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In Era Of Overlapping Crises, Drug-User Organizers Share Lessons Learned Fighting Abandonment


Out of context, those words written on a piece of cardboard that hung in a Massachusetts window in November 2021 read like a rallying cry for any number of movements. 

The sign could’ve been in protest of inadequate responses to the climate crisis or COVID-19. But it had nothing to do with either; it was a response to the poisoned drug supply and overdose crises.

These crises have been worsened over decades by policies that are either indifferent to the need for comprehensive solutions or are actively harmful, such as the criminalization and policing of drug users. 

Over the past three decades, people who use drugs have recognized this policy program as one of organized abandonment: a concept used by Ruth Wilson Gilmore and others to explain how the profit-seeking organization of business and government exploits and neglects specific populations deemed to be surplus or unproductive. It can look like governments prohibiting the distribution of clean and safe equipment for using drugs, or forcing people to work without enacting basic public health protections to stem the spread of COVID-19.

Drug users have organized back. From New York City, to Vancouver, British Columbia, to the midwest in Iowa, they’ve gathered together to determine what they need to live well and in safety, and then worked cooperatively to build those things.

Some of these struggles are visible and above-ground, like the establishment in the early 2000s of Vancouver’s safe injection sites and, more recently, the Drug User Liberation Front [DULF]’s distribution of tested and safe drugs in the city. Some are still, by necessity, obscured and secret, like underground syringe exchanges and community-run safe injection sites. 

Most of these solutions were at one point illegal. Some have since been approved and/or co-opted by the state (depending on how you look at it) after years of conflict and prohibition, while others still operate under threat of incarceration. But while politicians maintained policies that resulted in drug user deaths, drug-user organizers worked to stop as many deaths as possible.

Now, states around the world are broadening their programs of organized abandonment, threatening broader groups of people with harm and death through their roles in overlapping crises from the pandemic to the climate emergency. More communities are struggling to figure out how best to survive.

Drug-user organizers know how to fight back and get what they need when they’re left to die. The skills and experience these organizers have built are increasingly relevant for grave new contexts.


In 2003, Cameroonian historian and political theorist Achille Mbembe coined the term “necropolitics” to describe the power of the state to normalize and enforce conditions that will cause death for certain people, and especially how racism and white supremacy shape that power. 

While the context is different, Garth Mullins, the host of the Crackdown podcast and organizer with the Vancouver Area Network of Drug Users (VANDU), uses the term to describe government policies toward people who use drugs. “It’s the power to decide who lives and dies,” says Mullins.

In British Columbia where Mullins lives, this power is exercised with lethal results each year. Since 2016, recorded overdose deaths in the province have more than doubled and it is likely this figure is an undercount. Last year, more than 2000 people died. 

Mullins and his cohort learned long ago that they were on their own, and it was up to them to protect one another. He came to drug-user organizing in Vancouver in the 1990s, when the province had declared a public health emergency in response to a spike in overdose deaths from potent heroin alongside rising HIV deaths. 

The provincial government was holding out on needle distribution. To a younger Mullins, their stance was clear: “‘Oh, they don’t care if we die. It doesn’t matter to them.’”

The policy didn’t sit well with him.

“I guess I thought of my own life as not very valuable either,” says Mullins. “I thought, ‘well, maybe I don’t care if I die also.’ If all the structures around you treat you like you’re not very valuable or useful, then you start to feel that about yourself.”

Mullins began attending meetings with fellow drug users in the city, gatherings that would eventually lead to the creation of VANDU. At these meetings, demands and analyses weren’t tempered by expectations of what the state might consider to be “realistic,” nor were they limited to what was legal. People could speak the truth of the situation and decide how to proceed with shared understanding. 

This sort of organizing created liberatory actions and projects like North America’s first illegal safe injection site, and DULF’s distribution of safe drugs.

Mullins argues these actions, determined internally according to their own needs, serve two purposes. 

The first is immediate and material: they save and positively impact lives on that day. “There kinda can’t be even a bigger unit of success than someone not dying,” says Mullins. 

But the other result is just as powerful. “It also shows you and everyone around a little glimpse of a possible future,” he said. “This future has had the door sealed shut by the state for so long, and now we’ve just taken a pry bar, popped that lock, and had a little glance through into what’s possible.”

“Across the board, the state has just decided they’re abandoning people and they can die,” says Mullins. “Maybe they’re gonna die of COVID, maybe they’re gonna die in climate emergencies like the heat dome, maybe they’ll die of overdose.”

Like Mbembe’s concept highlighted, Indigenous and Black people in North America know these policies to be baked into the Canadian and American states. 

“It’s been here the whole time,” says Mullins, “and I think what we’re seeing is an expansion of that.”


Any drug user could likely rattle off a list of names of friends and loved ones who died along the bloody road to state concessions to efforts like legal safe injection sites and needle exchanges. To add insult to injury, the state usually paints demands for basic survival needs as radical and unattainable. This tactic sows discord and encourages movements to water down their convictions.

Sarah Ziegenhorn, a founder and former organizer of Iowa Harm Reduction Coalition (IHRC) , was surprised by the intensity and character of resistance from state government while working with the group. 

Founded in 2015 and based in Iowa City, IHRC ran an underground syringe exchange while formally connecting people to treatments and services for HIV and hepatitis C. By 2019, they were handing out a million syringes per year in a state of just three million people, with no official funding. 

