Keynote POCA Fest Milwaukee May 2019 — ALL EARS!!!

By Ellen Vincent

I'd like to acknowledge that we are on land that was the tribal seat of the Bear Clan of the Potawatomi Indians. The name of this area, Mukwonago, is derived from the word mequanego which translates to bear's den. The Potawatomi were part of the Three Fires Council that dates back to 796 A.D. comprised of Potawatomi, Ojibwe and Odawa, collectively known as  Anishinaabe peoples. By the end of the 18th century, the federal government reduced Potawatomi landholdings by removing them to smaller reserves in Iowa, Missouri and finally Kansas in 1846. In 1861, the Potawatomi in Kansas was officially divided by way of a treaty that required its signers to surrender tribal membership and adopt U.S. citizenship, in turn creating the foundation for Citizen Potawatomi Nation. It was a decision that led to the eventual migration to Oklahoma. You can learn more at https://www.potowatomi.org

Content note: discussion of the opioid epidemic, statistics, and description of overdose scenario. Any of this may be difficult to hear, so I wanted to let you know ahead of time so you can take care of yourself.

One afternoon a couple of years ago I was at a friends’ dinner party waiting for my partner Josh to arrive after his clinic shift. When he got there, he told us about stopping to get gas at a Circle K and realizing, after he pulled in to the station, that there was a man just lying there on the concrete between the rows of gas pumps, overdosing. Someone had dumped him there and left him to die. Josh sat with him and performed CPR until the paramedics arrived.

Everyone at the party empathized with Josh, who was pretty shaken up about it, and he did his best to enjoy himself that evening. But a few days later, he told me he needed to talk more. He told me how traumatized he had been feeling since that day. He gave me all of the details: what the man looked like and smelled like, lying there dying, the sounds his body was making. He never found out what happened — whether the man lived or died. He thinks he probably died. Since then, Josh avoids that particular gas station and even that entire strip of roadway.

The latest national statistics on the opioid epidemic from the NIH state that every day, more than 130 people die from an overdose of opioids in the United States. That’s an average of just over five people every hour. In 2016, 64,000 people died in the opioid epidemic. In 2017, “an estimated 1.7 million people in the United States suffered from substance use disorders related to prescription opioid pain relievers.” In the past two years just in Arizona, where I live, there were almost 3,000 opioid-related deaths, and 20,000 opioid overdoses. 1300 babies were born with neonatal abstinence syndrome during that time period.  Accidental drug overdose is currently the leading cause of death in the U.S. for those under 50.

When Susan Williams, also from Arizona, found out there was a disconnect in the state laws governing the certification and practice of auricular acupuncturists, she thought about how many people in her own little world had died from accidental opioid overdose or suicide in the recent past. She counted seven people. Most of these casualties were found by a family member. And the trauma from the experience of being a first responder, attempting to save a life but failing to do so, is just one way the opioid epidemic impacts entire communities. The statistics we quote here are only a small representation of the damage  from this epidemic.

We know all of this is just the tip of the iceberg of the intersecting epidemics of trauma, addiction, and pain. We also know that the current opioid epidemic has a white face on it, so is seen as a public health crisis, whereas heroin and crack addiction are met with criminalization and incarceration, targeting Black and Brown communities and bodies specifically.

Last month, a regular patient of mine came to the clinic, her body shaking because her best friend had died that week of an overdose. She looked me in the eye and said “acupuncture saved my life.” And I believe her.

Hopefully, everybody sitting in this room gets it: that acupuncture can save lives and is the kind of “safe, effective, non-addictive strateg(y) to manage chronic pain,” that the National Institutes of Health are looking for as part of their prevention efforts.

The 5 Needle Protocol that was developed by the Young Lords and the Black Panthers in the 1970’s, and later put into more widespread use by Michael Smith and NADA, is an extraordinary tool.

Its effects  that we do know about: calming the brain, which is where all pain is experienced, activating the parasympathetic nervous system, enhancing the body’s detoxification and elimination processes, and awakening the body’s endogenous motivation and reward systems, probably don’t even begin to describe what the 5NP is actually doing beyond what we can know about. And, while we know that we have a powerful tool to help all of the people who are affected by the opioid epidemic and other substance use disorders, it obviously does no good if people can’t use it, if there’s no access to it.

