Dan Bigg, Director of Chicago Recovery Alliance

Q:                    Could you describe your job in the Chicago Recovery Alliance?

Dan:                My job is the Director of the Chicago Recovery Alliance. Our job is to assist in the reduction of drug-related harm with all people as they're interested in doing so and to offer a wide variety of options for reducing drug-related harm as we can afford. And we tend to use the ones that are effective, most proven effective, and are most desired by our participants. My job can include everything from changing the oil on the van to helping people learn about recognizing, and preventing overdose and giving them naloxone, the antidote for opioid overdose.

Q:                    Could you talk a little bit about your path to your current position.

Dan:                I graduated high school in '77 and in college I wanted to do something that made a difference with regards to the health of people, health and happiness of people. And initially I thought that was medicine. I was working in the hospital, until I came across something called a pilonidal cyst which is a, well you don't need to know what it is, other than the fact that it made me choose another profession. And I didn't know what the profession was but after I graduated from college, I went to Washington and worked on smoking issues. My two areas were getting the U.S. government to acknowledge the addictiveness of tobacco and also to prevent third world marketing of tobacco that the government was funding. That turned into several years of work there and, for what it's worth I was living in a house on Logan Circle which is now real ritzy area of Northwest Washington. Back then it was really run-down and dangerous but a wonderful place to live in, not unlike the community we're in now. Very personable, people know each other, people look out for each other. Despite the fact there's some of the biggest open-air drug markets in the world including near here. I came back to Chicago because of a sweetie and she said she wanted a guy who had a one-word profession, I kid you not. And I did not have a one-word profession. So, I found one, it was called psychologist, and I started a doctoral program in clinical psychology. I was also working in an outpatient methadone treatment program during the day and at night I attended the Chicago School of Professional Psychology. And over the years, I followed the path of HIV. HIV arrived in this clinic on the north side of Chicago near Diversey and Clark. At the same time, I learned about methadone treatment, and a number of other things related to drug use. Some of them are correlated with smoking and addiction in general. So, it was a natural turn. This was 1985. The only way we were dealing with HIV was preparing to succumb to it. And that was pretty depressing. I had always thought to be part of a solution to this epidemic, pandemic. And after attending a conference in Washington D.C., I brought all this information back to my people I was seeing in treatment. People were dying in huge numbers back then. And the question was what could we do to help people who are injecting, to stop this disease, stop spreading it, and live well with it. What we did was learn about what killed HIV which was bleach and we knew clean syringes of course couldn't transmit anything. At that time, I was working We did trainings all over the state for people in addiction treatment about HIV, what it was and what it wasn't. We wanted to start a support group because a lot of people were in 12-step groups like AA and NA and when they mentioned they had HIV, they were told to get out because it was an outside issue, and it prevented people from working on their recovery. We started a group, called HIVIES, HIV information exchange and Support Group. We put together something comparable to the 12-step book, we made 12 steps, 12 traditions, they were personal stories. At that time, over a third of people who had AIDS were injectors. Right now, it's around 8 percent. And so, people injecting have made huge strides in reducing this. And largely through sufficient access to clean syringes. So, it's been thrilling to do that. Probably the most important thing we did is define recovery as any positive change as a person defines it for him or herself. In those three words was a revolution that we're still living to this day. All of a sudden we take the biggest blow against shame and stigma, we, it becomes a matter of logistics and collaboration, cooperation, openness, willingness to accept another for what they believe. You know some basic tenants of humanity, that has guided us ever since. The people that work and volunteer with Chicago Recovery Alliance, very diverse group of people. The only thing that unites them is the notion of any positive change. And so we've been practicing since the beginning and then people started looking at other things in their life. Among the the challenges of addiction, was financial challenges, was overdose. Overdose was killing a lot of people in the mid-later 90s, somewhere between 100, maybe 200 people in all of Cook County. To put that number in comparison, in 2016 there were 1100 opioid-related overdoses. We learned that there was an antidote to opioids called naloxone or also known under the brand name Narcan. It had been on the market since 1971. And we started asking our participants is this something you would like? And people would say yes. We began distributing naloxone in August of 1996. Some friends of mine who were physicians ordered it for us. The first guy I ever gave it to, he's a man that we see in Cicero Wednesday nights because he has glasses, you know thick glasses. And in the middle he has a Band-Aid and tape holding them together. He's a craftsman, he works with his hands all day. Opioids have always given him a relief from the aches and pains of bricklayer. And he's the first reversal I learned about. He was sitting in a downstairs apartment with his friend. They were watching TV and they heard a thump upstairs and to them it sounded exactly like their landlord living, who lived upstairs falling on the ground. And they knew she used opiates as well. So they went upstairs, door was locked, they broke it in, she was laying blue or cyanotic, she didn't have enough oxygen. She was experiencing opioid overdose. They injected her with naloxone and she woke up. And they were just sitting there, my God this stuff works. It looks just like water but it actually works. More and more people, once they realized this was a possibility were thrilled about it. So in addition to safer injection regarding HIV, which is largely about clean syringes, we started distributing naloxone in 2001, And many, many lives were saved. Now it's become one of the more effective interventions to reduce opioid overdose. Substitution therapy, very effective but very limited. But giving people access to naloxone cheaply, freely, and with the idea of saving lives has made a huge difference. The other thing that our participants have guided us to is focusing on safer injection as it regards to hepatitis C. Making a hepatitis C preventive injection is different than an HIV preventative injection in that it's not just about the syringes, it's about surfaces and hands and procedure. So that's been our focus since the late '90s as well. And to this day, believe it or not, those have been our main objectives, HIV, overdose and Hep C. We realized, again substitution therapy was important, and in 2005, we twice won the mayor's Excellence in HIV Prevention Award. It came with a 25,000 dollar gift. And with that we built a van to do what we called MOST, Mobile Opiate Substitution Therapy. There just had to be more access to this. 

