Dan Bigg saved tens of thousands of lives, perhaps hundreds of thousands. Mothers, daughters, sisters, brothers, sons, fathers—countless loved ones survived addictions thanks to the work of the Chicago native and those he inspired.
Every time an opioid overdose is reversed by a friend, family member, or other non-medical person using the antidote naloxone anywhere in the world, Bigg deserves credit. He was the first to free this lifesaving medication from hospitals and ambulances and get it onto the street where, when reversing overdoses, every second counts. Without Bigg’s work, an opioid overdose crisis that has taken around 300,000 lives since 2002 would almost certainly have killed many times more.
But in a loss that stunned his family, friends, and an entire movement that he’d helped build, Bigg was found dead in his home at age 59 on August 21. This week, his death certificate was released by the Cook County Medical Examiner’s Office. It showed that he died of multidrug poisoning. Bigg, according to those close to him, suffered from chronic insomnia and his widow, Karen, suspects he may have been desperately trying to sleep.
When someone who devoted his life to fighting overdose dies from one, the natural tendency is to try to hide what happened. Instead, as they mourn, Bigg’s family and colleagues see his death the way he saw his own life: as an opportunity to help others and to reduce the shame and stigma that actually increase overdose death risk and reduce the odds of recovery. Today’s toxic and rapidly changing drug supply makes that task much more difficult.
The substances found in his body included heroin, two benzodiazepines (one that Karen says was prescribed for his insomnia), methadone, fentanyl, and acetylfentanyl. All the drugs other than the sleep medication he was prescribed appear to have been sold together as “heroin” in one toxic dose of powder, she said. By itself, fentanyl overdose can kill within seconds to minutes—let alone when mixed with other respiration-slowing drugs like benzodiazepines and different kinds of opioids.
The cause of Bigg’s death, however, in no way repudiates the cause to which he devoted his life.
Bigg was one of the leading proponents of “harm reduction”—the idea that efforts to fight drug problems should focus on minimizing damage, rather than continuing the clearly futile effort to prevent all use or highs. Since the 1980s, harm reduction has gone from an idea suggested by a psychologist in a small British newsletter to an international movement with thousands of adherents.
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Study after study of harm-reduction techniques show that they are more effective than the “just say no” approach: needle exchange programs, for example, have been shown around the world to reduce HIV infection rates while not increasing teen drug use. Contrary to fears about prolonging or encouraging addiction, syringe exchanges actually make it more likely for people to seek help and recover from addiction.
Similar findings are seen with safe-injection facilities: although millions of injections by thousands of people in countries like Australia, Canada, Germany, and the Netherlands have taken place in these medically-supervised rooms, no overdose deaths have been reported in them. They don’t increase youth drug use, but do serve as a pathway to recovery.
The naloxone programs Bigg pioneered have also proved highly effective: One study in Massachusetts, for example, found that communities with greater access to naloxone and larger numbers of lay people trained to use it had almost a 50 percent reduction in overdose deaths compared to those that did not scale up such programs.
Bigg’s work paved the way for today’s massive expansion of naloxone distribution; in many states, it can now be purchased from pharmacies without a prescription. Personally, Bigg himself reversed at least six overdoses—and the agency he founded, the Chicago Recovery Alliance (CRA), reported nearly 11,000 saves prior to 2016.
But his legacy is far more than simply handing out naloxone—though he did tons of that, often carrying duffel bags full of the stuff to conferences to urge those who wanted to help to start programs in their own communities. Dozens took him up on it: by 2014, there were more than 644 known naloxone distribution sites across the US.
From the time Bigg founded the first program in Chicago in 1996 to 2014, more than 150,000 naloxone kits were distributed and over 26,000 overdose reversals reported in America. (Note: since reporting is not required, there were almost certainly many more). In 2018, according to interim communications director Maya Doe-Simkins, CRA expects to distribute 100,000 kits.
His legacy as a mentor and an exemplar of the compassionate philosophy of harm reduction may be just as important. Over the years, dozens of people have told me how meeting Bigg was a life-changing experience; as interim CRA executive director Greg Scott put it, “Nobody has influenced my moral character more than Dan has, with the exception of my parents.” Kindness and unconditional love were the heart of his work.
