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Harm Reduction, Drug User Health, and the Transformation of Social Policy in New York

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Harm Reduction, Drug User Health, and the Transformation of Social Policy in New York City University of New York (CUNY) CUNY Academic Works All Dissertations, Theses, and Capstone Projects Dissertations, Theses, and Capstone Projects 9-2015 Getting Out of the Ghetto: Harm Reduction, Drug User Health, and the Transformation of Social Policy in New York Rachel Faulkner-Gurstein Graduate Center, City University of New York How does access to this work benefit ou?y Let us know! More information about this work at: https://academicworks.cuny.edu/gc_etds/918 Discover additional works at: https://academicworks.cuny.edu This work is made publicly available by the City University of New York (CUNY). Contact: [email protected] GETTING OUT OF THE GHETTO: HARM REDUCTION, DRUG USER HEALTH, AND THE TRANSFORMATION OF SOCIAL POLICY IN NEW YORK by RACHEL FAULKNER-GURSTEIN A dissertation submitted to the Graduate Faculty in Political Science in partial fulfillment of the requirements for the degree of Doctor of Philosophy, The City University of New York 2015 ©2015 RACHEL FAULKNER-GURSTEIN All Rights Reserved ii This manuscript has been read and accepted for the Graduate Faculty in Political Science to satisfy the dissertation requirement for the degree of Doctor of Philosophy. John Mollenkopf ____________________ _______________________________________ Date Chair of Examining Committee Alyson Cole ____________________ _______________________________________ Date Executive Officer John Mollenkopf _________________________________________________________________ Joe Rollins _________________________________________________________________ Janet Gornick _________________________________________________________________ Supervisory Committee THE CITY UNIVERSITY OF NEW YORK iii Abstract GETTING OUT OF THE GHETTO: HARM REDUCTION, DRUG USER HEALTH AND THE TRANSFORMATION OF SOCIAL POLICY IN NEW YORK by Rachel Faulkner-Gurstein Adviser: Prof. John Mollenkopf This dissertation is a qualitative study of the emergence and evolution of harm reduction drug policies in New York City. It examines harm reduction as a case of the institutionalization of a public health policy movement. Harm reduction seeks to treat the medical and social consequences of drug use without requiring abstinence. The dissertation examines the process by which harm reduction has managed, in the words of one informant, to “get out of the ghetto” and become increasingly integrated into New York’s public health establishment. Harm reduction has undergone three stages of institutionalization. It began as an activist policy movement. This was followed by a period of partial institutionalization, characterized by grant funding, organizational autonomy and limited state support. Finally, with harm reduction’s integration into Medicaid as well as the widespread adoption of naloxone overdose prevention strategies, it has assumed a mainstream position within the health system. This dissertation argues that institutionalization has changed harm reduction at the grassroots level and also contributed to wider changes in the design and delivery of public health in New York State. While some activists remain skeptical of what they see as harm reduction’s co-optation, the process has created new relationships between marginalized communities and the state, iv and led to new forms of social and political inclusion for drug users. This research demonstrates the effectiveness of social movements as policy actors and provides a case study of progressive policy change during a period marked by the privatization and restructuring of social welfare provision. The harm reduction approach, pioneered by drug users and public health activists, is now being applied to the health system more broadly. v Acknowledgements This dissertation would not have been completed without the help and support of a great many people. First, I’d like to extend my profound thanks to the dedicated and knowledgeable service providers, users activists and public health officials who generously took the time to teach me about harm reduction in New York. I first entered the field as a naïve Canadian, keen to learn but not always the most tactful. The people I met throughout the city at syringe exchanges, government offices, protest rallies, and everywhere in between showed me bottomless patience and a real willingness to help and support my research. Confidentiality prevents me from identifying individuals by name, but I have been and will remain deeply impressed with the great efforts so many have made to bring about change in the way drug users are treated in New York. It is my hope that my research reflects their experience faithfully. I am grateful also to my excellent committee and the many professors who have provided me with guidance on this project. Thanks especially to my advisor John Mollenkopf whose knowledge of New York politics is as incisive as it is vast, and Joe Rollins whose