10 Innovative Ideas That Propelled America Forward in 2016

The most contentious presidential election in modern history offered Americans abundant reasons to shut off the news. But if they looked past the front page’s daily jaw-droppers, our countrymen would see that there’s plenty of inspiring work being done. At NationSwell, we strive to find the nonprofit directors, the social entrepreneurs and the government officials testing new ways to solve America’s most intractable problems. In our reporting this year, we’ve found there’s no shortage of good being done. Here’s a look at our favorite solutions from 2016.

This Woman Has Collected 40,000 Feminine Products to Boost the Self-Esteem of Homeless Women
Already struggling to afford basic necessities, homeless women often forgo bras and menstrual hygiene products. Dana Marlowe, a mother of two in the Washington, D.C., area, restored these ladies’ dignity by distributing over 40,000 feminine products to the homeless before NationSwell met her in February. Since then, her organization Support the Girls has given out 212,000 more.
Why Sleeping in a Former Slave’s Home Will Make You Rethink Race Relations in America
Joseph McGill, a Civil War re-enactor and history consultant for Charleston’s Magnolia Plantation in South Carolina, believes we must not forget the history of slavery and its lasting impact to date. To remind us, he’s slept overnight in 80 dilapidated cabins — sometimes bringing along groups of people interested in the experience — that once held the enslaved.

This Is How You End the Foster Care to Prison Pipeline
Abandoned by an abusive dad and a mentally ill mom, Pamela Bolnick was placed into foster care at 6 years old. For a time, the system worked — that is, until she “aged out” of it. Bolnick sought help from First Place for Youth, an East Bay nonprofit that provides security deposits for emancipated children to transition into stable housing.

Would Your Opinions of Criminals Change if One Cooked and Served You Dinner?
Café Momentum, one of Dallas’s most popular restaurants, is staffed by formerly incarcerated young men without prior culinary experience. Owner Chad Houser says the kitchen jobs have almost entirely eliminated recidivism among his restaurant’s ranks.

This Proven Method Is How You Prevent Sexual Assault on College Campuses
Nearly three decades before Rolling Stone published its incendiary (and factually inaccurate) description of sexual assault at the University of Virginia, a gang rape occurred at the University of New Hampshire in 1987. Choosing the right ways to respond to the crisis, the public college has since become the undisputed leader in ending sex crimes on campus.

This Sustainable ‘Farm of the Future’ Is Changing How Food Is Grown
Once a commercial fisherman, Bren Smith now employs a more sustainable way to draw food from the ocean. Underwater, near Thimble Island, Conn., he’s grown a vertical farm, layered with kelp, mussels, scallops and oysters.

This Former Inmate Fights for Others’ Freedom from Life Sentences
Jason Hernandez was never supposed to leave prison. At age 21, a federal judge sentenced him to life for selling crack cocaine in McKinney, Texas — Hernandez’s first criminal offense. After President Obama granted him clemency in 2013, he’s advocated on behalf of those still behind bars for first-time, nonviolent drug offenses.

Eliminating Food Waste, One Sandwich (and App) at a Time
In 2012, Raj Karmani, a Pakistani immigrant studying computer science at the University of Illinois, built an app to redistribute leftover food to local nonprofits. So far, the nonprofit Zero Percent has delivered 1 million meals from restaurants, bakeries and supermarkets to Chicago’s needy. In recognition of his work, Karmani was awarded a $10,000 grant as part of NationSwell’s and Comcast NBCUniversal’s AllStars program.

Baltimore Explores a Bold Solution to Fight Heroin Addiction
Last year, someone in Baltimore died from an overdose every day: 393 in total, more than the number killed by guns. Dr. Leana Wen, the city’s tireless public health commissioner, issued a blanket prescription for naloxone, which can reverse overdoses, to every citizen — the first step in her ambitious plan to wean 20,000 residents off heroin.

How a Fake Ad Campaign Led to the Real-Life Launch of a Massive Infrastructure Project
Up until 1974, a streetcar made daily trips from El Paso, Texas, across the Mexican border to Ciudad Juárez. Recently, a public art project depicting fake ads for the trolley inspired locals to call for the line’s comeback, and the artist behind the poster campaign now sits on the city council.