Q:                    As you know I'm interested in criminal justice reform. I’m wondering with all of the amazing work you've do what are your thoughts about criminal justice reform and how it relates to drug use and syringe exchange.

Dan:                The criminal justice system, interdiction, law enforcement, arrest, adjudication, incarceration, all of these things have been taking the lion's share of resources. Since the drug wars started around 1970, the number of people incarcerated has grown massively. And the amount of money dedicated to that has prevented us from taking any other course, any other option. A positive thing today is that we've been focusing more on diversion. That used to mean preventing pharmaceuticals from getting into the wrong hands. Now it more commonly means diverting people from arrest and incarceration. For example, Chris Nyrop, one of our colleagues in Seattle helped develop a system called Law Enforcement Assisted Diversion, LEAD, and people arrested don't get booked for non-violent drug crimes, and don't waste all of those resources. They get offered the option of doing something positive which could mean coming to our program, it could mean going into treatment program, it could mean any number of things. And therefore, their arrest turns from being a sinkhole of resources to a positive change of their choosing. That's how it's ideally used and the more and more we've done that, the number of people incarcerated in Cook County Jail has decreased by a good 20 percent. Overcrowding is becoming less of an issue. And people are realizing that not only the price we pay for using law enforcement and incarceration as our primary weapons, is not effective, and hasn't been over the last 50 years, it doesn't look like it's going to be effective. So, let's try some alternatives and this is one of the most exciting. The people have wanted to divert resources from criminal justice to health for a long time. But no one had been willing to get up there and say this is what we should do. And now some people in power, our sheriff, Sheriff Dart, our mayor, Mayor Emmanuel, and some national leaders have been willing to make some changes. When we were trying to legalize the sale of syringes in Illinois I approached our President who was State Senator Obama then. And I got to talk with him about voting for this pharmacy sale of syringes. He said if I voted for that my constituents would fry me' were his exact words. And I said you know it's no cost and it would push public health forward, be cost saving and prevent sickness and death and so forth. 'I know all of that, he says, 'but I can't vote for it until there is more coverage.' Now what happened was coverage developed for all of these reasons. The AIDS Foundation worked hard on it, other people worked hard on it, and when it came up for a vote, it passed, almost unanimously. So it was the right time and I said to myself, that's what a politician does. They wait for the right time. What we do is wait for the right thing. They waited for the right time. But somewhere along the lines hopefully and certainly in my lifetime, they've come together. 

Dan Bigg passed away August 21, 2018. He was loved deeply by everyone who knew him, and touched so many lives. I am honored to have been able to interview him.