Jonathan Goyer has had a lot of wakeup calls since he started using heroin about 15 years ago. His dad died in 2004 from a heroin overdose; in 2009 his brother died from one, too. Yet both deaths did little to deter the habit. Goyer kept using, dropped out of high school, and ended up on the streets of Providence, Rhode Island, sometimes engaging in sex work for money.
In 2012, after being arrested on a drug-related charge, Goyer finally went to rehab. But six months in, the itch got the best of him—he left rehab, bought some dope, went back and shot up. He’d been clean for months, and his tolerance was low. Looking back, he also thinks the heroin was laced with fentanyl, a super-powerful opiate drug dealers use to up the strength of their product. He passed out within seconds of shooting up. Goyer likely would’ve died if his roommate hadn’t found him lying there and rushed to get a dose of naloxone (also known as Narcan), a drug that blocks opioids from attaching to people’s brains and reverses overdoses instantly. (You know that needle scene in Pulp Fiction with Uma Thurman? Like that.) The roommate injected the Narcan into Goyer’s leg, and he was rushed to the hospital. That was the last time he used heroin.
“I’d been in so many treatment centers and detoxes and psychiatric wards that I’d lost count,” Goyer, 28, tells me. “But with the overdose, I finally reached death. Like, I knew I wasn’t going to be socially using, I'm not going to get high and end up in a detox, I'm not going to end up back in jail—I'm going to die. I had to choose.”
But just as Goyer finally decided to get clean, it seemed like everyone around him in Rhode Island was headed in the opposite direction. He saw more and more friends hooked on pain pills and heroin. The U.S. is battling an opioid epidemic right now, thanks to a combination of rampant over-prescribing of pain pills and economic stagnation in working-class and middle-class communities. But it’s worse in Rhode Island, where the local economy is stagnating: In 2013, the state had the dubious distinction of having the highest rates of drug use in the nation. Last year alone, the state saw 260 overdose deaths.
The crisis doesn’t show any signs of letting up. The opiates are still there, and fentanyl is now killing as many people as heroin. So Goyer has taken up the mantle of convincing people—from drug users to parents to policymakers—that the way forward is not to crack down on those using, as has traditionally been the case, but to open up more rehabs and counseling clinics and bring users to treatment facilities instead of jails. It's a mission that runs counter to history. It's a mission driven by a very acute sense of empathy.
GQ: After your overdose in 2013, it seems like you could’ve gone back to using. What made you decide to go another route?
Jonathan Goyer: I realized how lucky I was. I became interested in Narcan and wondered why I'd never heard of it. I started going to community forums. I joined some local committees, volunteering any way that I could. Rhode Island is such a small state, and I realized it was really easy to get all of our politicians in a room at once and talk to them.
That’s interesting you say Rhode Island is a small state. How does that change your work and the nature of the crisis?
I don't think there's one person in Rhode Island who doesn’t know a friend or a neighbor who’s been through an overdose. In 2014, we had over 2,000 EMS-documented doses of Narcan administered in a state of only a million people. And fentanyl is making it worse. The deaths, the addiction, has always been there; it's just it wasn't this bad. It's now impacting so many people that it ends up hitting the middle and upper classes more, to the point where there's more pressure on the state to do something about it.
What’s so dangerous about fentanyl?
Fentanyl is the most potent opiate that you can buy on the street in illicit form or really even in a prescription form. If you develop a prescription-drug habit, then you move to heroin use because you're building a tolerance where you need more and more to feel the same sort of high. Fentanyl is stronger than heroin, so some people are now specifically seeking it out. But for people who haven't been doing illicit drugs for 10 years—maybe they're in their first month or so of beginning to use daily—those people will come across a batch of the fentanyl and it kills them immediately. I'd guess more than 50 percent of the people who are dying were not long-term heroin users. These are people who were using for less than a year.
So what kind of solutions are there to the crisis?
Last August, the governor signed an executive order to start a task force on overdose prevention. I think that was a really good step for the state. I helped to write the strategic plan that the governor used. A big part of that is using peer recovery—using people who lived in active addiction for years and years and they found recovery, just like I did. They serve as a bridge to treatment.
My organization has access to recent overdoses, both fatal and non-fatal, from every hospital in the state. If somebody gets brought to an emergency room because of an overdose, they call us and we dispatch a peer-recovery coach to go meet with that person at the hospital. We've seen over 600 people in the last year alone.
That’s basically harm reduction, right? Not trying to police the problem away?
We meet people where they're at. A lot of the people that we help on a daily basis are not clean, nor do they want to be 100% abstinent, which is fine. A lot of people don't want to go detox, so we make referrals to medication-assisted treatment, such as methadone or Suboxone. We help them to get into better living situations where they will be able to take their prescriptions as prescribed. And we deal with “wrap around” problems like housing and employment.
So a lot of people are talking about the next step in harm reduction: supervised injection sites (SIFs), which would allow people to shoot up under the supervision of medical professionals, with clean needles and cotton balls and everything else. It’s pretty controversial, because some people say it’s essentially encouraging people to use heroin. What do you think?
If I was king of the world, I would say open one now. To me, it’s not about whether I think it's morally right or not. SIFs have been running for long enough in other countries that you can step back and look at the impact, and the numbers are good: There's fewer overdoses. In Norway, they even have a heroin clinic there. Not a methadone clinic. A heroin clinic. We're looking into things like that. Overdoses go down, new cases of HIV go down, and new cases of hepatitis C go down. From an evidence-based standpoint, I can't help but be on board for it. I think more and more people are beginning to understand that jail is not the answer and that addiction is a disease and it needs to be treated like a disease, and not punished.
Interview has been edited and condensed for clarity.