Monique Tula

Monique Tula

Interviewed on September 28, 2022 over Zoom

Recorded by Corinne Beaugard

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Summary: Monique walked into harm reduction by accident. After moving to Western Massachusetts in 1995, she needed work and saw a posting for an administrative position at FPCWM, eventually Tapestry Health Systems. She had no experience in harm reduction settings but was offered the position. By 1997 she started clinical duties and was conducting HIV testing. Eventually, she moved to Cambridge and took a job at Cambridge Cares about AIDS. Despite the initial draw, working in direct service was unsustainable- it was draining and left her feeling guilty. The generosity of spirit required on the frontline left her with too little to care for herself at the same time. At Cambridge Cares about AIDS Monique transitioned to management, which allowed her to see harm reduction as her life’s work, a path with longevity.

In her new role, Monique was required to become a researcher and social policy advocate to undertake the work she wanted to. She shared some examples: Monique supported the underground naloxone acquisition, purchasing supply from Dan Bigg in Chicago. These purchases were primarily funded out of individuals’ pockets. Because Monique had power within her organization, she redirected funds originally intended for research to purchase naloxone. At the time, naloxone was considered drug paraphernalia and possession could be cause for arrest. Eventually she became concerned that distributing naloxone could endanger the staff, the participants, and ultimately the organization. She sought internal approval from the organization’s Board of Directors to continue distributing naloxone. They denied the request, citing lack of information/ evidence about naloxone’s efficacy.  She and a board member got to work. They designed a study to demonstrate the efficacy of naloxone and started to build the evidence base. Their research was informal but rigorous and helped lay the foundation for Massachusetts organizations to embrace naloxone. 

I asked Monique why she thinks harm reduction has grown in popularity over the years. “Crisis,” she said. She offered a few examples. In 2014 in Scott County Indiana, Opana was the local opioid of choice. With the genesis of prescription monitoring programs, it became increasingly difficult to find, which led to increased heroin use and injection drug use. The demand for syringes surged, but there was no way to acquire them. The county saw an unprecedented HIV outbreak with 215 new cases in 2014-2015. This outbreak pressured local leaders to sanction emergency syringe exchanges. 

The flood of young, white opioid users was another crisis leading to change in public opinion. Their moms, she said, were excellent advocates. She spoke with admiration for their determination, and acknowledged their proximity to power catalyzed funding, policy change, and public support.  The shift in public narrative about drug use at the time demonstrated how racism and classism otherwise obscures drug users from public attention and empathy. She did not resent them, she said. “There was too much death to be adversaries- even with the cops.”  Events like these facilitated greater empathy from the public, but the delayed response cost too much. 

At the end of the conversation, I asked Monique whether things have changed over the past 30 years. Yes and no, she replied. Yes, because HIV is no longer the crisis it was, syringe access programs are more commonplace, paraphernalia laws are less strict, and Good Samaritan Laws and naloxone standing orders are in place. And no because the circumstances underlying drug use are the same and just as virulent. There is not enough investment in basic needs, adequate food, shelter, and education. Without amending these social ills, harm reduction, a mere band aid, cannot truly “work.” 

Interviewer: Corinne Beaugard

Interview language: English

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