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The Other End of the Needle
How a Group of Rebels Are Taking on America’s Addiction Epidemic
America’s ongoing overdose crisis has thoroughly gripped the attention of politicians, thought leaders, and big media, yet overdoses continue to skyrocket in the face of bipartisan support, sympathetic awareness campaigns, and tireless advocacy. Drug hysteria and panic has clouded our response to this public health catastrophe. “The Other End of the Needle,” brought to you by a former heroin user turned journalist, is a series of stories that will challenge the narrative of America’s addiction epidemic.
In 1983, three months before Justin Kunzelman was born, his dad, an alcoholic, died. Kunzelman grew up in Clewiston, Florida, a small village on the southwest edge of Lake Okeechobee. Row after row of sugar beets encircle the lake. After every harvest, the sucrose-rich roots are driven by the truckload to a sugar refinery in Clewiston, earning its motto, “America’s Sweetest Town.” But Kunzelman’s childhood was more bittersweet.
He has memories of his mom, lethargic from a medley of pills she often took, falling asleep at the refrigerator door. One time, she fell asleep while smoking a cigarette, and her chair ignited.
A lack of structure at home caused a seven-year-old Kunzelman to act out in school. He was prescribed Ritalin after being diagnosed with attention deficit hyperactivity disorder, but the stimulant made him feel sluggish. He missed his former self—jumpy, energetic—so he stopped taking the pills. He began selling his Ritalin to friends in middle school. Long before his own addiction would develop, Kunzelman identified as a rebel. While most of his peers played baseball and basketball, Kunzelman preferred skateboarding and watching professional wrestling. He read comics, too. His favorite superhero is the Flash — known for his superhuman speed.
Smoking and drinking during high school eventually gave way to taking ketamine, ecstasy, cocaine, and a variety of hallucinogens, the usual suspects found in South Florida’s warehouse raves, where Kunzelman hung around during the early aughts. (The lawless, off-the-grid raves of yesteryear bear little resemblance to today’s brought-to-you-by-Heineken corporate gatherings.) Kunzelman’s 24 Hour Party People lifestyle exhausted both his mom and his stepdad (Kunzelman refers to him as just “Dad”), who has worked on a nearby sugar plantation since he was 17 years old. Kunzelman wound up homeless in Lake Worth, a coastal city south of Palm Beach. Chasing women and eating chemicals at underground parties devolved into smoking crack and drinking hot Steel Reserve behind dumpsters.
Mental health problems, transmitted to generation after generation in the Kunzelman family, along with substance abuse, pulled Justin down like gravity. But he fought back and was able to sober up at age 26. “Back then, I was a homeless anarchist with no bank account,” says Kunzelman. “But I wasn’t interested in following the same pattern that my family followed. As much as I respect what they did, I definitely didn’t wanna work in the sugarcane fields.” And he sobered up the old fashioned way: through community self-help via the 12 steps, coupled with stints at various halfway homes.
Kunzelman’s recovery didn’t stop at his own. Rather than staying anonymous and sharing his story over and over inside the safety of his 12-step meetings, he became an advocate for people who were suffering. One of his early achievements in Florida was a peer-support program for overdose victims inside emergency rooms. “Waking up in withdrawal surrounded by cops and EMTs, that’s some scary, traumatic shit,” says Kunzelman. “Wouldn’t it be nice if someone who’s been through that before held your hand during it?” Kunzelman found that overdose victims were more likely to open up to people like him than to doctors or police.
And the recent proliferation of synthetic opioids like carfentanil — sardonically nicknamed “elephantil,” because of its use in veterinary medicine to sedate elephants — has created a new sense of urgency to his work: People (especially new heroin users) are dying in record numbers. “Florida is the epicenter for carfentanil,” Dr. Bruce Goldberg, director of University of Florida’s Forensic Medicine Department, told me over the phone. He said he’s never seen anything like it.
“Medical examiner and coroner offices across the U.S. are overwhelmed. There are just so many deaths right now,” said Goldberg.
Cities in South Florida also have some of the highest HIV rates in America. Being on the front lines of a public health crisis, Kunzelmen saw an arsenal of interventions — like syringe exchange programs and over-the-counter naloxone, the overdose antidote — being left untapped. But implementing a progressive drug policy agenda in conservative South Florida isn’t easy. Javier Ortiz, head of Miami’s police union, for example, wants to kill the city’s needle exchange program.
On a hot summer night in Jupiter, Florida, Kunzelman met Chad Sabora for dinner. In his previous life, Sabora was a Cook County prosecutor in Chicago. But his career as an attorney abruptly ended when Chicago police caught him doing heroin in his car. The scandalous story exploded, and Sabora lost his job, his fiancée, and his house in the suburbs. But he had long been medicating a more profound loss: the death of his parents, both of whom died from cancer in the mid-2000s.
After several false starts, sobriety finally stuck for Sabora in 2011. And like Kunzelman, Sabora didn’t just stop there. Combining his backgrounds in both law and addiction, he channeled his energy into passing legislation that could save lives in St. Louis, Missouri, where he’d been building a new life.
Sabora helped craft and analyze bills, including one that passed in 2016 allowing anyone to purchase the lifesaving overdose-reversal drug naloxone over the counter. He also helped write another bill that prohibited courts from denying the use of buprenorphine and methadone, medications that research shows are the most effective treatments for opioid use disorder. Access to these drugs has the potential to cut mortality rates in half. Finally, after three failed attempts, Sabora helped pass a 911 Good Samaritan law that grants immunity to people who phone in overdoses. “People shouldn’t have to be afraid of dialing 911 if their friend is dying in front of them,” says Sabora.
