Over the years, the very potent synthetic opioid drug fentanyl has been mentioned more in the media—and, in many cases, it has been connected to someone’s death. And with fentanyl being approximately 100 times more potent than morphine and 50 times more potent than heroin, it takes very little of it to permanently alter someone’s life.
During the April 18 Chicago Humanities event “The Infrastructure of Compassion: Rethinking Public Health in the Fentanyl Era,” Gregg Gonsalves—an epidemiologist who is a member of the LGBTQ+ community and an expert in both health-related policy modeling and the intersection of public policy and health equity—will talk with University of North Carolina street drug scientist Nabarun Dasgupta about the failings of the current systems and a proposal for a better one.
Note: This conversation was edited for clarity and length.
Windy City Times: When did fentanyl use become so widespread? It used to be about cocaine and heroin; however, fentanyl seems to have been responsible for so many deaths and it’s even surpassed meth as the deadliest drug in some areas.
Gregg Gonsalves: I would say it’s probably around and that it dominates the market because it’s cheap and potent, right? And when something is cheap and potent, it’s more widespread and, therefore, more prone to accidental overdose.
WCT: Do you have any idea how it affects the LGBTQ+ community? I’ve seen research that says [fentanyl use is] disproportionate.
GG: You know, I work on substance use but I don’t do it in the context of LGBTQ+ communities. You know, the big drug of choice for a long time in the LGBTQ+ community was methamphetamine. So I’m going to go look that up because it’s interesting to me how much opioid use happens in the LGBTQ+ community. Let’s see, I’m seeing if I can find [information] because I’m just curious now. [Researches] Yeah—it’s saying thousands each year.
The other thing to think about is that when we talk about compassion in the fentanyl era, I mean that we’re really just talking about drugs in general. Fentanyl is [part] of the latest wave of overdoses and other sorts of drug use in the U.S.
WCT: So could you provide a little preview—like how exactly would compassion work? There are plenty of detox centers, for example, but with compassion it sounds like you’re talking about a horse of a different color.
GG: Well, what do we do to drug users and people who use drugs in the United States? We lock them up. [There’s a disproportionate number of] Black men in jails in prisons in the U.S., often due to minor drug crimes. That is not compassion.
We send people to programs that don’t work for them, right? Detox doesn’t often work, and things like methadone and buprenorphine—which are well-proven opioid treatments—are not available to everybody who needs them. And we stigmatize people who use drugs.
Programs like needle exchanges or open overdose prevention centers get targeted—and that’s not compassion, right? But when you think about compassion, you think about communities taking care of each other, like the LGBTQ+ community took care of itself in the beginning of the AIDS epidemic. And what did we invent? We invented harm reduction for sex, which is called safer sex.
It was LGBTQ+ people and people who use drugs who thought about syringe exchange in the context of the AIDS epidemic because our friends were dying. And so, harm reduction has been based on compassion for a very long time in the LGBTQ+ community. And it’s about us trying to save each other’s lives and do it in a way that doesn’t stigmatize or denigrate anybody. And we didn’t do it out of sort of like a public health or medical agenda. We did it because people were dying—our friends were dying.
WCT: Is this an approach that you feel will help everyone?
GG: So we need to have a more humane, compassionate view of drug use in America. There are places you can go in the United States where you can take substances that are addictive. And we have rules that if you’ve had too much, somebody can drive you home—that place is called a bar, right? So we have these places where we use drugs in a way that is completely relatively unstigmatized.
But for heroin and other drugs that are scheduled differently, we treat [users] differently. People deserve the same humane treatment that we would give anybody in our community who is wrestling with any other addiction. We should treat it as a medical issue—an issue of caring for each other. And it will help everybody.
I have many friends in the LGBTQ+ community who had methamphetamine tear them apart. The use led to rising HIV rates; this was maybe 20 years ago. I’m old now, but I remember people like my friend Peter Staley; I remember him organizing some outreach campaigns and stuff like that. We, the gay community, has had its own issues with substance use, but there have been compassionate programs to help people suffering and dealing with addiction. Those are going to be good for everybody.
The idea of sending everybody to jail and making them feel like they’re pariahs is not building community and showing compassion for each other.
WCT: And you actually participated in a research project based on a math model. You all concluded that lowering thresholds for felony possession of fentanyl actually resulted in more opioid deaths. And were these real or extrapolated numbers that were used?
GG: So, basically, we have a paper that my PhD student Sasha [Alexandra Savinkina] did. It said that if we enhance penalties, you have more people incarcerated and more people dying of overdoses. And so, again, this goes back to the concept that criminalization doesn’t work.
It’s a model; it’s not empirical research. A lot of the work we do here is based on models, like computer simulations.
WCT: Now, this approach of compassion is for users, so it doesn’t address the source, correct?
GG: When we think about harm reduction, we’re thinking, “I use heroin, cocaine or methamphetamine. I have a chronic relapsing neurological condition called addiction.” And [despite what] Nancy Reagan said, you can’t just say no. So I want to reduce the chance of you getting sick and dying.
And that’s what harm reduction is based on—trying to meet people where they are. It’s also about keeping them healthy and alive despite the fact that they use substances. Everybody has their own drug of choice, whether it’s cigarettes, alcohol or bad TV shows. [Smiles]
WCT: It sounds like you are offering hope, basically.
GG: It is hope. I mean, the point is that we live in a terrible world. People have been demonized up and down over the past several years by people in this administration and other places, [turning] people into pariahs. And we’re saying that, for everybody, there’s hope; there’s room for compassion.
Everybody’s life has dignity.
“The Infrastructure of Compassion: Rethinking Public Health in the Fentanyl Era” takes place Saturday, April 18, 10-11 a.m., at the Ramova Theatre, 3520 S. Halsted St.
