No More About Us Without Us: A Conversation with Ryan Hampton

RYAN HAMPTON DOESN’T HOLD BACK when assigning blame for the United States overdose epidemic. “I have an opinion about Big Pharma and opioid medications,” he writes in American Fix: Inside the Opioid Addiction Crisis — and How to End It. “To put it simply: They’re evil. […] Big Pharma is one of the primary creators of the opioid epidemic. Public enemy #1. Its greed and unscrupulous behavior has buried many, many people.” For a crisis of such scale — a crisis that killed more than 72,000 people in the United States in 2017 — there is plenty of blame to go around. From the private sector, Hampton turns to politicians. “Our elected officials make horrific addiction-related policies with impunity,” he writes. “The result is systemic genocide: laws that target, punish, and kill people with substance use disorder.”

Critics might accuse Hampton of hyperbole, but on these subjects he speaks with authority. In American Fix, Hampton writes with equal candor about his own experiences with addiction and recovery and the criminal failings of the treatment industry. Hampton didn’t spend his time on heroin under a bridge. As a political staffer in Washington, DC, he stood alongside some of the most powerful people in the United States. The book recounts a 2012 campaign fundraiser for Barack Obama where Hampton shook hands with the president and conversed with him for several minutes, all shortly after injecting himself with heroin. It’s an important anecdote because the opioid epidemic afflicts every race, class, and region of the country, but too often it is presented as a problem of the rural white or urban black poor. The story of the so-called “functional addict” that Hampton shares is one we need to hear more often.

Hampton’s journey turned him into an activist, and an effective one at that. In 2016, Democrats in California selected him as one of their convention delegates. In 2018, he is on a mission to register one million people from the United States recovery community to vote in the next presidential election. It’s not only about ending the opioid epidemic, Hampton argues, but about ending what he maintains is a blatant example of ongoing systemic discrimination. “The disease of addiction is criminalized,” he writes.

Once you’ve been identified as an “addict,” you become the target of social and institutional discrimination. That can happen if a doctor puts your name into a drug database as a drug seeker, which creates an obstacle to medical care. It can happen if you end up with a criminal charge on your record. Even if you’re not convicted, that charge can affect everything, from custody of your children, to your car payment, to your ability to find housing or a job.

While at times light on specifics, American Fix is a powerful rallying cry that deserves to be heard. “Those of us who have survived the struggle,” Hampton writes, 

cannot allow politicians to make laws that hurt us, cut funding that will help us, and compare our deadly disease to a moral failing. We will no longer be abused. We will no longer be ignored. We will no longer be denied. There are 23 million of us, and we are rising up.

Hampton recently spoke to me about American Fix and his thoughts on how to end the country’s epidemic of drug-overdose deaths.

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TRAVIS LUPICK: American Fix recounts your own struggles with addiction. Are there opinions and attitudes you held on drug policy before your own experiences with opioids that have since seen dramatic revision?

RYAN HAMPTON: The honest answer is, I knew very little about the United States drug policy before I entered recovery. This has been a trial by fire for me. I just wasn’t concerned with it. It was a whole different realm that I didn’t care about. While I was using, all that mattered to me was that I was able to keep using. … That being said, I am a product of “Just Say No.” I am a product of Reagan-era, Clinton-era, every-era drug policies. I lived it. I saw it. I saw friends of mine get locked up on small possession charges and I thought that was just the way things were. It was accepted. It was culturally encouraged, and I didn’t really question it.

I guess my introduction to the depths of the United States drug policy was when my friends started dying. I don’t think that’s unique. I think the more that we pull the covers off decades of United States drug policy and see how it is affecting us in the current day, the more we’re learning. … And the biggest conclusion that I’ve had come out of this is that we have ignorant, uneducated, complacent lawmakers. That’s why we have irresponsible drug policy.

Your book includes strong anecdotes and arguments against the common belief that so-called “tough love” is an effective response to addiction. Why does tough love often backfire? And why do you think that a belief in tough love is so widely and deeply accepted?

I think it’s stigma. There’s not tough love and untough love. There is only love. I look at this through the lens of myself and friends of mine whom we’ve lost and friends who have made it into recovery. You can love someone through their addiction. You can set healthy personal boundaries and still love someone.

My mom, when I wasn’t allowed in the house because I would take money or would take advantage of staying there, she still would answer the phone whenever I called. She encouraged me to talk about what was going on. She was the person who helped me at the end get into treatment. Had it not been for that, I probably would be dead. She insisted on still seeing me, would bring me meals, and would take me to dinner. Even if I was using, she still respected me as a human being.

Tough love doesn’t work. Tough love has put countless people into the ground. I’ve seen it. I think that people get tough love and boundaries mixed up. I think this old way of saying, “Don’t take their calls, don’t help them, let them figure it out on their own,” it is only adding to the crisis.

You count yourself as an advocate for the 12 steps of Alcoholics Anonymous, but American Fix includes a lot of criticism of that program as well. Can you explain?

I’m a 12-stepper. And while I’m not very public about it, I also don’t hide it. For me, personally, it is something that has worked. The program has worked for me. Now, where I have a problem is in misinterpretation of the 12 steps. I have a problem with a lot of the culture that exists within the 12 steps and within the 12-step community.

