Harm reduction is by its nature a controversial topic within and outside recovery communities.
Are you enabling substance users by giving them life-saving Narcan to reverse the effects of an overdose?
Are you encouraging users to stay on drugs, steadily destroying their lives and the families who love them, by giving them a safety net through a program such as Never Use Alone?
For FitzGerald, such questions are moot when lives are literally riding on the line.
FitzGerald is a retired member of Insulators Local 1. He knows firsthand how widespread drug use is among blue-collar workers. Some of his friends, or their children, have died from drug overdoses.
So, among a myriad of other do-gooder pursuits, FitzGerald spends a lot of his time handing out free Narcan, especially at local picket lines and other trade-union-sponsored events.
"Enabling?" he says about Narcan. "This is used when someone is dying."
And yet the question of whether his actions are enabling substance abusers keeps coming back to him, a constant refrain from both his union buddies and the public at large — principally because of ignorance.
An acquaintance of his who's been in recovery for two decades from alcoholism recently revealed her disapproval of his Narcan distribution efforts, FitzGerald says.
"She said that's enabling," FitzGerald says. "Somebody's literally dying."
Mike Brown, a recovering heroin user who started NUA in the fall of 2019, pushes back against the idea that his program enables substance users.
"We get that a lot," says Brown, who makes his home in southeastern Tennessee. "But I don't think it is, because the only thing we're helping that caller avoid is death."
Brown makes the point that if NUA was taken out of the picture, more people would die. And how would that make anything better?
"So I don't think we're enabling anything," Brown says. "We're enabling people to stay alive long enough to find a path to recovery. But no, I don't think it's enabling at all. The only consequence we're helping them avoid is death."
Jay Moore, an NUA volunteer operator in Oklahoma City, says harm-reduction programs should be supported.
"You might as well choose the side of public health ... and just compassion, really, and meet people where they're at," she says.
In recent years, city, state and federal governments have been increasingly sympathetic toward harm-reduction strategies as they try to get the OD drug epidemic under control.
The shift toward harm reduction is a response to the failures of the "Just Say No" philosophy driving countless DARE school programs going back to the 1990s, Brown says.
"We're realizing now — pardon my French — that's bullshit," he says. "The whole war on drugs has taught society that drug users are bad people. ... I think we're finally turning the corner. Society is seeing that this isn't what they told us it was. The whole war on drugs was started with racism. That's what it is. I think America is waking up."
Case in point: the nearly $2 trillion American Rescue Plan, which was signed into law in March of this year. It allocates hundreds of billions of dollars for big-ticket projects aimed at reviving America's economy from the damage caused by the COVID-19 pandemic.
Among the projects in the stimulus plan is $30 million for a range of harm-reduction services nationwide.
This is the first time the federal government has provided funding for such services. The legislation directs grants to be provided "to support community-based overdose prevention programs, syringe services programs and other harm reduction services."
Chad Sabora, the cofounder and executive director of the Missouri Network for Opiate Reform and Recovery, in St. Louis, is one of the region's leading voices for harm reduction.
Sabora harbors doubts that, in Missouri at least, the federal dollars earmarked for harm-reduction services will truly reach them.
"But that's going to be a pass-through to the states," Sabora says of the $30 million federal allocation. "And they can decide what harm reduction is."
Sabora notes that he has tried for years to set up legal needle exchanges and safe injection sites in the St. Louis region — programs that have long been in place in such European nations as Switzerland, the Netherlands and Portugal, with decades of well-documented evidence to back up their safety and efficacy.
But here in Missouri, local governments and the state have thwarted those harm-reduction efforts.
"We don't have the infrastructures nor the interventions to properly spend that money to be most effective," Sabora says.
The idea behind Never Use Alone took shape in the late summer of 2019. That's when a member of a Facebook group for substance users posted that a friend had died the night before because he had used drugs alone.
As a tribute to the lost friend, the poster made an offer: "Here's my phone number. If any of you guys use today, call me and I'll sit on the phone with you."
Brown, a member of the group, saw the posting and experienced an epiphany of sorts.
"Why can't we do this on a large scale?" Brown recalls thinking. "So I looked at it, and I was surprised there was nothing like this already. And it's such a simple idea. I couldn't believe nobody did it before me. Never Use Alone was born three or four days later."
NUA has spread all across America in the years since. The program has set up dedicated phone lines in New York City and New England. Satellite programs have sprung up in Canada, the United Kingdom and Australia.
So far, NUA has recorded more than 5,000 calls and made 31 calls for ambulances.
"So the large majority of our calls end safely," Brown says. "Thirty-one times they called an ambulance, and 31 times the caller survived."