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As overdose deaths continue to mount and debates rage over harm reduction, drug policy, and homelessness, Hit Doctors offers a crucial on-the-ground perspective pointing to a humane future.
Finding a vein is difficult. As veins collapse and scar over, it becomes almost impossible. For the millions of Americans who inject drugs and can’t do it alone, the solution is to find someone who can. Enter the “hit doctor.” Though uncredentialed, hit doctors develop expertise through necessity, providing injection assistance and addressing needs that dominant medical systems exclude or criminalize. They share the same conditions as the people they serve: sleeping in encampments and alleys, living in cramped single-room-occupancy hotels, suffering from untreated illness and trauma, and grieving friends who keep dying.
Sarah Brothers spent more than seven years observing and interviewing hit doctors and their clients across San Francisco. Hit Doctors is an intimate portrait of the daily lives, relationships, and ethical worlds of people managing extraordinary hardship at a pivotal moment, when fentanyl arrived and thousands began dying annually. Brothers’s long-term ethnography yields critical insights. People seeking help strongly prefer women hit doctors, perceived as more careful and less likely to turn violent. But even as their expertise is valued, hit doctors are targets for abuse, and they suffer as the people they care for decline and die. That is the cost of trying to keep each other alive when formal systems of support have failed.
“In one of the most gripping ethnographies in years, Brothers maps marginalization across multiple scales, taking us from the cold architecture of structural violence, to the improvised solidarities of the street, to the tense moment when a needle finds a vein. This book is a reckoning—about those we’ve cast off, about how they learn to survive, and about who counts as an expert in the world of substance use.”—Forrest Stuart, Stanford University
"A moving and empathetic picture of a hidden world, where people who inject drugs struggle daily to survive and help each other when no one else will. Hit Doctors tells the story of a highly stigmatized group of people doing their best in the face of exploitation and unfathomable trauma."—Maia Szalavitz, author of Undoing Drugs: How Harm Reduction Is Changing the Future of Drugs and Addiction
“This compelling and truly original ethnographic exploration of hit doctors and their clients plunges readers into a domain where uncredentialed expertise is the only viable response to social neglect. With this fascinating account of unconventional medical practice, Brothers breaks new ground in the study of expertise and authority at the rough edges of our health care and social service systems.”—Steven Epstein, author of The Quest for Sexual Health: How an Elusive Ideal Has Transformed Science, Politics, and Everyday Life
“A gripping, poignant, highly readable account of urban drug use. The book provides an unusually vivid portrait of poverty in America. It is excellent at highlighting how social conditions end up facilitating drug use in urban America. Superb for teaching!”—Annette Lareau, author of Unequal Childhoods: Class, Race, and Family Life
"Written with wit and empathy, Hit Doctors is a unique contribution to our understanding of uncredentialed expertise in the context of harm reduction with people who use drugs. Intimate without being invasive, Sarah Brothers's deft and hard-hitting ethnographic work is a masterful guide to the protective strategies used in everyday lives of extreme precarity."—Nancy Campbell, author of OD: Naloxone and the Politics of Overdose