The first of 3 key concepts in liberation acupuncture, the preferential option for the poor, (and I’m quoting here from the liberation acupuncture website): “requires us to ask ourselves what stands in the way of acupuncture in North America belonging to people who have little or nothing… The question is: to whom does acupuncture belong? Can anyone now living own it, or assert the right to control its parameters?… We could.. choose to define (acupuncture) as something simple, something to share. Approaching these issues from the perspective of a preferential option for the poor instead of from the perspective of turf warfare, we could …  claim that if acupuncture belongs to anyone, it belongs to the people who need it the most, the people with the fewest resources, the people for whom its simplicity makes it uniquely accessible.”

This simple 5 needle protocol that was developed not by licensed acupuncturists, but by laypeople — the Young Lords, the Black Panthers, and early members of NADA — is now controlled and regulated by governments and acupuncture boards. If you remember some earlier keynotes and presentations by Tyler Phan, that’s an example of what he calls “orientalized biopower,” in which regulation by the State serves to remove access to community acupuncture from the very people who developed the practice.

The 5 Needle Protocol is so simple to learn and to teach (put the sharp end in the patient, as Michael Smith famously once said), so incredibly safe to use. We are doing what we can to put it back in the hands of the people to whom it belongs.

What we now call POCA’s Ear Circle began six months ago with Susan Williams, a former POCA Tech student who serves on the State of AZ Acupuncture Board of Examiners. During a three-hour meeting in Tucson with other NADA advocates, we learned that the state of Arizona is roughly the same geographical size as the country of Denmark. But while Denmark has 16,000 NADA practitioners, Arizona only has 34 auricular acupuncture certificate holders. In Wyoming, the ratio of auricular acu-detox specialists to licensed acupuncturists is 3:1 (three auricular practitioners to every one licensed acupuncturist). And that may not compete with Denmark’s numbers, but it sounds about right as an initial goal to work towards.

Susan had already begun working with the AZ acupuncture board to change the policy that dictated the settings where the 5 needle protocol could be practiced, but at the time there were no NADA trainings happening in Arizona outside of the behavioral health clinics on reservations, held only for the people who would be employed there. And the process for a licensed acupuncturist (or anyone else) to become a NADA trainer required a two-year NADA membership before even beginning the process of trying to become a trainer. When Susan and I were brainstorming on the phone one day after that meeting, she said “Why doesn’t POCA just make its own training?”

To which I responded YES, you’re brilliant, YES. Of course we should.

The cooperative nature of POCA’s sociocratic governance system really lends itself to what I like to do best: get things done and have fun in the process. In case you’re not familiar, that’s basically the wikipedia definition of sociocracy:  “a system of governance which seeks to achieve solutions that create harmonious social environments as well as productive organizations.”  At one point in our discussions Cris suggested a tagline: POCA: we get (sh)IT done.

Agreed!

All of the people involved in the genesis of the Ear Circle were very clear that we needed to do this, and, while honoring that we all have very busy lives, wanted to make it happen sooner rather than later. As opposed to reacting to anybody, we decided to figure out what we really wanted to do and since then have been figuring out how to do it. As Lisa put it, and for anyone who has read adrienne marie brown’s first book, it’s all been very “Emergent Strategy.” adrienne marie brown’s ideas about what defines Emergent Strategy can and do encompass an entire book (which I highly recommend), but to quote it very simply: “It is our right and responsibility to create a new world.” And as Lisa wrote in her book Punking: the Praxis of Community Acupuncture, describing why we call ourselves punks, “we use what we’ve got and we’ll do what it takes.”

I have personally been involved with POCA since almost the beginning, back when it was the Community Acupuncture Network (CAN), so I’ve seen a lot of change happen, a lot of people come and go.

Since joining the Ear Circle I have been noticing how I, too, have changed over the past 13 years. Part of it is just the cyclical growth that happens as you get older, but I do think that being a part of POCA has helped move me from what most of us in America are socialized towards: independence, bootstrapping, and competition, to what feels infinitely more powerful, stable, and rewarding: interdependence, and not needing to control everything (that’s a hard one for me — anyone else here have control issues?).

Realizing that I don’t have to do everything, because there are other people who are raising their hand to contribute. Realizing that I shouldn’t be the one to do everything, because other people have ideas that I would never have thought of (and they’re really good ideas!). Being able to relax around the process, to ask for and accept help, to trust: these were all a lot harder for me before. I think I’m getting better at all of that, thanks to my experience in POCA and in the Ear Circle.

So here we are, some months later, having gotten a lot of (sh)IT done such that we are standing before the first ever group of non-acupuncturist Auricular Acu-technician trainees!  (APPLAUSE ALL AROUND). We are so grateful and excited to have you here with us, and to train you in this technique that has the potential to do so much good in so many communities. Thank you for being here with us. Can you all stand up so we can welcome you??

