Early on, Dr. Smith knew two important things about her future career: she liked helping people and she was good with paperwork. In 2010, she found her way into the work of addressing substance use and overdose prevention through an internship at the Center for Substance Abuse Prevention (CSAP) with the Substance Abuse and Mental Health Services Administration (SAMHSA) in Washington D.C.

During Dr. Smith’s time with CSAP, she gained valuable experience and says she, “fell in love with being able to help bring additional voices to those communities.” Her passion for this work developed when she realized that she liked the organizational side of public health most. Dr. Smith explains, “when I got the internship [with CSAP] it was definitely a way for me to be able to help move organizations, campuses, and departments forward.” She added, “What I really enjoy is that I get to provide support for the staff that do the heavy lift of seeing and treating our students.”

The LaCASU was formed in 1998 following the tragic drinking death of a Louisiana State University (LSU) student. As a result, LSU was selected to take part in an eight-year research study with the Robert Wood Johnson Foundation’s “A Matter of Degree” program, to address binge drinking on college campuses across the country. The LaCASU established and manages the LaHEC to serve as a statewide coalition of institutions of higher education to implement prevention strategies. Eventually, the LaCASU offices moved to the Louisiana State Board of Regents, where it is currently funded by the Louisiana Department of Health, Office of Behavioral Health.

Today, LaHEC is the “nexus” of the relationship between the Louisiana Department of Health and the Board of Regents because none of these institutions traditionally worked together before on substance use or overdose prevention in higher education. 

Dr. Smith joined the LaCASU office in 2010 as a Graduate Assistant, where she went on to complete a Master of Public Administration (2011) and attain her Doctorate in Educational Leadership, Research & Counseling with a Specialization in Higher Education Administration from Louisiana State University (2016). In her current role as Sr. Program Administrator, she is the only constant staffer of the LaCASU office and has built invaluable institutional knowledge and trust within her community. Dr. Smith plays a key role in providing technical assistance and support to build overdose prevention efforts on more than 35 campuses across Louisiana.  A cornerstone of her work is administering the Core Alcohol and Drug Survey Project of Louisiana, offered free of charge to all Louisiana institutions of higher education. Survey results assist higher education staff in strategic planning to reduce problems associated with substance use on their respective campuses. In addition, results prompted the state’s leadership to right a glaring hole within existing policies – the BOR did not have a policy that focused on substance use prevention on campuses.

This led to the adoption of the Board of Regents (BOR) Opioid Education, Training, and Reporting Policy, a game changer in substance use and overdose prevention for the state of Louisiana. The core components are educational awareness, naloxone administration reporting, and required training for all athletic staff, counselors, the health and wellness center, Resident Advisors, and all students that live in residential housing, including every Greek life organization within the BOR jurisdiction. Through the partnership with the Louisiana Department of Health, LaHEC is able to provide naloxone to all campuses free of charge.

Dr. Smith explains that it required multiple conversations between the state, coalitions, BOR, and staff about how to place naloxone on campus and make it accessible to faculty, staff, and students. Further, LaHEC and BOR had to combat the prevailing school of thought that easy access to naloxone would encourage or even increase substance use on campus, versus the benefits of being able to easily access naloxone to save lives. 

While the number of campus students reported to be living with a substance use disorder (SUD) or opioid use disorder (OUD) in Louisiana is lower than in surrounding communities across the state, the LaHEC and BOR see this as an opportunity to establish good prevention practices now. They hope that these efforts will also lessen other issues like sexual assault, hazing, and binge drinking.

Dr. Smith says, “the [BOR] policy is the highlight of [my work]. We never passed policy before. We only did programming with our campuses.” She explains that moving their coalition to the Board of Regents has put higher education in a unique position to, “step-back and take a broader look and see how we can help shape behavior” of college students on campuses across Louisiana. In order to keep students safe, Dr. Smith states that, “looking at those environmental strategies, what kind of policies can we put in place and understanding that our numbers, particularly even for college students, are not as high for students than the community but we are in a really good space where we can do prevention on the front end, so they never get to where other numbers are.  We still have work to do on stimulants and alcohol and even cannabis use but we can’t afford to let another substance keep climbing.”

The perception of a pharmacist as someone behind a counter counting out pills is seriously outdated.

