The last client of the day was a man in his late forties who asked for 27-gauge long-point needles, which are one-half-inch long and push deeper under the skin than the three-eighth-inch needles, more reliably tapping veins scarred by years of abuse. The man was representing not only himself, but seven or eight others. Two cases of 500 should do, he said, setting the cardboard boxes on the ground beside his backpack and moving on to collect other paraphernalia from a grid of Tupperware bins: cookers, cotton balls, hemostatic pads, alcohol wipes, and Band-Aids. Everything went into a shopping bag. One of his friends smoked crack, in addition to using heroin. Cliff Sanchez offered a glass pipe without looking up from his iPad, where he listed items and quantities to keep inventory.
"You need Narcan?" Sanchez asked. Sure, the man said. No overdoses in the past week, but always good to have the stuff on-hand. Sanchez gave him three vials. They commiserated over the way Narcan throws you into withdrawal, the physical misery of walking back from death. "It's not pleasant," the man said. "That is not pleasant."
He gathered his belongings. He dropped one case of syringes into his backpack, which he lifted to his shoulder. The other case along with the rest of the supplies went in a large black plastic bag. Before the man left, Sanchez offered him two parting gifts: a cooker attached to a key ring and a cylindrical piece of cotton tucked inside a plastic vial. They were new product samples, designed to do the job better. "Come back and tell us what you think."
"You guys are a big help."
"Be safe out there."
Sanchez started volunteering with the Chicago Recovery Alliance in 1996. He was hired to work part time in 2001, full time in 2006. He, like most CRA employees, has "been on the other side of the fence." First he used hallucinogens, and then PCP, and then crack and cocaine. He finally switched to heroin when a friend praised the drug's relative affordability. After the switch, Sanchez began doing things he never thought he'd do: pawning beloved possessions, scanning his wife's jewelry drawer, shooting up at night, and then in the morning before work. He remembers longing for lunch break so he and his friend could drive to the city's west side and get high before returning for the afternoon shift. "Heroin brought me to my knees," he said. Four days after his third daughter was born, he quit, a second time, and it stuck. He's been clean for 21 years.
We were in CRA's mobile unit, a converted bread van painted silver and emblazoned with the organization's logo. On the same days each week, on the same city blocks, the van makes scheduled stops in Chicago neighborhoods known for high drug use and few services. Locations have changed over time—public housing comes down, money migrates, condos go up—but demand has remained strong. Clients are gracious and thankful. Many are regulars who stop by to collect a month's worth of supplies. The homeless visit more frequently; they have nowhere to store what they take.
Sanchez's work can at first seem viscerally unsettling. At one point, a Puerto Rican man stepped into the van, shifting from foot to foot as he talked with Sanchez, glazed and abuzz with off-balance energy. They discussed the safest approach to speedballing. Break the crack down with ascorbic acid, Sanchez said, opening a drawer and pulling out a ration to give the man. Not lime, not lemon. "One part ascorbic acid, one part crack, mix it up," he instructed. "Best stuff for the veins, best stuff for the body." He then warned the man to go slow if he's using heroin from a new dealer, as the drugs these days are often cut with potent synthetics, like fentanyl. Overdoses have become strikingly common. If 30 milliliters is your normal dose, Sanchez explained, try 10, see what that does for you. "And if you get high off just that 10, then—hey!—save the other 20 for later."
CRA's mission, though, is not addiction treatment. While the organization actively refers people to social services and health-care programs, their focus is harm reduction. "We meet people where they are," Sanchez said. What might initially look like enablement is a well-proven and highly effective public-health service. According to Sanchez, CRA has prevented at least 3,000 overdoses in the last 15 years—more than one every two days. The organization is instrumental in checking the spread of HIV, Hepatitis B, and Hepatitis C. And people shooting up with old needles no longer resharpen the tips on matchbooks or improvise with glass eyedroppers and a sewing needle, as was common around the time Dan Bigg founded CRA in 1992.
Distributing hypodermic needles was illegal back then, so Bigg, who died this past summer, did his work furtively from the back of a station wagon on Chicago's south side. In 2003, Illinois legalized possession of needles for a broad class of people, including those involved in scientific research, and so CRA, though fundamentally driven by the deep moral conviction of its founder, became, by legal necessity, a research program. By operating under the auspice of universities studying drug use and infectious disease, CRA has found legal refuge. All of the needle give-outs, all of the best-practice discussions, all of the well wishes to regular and new clients, are offered in the name of science.
Outside, it was winter in the Midwest, the giant park across the street faded and desolate. The city would soon be under snow. Sanchez lidded Tupperware as his two-hour shift wound down. Passing trailer trucks rocked the van gently, and, in combination with the quiet susurration of traffic, it felt like we were adrift at sea. He talked as he closed up about his past and the way he can relate to clients who wander into and out of his life, most of them in search of oblivion. People want to cover their problems in the fog of opiates. But it's better to deal with things, Sanchez said. That's what he's realized. It's uncomfortable to face reality, but that pain is only temporary. He started the engine. "Be safe out there," he told me as I left.