmurs of “bad batches” circulating. D hears the stories, or sees it for himself, and tries to connect the dots. Three people whom he’d seen the day before all found dead in an abandoned building. Some guy told D about how he snorted, slipped out of the alley afterwards, and immediately dropped to the ground. You know it’s bad when the snorters are dropping. Soon there will only be bad batches.
What D got that day—the day I was with him and the others in East Baltimore—was alright, it seemed. His one buddy just wrapped up. The other was deep in a nod. The good kind, though. Now it was D’s turn. He sat down against the vacant, and pulled up the sleeves of his oversized hoodie and stretched out, Narcan next to him.
“Hey, it’s y’all’s turn to watch me,” he reminded his friends, both heavy-lidded and relaxed.
No one overdosed behind that vacant on that day in January 2020. What D was doing that day was essentially running an overdose prevention site, or “OPS”—a place where people can safely use drugs with other people present to monitor them and stop them from overdosing if necessary. If D or one of his friends had overdosed, another one of them would have been right there to provide naloxone and call 911.
If D didn’t have naloxone or fentanyl test strips, he would still use. If he didn’t have clean needles, he’d still do it, too. D and millions of people like him (and I, for that matter) are going to do drugs. You can’t stop us. And no matter how many bricks of dope the cops seize, drugs aren’t going anywhere. The solution is to make drugs safer and easier to do, because it’s not the drugs themselves tearing communities apart; it is the drug laws that keep people hiding and desperate and that keep the drugs unregulated, unsafe, and, these days, especially deadly.
“Legalize heroin,” D advised, yelling it like a protester, mocking advocates and advocating at the same time.
In June 2021, I ran into D again. I hadn’t seen him since that day behind the vacant. He hadn’t seen his two friends in months. He worried they were dead—of overdose or COVID-19.
D was thinner 18 months later. His hair was longer. He had a lot to say. During COVID-19, D was encouraged to social distance but he literally had nowhere to go. He’s homeless. Even the rare public places someone like D could sneak into and wash up or fill a water bottle—such as a coffee shop bathroom—were closed, and if they were open and forcing workers to serve lattes during a plague, bathrooms were locked. If D had decided to go to a shelter, he would’ve been surrounded by people who could possibly infect him—or he, them. He also wouldn’t be allowed to use drugs in the shelter.
2020 saw nearly 100,000 lives lost to overdose on top of the 375,000 people who died due to COVID-19. Hundreds of millions learned what it’s like to be neglected and considered expendable—which is how D and so many other people who use drugs have felt their whole lives.
“If you told me last year that the government would treat everybody the way they treat junkies like me, I wouldn’t have believed it,” he said. “They want us all dead. To them, we’re better off dead.”
“We’re Doing This Purely Out Of Love”: OPS installation, July 2022.
In July 2022, I stood inside the NoMüNoMü arts space on Howard Street and got a tour of a mock overdose prevention site. For harm reduction advocates in Baltimore City, the installation was an experiment in what was possible and what absolutely should exist—places where people who use drugs can use them safely and without fear of arrest or even judgment.
Baltimore Harm Reduction Coalition’s Dave Fell began the tour. Fell moved a dozen of us through the art space—appropriately decorated with Black Panthers posters and newspapers, a nod to a long tradition of radical, community-oriented healthcare—and into the overdose prevention site (OPS). The installation simulated the intake process, using drugs in the use room, and the ways resources are offered at an OPS.
“When we talk about overdose prevention sites, we are talking about bringing people who are very alienated from organized services in. If there’s one thing you leave with today, it’s that we’re trying to facilitate health, safety, dignity, safe spaces, and just bringing people into love,” Fell told us. “We’re doing this purely out of love for our community and for ourselves too because we’re people who at various points in our lives would definitely have loved to use an overdose prevention site.”