“Pharmacists are one of the most underutilized professions. I don’t think the public has taken advantage of their expertise,” says James J. Gasper, PharmD, a Board Certified Psychiatric Pharmacist (BCPP) with the California Department of Health Care Services.

According to Gasper, pharmacists today are “stewards of medications who control the drug supply.” They work in many different venues—hospitals, clinics, managed care, privately owned pharmacies and a very few, like him, specialize in psychiatry and substance use disorder.

Gasper uses his expertise and passion for treating substance use disorders to educate other pharmacists, health care providers and public health professionals about improving the care and outcomes for people with psychiatric illnesses. He’s conducted research, published data, presented to Board of Pharmacy advocating for pharmacists to be involved in substance use disorder treatment. In addition, he’s a preceptor for psychiatric pharmacy residents at Zuckerberg San Francisco General Hospital, a member of the technical expert panel on the use of emergency medications for the National Association of State EMS Officials and consultant to health departments throughout California.

He came to his career through a “purely nerdy academic interest in the brain.” As an undergrad major in biology at the University of Denver, he discovered a copy of Robert Julien’s book, A Primer of Drug Action, considered the definitive guide to the effects of psychoactive drugs on the brain. After reading it cover to cover, he talked his way into an upper-level course on neuropharmacology. The professor told him that if he wanted to apply his interests to human beings, instead of research, he should go to pharmacy school.

 After completing a specialized residency at UCSF, Gasper began working for the San Francisco Department of Public Health treating mental health and substance use disorders. This was in 2004 just as buprenorphine, the first drug available outside of an opioid treatment program to treat opioid addiction, was first introduced in San Francisco.

 Six years ago, he left his position to work for the California Department of Health Care Services (DHCS) to spread the lessons learned in San Francisco to other parts of the state, especially rural areas that have the highest overdose rates with the fewest resources.  

 Gasper says, “The greatest threat to someone’s mortality is always their addiction to opioids. You don’t drop dead tomorrow from high blood pressure or diabetes. But opioid addiction is an immediate threat and the reason why people lose their jobs and their relationships, get picked up by law enforcement or end up in the hospital.”

 Gasper is motivated to do this work by getting more primary care physicians on board to treat patients with substance use disorder in their clinics. He adds, “Opioid addiction is by far the easiest disease to treat. We have highly effective and well tolerated tools. We just have to give them to people.”

 Day by day, year by year, he’s making a real difference. Within a few years of joining the DHCS, he says that they’ve gone from treating a few thousand people a year with buprenorphine within the Medi-Cal system to treating over 30,000 people annually.

 To do even better, he believes that every county needs to have universal low-barrier access to treatment, clinics and pharmacists with a 24/7 drop-in center where someone can show up and get help no matter what drug they’re using.

 Gasper also advocates for changing the conversations about drug use. He says, “Stigma is the final frontier in this. Too many people believe that addiction is a choice, a moral failing, an illegal activity, rather than a treatable disease. We have to normalize the conversation . . . in health care, schools, workplaces, advertising, social media. People are fairly comfortable talking openly about physical health, but less comfortable talking about mental health. One in five people suffer from depression.”

 He adds, “The scariest thing about addiction is how hidden it is. I’ve worked with pharmacists in recovery in every state. They’re the last people to come forward. Psychiatrists are dying from suicide because they won’t talk about their depression. It’s uncomfortable, but people need to keep speaking matter-of-factly about how they’re feeling.”

 What keeps him motivated? Gasper says, “It’s knowing that the work that I’ve done and continue to do has given voice to underserved people who otherwise wouldn’t be receiving treatment and the care they need, and consistently and diligently looking for people who have not been treated well by the healthcare system. That’s what keeps me going.”

But she’s probably best known for her “extra-curricular” work. “They call me the Opioid Queen,” she says, because combatting substance use disorder is her passion.

Gerhardt adds, “No one chooses to be an addict, and no family is untouched by the crisis.” Not even her own. She confides that she grew up in a dysfunctional family and, as a child, had a lot of contact with law enforcement. She watched what alcoholism can do to a family and how law enforcement officers can help. That may be why three of her siblings also chose law enforcement as a career.

Gerhardt has seen first-hand the devastation of drug addiction. In 2016 one of her nephews died of an opioid overdose. She supported a friend as she dealt with her 17-year-old son’s addiction to heroin. One of her daughters had a friend who overdosed and died. In 2017, another nephew died of an opioid overdose.

