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Dan Bigg Revolutionized Opioid Treatment

The public health advocate, who died Tuesday at age 59, treated addiction with ruthless empathy, championing the idea that users’ lives are worth saving.

Bigg in 2017   Photo: Matthew Avignone

Dan Bigg, the longtime harm reduction advocate who challenged the stigma of opioid addiction and saved lives through his efforts to expand the use of the overdose reversal medication, Naloxone, died at his Chicago home on Tuesday. He was 59.

The Cook County Medical Examiner said the cause of death is still undetermined.

For nearly three decades, Bigg served as the director of the Chicago Recovery Alliance, a primarily mobile support organization that offers education, care, and recovery help for people addicted to drugs. Bigg was a cofounder during CRA’s early years in the 1990s when it was focused on clean needle exchanges mainly to curb the spread of AIDS. But it was the overdose death in 1996 of his friend and CRA cofounder, John Szyler, that prompted him to expanded CRA’s mission.

“[Bigg] was a tireless community advocate who pioneered efforts to save lives in Chicago and beyond, and put the health of people who use drugs ahead of all other pursuits,” CRA wrote in a statement Wednesday. “He was an unparalleled harm reductionist and the most generous of human beings — a life that changed each one of us in the CRA family, and many, many more.”

Bigg is widely recognized today as the pioneering force behind “take home” Naloxone programs in the U.S., which aim to make the medication (formerly known by the name Narcan) accessible outside of traditional emergency room situations by putting it directly in the hands of opioid users.

“I don’t know that everyone knows that CRA was the first place on the planet to use Naloxone to reverse opioid overdoses. Now it’s the standard of care,” said Kathie Kane-Willis, a public policy researcher with the Chicago Urban League who was a friend and collaborator of Bigg.

Those close to Bigg said almost as novel as his ideas about addiction recovery was his approach. Harm reduction, the philosophy of mitigating the negative consequences of drug use — such as incarceration and stigmatization — underpinned every aspect of Bigg’s work, said Suzanne Carlberg-Racich, a public health professor at DePaul who also serves as CRA’s director of research and was a longtime friend of Bigg.

“He was light years ahead of almost everyone in the harm reduction movement when it came to thinking of what it took to save lives,” Carlberg-Racich said.

Bigg in 2002 outside one of Chicago Recovery Alliance’s vans, where the organization continues to conduct blood tests, distribute naloxone and clean needles, and provide other services. Photo: Phil Velasquez/Chicago Tribune

Bigg’s reputation in the early years of CRA was that of a “renegade,” pushing ideas other leaders in addiction treatment circles treated as hypotheticals at best, according to Kane-Willis.

“If Dan didn’t agree, he would fight with you. He was not going to roll over,” she said. “He was going to push and push and push. That could be a challenge. But it could be a good thing, too.”

Carlberg-Racich said Bigg had little patience for red tape (“A bureaucratic hurdle standing in his way was ridiculous to him”) and plenty of audacity to cut through it.

When the two attended the earliest harm reduction conferences in the 2000s, when CRA’s Naloxone program was still young, Carlberg-Racich said Bigg would always bring two extra duffel bags of Naloxone along to their presentation.

“After the talk, he’d open his duffels and say, ‘who wants to start a program?’ ”

The stunned audiences would wonder whether he was serious.

“But then some gutsy person would walk up and say, ‘hell yeah,’ and it would start what Dan called a ‘fire sale.’ And that would get someone started [on their own program] in small towns or counties.”

While Bigg’s ideas have been widely embraced in public health circles, he faced vigorous pushback for them too, particularly from supporters of 12-step recovery programs that advocate drug abstinence.

Bigg, however, rejected abstinence as a realistic or even successful framework, favoring “any positive change, as a person defines it for him or herself” — a mantra coined by his CRA cofounder, John Szyler.

Bigg described his outlook during a 2017 interview with WBEZ:

“We go from having an absolute mythical belief that the only positive change is abstinence: totally untrue, totally burdensome on the human condition, to have instant and dramatic, permanent change. And you had two poles: chaotic, out-of-control addiction and utter abstinence. Turns out, there’s a huge fertile ground in that midsection that doesn’t demand abstinence. Turns out, drug users in huge numbers wanted to make change in their lives.” “Positive change” Bigg added, offers those struggling with addiction a “smorgasbord of options and [gives] them a knife and fork and the invitation to find what they like.”

Kane-Willis said among Bigg’s legacies will be his approach to treating people with addiction with dignity and humanity.

[Dan] pushed the message out that says ‘these lives are worth saving,’ ” she said. In the years before his death, Bigg earned growing recognition for his role in changing the standard of care for treating opioid overdoses and people addicted to opioids.

The Drug Policy Alliance, one of the most influential nonprofit advocates of harm reduction in drug treatment, awarded Bigg The Norman E. Zinberg Award for Achievement in the Field of Medicine in 2015.

“Almost everyone who had received [the award] before were physicians, and then you had Dan,” Carlberg-Racich noted. “That’s the one moment where I think I saw him feeling really pleased with what he contributed.”

She noted Bigg’s “almost pathological resistance to taking credit,” but said she knew he was proud of CRA’s achievements, a feeling he shared again last year when this magazine named him a Chicagoan of the Year for his efforts to quell overdose deaths amid a surging use of synthetic opioids. (That same year the Centers for Disease Control reported opioid deaths jumped to a record high in 2016, killing about 64,000 people, while CRA alone handed out some 100,000 Naloxone kits.)

Also in 2017, CRA received $600,000 in local and federal government funding, a longtime goal Carlberg-Racich called a “game changer.”

“The fact that people talk about medication-assisted therapy in circles other than harm reduction strategy is phenomenal,” she said. “That’s all because of Dan.”

A spokesman for the Drug Policy Alliance said Wednesday that Bigg’s death has “devastated” the harm reduction community; meanwhile, Carlberg-Racich said there will be no changes to CRA — not even service interruptions.

On Wednesday morning, as news of Bigg’s death made its way through CRA’s network, Carlberg-Racich said there was never even a question of whether CRA would cancel its mobile unit services for the day. CRA’s vans, as planned, were parked at locations on the South and West Sides, providing Naloxone and clean syringes, conducting blood tests, and continuing the work Bigg began almost thirty years prior.

“Dan is what we’d call a real mensch,” said Kane-Willis. “He really saw the human-ness and mensch-ness in everybody.”

Bigg was born in Winnetka but lived most of his life in Chicago. According to the Chicago Tribune, Bigg is survived by his wife, Karen Stanczykiewicz-Bigg; their teenage daughter, Sophia and another daughter, Alexandria Hinkle; and a son, Zachary.

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