Continue reading “10 Innovative Ideas That Propelled America Forward in 2016”

Baltimore Explores a Bold Solution to Fight Heroin Addiction

In the emergency room at George Washington University (GW) Hospital, in D.C., Dr. Leana S. Wen administered anti-inflammatory meds to kids choking with asthma, rescued middle-aged dads from heart attacks and sewed up shooting victims. Unlike a primary care doctor, she knew almost nothing about the strangers wheeled into the frenzied space: their medical history, financial situation and neighborhood all mysteries.
The usual anonymity made it all the more surprising when she recognized a 24-year-old mother of two. Homeless and addicted to opioids, the woman would show up nearly every week, begging for treatment. Without fail, Wen delivered the disappointing news that the next available appointment was three weeks away. Inevitably, the young mom relapsed during that window. The last time Wen saw the young woman, she wasn’t breathing. Her family had discovered her unresponsive, killed by an overdose.
“I always think back to my patient now: she had come to us requesting help, not once, not twice, but over and over again, dozens of times,” says Wen. “Because we do not have the treatment capacity, the people looking to us for help fall through the cracks, overdose and die. Why has our system failed her, just as it is failing so many others who wish to get help for their addictions?”
Last January, at age 32, Wen took a new job as the city’s health commissioner. As the leader of the country’s oldest public health department (established in 1793), Wen devotes much of her attention to an urgent problem: addiction to opioids (a class of drugs that includes heroin, morphine and oxycodone) and prescription painkillers. In the seaside port city of 622,000 residents, two-thirds of them black, heroin addiction grips 20,000 people. Many more pop prescription drugs before turning to heroin, a drug that’s cheaper than ever and more socially acceptable since it can be snorted and not just injected.
Baltimore’s drug addiction is lethal: Last year, 393 residents died of overdoses, a staggering number that surpassed the city’s 344 murders in a year of record gun violence. Long past a criminal “war on drugs,” Wen is implementing a public health response to this medical crisis. Her three-part plan involves preventing overdoses, treating addiction and ending stigma against drug users. By treating addiction as a sickness, not a scourge, she’s now saving lives on a broader scale than any emergency room physician.
“It ties into every aspect of the city. I’ve spoken to kids who question why they have to go to school every morning when everyone in their family is addicted to drugs and doesn’t get up. If we have employees that are addicted or have criminal histories because of their addiction, then what does that mean for a healthy workforce?” asks Wen, a fast talker who regularly works 14-hour days. “This is absolutely something we need to address as a critical public health emergency.”
Tenacious even in childhood, Wen spent the first eight years of her life in post-Mao China, until the 1989 Tiananmen Square massacre forced her politically dissident parents to flee the country. They moved to Los Angeles’s gang-infested neighborhoods like Compton and East Los Angeles, scraping money together from jobs as a dishwasher and hotel maid. With money tight, Wen remembers her aunts choosing between prescription medications, food or bus passes. Never one to wait, Wen enrolled in classes at California State University, Los Angeles, when she was just 13 years old. By age 18, she finished her degree, graduating with the highest honors, and went on to earn her M.D. from Washington University School of Medicine in St. Louis.
Working as a public health professor at GW, Wen spearheaded campaigns to cut healthcare costs, remove lead from homes and design walkable neighborhoods with access to reasonably priced, nutritious food, which caught the attention of Baltimore Mayor Stephanie Rawlings-Blake and landed her a new job.
A key to Wen’s plan for fighting opioid addiction is the distribution of an antidote to reverse a life-threatening opioid overdose. Inhaled through a nasal spray or injected into the upper arm or thigh like an EpiPen, Naloxone instantly revives a person from an overdose with few, if any, serious side effects. During a heroin high, chemicals block pain and induce euphoria — dulling the body to such an extent that the lungs forget to breathe while sleeping or the heart fails to pump adequately. Essentially shaking the brain out of its high, Naloxone creates a 30 to 90 minute window in which medical treatment can be sought. “It truly is a miracle drug,” Baltimore County Fire Chief John Hohman tells the Baltimore Sun. “It takes someone from near-death to consciousness in a matter of seconds.”
There’s only one catch: “You can’t give yourself this medication,” Wen explains. A person in the midst of an overdose often doesn’t have the wherewithal to inject the antidote. “That’s why we need every single person in our city to have access to it,” she adds, explaining that friends, family and community members have the ability to save a life.
