Hit Doctors : Care, Harm, and the Art of Survival

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.