I have philosophical differences with my own program, with Narcotics Anonymous World Services issuing a broad statement that says people on medication-assisted treatment are not in recovery. I disagree with that. I disagree with that strongly. That being said, it still is what works for me.

I can be critical of the 12 steps and still be a member of the program. That’s not a problem. I think that challenging systems that you are a member of, challenging systems that you are a part of, is a responsible thing to do.

It would be an understatement to say that American Fix includes a lot of criticism of the current state of the United States treatment system. If, tomorrow, President Donald Trump appointed you his drug czar, where would you first get to work?

Recovery. Recovery support. We have a treatment system that is broken and needs massive reforms. And that is going to take some time. At the end of the day, nine out of 10 Americans who need help, who need treatment, aren’t able to access it.

We also need to start looking beyond treatment. When I say “treatment,” I’m talking about your traditional, brick-and-mortar, 28-day programs. Beyond that, we need to be looking at peer-support programs, we need to be looking at [medically assisted treatment options such as] buprenorphine, methadone, and Suboxone, looking at peer support, and giving people more recovery choices when they come into the emergency room.

When we support someone, when we give them the type of recovery supports that they need to get them to year five [abstaining from drugs], then, after year five, they have an 85 percent chance of sustaining recovery for the rest of their life. So, my question is, why aren’t we supporting people up to year five?

We need to be investing in recovery infrastructure that supports people for those first five years. What does that look like? It looks like peer-recovery coaches, it looks like sober coaches, it looks like access to stable recovery housing, it looks like access to employment, access to behavioral health-care services. All of those things are critical to someone sustaining their recovery.

Treatment needs a complete overhaul. In what industry — in what world — is it okay to have a $35 billion industry that has zero accountability for outcomes?

In the United States, drug decriminalization has never seemed further away. But harm reduction is gaining ground. What role should harm reduction play in response to the opioid epidemic?

It’s critical. We need comprehensive user-engagement sites, which I like to call overdose-prevention sites [also known as supervised-injection facilities], in cities, towns, urban, suburban, and rural areas, and all across this country.

As a result of not having adequate harm-reduction measures in place, I saw my health suffer. I had many health problems that I dealt with early in recovery and am still dealing with today as a result of not having access to clean syringes and not knowing how to use without harming my body. … I lost one of my best friends last year because naloxone was not available and because people didn’t have an overdose-response plan in place.

An overdose-prevention site is a place where we can, in a clinical setting, and in a way that does not shame people, help to break stigma, help to break down barriers, and establish trust between user and clinician, where someone is led to that “yes” moment [to enter treatment] a lot quicker.

These are simple, simple things. … They require a little bit of work and they require an open mind. When I look at this crisis and when I look at the solutions that are on the table, I always think back to my experience: What would have benefited me? What would have led me to recovery quicker? Would I have overdosed? Could I have avoided going through this regimen of hep C treatment right now? Would all of these things not have happened if I had had access to A, B, and C? Harm reduction? It’s an easy answer, when you look at it that way. But trying to explain that to someone who is making policy for us, that is a little more difficult.

That’s why the call to action around the book is for us to stand up, get involved, get to the table, and demand that there are no decisions made anymore about us without us. Because when they decide things about us without us, we end up with stale drug policy. That is the history of the last four decades of drug policy in the United States.

You repeatedly describe how drug users are treated with “discrimination.” Why do you use that word? What can be done about it?

We are treated as a second class of citizens. We are textbook, dictionary definition, discriminated against. It is hard for us to get jobs. We are denied health care. Even when we are in recovery, we are denied life insurance plans. We get locked up. We do not have the same opportunities. … It is textbook discrimination on the basis of being a former drug user. We don’t treat other health problems like that.

Where do your efforts as an activist go from here?

The whole purpose of American Fix was not just to write a book, publish it, and get it on the shelves. I wanted people to read it, put it down, and say, “Okay, I’m ready. Now what’s next? What do I do? How do I get involved?” It’s an agenda. We want to take that agenda off the page and we want to put it into action.

We need to organize this constituency. Between drug users, people in recovery, their family members, and family members of those lost — when we are organized, we can be the largest constituency of consequence that this country has ever seen.

If one in three households in the United States is impacted [by addiction] — 21 million people currently suffering and over 23 million Americans in recovery, so about 45 million Americans — that is a lot of voting power. That is a big constituency. We can organize them, vocalize them, get them registered to vote, and then get them to be single-issue voters on addiction and recovery.

So the first thing on the agenda is to start registering people to vote. … We’ve created a partnership with When We All Vote and some other initiatives. When We All Vote is co-led by former first lady Michelle Obama. She’s attaching her name to the initiative, which we are really excited about. So I think we are going to register a lot of people to vote. And then we’re going to get them out voting. And then, after that, we’re going to get some of them running for office.

If you look at histories of movements and the arc of movements in this country — whether it’s women, civil rights, or LGBT — that’s when the real power comes in. When we get involved politically.

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Travis Lupick, a journalist based in Vancouver, Canada, is the author of Fighting for Space: How a Group of Drug Users Transformed One City’s Struggle with Addiction (2018).