Undercover cops would come to their space, snap pictures of the group handing out syringes and Narcan, and email them to state legislators, who would then withdraw support for IHRC. 

Historically, when drug-user organizers have built enough power, the government concedes to some degree and signals a willingness to negotiate. The compromises that result from that process can be tempting, especially in desperate situations, but can result in services that are often judgemental, punitive, or too little, too late..

Ziegenhorn warns that for others beginning to organize in the face of abandonment, this situation can produce a chilling effect by introducing a conservative sense of “moral superiority” to the work that influences people toward compromise.

“That can be a kiss of death in organizing if people decide to believe that,” says Ziegenhorn.

When she would go to meetings with elected officials to discuss IHRC’s work, Ziegenhorn would bring physicians who were newly supportive of harm reduction efforts. After meeting with politicians who chastised them for the efforts, the physicians would balk. 

“They’d be like, ‘Okay, my peers are saying this is wrong, we have to wait for the laws to change, it’s really dangerous to do these things that are illegal, this is crazy.’”

This characterization of basic material demands as radical and immoral helps to discredit ideas and undermine grassroots organizing against abandonment. The key to avoiding this, says Ziegenhorn, is “a really well-established network of people who trust each other and believe in one another and the work they’re doing.” 

“You have to be comfortable with sticking to a set of values, and remembering your grounding in things that are important to you, like one another’s wellbeing and happiness and ease of living,” says Ziegenhorn. “Doing things that clearly further those goals is not radical or too out there or crazy.”


Some drug users maintain that even though government negotiation and compromise can be thought of as an acceptable end goal of organizing, decisions made by and for impacted community members are the only proven tactic for attaining better living conditions.

Sessi Kuwabara Blanchard noticed fellow trans sex workers and drug users in New York City weren’t accessing harm reduction services that were available. The reason was that providers operated on schedules that conflicted with that of sex workers. So, she started a mutual aid group for trans sex workers using drugs. 

Do It Safe, Heaux! (DISH!]) and its members distributed harm reduction supplies to one another. When trans sex workers faced transphobia and judgment at Narcotics Anonymous programs, DISH! started their own support group.

But for Blanchard, who is an organizer with VOCAL NY’s Drug Users Union, the clearest indictment of fighting for state policy concessions came when she wanted to get a prescription for Suboxone to transition from using heroin and fentanyl. 

She called a telehealth Suboxone clinic that advertised rapid access, but was told on the call that she’d be contacted later with an appointment date. Blanchard, already experiencing withdrawal, began to cry. The person she was speaking with hung up.

“It was one of the most devastating feelings,” Blanchard recalled. “The clinic staff hanging up on me was the distilled, purest form of abandonment that I felt.”

The lesson was that even services that purport to work toward the same goals as militants will often only do so on their terms.

Blanchard says one way to avoid being upended by this is to adopt and adhere to immediate local goals. “We only have to work with what’s in front of us and how the world is set up today,” she says.

“Building trusting relationships with the people that are surviving the conditions they wish to change is the absolute first starting place. You have to respond and strategize from the point of your everyday life.”


When hostile conditions like the climate crisis seem insurmountable, organizing can seem impossible, especially to people who are becoming acutely aware of their vulnerability. 

“Any action that you consider to be unsuccessful, maybe it’s just not successful yet,” Mullins said. “If you asked this question around civil disobedience around safe injection sites in 1997 in the peak of the HIV and overdose deaths, it would’ve been several years into the campaign but there was no InSite on the horizon for years.”

“Unfortunately, the timelines are really long. We also were asking for Narcan for a long time, and finally getting that five to six years ago. But there’s nothing about civil disobedience that need take a long time.”

Crises often scream for urgency, but trying to accomplish too much all at once can stifle action and morale. Vince Tao, an organizer with VANDU and the Vancouver Tenants’ Union, says that centering immediate material conditions is important to momentum and community cohesion.

While VANDU’s primary emphasis is drugs, Tao says they view it as just one piece of a larger puzzle. Siloing the issues of class struggle, he says, allows the state to play “whack-a-mole” in suppressing them, so building impactful movements means starting from the bottom.

Tao adds that good organizing leaves room for people to come in and out of activities, forgiving rather than chastising someone for falling behind on tasks or missing meetings. He says that members often can’t make VANDU meetings because they’re busy trying to evade eviction, policing, or other forms of violence, and “as the rising tide starts to swallow up our planet, this is gonna get more fucking crazy, and we’re gonna have to give each other a lot of forgiveness for not being able to do stuff.” 

“That is the work of organizing,” he continues, “not meeting every Thursday night on Zoom at 7PM after a work day and spending an hour on introductions then getting two things done. That’s not it. The real organizing is being able to navigate really complex social relations.”

VANDU has a small ritual that keeps the long-term scope in focus: at the end of every meeting, regardless of size or length, they have a moment of silence and speak the names of people they’ve lost. This can happen up to five times a day.

“Whether you’re in the downtown eastside and you’re literally losing hundreds of people in your life from drug toxicity, or you’re on a dying planet, we have to be able to mourn these things and not forget them,” says Tao. Every time he repeats his friends’ names, he still tears up. 

“It recommits me to the fight,” he says. “It’s a very practical method that we use, but it’s really important to keep up that militancy. We mourn the dead and we fight like hell for the living.”

Luke Ottenhof

Luke Ottenhof

Luke Ottenhof is a freelance writer based in Kingston, Ontario.