In January of 2018, Governor of Arizona Doug Ducey called a Special Session of the Legislature and the Arizona Opioid Epidemic Act of 2018 passed unanimously.
That law made important changes, including: Medical education for those who prescribe or dispense opioids, expanding access to the overdose reversal drug naloxone, and a Good Samaritan exception so friends and family won’t be penalized for calling 911 in case of overdose. Those last two could very well have saved that man at the Circle K’s life.

The news on the auricular acupuncture front is huge. Thanks (again) to Susan Williams and also to federal judge Chuck Pyle, the Arizona Acupuncture Board just unanimously decided in April to discuss pursuing a statutory change that will expand the scope of Auricular Acupuncture Certificate holders to not only be allowed to treat people struggling with substance use disorders when under the general supervision of a Licensed Acupuncturist, but these certificate holders would then be legally allowed to use the 5NP to treat anyone affected by trauma once the statute has changed.

Once our first acu-tech trainees here have completed all of the requirements for their AAT certificate from POCA, they will be able to practice the 5NP in Wisconsin under physician delegation, which is part of why we wanted to speed things along in order to hold this training here at POCA Fest. In Arizona, the next step will be to make sure the board considers this training substantially equivalent to the NADA training and issue our trainee applicants an Auricular Acupuncture Certificate. And in Rhode Island, Licensed Chemical Dependency Professionals can use 5NP after getting trained by a NADA or equivalent program, which would include our new ear training.  Cris has built a local POCA coalition that is advocating strongly for pending legislation that would expand access to other licensed and certified healthcare professionals, including peer recovery coaches, nurses, and mental health counselors.  And the second POCA Auricular Acu-technician Training is already scheduled for Providence on June 22nd and 23rd!

The Young Lords, the Black Panthers, NADA and their advocates have already laid down massive amounts of grassroots and legislative groundwork in the United States, work for which we are immensely grateful — and still only about half of the states have what are unofficially called “NADA laws.” Based on my own experience of bureaucratic power dynamics, I can imagine that none of that legislative work has been very much fun, in fact, most likely the exact opposite of fun. But it has been very necessary.
In a recent interview, Mutulu Shakur (co-founder of the Black Acupuncture Association of North America (BAANA) and the Harlem Institute of Acupuncture) said:

“Acupuncture in the hands of the revolutionary-minded, particularly addressing addiction, was an intervention that the government was not willing to accept at the time because it attacked and exposed the complicity of the government in imposing chemical warfare on certain segments of the community. We weren’t only providing medical care and exposing chemical warfare, we were challenging Western occidental medicine by Eastern medicine and natural healing. Right now, today you can go into New York City and in those municipal hospitals within Black and Puerto Rican and poor communities– a municipal hospital, not a private hospital but the municipal hospital– you can now receive acupuncture treatment for drug withdrawal as an alternative method of treatment. I am proud to have been a part of the required effort and accomplishments making this possible.”

There is still a ton of grassroots work that needs to be done, both in terms of adding more states to the list of those that even have regulations for auricular practice, and in terms of getting the POCA Auricular Acu-Technician training approved as a prerequisite. The statistics from the opioid epidemic should make it difficult for anyone to deny that there is an urgent need for increasing access to any tool that has the potential to help, especially one as simple and safe as the 5NP.

The key word there is “should.”  (In an ideal world, those statistics would make it impossible, not just difficult, for anyone in power to justify the restriction of access.)
I was talking to my therapist recently about all of my personal “shoulds” in life, (people should really know better, is what the shoulds usually boil down to), and she gave me some advice. She said that every time I feel myself reacting to people, or to the world, with a “should,” I could turn it into a wish. Instead of thinking “they should… fill in the blank,” turn it into “I wish,” and then think about what I could actually do to make that wish a reality. Sometimes (when I remember to use it), that technique helps me to realize that actually, there’s nothing I can do to make that specific wish come true, and that realization helps me to just let go of a particular “should” and relax.  Sometimes, it helps me to figure out exactly what I can do to try to have my wish come true, versus believing that someone else should just be different from how they are or that they are the ones who should do the work to create the change I want.

In the case of turning this particular legislative “should” into a wish, it turns out there is a lot that we can do. There is no shortage to the number of steps we can (and dare I say should?) take together to liberate this almost ridiculously simple yet incredibly powerful tool, the 5 Needle Protocol — to put it back where it belongs: in the hands of those of us who need it the most. 

The first step we take together? It’s this training at this POCA Fest in Milwaukee, Wisconsin. We’ve been so looking forward to it. Thank you for being here.

Author: lisafer