SAN FRANCISCO — Heroin shooters, speed users, pot smokers and even some men and women who now are drug-free convene regularly in this city's gritty Tenderloin district — not for treatment, but to discuss public health policy and share their experiences free from shame or blame.
On this particular evening, the dozen or so in attendance had some pressing questions, including how those heading to a users' conference in Oregon this fall would obtain their methadone or safely procure other drugs to use in a supervised injection room.
"We have to figure that out," said Isaac Jackson, the group's senior organizer. The 56-year-old, who holds a doctorate in media arts and sciences from MIT, turned to speed in his mid 30s. "Nobody should (skip) this conference because they're afraid they're not going to get their dose."
This is the San Francisco Drug Users Union, one of a few such groups in the United States and part of a growing worldwide movement of thousands who, according to the International Network of People Who Use Drugs, are demanding a voice "in decision-making processes that affect our lives."
In the coming months, members of the San Francisco group plan to testify before a city panel on housing discrimination; co-host the first conference in the United States by and for drug users; and hold a design contest for a safe-injection site similar to one in Vancouver, British Columbia, where public health workers provide sterile needles and intervene in cases of overdose. They also have crafted a manual for medical personnel, to be released this month, in hopes that drug users will get better emergency care.
The group's ultimate goal is decriminalization, an unlikely prospect but one increasingly debated by policy analysts who contend that the four-decade "war on drugs" has exacerbated social ills.
Linked to the harm-reduction movement — a philosophy that aims to reduce disease, injury and death among drug users without passing judgment or demanding abstinence — the union mostly hopes to put a face on those whom, Jackson said, "most people despise."
"People say, 'You're a drug user, you brought this on yourself,' " Jackson said. "Do people say that when you're 300 pounds with heart problems from eating McDonald's every day?"
Barbara Garcia, director of San Francisco's Department of Public Health, opposes the safe-injection site for now but said she welcomes the union's organized advocacy. "We may not be able to always give them what they want," Garcia said, "but we're here to listen."
The union — with about five dozen members who attend meetings — eschews words like "addict" and "abuser." It neither encourages nor discourages use. At the recent meeting, one man who took a long restroom break emerged to alternate between dozing on the couch and scratching himself, signs of an opiate high.
Jackson said that injecting is not condoned at either the biweekly meetings or in individual workshops, but "we know who our members are." A biohazard box is available in the restroom for dirty syringes. The door latch is flimsy by design so it can be opened if someone hits the floor.
The rules are simple: No dealing at meetings. You can be high, but don't be disruptive.
San Francisco police haven't interfered with the union's activities, focusing drug enforcement on dealing and related street crimes. Reflecting that ethos, San Francisco District Attorney George Gascon recently said that he believes drug use "is a health problem, not a crime problem, and should be dealt with accordingly."
The leaseholder on the cozy office space members call their "community living room" is the Harm Reduction Therapy Center, which also provides the union with financial support. The rug is faded, the couch comfortable and the walls covered with straight-talking pamphlets about drugs, disease and overdose.
The harm reduction philosophy has deep roots in this city, whose public health department in 2000 was the first in the nation to adopt the approach.
The city funds an overdose prevention education group that prescribes antidotes and provides training on administering them to opiate users. San Francisco General Hospital has established a wound-care clinic for injection drug users.
Half an hour before a recent meeting, the center's security gate creaked open and Gary West, who became a paid organizer after proving himself a reliable and enthusiastic union member, welcomed others as the blues wafted from a small boom box. There is an easy vibe of shared affinity.
Skyler Foster, 53, has been a regular since he heard about the union two years ago while at a clinic that treats and educates drug users with Hepatitis C.
A gaunt man with graying hair, Foster weighed in on the group's medical manual and asked about the upcoming design contest for the safe-injection site.
"It's important that this type of advocacy is around," Foster said.
Lydia Blumberg, 34, no longer uses methamphetamine but said she felt a weight lifted the minute she walked into her first union meeting. An arrest record for "being high in my own house" has prompted landlords to turn her away, she said.
Yet the deepest wounds come from what she described as society's demonization of drug users.
"I felt I didn't deserve to be loved or respected by people who didn't use illegal drugs," Blumberg said.
Drug users unions first took shape in the Netherlands in the 1970s with the Junkiebonden, which sought to stem the spread of Hepatitis C through distribution of clean needles, said Merrill Singer, a University of Connecticut anthropologist.
The HIV/AIDS epidemic added urgency to such efforts, and in time groups led by public health advocates took root in Europe, Australia and Canada. The Vancouver Area Network of Drug Users, now funded by public health officials, was formed in 1998 and played a key role in creating the Western hemisphere's first — and so far only — safe-injection site in 2003. Europe has nearly 100 such facilities.
The movement is relatively new to the United States, Singer said, because of "racism and class discrimination, which are intimately bound together in our conception" of drug users.
America's first official drug users union formed in New York in 2005, followed by one in Seattle that more recently morphed into the Urban Survivors Union.