good questions, thank you for asking.
first, I do needle exchange in two contexts- I'm a peer intern at a formal public health exchange, and I do syringe access & other supply distro with my local mutual aid community / a radical collective I formed with other PWUD.
in both of these contexts, clean sharps are provided to anyone who needs them. trans people, people who inject prescribed meds, and people who inject any drug, licit or illicit. we do have a trans specific needle exchange day at the nonprofit so that people can choose to be in that specific space for various reasons (including their own safety / privacy / being amongst other trans people), but trans participants are always welcome to show up at regular exchange, and we carry gauges/types that work for intramuscular and subcutaneous injections. same goes for people with other injection reasons/needs.
"why free narcan for [people who use drugs] but not free insulin" is a strawman.
I have never met a harm reduction worker/activist who wasn't also loudly demanding accessible healthcare and disability justice across the board.
the reality too, is that "people who inject drugs" "disabled people/chronically ill people" and "trans people" are not 3 separate circles without overlap. many people who use licit or illicit opioids, or other substances that may contain them (who are therefore at risk for opioid overdose) also have a medical condition or disability. that's a common intersection. people use drugs for many rational reasons, but pain is certainly a common one. there are also exchange participants who are trans and injection drug users. we don't silo people off into categories when they walk in the door or approach us during outreach - they need sharps, we give sharps.
so this myth that we turn away people who need sharps for other reasons, or steal from their supply, is bullshit. non-illicit drug using people who access syringes are welcome at every harm reduction program I've seen.
underfunded harm reduction programs also have to go through great lengths to get naloxone. it's not like we're getting handouts left and right from pharmaceutical companies.
when Dan Bigg and other drug user rights + harm reduction + recovery activists at Chicago drug user union & Chicago recovery alliance were first fighting to convince doctors to prescribe naloxone to laypeople, and to change laws to allow this on a greater scale, it was around $1 per vial (of the injectible variety). since then, not only has the price of injectible naloxone been raised steadily by all the companies who have made it, but other delivery methods have come out and been popularized as well (nasal, + auto injector), and price gouging has become a new norm. so most naloxone on the market is not accessible to low barrier harm reduction programs unless a significant foundation or benefactor donates it.
Pfizer is the only pharmaceutical company that has cut a half-reasonable deal with low barrier harm reduction programs to subsidize their naloxone. they have an arrangement with a network of on-the-ground harm reduction organizations called the OSNN naloxone buyers club. the ~112 small, underfunded community harm reduction programs that participate in this buyers club are distributing more naloxone to people who use drugs and our loved ones than any larger public health or medical entity, who could afford thousands and thousands more doses.
since COVID started, while most social service programs became overwhelmed and reduced capacity, these overworked programs that participate in the buyers club (mostly run by staff with lived experience) have actually worked harder, and managed to ramp up their naloxone distribution significantly despite financial strain, staff shortages or burnout... we are some of the only people who care about our own.
there's some grim news around this too - this year, Pfizer announced a shortage of that naloxone. so now the only pharma company that subsidizes naloxone for community-based harm reductionists has stalled putting out product. this is going to translate to thousands of deaths.
there are a couple takeaways here. a glaring one is that pouring naloxone into communities as the single form of palatable harm reduction is not enough. small orgs of marginalized people trying to stem an onslaught of death with more and more low barrier naloxone distribution programs is one of the most vicariously traumatizing and burnout-inducing things I've ever witnessed. we need an end to the prohibitionist system that fuels the ever-more-chaotic illicit supply. we need to meet people's needs, both diverse needs around their drug use itself, and their general wellbeing (which impacts their drug use) in ways that involve sweeping systemic overhauls and autonomy and access to resources.
the other takeaway is that the idea that harm reduction programs are coddled & given resources that could be allocated elsewhere, is a stigmatizing myth. we are barely given any resources as it is. it's clear to me that any resources given to PWUD are considered too many resources. we could be given a $5 budget and they would tell us to give it to someone else. our lives are devalued.
there's something rotten happening when corporations can make more than enough supplies to resource anyone who needs them, then jack up the prices on them and create artificial scarcity... yet scrappy low-barrier programs serving PWUD are the ones getting scolded for causing... disparities that aren't even accurate. we are on the same side of the disparities that do exist. PWUD are not getting a wealth of resources where diabetics aren't.
at the end of the day, many people who say "what about free insulin" are only caring about poor people with diabetes in the form of lip service, with the ulterior motive of a put-down toward PWUD.
insulin getting price gouged and naloxone getting price gouged are issues that go hand in hand. both insulin and naloxone are needed by highly vulnerable populations who are being taken advantage of, and there is overlap between them.
disability / healthcare justice, critiques of medical and pharmaceutical institutions, and anti-capitalist concerns need to include people who use substances. it is a human behavior, it shows up in a vast spectrum of ways, whether or not it's problematic. and when it is problematic, that's systemically informed too. leftists need to have a reckoning with the amount of War on Drugs propaganda they've learned to cough up on cue.
I know that "free narcan but no free insulin?" is framed as a rather conservative argument, but I've seen leftists parrot it, and there is a noticeable amount of vitriol in left spaces for PWUD. and the amount of people who have come to me to ask me to break down why that argument is bullshit is jarring- not because I'm mad that you or anyone else came to me, I'm happy to talk about it. I'm mad that we have all been so thoroughly propagandized about this, that it isn't intuitive to argue for the value of drug user human life, and include PWUD in these types of resource access concerns and justice efforts.