In a controversial move, Wen issued a blanket prescription to the entire city last October — meaning anyone can buy the drug from a pharmacist. (For recipients of Medicaid, the price was reduced to $1 at a time when the drug’s price spiked drastically.) Wen sent training videos to jails and hospitals. Health department staffers visited areas notorious for open-air drug markets. Last year, the agency distributed 10,000 units of Naloxone and trained 12,500 residents how to administer it. That’s a big number for a program’s first year, but it’s still only half the number of active heroin users in Baltimore.
Outside of the roughly 30 recorded uses of Naloxone by police officers, there’s little hard evidence whether the drug has saved lives inside the city’s crack houses, parks and underpasses. Using data from Poison Control and other sources, Baltimore estimates Naloxone saved hundreds since 2015. “This remains a vastly underreported statistic,” says Sean Naron, a city spokesperson.
Critics claim that Naloxone encourages risky behavior and perpetuates the cycle of addiction because it removes the risk of death. “Naloxone does not truly save lives; it merely extends them until the next overdose,” Maine’s Gov. Paul LePage, wrote in April when he vetoed a bill that would have expanded access to Naloxone without a prescription. Suggestions like that make Wen balk. She calls them “specious,” “inhumane” and “ill-informed.” “That argument is based on stigma and not on science,” she responds. “You would never say to someone who is dying from a peanut allergy that you’re withholding their EpiPen to make them not eat peanuts.” Similarly for drug addiction, Wen believes there’s no use in talking about recovery tomorrow, if we don’t have the ability to stop a fatal overdose today.
Most in the medical community agree on the dire need for Naloxone. Experts caution, however, that it can’t be the sole response to this health crisis. Like most other cities, Baltimore is still trying to figure out how to effectively direct users whose lives were saved by Naloxone into long-term treatment programs, says Dr. Marc Fishman, medical director at Maryland Treatment Centers, a regional clinic. After reversing an overdose, an addict may “get dusted off and given a piece of paper with some phone numbers. They’re told to call this number today, tomorrow, next week. Maybe somebody will answer. Maybe they’ll take your insurance. Maybe they’ll see you next week or next month,” explains Fishman, who is also an addiction psychiatrist and faculty member at the Johns Hopkins School of Medicine.
Instead, Fishman suggests the medical system needs a “full continuum” from Naloxone administration to addiction treatment. It’s not unprecedented: just look to patients with heart issues, he says. They, too, receive lifesaving drugs to stabilize their ticker, but rather than being discharged immediately, a cardiac clinic assigns a care plan and prescribes maintenance medicines to patients.
Wen fully embraces the idea: she wants to see medication-assisted treatment that fools the brain into thinking it’s getting opioids without getting high or blocks an opioid high after shooting up, alongside housing and supportive social services. In the meantime, she’s set up a 24-hour hotline for users to get treatment option referrals. (Since October, it’s received 1,000 calls every month.) By next year, Wen wants to open a stabilization center where a person can drop in for several days to get sober.
It’s far from the perfect solution, Wen acknowledges. But at the moment, she’s constantly iterating new approaches. Last year, at a meeting of the Mayor’s Task Force on Heroin, Wen asked her colleagues to think of what they could do immediately that wouldn’t need further funding or manpower. That type of thinking fits with the approach she learned from life-or-death decisions in the emergency room: it’s better to act quickly now with what’s available than to wait for an instrument that might never come.
“Everybody is working hard and trying stuff. Some things are succeeding, and some are failing,” Fishman says. “I get a sense of dynamic enthusiasm. People are rolling up their shirtsleeves. I’m sorry that white kids from the suburbs had to start dying before anybody started paying attention, but it’s better late than never.”
Despite Wen’s tireless efforts, overdoses continue to rise in Baltimore. Last year, 260 heroin users overdosed, tripling the 76 intoxication deaths in 2011. Why are people still dying? Wen returns to the idea that a heroin user, on the brink of an overdose, can’t save himself; the rest of the city needs to be on the lookout, which isn’t always the case.
Baltimore’s response to this crisis has the ability to end an epidemic and to unite an ailing community. Wen, who says she’s an optimist by nature, might just find a way to cure a hurting American city after all.
Homepage photo by Spencer Platt/Getty Images
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A Push to Make the Life-Saving Antidote to Overdose Available to All