“I had to do something. I could no longer stand on the sidelines and watch this happen. I knew I had to share my experiences and raise awareness of what addiction looks like, who’s affected by it and what steps we can take to do something to change the paradigm,” says Gerhardt.

After going public with her story, many people responded by sharing their tragedies. This inspired her to create a safe place for people to talk about solutions to the epidemic, so that families didn’t continue suffering in silence.

One of the first things she did was work with the Los Angeles County’s Board of Supervisors to bring together County departments—public health, mental health, emergency management services, fire department, coroner’s office and others—to collaborate, educate and raise awareness about the opioid epidemic and work together toward common goals and strategies.

She admits that there are challenges to changing how law enforcement sees addiction. “Law enforcement’s mission is to keep communities safe. Drug use is a criminal activity, and it’s their responsibility to aggressively pursue those who manufacture, sell and distribute drugs to vulnerable populations. We have to impact the supply, but we know that we won’t solve the problem by arresting our way out of it. As long as there’s a demand, illicit drugs will be available.”

The challenge is to prevent people, especially youth, from getting involved with drugs and the law enforcement community in the first place. That’s why she advocates for early prevention by working closely with parents, school and adolescent sports communities to educate them about addiction, that it is a serious disease and how to recognize the signs.

Another challenge is what to do when someone finds themselves or a loved one suffering from addiction and they don’t know where to turn. Not everyone knows what to do when someone wants treatment, and the window of opportunity and willingness to get help has to be captured quickly or it will close. Options for treatment may be limited, expensive and difficult to find.

She worked closely with first responders to save lives from overdoses. Naxolone is an easy-to-use medicine that reverses overdoses, but Gerhardt says that there were too many hurdles to jump to get it into the hands of law enforcement and other first responders. So, along with Assemblyman Miguel Santiago, she drafted Assembly Bill 2256 to allow law enforcement to purchase Naxolone. The bill passed 80 to 0 in 2018. Then she secured more than $2 million in grant funding to pay for the life-saving drug.

“Law enforcement’s mission is to create safe communities, but safe doesn’t always mean well,” says Gerhardt. That’s why her goal, now that she’s retired, is to use her unique skillset, many contacts and passion to build bridges between all of the silos. She believes that the faith community, public health, mental health, correctional health, criminal justice, schools and other stakeholders are all essential if we’re to have safe, healthy communities. The private sector has a major role in this as well. She wants to see private companies and large corporations partner with government and non-governmental institutions to raise awareness, eliminate stigmas and offer employment opportunities to people who have successfully recovered from substance use disorder.

Gerhardt ended by saying, “Long-term solutions are complex, but not impossible.”

When Dr. Westley Clark says, “Youth always threaten the status quo,” he’s not just talking about the undergraduate students he teaches in his Substance Abuse and Addiction, Public Health Ethics and the American Health System classes at Santa Clara University. He’s also talking about himself.

Growing up in Detroit in the 1950s and 60s, he has vivid memories of the week he spent in jail during the 1967 riots because he believed that it was important to challenge inequities and unjust policies.

And he still does, especially now with COVID-19 shining a bright light on years of health disparities. The difference is he’s a nationally respected leader in behavioral health who works within the system.

As the first person in his family to go to college, Clark earned doctorate and master’s of public health degrees from the University of Michigan and is a board-certified psychiatrist. He’s also a licensed attorney with a degree from Harvard University and has nearly 50 years of experience working at the federal and community levels, and on Capitol Hill, including three years of working on health policy for Senator Ted Kennedy.

“We’ve made incremental changes. People are suspicious of radical changes, but we can’t quit now. If we keep going, we will make changes.”

Throughout his career, Clark understood the importance of mobilizing communities to improve health, which is why he supports coalitions. “What coalitions do is show that everyone has a stake in the outcome.”

He adds, “There is a lot of mythology, stigma and prejudice that drives wedges within communities, but I believe that you can’t simply walk away from the issues, especially when it comes to substance use.“ We have to understand that substance use is a brain disease and look at what preceded the drug use. Some people are victims of trauma or discrimination or they have inherited a gene set that predisposes them to use substances.”

“When it was mostly African American and Hispanic children who were dying from overdoses, there was less interest, but when young white kids started dying, perceptions around drug use and overdoses changed.

