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Award-winning journalist shows what European countries can teach the U.S. about containing opioid crisis Date: 08/11/20

Taylor Knopf

By Taylor Knopf

In 2018, I hijacked a personal vacation and produced a six-part series called “Lessons from Abroad” on successful harm reduction methods Europeans use to support people who use drugs.

It all stemmed from a small grant opportunity. That summer, my editor asked if I had any solutions-based story ideas we could pitch to Solutions Journalism Network. I had written about the opioid crisis in North Carolina and found that, despite best efforts, our drug-related death and disease statistics were grim.

Meanwhile I had read that France and other European countries had experienced a heroin epidemic a few decades ago, and how Paris had recently opened a drug consumption room (or safe injection site). These are supervised health facilities where people can use drugs in a clean, safe, non-judgmental space. After doing some research, it was clear that the methods France was using to combat drug-related disease and overdose were working.

My husband and I already had airline tickets to Paris for mid-November, so I proposed tacking on a few extra days to my trip to visit the safe injection site and other programs that serve people using drugs.

Still more research into the history of harm reduction in France, showed that the Swiss pioneered many of the more controversial (but effective) approaches. Since Geneva is only a three-hour train ride from Paris, I included Switzerland as well.

While in Europe, I observed innovative harm-reduction programs unlike anything I’ve seen in my previous reporting. Harm reduction strategies aim to lessen the damage caused to a person by their use of drugs. Needle-exchange programs fall under this category, as do safe injection sites, the latter of which are not legal in the United States. The Swiss also embraced solutions such as access to an array of treatment options, including prescription heroin. After introducing these programs, drug overdose deaths dropped by 64%, HIV infections dropped by 84% and home thefts dropped by 98%.

With the help of interpreters, I talked to addiction psychiatrists, doctors, nurses, social workers, educators, policy influencers, chemists and drug users.

Tip: Budget for interpreters. Using interpreters was much more expensive than I anticipated. It can be helpful to learn some key phrases and words before you go. I downloaded a French language app and practiced a couple of minutes a day in the months leading up to the trip.

I’m proud of how the series turned out, especially since it was my first time reporting outside the United States. This series has been of interest to thousands of people, and the stories trended on our website a year later and were the top read on the North Carolina Health News site in 2019.

Gurvan is a nurse at the drug consumption room in Paris and has been there since it opened in 2016. He said he talks to users a lot and wants them to feel comfortable. “As long as we don’t judge them for weeks, months, years, we know they will come to us when they need something,” he said. (Photo: Taylor Knopf)

But it was a little difficult to get the whole project started.

Having no connections in either country, I started the long process of asking around, using sources and fellow reporters to find someone who knew someone, who knew someone, who could connect me to the right people. I ended up scheduling a Skype call with an addiction expert in Switzerland who became key to unlocking so many doors. He not only gave me an overview of how harm reduction worked in his country, but also recommended several people to interview, programs to visit and research to read in advance.

Tip: Ask for research, reports and papers to read before the trip and get the more of your research done before you leave.

Because France is part of the European Union, there were some great databases that I could easily navigate. Switzerland, however, is not part of the EU. I asked experts to point me to different data sets, and not all were in English. That was a challenge, so I sent my findings to the Swiss experts to verify before publication.

In Switzerland, I scheduled visits to a safe-injection site and two heroin-assisted treatment facilities in Geneva and Zurich. Pure grade heroin is prescribed and used as an addiction maintenance medication, such as methadone is used in the United States. Because these are medical facilities, I had to sign media waivers in advance. I also requested the opportunity to speak to a patient of the heroin-assisted treatment program.

One patient was so open to talking about her life story that she suggested going to a cafe across the street. This setting was much more comfortable than the clinic for an in-depth interview. After over an hour of conversation, I had great material.

Tip: Have a detailed schedule with times, addresses and people to contact on site. Look them up in advance and get a public transit map. I rented Airbnbs closest to my first stop in each city so that I could find it easily and be on time for my first interview.

A staff worker at the heroin-assisted treatment facility in Geneva prepares injectable heroin before the patients arrive. (Photo: Taylor Knopf)

My Swiss expert also connected me to a point person in the French harm-reduction network, whom I spoke with on the phone before the trip. In France, the harm-reduction strategies are not quite as cutting edge as they are in Switzerland. Instead, the French work to support drug users through more than 300 full-service harm-reduction centers that offer wrap-around services, such as clean needles, medication-assisted treatment, counseling, medical treatment, hot showers, laundry machines, life skills classes and places to sleep. In addition to the harm-reduction centers, France also has 480 addiction-treatment facilities.

In Paris, I visited a drug-consumption room and a harm-reduction center that doubled as a shelter for those who use drugs. I also visited a harm-reduction center that offered to check illegal drugs for harmful additives. To learn more about harm reduction in rural areas, I spent a day reporting in Bordeaux.

Tip: When scheduling an international reporting trip, don’t just send emails. Call people in advance. This helped me form connections with sources in both countries. These calls also allowed me to explain the purpose of my trip, while navigating some of the language barriers.

Once I was on the ground, I said “yes” to every opportunity, even if it seemed to be something I already saw at another location. My goal was to get more content than I could possibly use just in case something fell through later. I also learned that not every interview is rich with content, especially with a language barrier. Some of the interviews I was looking forward to most didn’t yield as much as I anticipated. There are so many people I talked to who informed the article, but some were too difficult to quote.

I bought a new, reliable recorder before the trip, and would sometimes use two recording devices just to be certain I’d capture what I needed.

NC Health News reporter Taylor Knopf interviews Thilo Beck, head of psychiatry at Arud Centre for Addiction Medicine inside a heroin-assisted treatment facility in Zurich, Switzerland. (Photo: Andy Specht)

Tip: Take more photos and video than you need.

I didn’t publish the majority of the photos and video I took, but they helped me add detail and color to my stories later on. (I’m lucky to have a husband who is also a reporter. He tagged along on a tour of a heroin-assisted treatment facility in Zurich and took video and photos for me.)

Though I view the entire trip as a success, I don’t know that I would recommend tacking on a huge reporting project to a vacation. While it was all interesting and exciting, I felt like I needed a vacation when I got home.

Taylor Knopf (@tayknopf) is a health care journalist covering mental health for North Carolina Health News. Earlier this year, she won first place in the Public Health (small) category in AHCJ’s Awards for Excellence in Health Care Journalism contest for a six-part series, Lessons from Abroad.