Through the work of his nonprofit organization, the Chicago Recovery Alliance, Dan Bigg has helped save thousands of lives from drug overdose. Bigg, personally, has saved at least six. One night a few years ago, for example, Bigg was doing outreach work with a group of intravenous drug users in their apartment in Chicago when he noticed that a striking young woman in her 30s had become ashen. Her breathing had slowed dangerously. Her friends said that she had taken heroin. Brushing aside their objections that he would tear her designer clothes — the woman “looked like a fashion model,” according to Bigg — or bring her down too hard from her high, he injected her with an overdose antidote called naloxone and instantly restored her breathing to normal.
A few weeks later, she called him to say thank you: If you hadn’t been there, she told him, my friends might not have realized I was so close to death.
It is a scenario that has grown increasingly common in the United States: accidental overdose from opioids like heroin and, more commonly, prescription painkillers including oxycodone and Vicodin. There are now more deaths from drug overdose — roughly 100 Americans every day, according to the Centers for Disease Control and Prevention (CDC) — than from car crashes or homicides. And in at least half of the overdose cases, people die in the presence of friends or bystanders who could have done something to save them.
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Dan-BiggDan Bigg
Without Bigg, that number would be much, much higher. Since the mid-1990s, the 55-year-old co-founder of the Chicago Recovery Alliance (CRA) has been handing out naloxone, the antidote, to drug users and to their loved ones, who would be in a position to help them in case of an overdose. The life-saving drug, which goes by the brand name Narcan, was previously used only in hospitals and emergency departments (today, many first responders like emergency medical technicians and some police officers and firefighters also have it at the ready) — and it worked well in these settings, except for the fact that many witnesses to overdose don’t call for help or get victims to the hospital in time.
So Bigg pioneered the strategy to get naloxone into more hands. You don’t have to be a health-care worker to use it safely. Naloxone is nontoxic and non-addictive, and it can quickly — typically within seconds, or sometimes minutes — reverse the potentially deadly effects of opioids. It can be injected or delivered through the nose, though so far, only the injectible formulation has been approved by the Food and Drug Administration (FDA). Naloxone also reverses overdose from combinations of drugs — generally, opioid overdoses involve other depressant substances like alcohol or Valium — as long as one of the drugs is an opioid. It’s safe to use because you can’t get high on it; it works by blocking the effect of opioids on the brain, so it produces the opposite of a high: withdrawal.
There has been an upswell of interest in naloxone since the actor Philip Seymour Hoffman was found dead of an overdose on Feb. 2, reportedly with a needle still in his arm and in possession of dozens of bags of heroin. Many in the media have called for making naloxone more widely available, not only for medical workers and first responders, but also for addicted people and their families. It’s an idea that has been around a long time — no one can remember who first came up with it as a way to save overdose victims — but Bigg is credited with being the first to take action on it.
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The second son of a surgeon and a nurse, Bigg started his own public health work as an undergraduate at Claremont McKenna College in California and then at Indiana University. Aiming for a doctorate in psychology, he worked at Chicago’s Lakeshore Hospital in the mid-1980s in one of the first programs in the country to address the connection between injection drug use and the risk of HIV. “I remember reading about what was then called GRID,” says Bigg, referring to the acronym for “gay-related immune deficiency,” which was what health officials called AIDS before the human immunodeficiency virus was discovered and its transmission understood. Soon thereafter, researchers realized that what they thought was a gay disease spread particularly fast among at-risk groups like injection drug users.
Bigg himself isn’t gay and has never suffered from addiction, but many of his close friends did and they were affected by AIDS. So his main goal was to break the connection between addiction and AIDS, and he did it in an unconventional way. Rather than pushing drug users to achieve abstinence, he wanted to try to simply reduce the harms associated with their habit — the risk of HIV being the worst of them at the time. In the early ’90s, Bigg co-founded CRA and began distributing clean needles and information on safer injection practices. And while most other anti-addiction groups were defining recovery as total abstinence, Bigg’s organization described it as “any positive change” that led to better health. By using a more inclusive, less severe approach, Bigg explains, CRA was better able to reach and protect the people at highest risk for AIDS. Soon, his group would become one of the country’s best known “harm reduction” programs.
