Summary: A narrative account of the overdose crisis in the United States, focusing on Newark, Ohio, a former industrial center, advocating for harm reduction and the involvement of drug users in policy decisions.

The events narrated in this book occurred in a town not forty miles from where I live in Ohio. Until the Covid-19 epidemic overtook the news, one of the most alarming recurring stories were the number of overdose deaths in our city (Columbus) and nearby cities like Newark. Five deaths in a weekend were not uncommon. In 2018, 3980 people died in Ohio due to overdoses. To put this in perspective, as I write [April 12, 2020] there have been 253 deaths from Covid-19 in Ohio. The 2018 numbers are down from a peak of over 5,000 deaths.

Jack Shuler is a narrative journalism professor at Denison University, located in the scenic college town of Granville, a few miles from Newark, the county seat of Licking County. This book is a work of narrative journalism tracing lives on the front lines of fighting against drug overdose death in Licking County--both advocates and users.

The account begins by introducing us to some central figures in this book--Trish Perry, whose son Billy has been in and out of prison, on and off drugs. Jen Kanagy is a local nurse. Eric Lee is an activist and recovery advocate. Tresa Jewell is another nurse. Chris Gargus leads a religion-based addiction treatment program called the Champions Network. They are together on a street corner distributing clothes snacks and harm reduction supplies including syringes, Naloxone, condoms, Neosporin, and other personal hygiene items--until they run out.

Shuler traces the efforts of these people over several years, from spring of 2016 to summer of 2019. We see them and others like them struggling with addiction, supporting people attempting to get off drugs in starting a new life, advocating with public health officials for programs that would reduce hepatitis A and C, make treatment programs more available, including prison diversion programs, and otherwise protect people from overdose deaths.

Billy, Trish's son typifies the struggle. Addicted to opioids, he nearly died and his girlfriend did from an overdose. Finally, he decides to get clean and does so for nearly a year, paying his bills, starting a painting business and hiring others. He becomes an eloquent advocate for harm reduction efforts. Then, an overdose death of a friend, and other pressures lead to a return to using, parole violations, and a return to prison.

Shuler's up close and personal study teases out the larger issues behind this book:

-The economic crisis so many towns like Newark face with the departure of industries, as people who have stayed try to eke out an existence and find hope.

-A public health crisis. Shuler argues that overdose deaths are not primarily a criminal justice issue but a public health crisis, often brought on by over-prescription of addictive opioids, scarcity of treatment options, as well as harm reduction efforts.

-Addicts have enough shame without punitive measures, and none truly want to be addicted. Harm reduction measures coupled with support that meets addicts where they are leaves the door open to getting into programs offering either drug substitutes or getting off drugs.

-Harm reduction doesn't enable drug use, which will occur with or without, but it saves lives, and saves costs of communicable diseases.

Perhaps the biggest message of the book is "nothing about us without us." Shuler seeks in this narrative to amplify the voices of those, users, former users, and advocates. Often, they are not a part of the public deliberations focused on addressing overdoses. They are seen as problems, not fellow citizens who may contribute.

One other theme that runs through Billy's advocacy and that of others is to base public health decisions not on preconceptions or on political pressure but on scientific data. The narrative approach presented this more in anecdotal form, which may be persuasive to some and not others. More of this may be found in the notes to the work, which I suspect many won't see. A postscript that makes a data-driven argument for the public health approaches advocated in this book would strengthen the book's argument. Particularly, I think there need to be stronger arguments that harm reduction does not enable, and potentially enlarge, the drug-using population, which may be the biggest sticking point in the public's mind.

Drug overdoses are not simply a Newark problem or an Ohio problem. They are a national problem that walls, wars on drugs, and incarceration have failed to address. It is a grievous problem in my state, from J.D. Vance's Middletown, to Columbus, where I live, to nearby Newark, and my hometown of Youngstown. Shuler offers a platform for those advocating a different approach for a problem that plagues all of our city's. Public health leaders have been able to mobilize significant political and civil will during the Covid-19 crisis. It is an interesting question to consider the possibilities if similar leadership and public will were exercised to address the overdose epidemic that has taken so many and has been declared a national public health emergency. Might lessons learned in addressing one epidemic be used to address another?

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Disclosure of Material Connection: I received a complimentary review copy of this book from the publisher via Edelweiss. The opinions I have expressed are my own. ( )