Hit Doctors: Care, Harm, and the Art of Survival with Sarah Brothers (U California Press, 2026)Hit Doctors: Care, Harm, and the Art of Survival with Sarah Brothers (U California Press, 2026)
New Books in Drugs, Addiction and Recovery
As overdose deaths continue to mount and debates rage over harm reduction, drug policy, and homelessness, Hit Doctors: Care, Harm, and the Art of Survival (U California Press, 2026) 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 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. Brothers joins host Emily Dufton to discuss the years of work behind her new book, the people she studied and the relationships she built with them. Emily Dufton is the author of Grass Roots: The Rise and Fall and Rise of Marijuana in America (Basic Books, 2017). Her new book, Addiction, Inc.: Medication-Assisted Treatment and America's Forgotten War on Drugs, was released in 2026.
1:00:47•14 Oct 2026
Hit Doctors, Hidden Care: Survival, Risk and Uncredentialled Expertise
Episode Overview
- Hit doctors provide assisted injection for people who cannot safely inject themselves, operating with standard prices and informal rules shaped by community norms.
- Many clients prefer female hit doctors, associating women with greater care and lower risk of violence, while women develop detailed strategies to protect themselves and their clients.
- Dr Sarah Brothers introduces "uncredentialled expertise" to describe practical, high-stakes skills and authority built through experience rather than formal accreditation.
- The arrival of fentanyl dramatically increased overdoses, leading hit doctors to reverse hundreds of overdoses and pushing some to stop practising due to trauma and emotional burden.
- Stories of Catherine and Lucy show how people using drugs can hold deep knowledge, responsibilities and ethics of care, even while formal health and social systems fail them.
“Uncredentialed expertise is expertise that develops through practice, independent from professional institutions, and addresses the needs of lay people.”
Understand the complexities of addiction with insights from sociologist Dr Sarah Brothers, as she talks with host Emily Dufton about her book *Hit Doctors: Care, Harm, and the Art of Survival*. The episode looks closely at "hit doctors" in San Francisco – people who inject others with illicit drugs for compensation – and why their risky, uncredentialled work has become so crucial in a deadly fentanyl era.
You'll hear how Brothers spent years doing ethnographic research, starting from her time volunteering at a syringe exchange and meeting people like Matt, a secondary syringe exchanger who casually told her, "Well, I'm a doctor, actually." From there, the discussion breaks down who needs assisted injection, how standard prices like "five dollars outside, twenty dollars inside" shape relationships, and why many clients actively seek female hit doctors for greater care and safety.
Two women, Catherine and Lucy, sit at the heart of the conversation. Catherine, trained as a phlebotomist and proud to "specialise in the impossible," ran a strict, rule-bound practice, firing clients who crossed her boundaries. Lucy, living with untreated breast cancer and houselessness, offered sweets, calm words and long observation after injections, insisting people never use alone.
Their stories highlight what Brothers calls "uncredentialled expertise" – authority built on practice and trust rather than certificates – and the heavy moral distress that comes with trying to reduce harm in an environment where harm is everywhere. The episode also tackles how fentanyl’s arrival shattered communities, with hit doctors reversing hundreds of overdoses and many giving up the work under the emotional strain.
Along the way, Brothers argues that people who use drugs carry deep knowledge, relationships and responsibilities, and that policy makers ignore this at great cost. If you’re curious about how care, risk and survival mix on the margins of formal healthcare, this conversation might leave you asking: whose expertise do we truly value, and why?
Do you want to link to this podcast?
Get the buttons here!
More From This Show
The latest episodes from the same podcast.