But in 1996, John Szyler, a recovering heroin addict and co-founder of CRA, relapsed. He overdosed and died shortly thereafter. “We asked, ‘What positive change can we make in John’s memory?’” says Bigg. The idea that had the most resonance was to distribute naloxone and promote its use to others.
It was a choice that prompted a lot less blowback than CRA’s other harm-reduction strategies, such as needle exchange. In recent years, Congress has seesawed on allowing federal dollars to be spent on needle-exchange programs (since 2011, federal funding has been banned), despite decades of evidence showing that they’re safe and effective. Though every public health agency that has examined the data on needle exchange, from the World Health Organization to the CDC, has come down in favor of them, conservative critics of the programs continue to suggest that they enable drug use. Naloxone distribution has been viewed somewhat more positively, however, perhaps because it has the overwhelming public support of so many grieving parents whose children might have been saved by the harmless medication.
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Since CRA started distributing the drug and training people to use it, more than 32,000 people in Chicago alone have participated in his program, with 5,000 successful overdose reversals reported. At least 180 other organizations around the U.S. are now following CRA’s lead, including some state and city health departments. New York State, for example, which has the world’s largest population of injection drug users, now provides naloxone to people leaving drug treatment and to those using needle-exchange programs. Nationwide, to date, 10,000 successful overdose reversals have been reported.
Massachusetts also has a naloxone distribution program, the effectiveness of which researchers studied and reported in January 2013 in the medical journal BMJ. The results? Overdose death rates in localities with the highest access to the drug and the largest number of people trained to use it fell to nearly 50 percent lower than those in regions with limited or no naloxone availability or response training.
Even the federal government has climbed aboard the naloxone bandwagon. In 2012, the Obama administration called for making the antidote more widely available. And last month, shortly after Hoffman’s death, the hardline Office of National Drug Control Policy, the drug czar’s office, which has traditionally viewed addiction as a law-enforcement issue, acknowledged that it is actually a public-health problem — a “disease that can be prevented, treated and from which one can recover.”
“We cannot arrest our way out of the drug problem,” R. Gil Kerlikowske, the current drug czar, told reporters, noting that strategies like wider distribution of naloxone, along with prescription-pill take-back programs and better treatment of addiction, are needed.
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There are still holdouts: Maine’s Republican governor, Paul LePage, the only known remaining anti-naloxone activist, recently rejected laws expanding access to naloxone because he believes it will make drug users feel invincible and, therefore, more likely to take more drugs. But there’s no evidence to support his view. More commonly, a brush with death leads drug users to seek recovery, not to continue their addiction.
Mark Kinzly is a recovering addict and a harm reduction advocate in Massachusetts. Between 1993 and 2004, the 11 years he was drug-free, he saved four people with naloxone. In 2004, he relapsed and had to be revived with the drug himself. “I didn’t feel great, but I sure was grateful,” he said in an interview in The New York Times in 2011. He went back into recovery and then proceeded to revive at least 10 other overdose victims — some of whom, like him, sought help for their drug problems upon their revival.
Of course Bigg supports current efforts to expand naloxone access, but he thinks they aren’t enough. Among the nearly 40,000 people a year who die by overdose, some of those who are at highest risk of death are new drug users, like teenagers who get pills from their parents’ medicine cabinet and whose family members have no idea they are taking drugs. They won’t be saved by making naloxone available only to drug addicts and their families. We would have to put naloxone in almost every home — for example, as part of every first-aid kit.
“I don’t think we will have successfully dealt with this until naloxone is available over the counter at an affordable price,” says Bigg. It’s possible that could happen, if the FDA approves the version of the drug that’s delivered nasally; the National Institute on Drug Abuse is testing it now. But it probably won’t happen quickly without public pressure of the type exerted by AIDS activists in the ’80s and ’90s to push the agency.
Until then, if you want to have naloxone on hand, visit this website to find a local distribution group. And then call the FDA and urge them to make the drug available over the counter. It could save the life of an infant who gets into his older sister’s dental codeine, or a grandfather who takes too much of his prescribed OxyContin, or a teenager who does something stupid with heroin. It could save your life as well.
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Update: Dan Bigg died on August 21, 2018. He is survived by his wife, son, and two daughters.