Jean McGuire
Jean McGuire
Interviewed on October 10, 2022 over Zoom
Recorded by Corinne Beaugard
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Summary: Jean’s introduction to harm reduction came after a series of challenging personal and professional transitions that left her looking for work. Her friend who worked at a methadone clinic needed help writing their human rights agenda and called Jean. Jean took the position and was involved in all tasks at the clinic from toxicology screens to sedation monitoring. She left the position feeling that the system could be improved. Her next engagement with harm reduction was through her position as a lobbyist at the AIDS Action Council from 1987-1991. During this period, there was less political will behind the harm reduction movement.
In the mid-90s Jean was appointed the Assistant Commissioner and Head of the HIV/AIDS Bureau (1996-2000/ 2003) and advised John Auerbach, the Commissioner of Public Health. Jean was well poised to make the case for harm reduction, with her civil rights and anti-discrimination lenses, as well as a poverty orientation (“preferential option for the poor”). These frameworks were bolstered by her education in epidemiology. She reflected on the importance of strategy, developing best practices, and the capacity to argue the case from all sides.
During her time at the Department of Public Health (DPH), the agency was focused on decriminalizing syringe possession, syringe distribution, and syringe access at pharmacies. To roll out syringe access at a meaningful scale, they had to build the science and support within DPH and the state government. When she started in her position, state laws permitted 10 distribution sites, but only four were operational in Boston, Cambridge, Northampton, and Provincetown. Other municipalities were not interested in housing these programs. Cambridge was a leader in developing public health infrastructure to distribute syringes and was able to do so because of effective relationships with public safety.
Jean talked about how the harm reduction movement’s momentum created functional synergy across sectors- shelters, hospitals, public safety, community centers, and city council members. It wasn’t always like that, she said, “In the beginning it was people sticking their necks out at every level.” Harm reduction is relational work- a horizontal and vertical movement, with reliable thoughtful, and trustworthy people at every level of the movement. Amidst progress they encountered many challenges. She talked about how increased syringe distribution meant syringes were showing up in places they didn’t used to. The folks running the exchanges needed to care about that and work on improved collection, for example, or it risked their ability to continue. Courage was necessary to overcome these bumps in the road.
Managing secondary distribution- or giving syringes to one person who could share with their partner or community members- was a logistical and legal challenge during these years. Though MA did not have a one-to-one exchange rule, there were limits on their ability to distribute syringes to drug users who did not show up at a site themselves. The importance of secondary exchange was brought to their attention at a state and national level in the cases of women who received syringes from their male partners. With only four legal sites, they needed to maximize access to syringes through secondary distribution. In practice people working at exchanges increased distribution by limiting their questions. They did not ask people where they came from or whether they were going to engage in secondary distribution. During this time, Gary Langis was on trial for secondary distribution outside of sanctioned exchange zip codes. Jean testified on his behalf and spoke to the necessity of increased distribution from a public health perspective. Gary was not convicted.
She made an interesting point about the integration of linkage to care within syringe exchange settings, though, she notes, some were against this because it “tainted” the purity of the harm reduction mission. However, Jean points out that by increasing the connection, medical providers became more familiar with harm reduction and could incorporate it into care. Despite increased awareness and effective medications like buprenorphine and naloxone, the stigma and aversion to treating patients with addiction has prohibited maximum uptake.
Interviewer: Corinne Beaugard
Interview language: English
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