Scott said that before he met Bigg, he had often felt ashamed about his own drug use. “It was transformative intellectually and emotionally and autobiographically,” he said, adding that he’d never previously met anyone who showed such love and compassion toward people like him. “In that one instant, Dan gave me permission to be who I am and just love…Dan activated in me that kind of unconditional self-regard.”
Bigg had planned to participate in last week’s Harm Reduction Conference, held in New Orleans, which may have been one of the largest such gatherings ever held. More than 2,000 people attended—and nearly every speaker on every panel I attended noted their personal connection to Dan and their grief over his loss.
In a rapidly arranged ceremony to give out a new award in his name, Karen spoke eloquently. “Dan was my anchor of inspiration and I know everyone here feels his loss,” she said. “His death throws us into a sea of uncertainty, but someone will throw us a lifejacket. It’s us. We’ll hold each other up.”
She added, “We often talked about how living exists in that complicated grey area and in the murkiness of that grey area, there isn’t always an answer. What works for you doesn’t work for me. What worked yesterday is a mistake today. Stigma and shame and silence often result.”
The winner of the award, Louise Vincent, was overcome as she accepted it. For more than a decade, Vincent ran what was likely the largest underground needle exchange program in the American south—and using naloxone, she personally reversed hundreds of overdoses. Although she lost a daughter to overdose in a rehab that unaccountably failed to have naloxone on hand—and in the same year, lost a leg due to an infection—harm reduction keeps her going.
“I loved Dan and he was an awesome mentor to me,” she said in her acceptance speech. “It has been harm reduction and this work that has sustained me when my daughter died. It’s been harm reduction and this work when my leg was gone. It’s harm reduction and this work that keeps me alive every day. I know that people who use drugs can find love here…and I believe that’s what Dan intended.”
Karen told me her husband always stressed that people who use drugs don’t “deserve to die inevitably of overdose. So the way he died doesn’t take away from his human dignity, just as it doesn’t for anyone else who dies of an overdose. There shouldn’t be shame and stigma around it.”
Suzanne Carlberg-Racich, interim associate director of the Chicago Recovery Alliance and a longtime friend of Dan’s said, “I understand when people take risk and I feel no conflict about that whatsoever. Human beings take risks, without [that], life is meaningless.”
But when someone dies while mountain climbing or hang-gliding—or even in a car crash because they carelessly didn’t look both ways when crossing the street—they aren’t judged in the same way that overdose is. Although a person who dies on Mt. Everest is every bit as selfish for taking on needless risk despite the harm it might do to their family, a person who dies while taking drugs is viewed in a much harsher, more shameful light.
Even worse, people taking other risks can far more easily protect themselves: It’s not as though seatbelts, car mirrors, stoplights, belay ropes, and other forms of protection and knowledge about how to use them are hidden or even illegal. However, while protecting oneself while engaged in sports or driving isn’t seen as unduly encouraging others to take foolish risks, doing the same or even providing information about how to do the same with drugs is dismissed and sometimes actually criminalized.
Bigg founded and skillfully ran a complex agency for more than 20 years; this year, CRA’s budget was over a million dollars, Doe-Simkins said. He helped the harm reduction community redefine recovery, which he saw as making “any positive change” rather than simply demanding abstinence. He raised three children; his youngest daughter, who volunteered with CRA, just turned 15. He mentored hundreds and saved thousands.
But even he was no match for today’s toxic illicit opioids, the products of a chaotic and constantly changing illicit market. As Bigg often put it, while naloxone access is necessary, it is not sufficient. Fentanyls and other synthetics are poisoning the drug supply. They are too cheap, too easily made, too easy to hide, and too potent to be eliminated by prohibition or be outcompeted by drugs with a more complex supply chain, like heroin. Ultimately, the only way to save the lives of people who use drugs is to provide a safe, legal, appropriately regulated supply.
We can’t afford to keep losing people like Dan Bigg.
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