Kunzelman saw a comrade in Sabora — another energized, recovering heroin user interested in bulldozing a health care and justice system that they saw doing more harm than good. During their dinner in Jupiter, Sabora asked Justin to get on board with Rebel Recovery, a grassroots advocacy group Sabora started in St. Louis. Rebel offers free services to anybody with addiction and breaks traditional norms of addiction advocacy by distributing naloxone and running underground syringe exchange programs, without permission from the law.
After their first meeting, Kunzelman asked Sabora for naloxone in a Facebook message. Soon enough, a box of 30 auto-injectors showed up on his doorstep. Kunzelman then asked for sterile syringe kits, and Sabora sent those, too. It wasn’t long until they had a robust needle and naloxone distribution network in South Florida.
The rebels shun do-nothing awareness campaigns and keep their focus on specific policy goals. They reject a long-held tradition of recovery: that one must abstain from all substances to get better. But their embrace of harm reduction and meeting drug users wherever they are has attracted criticism from within the recovery community—the 12-step faction in particular (ironically, where both men became sober).
“We’re challenging the core beliefs about drugs and addiction held by the general public and people in recovery,” Sabora says about his critics. “We hear all the time that we’re enabling drug use, especially when it comes to syringe exchange programs.” But when you’re crafting public health policy aimed at addressing a plague-like contagion, Sabora leaves prejudice at the door and sticks to the data. Research demonstrates that providing access to sterile syringes is an effective lifeline for people who inject drugs. “When you bring this evidence to people, they’re going to get scared,” says Sabora. “But I want to show our critics empathy, because they don’t always show it for us.”
Kunzelman’s peers in 12-step groups also rebuked him for for his advocacy. “They told me, ‘Hey, you can’t be doing all this harm-reduction stuff. You’re a 12-step guy.’”
To which Kunzelman would respond, “I can do whatever the fuck I want.”
“Instead of having this broad view of recovery—‘I’m free; I can do whatever I want’—people in meetings confine themselves into a little box that’s comfortable and easy to digest,” says Kunzelman. “That mentality is what leads people to push away the use of medications, naloxone, and syringe access, even though their own [12-step literature] suggests keeping liquor around to safely detox people.”
The rebels also face off against conservative methods to tackling drugs and crime. “South Florida has a real law-and-order approach,” says Kunzelman. Take this Reason investigation, for example, which found that small-time pushers are getting 25-year mandatory minimum sentences. New laws reminiscent of the crack era are going into effect, under which people caught with fentanyl face stiff penalties. In an attempt to bridge the gap between his harm reduction approach and old-school drug war tactics, Kunzelman recently joined Palm Beach County’s heroin task force. His hope is to change minds from the inside.
But the rebels also have partners in Florida, like Julie Negron from the Suncoast Harm Reduction Project, a group pushing for harm reduction policies around Tampa. “Florida needs to pull together as one voice in harm reduction,” says the 68-year-old Negron, who was described by Mother Jones as a “former injection drug user cleverly disguised as a nice grandma.” “We should be a tighter coalition,” she says.
While they fight to enact change, both Sabora and Kunzelman still practice the 12 steps and attend meetings as their personal way of caring for themselves. One of their colleagues, Robert Riley II, who co-founded Rebel Recovery with Sabora in St. Louis, also credits his recovery and success after prison to working the steps. Riley is also a counselor at a buprenorphine clinic based in St. Louis.
Next, the rebels have Pennsylvania and New Jersey in their sights. They’re looking for someone as passionate as they are to get legislative reform off the ground by using their same grassroots approach to vigilante addiction advocacy. Policy-wise, they want to see drug-consumption rooms — facilities where people can use drugs under medical supervision — become the norm in America, much like they are across Western Europe and Canada. Sabora drafted a consumption-room bill for Missouri’s 2018 legislative agenda. “We realize the bill will be dead in the water,” he says. But they have to start somewhere.
I’ve been tracking the addiction recovery movement ever since my own affair with heroin ended in 2012, when I was 22 years old. Since then, more and more people have shed their anonymity, breaking traditions in Alcoholics and Narcotics Anonymous that date back to the 1930s. Being relentless, critical, and loud is new, but it has helped the addiction movement gain national traction.
I don’t associate myself with a particular recovery group, movement, or organization. But as an empiricist, I value the decades of medical and public health research that show us how to address our ongoing overdose crisis.
Addiction advocacy today shares several plot points with the LGBT movement. Both are born out of tragedy: Deaths from opioids, including heroin and, increasingly, illicit fentanyl, have quadrupled since 1999. Just like many of us know an LGBTQ friend or family member who was bullied, shamed, or worse, we also know someone who’s dealt with addiction. Awareness campaigns that upend stigma are worthy efforts — but just like the LBGTQ movement won marriage equality, the addiction movement needs to focus on policies that will reverse record-setting overdose rates, as well as harms that stem from drug use. Kunzelman and his band of rebels are pushing for humane, data-driven policies that won’t punish people for having a chronic medical condition.
In 2009, when Kunzelman sobered up, he didn’t turn just his own life around—he also altered the trajectory of his family’s future. Three years into his recovery, when Kunzelman was just 29, his mom died. “She was my hero,” he says. “I understand this because I’m in recovery now, but she did the best she could with a shitty job and a husband that died three months before I was born.”
And he’s forming a new family. Kunzelman and his wife, Allegra, have a two-year-old son, Kaleo, which in Hawaiian means “the voice.” Kaleo’s middle name: “Lawless.”
In the end, Kunzelman says his greatest rebellion was against his own DNA. “Instead of a hot can of malt liquor behind a dumpster, my world is full of love. My world is my family.”