thoughtful comments have pushed me to be a more careful and strategic scholar. Their confidence in me has been a source of encouragement when I couldn’t see my way forward. Thanks also to Nicole Marwell who provided me with comments and support during the proposal phase, and to Janet Gornick for stepping in and helping me get over the finish line. My time at the Graduate Center would have been miserable indeed without the solidarity and friendship of excellent friends and colleagues. I’d especially like to thank Joyce Rivera whose unshakable political commitment, great intellect, and deep empathy showed me that vi there is no contradiction between being an activist, an academic, and a caretaker. Thanks also to Kate McLean for being a knowledgeable sounding board for my half-baked theories, Alex Zamalin for his political science department camaraderie, and the many others who made the journey though graduate school as rewarding as the destination. Kristin Hole, Daniel Cohen, David Wachsmuth, Esmé Webb, Dory Kornfeld Thrasher, Hillary Angelo, Ronna Popkin, Lee Naught and the volunteers at Bluestockings Feminist Bookstore, and others too numerous to name made New York live up to its reputation as a hotbed of lefty intellectuals. I am also grateful to Greg Falkin and George DeLeon at NDRI for inviting me to be a fellow in NIDA’s Behavioral Sciences Training program, and to the Social Sciences and Humanities Research Council of Canada whose financial support made this research possible. I moved to London, UK in 2012 and have been very fortunate to find a community of scholars and friends in this new land. The NYLON group has been a critical lifeline to a supportive academic network, and I am deeply indebted to Anna Bull, Ruth Sheldon, Katherine Robinson, Liene Ozolina-Fitzgerald, Fran Tonkiss, Vic Sidler, and the many other regular workshop attendees who have been such thoughtful and generous readers over the past three years. Thanks also to the London School of Economics Social Policy Department for giving me an institutional home away from home. As was true of New York, living in London is made so much richer by an excellent crew of friends. Thanks to Melissa Fernandez, Isaac Marrero-Gillamón, Farah Jamal, Eric Woods, Paula Durán, Austin Zeiderman and Michelle Kelly for easing my entry into British life. vii There is nothing that will settle you faster or more thoroughly into a new place than having a child. Which is exactly what we did in January 2014. The people we met in our NCT class have become friends, and we now have the pleasure and privilege of watching our children grow up together. Carrie Friese, Stephanie Miller and their daughter Hazel, Alicia Blum- Ross, Shez Sherrard and twins Penny and Abe, and the other mamas and papas and kiddos that make up our social circle are a vital resource that we rely upon for solidarity and hand- me-downs. Thanks especially to our expat family, Amanda Sheely, Tom Kemeny and their boys Milo and Nicholas for being a constant source of advice and support. Dinners in the park after nursery gave me something to look forward to at the end of a day of writing, and Sundays at the pub kept me sane throughout the long months of dissertating. No list of thank yous would be complete without an expression of deep and heartfelt gratitude to my crew of best girlfriends. Sheena Purcell, my oldest friend, can always be relied upon for a gossipy Skype session. She welcomed her third son to the world only six months after I gave birth to my daughter, and her wisdom and experience in the ways of parenthood have been invaluable to this newbie. In 2006, Ashley Thorvaldson and I packed our lives into the back of my ’85 Nissan pickup truck and drove east from Vancouver to Ontario. Now, nine years later, she will marry her Easterner only four days before I defend this dissertation. Her wit, humor, warmth and charm make her among my favorite people and I am thrilled that this summer will see the culmination of many years of heartache and hard graft, for both of us. When Alison Powell and I first met in 2010, it was immediately clear that we would be friends. Our friendship has been built on a bedrock of shared experiences—we both got married in the same now-defunct Polish catering hall, we both had babies while in graduate school, we both love to talk about our mothers—and our Skype chats have become a heavily relied upon lifeline to this reclusive author. Her viii brilliance, hard work, and commitment to family have been an inspiration and I am profoundly grateful to count her among my dearest friends. A lucky twist of fate has brought Sue Pell and I together in the same city again, after years of living on opposite ends of the continent. Sue has been a constant presence in my life since we first met as co- workers in 2004. We have stood by each other through all the ups and downs life has thrown at us. I was honored to have supported Sue at her wedding this summer, and I know I would not be writing these acknowledgements to preface a completed dissertation without her support and encouragement over the years.
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