When you enter the site, you’re greeted and you sign in, providing a minimal amount of personal information (mostly a name or even nickname and what drug you intend to use that day) and then you wait to be allowed into the room where drug use is allowed (you bring your own drugs, but clean needles and drug testing supplies are provided). In the meantime, there’s a room of couches to wait and relax. Some people also hang out in the room after they’ve used drugs to get settled or come down a little bit. Indeed, Fell noted, some people often hang out, or even show up to just hang and not even use drugs.
An OPS, it becomes clear, is a community space like any other, bringing people together, being there to help or just hear someone out, and providing access to a number of resources—including opportunities to stop using drugs, if someone is interested in that.
The use room itself is not complicated: A table, chair, mirror, lots of light, and a curtain for privacy. The mirror allows the person using drugs to do it more comfortably and safely. In an emergency, the person working the OPS can delicately check in on someone using. If the person using drugs is having any problems—including, most importantly, an overdose—there is someone there to help them. People die of overdose most frequently when they use alone.
During the tour, Baltimore Harm Reduction Coalition’s Harriet Smith stood before a rolling desk full of safer use supplies—with Narcan nearby—and discussed the role of someone working in the use room: “My job here is really just to make sure people are safe. That they feel welcome and they feel like people are caring for them and watching out for them and not all up in somebody’s space—but just up in their space enough to be helpful,” Smith said.
A press conference about OPS was held at the installation. City officials, including Mayor Brandon Scott, spoke out in support. “We owe it to ourselves, to our city, to our neighbors, and to those that we lost to overdose to try new ways that have been proven—even if they’re going to make some folks in our community uncomfortable,” Scott said at the press conference.
Opening up an OPS in the city is something Scott has talked about for a long time. More than two years ago, Scott told me, “There’s nothing that says we can’t [open OPS], so we can do it.” Since then, all that has happened locally is a handful of hearings and now this installation, which begins to make the idea a bit more tangible.
Commissioner of Health Letitia Dzirasa also spoke in support of OPS, noting a frequent talking point about the benefits of OPS: There are over 150 overdose prevention sites around the world, and no one has ever died of overdose in any of them. Dzirasa also pointed towards the decades-long fight to open OPS in the United States which was finally won by New York City. Last year, two OPS opened up, one in Washington Heights and the other in Harlem.
“New York in 2021 became the first and only jurisdiction in America to open an overdose prevention site. It is my hope that we are poised to be the next city to embrace three decades of best practices and more than 100 peer-reviewed studies that have consistently shown the positive outcomes and impacts of overdose prevention sites,” Dzirasa said.
In its first three months, OnPoint NYC’s two sites were used more than 10,000 times and staff reversed almost 200 overdoses.
William Miller Jr., a founder of harm reduction group Bmore POWER, spoke at the press conference, as well. Holding his young son, Miller Jr. brought with him the legacy of his father, William Miller Sr., an iconic harm reductionist who died of overdose in 2020. The Millers have been among those most vocal about the need for OPS for the longest.
“William Glen Miller Sr. started this work,” Miller Jr. reminded everybody. During the installation, a photograph of Miller Sr. sat on a table along with information about the BRIDGES Coalition, a large group of like-minded local organizations advocating for OPS at the state level, who worked together to create the OPS installation.
The OPS installation is an attempt to make real here in Baltimore what is real all over the world (and already operating in cities like Baltimore, illegally). It is a place that likely could have saved Miller Jr.’s father’s life and hundreds of other Baltimoreans’ lives each year. It can be simpler than that, though, Miller Jr. stressed: It’s also about giving people who use drugs their own place to be themselves.
“We can do a lot more to make people [who use drugs] feel good about themselves. And these places will have everything and anything that will make them feel comfortable,” Miller Jr. said. “People who will be using these facilities are people that use drugs—and they’re underserved. And they don’t feel comfortable anywhere else. I think it’s my job to make people who feel underserved feel comfortable.”
This story was made in collaboration with The Real News Network.