”With all of today’s seemingly intractable racial, social, economic, justice and pandemic issues, what keeps him motivated?

“We’ve made incremental changes. People are suspicious of radical changes, but we can’t quit now. If we keep going, we will make changes.”

A more realistic metaphor of the change he advocates is a switchback road on a mountain that goes back and forth, not straight up, but definitely not straight down. With his focus on “one step at a time,” at age 74, this Detroit native is still stepping.

“COVID has exposed so much of what is rotten. It’s like a storm came in and blew off the roof, and we found the walls were rotten,” says David Liners, director of WISDOM, a grassroots organization in Wisconsin comprised of people from 19 different religious traditions, including Christian, Jewish, Muslim, Buddhist, that’s a leading community advocacy group for criminal justice reform. He believes that right now there’s an awakening around racial and social injustice that didn’t exist before.

Liners, who started his career as a Catholic priest working in Mexican churches on the south side of Chicago, left the priesthood to become a bilingual community organizer for an organization in Milwaukee that started out fighting against hunger and evolved to address other social justice issues. Today he leads WISDOM and its network of 11 local organizations that use civic engagement, education, advocacy and community mobilization to address inequities in jobs and economic development, transit, housing, immigration, and criminal justice and prison reform.

“Organize. Find other people who care about your issue. Become part of a team. Have your team join other teams. You can’t battle for justice by yourself.”

“The vast majority of people in our jails and prisons are there because of addiction, substance use disorders or mental health issues,” says Liners. “It’s so clear that if you have an addiction but are well-to-do and have insurance, you’ll end up in a rehab program. But if you’re poor and black, you’ll end up in prison.”

Liners believes that “having a public health solution to health problems makes more sense than having a punishment solution.” The faith community has an opportunity to be a leader on social justice reform today, but he’s afraid that too many people in the faith community, unlike those working in WISDOM, don’t see themselves as potentially transformational.

“Even before the pandemic, a lot of churches, synagogues and mosques, were losing membership, which put tremendous pressure on faith communities to turn inward, get into survival mode and become risk adverse. The challenge isn’t new. Even in Dr. King’s time only a small minority of Black churches got involved in the civil rights movement. I do think that it’s a gut check for faith communities these days. The question is how will they handle this? Will they make themselves relevant and get involved in the world around them?” asks Liners.  

One of the biggest challenges to social change is knowing that real change takes a long time. He says that you have to be in the fight for the long haul.  The former community organizer recommends: “Organize. Find other people who care about your issue. Become part of a team. Have your team join other teams. You can’t battle for justice by yourself.”

WISDOM
2821 N. 4th Street
Suite 217
Milwaukee, WI 53212

E-mail:  wisdomforjustice@gmail.com
Phone:  414-831-2070

The more challenging times become, the more Laura Guzman is inspired to lift up marginalized communities and help people who want to be drug free and those who are still using substances to be understood, loved and supported.

Growing up in Argentina during the Argentinian Military Junta (1973-1982), she says, “In spite of 30,000 people being killed or missing, my passion for freedom and loving others was ignited. No matter how much pain and trauma there is, I have resilience.”

“We need to listen to people and understand where there are intersections. We have an important moment to challenge racism and classism, and use our collective asks to increase access to treatment.”

For the past 25 years Guzman has brought that passion to save lives of people infected with HIV AIDS, Hepatitis C and people with opioid addiction and other substance use disorders. She works through the lens of harm reduction. As Senior Director of Capacity Building and Community Mobilization for the Harm Reduction Coalition, she believes that incarceration and punitive approaches have never worked. The harm reduction movement, on the other hand, minimizes stigma to increase access to treatment so people can recover.

She’s learned that taking a soft approach is the best way to bring people around. She believes that today’s terrifying convergence of the COVID-19 pandemic, addiction, relapses and community protests offers a rare opportunity. “We need to listen to people and understand where there are intersections. We have an important moment to challenge racism and classism, and use our collective asks to increase access to treatment. When the system is broken, we have the opportunity to reimagine our future.”

East Coast

243 5th Ave, #529
New York, NY 10001
(212) 213-6376
hrc [a] harmreduction.org

West Coast

1111 Broadway, 3rd Floor
Oakland, CA 94607
(510) 285-2799
hrcwest [a] harmreduction.org