People use drugs for a myriad of reasons, including pleasure and pain. There has never been a drug free society, so for people who do drugs, how can we reduce the potential harms? The National Harm Reduction Coalition defines harm reduction as "a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.” Harm reduction can look a myriad of ways; following are some examples from our partners.
New Jersey Harm Reduction Coalition
Jenna is the Executive Director of New Jersey Harm Reduction Coalition
A lot of people I grew up with and love were dying from drug related overdoses, so I’ve seen how much the harm reduction infrastructure is really missing in New Jersey. The way I think of it is we wake up in the morning and say, ‘Are we doing everything we can do to end preventable overdose deaths and show up for our loved ones?’ And until we expand harm reduction, the answer is no. That’s driving why I’m doing this work.
One of our big priorities is putting harm reduction into practice in tangible ways. Another is making sure we’re deeply connected to other movements for economic, racial and social justice in New Jersey. We have incredible social justice advocates in our state and I think harm reduction has been siloed from that for a while so it’s really important we all work together to bring about the policies we need.
We’re fighting for policies that are common sense and have been proven to work. It’s really straightforward to get people naloxone, safer injection supplies, nonjudgmental support, and pathways to housing and healthcare. So with people in decision making positions asking, ‘What can we do to end the overdose crisis?’ it’s like, start with the easiest thing: make sure that people have access to the resources and supplies they need to stay alive.
Naloxone should be flooding our streets. It should be as easy to get as aspirin or a condom, especially for people who use drugs and their loved ones and people who recently stopped using drugs. But I think because people who use drugs have not been at the heart of our drug policy creation in New Jersey, we had naloxone going mostly to first responders. That’s important first responders often need naloxone but in places where people who use drugs have widespread access to naloxone, that’s who reverses most overdoses. This is such a safe medicine and it’s literally life-saving to have.
Harm Reduction Coalition
Raani is a Volunteer and does street outreach with Project SAFE
I do street-based outreach and I also volunteer at the house. My favorite spot is the clothing room I’m forever organizing the clothing closet. I really enjoy helping people pick out outfits. They’ll be like, ‘Does this look nice or does this match?’ and I give them feedback like, ‘No, those colors clash but this and this look nice together.’ Sometimes they’re looking for clothes that affirm their gender or their identity, like there are people who love dresses and people who don’t, and there are people who love cargo style baggy pants and people who would never wear them. There’s this older participant who loves pretty things bracelets and trinkets and things with gemstones-so sometimes I put things away for her and then she comes and she’ll be like, ‘Oh my God I love it.’ I really enjoy that about the house. I like helping establish relationships and getting to know people as they are.
Yashica, Client Services Coordinator, Wellness Services
Bryon is a Wellness Services Overdose Harm Reduction Specialist
When I started working here at the end of 2015, overdoses weren’t as prevalent—now you’ve got an overdose happening possibly every 5 to 10 minutes throughout the world. Since we started our naloxone program, we have distributed over 5,000 kits. Out of those kits, possibly 2,000 to 3,000 have been used in successful overdose reversals.
One of the key things about our program is we want our clients to feel accepted. I always say it’s how a person is treated coming into the building-customer service is a huge factor in bringing people back. People that have been so prone to stigma and being called all kinds of names, making them feel like they’re less of a person, when they come here they don’t feel like that. We ask them, ‘Hey, how can we help you today?’ That’s how we’ve been able to grow as much as we have.
We’re reaching people who are actually around people that are using by making sure that when that person comes in to get clean harm reduction supplies, they also have the necessary kit. We have people bringing their friends, loved ones, and even family members to get them trained on naloxone so in case that person goes into an overdose, their loved one or friend knows how to use the kit. I’ve had people access our program and be able to save a life that day. In another case, I had someone sign up for the program, get a naloxone kit, they overdosed and someone saved their life because they saw that they had the kit with their harm reduction supplies.
Once we built trust with the community and got people acclimated to what we’re trying to do to help prevent overdose deaths, we’ve had a lot of buy in from our community. Police departments and other organizations are pretty much on board with the naloxone kits now. We also provide trainings in schools. I actually did a training at a high school-they made sure their staff from the teachers to the principal to the coaches got trained on naloxone. As a kid that grew up in Flint, it’s great to see that.
We started distributing fentanyl test strips within the last two years. It’s one of the key items in our harm reduction supplies because people have been able to test what they’re using and detect what people are trying to mix in that could be dangerous to them. It’s also reducing overdoses because now clients are being proactive in making sure that they are safe and being mindful of what they’re doing. That’s a big change we’re seeing more and more.
Bryon with Wellness Services participant, Tonya.
Prevention Point Philadelphia
Prevention Point Philadelphia Participant
I started receiving mail here about a year ago because at the time I didn’t have a permanent address. A lot of things that I needed to get—like birth certificate documentation, Social Security documentation, even welfare cards—people that have no permanent address couldn’t get mail anywhere. Some people don’t want you to use their address because they don’t want to get in trouble with agencies that they’re using, so it really had an impact on people that were homeless or in between homes.
I’m currently in a recovery house and getting back on my feet so I come maybe 2-3 times a week to check my mail. I did the step-down program for Suboxone here. They feed you, they even give you clothing if they have it. This is a big part of Philadelphia’s recovering and non-recovering community. I’m just grateful to have them here.
Harm reduction comprises a spectrum
Downtown Evening Soup Kitchen
Program Manager at Downtown Evening Soup Kitchen
DESK provides food, resources, and services for folks experiencing homelessness and poverty. I think that the pandemic kind of laid bare exactly how many folks fall into those categories. We have professors, construction workers, electricians, hip hop artists, graphic artists, veterans. They have the most amazing stories and yet to many people, their experience of homelessness makes them not worthwhile.
New Haven gets a bad rap for the concentration of services being a magnet for folks from outlying towns and there’s a lot of animosity around, ‘If we concentrate the social services, we’re just drawing people in.’ But I don’t think that’s a bad thing if that is what’s going on. It takes a lot to ask for help and I think that the bootstraps narrative of, ‘If you just tried harder’ is really busted. It’s really powerful to have folks come and ask for what they need and it’s gratifying when I’m able to help facilitate providing those resources.
Our guests are very good at naming what we aren’t providing, whether that’s within a referral network or what we’re providing ourselves, and we use that feedback very carefully. Like I’ve been getting a lot of requests for employment services so I’m really trying to develop our employment and job readiness services. I’m learning all the time that our best teachers are our guests.
Since covid, we have re-allocated part of our dining hall into our supplies and clothing corner—we’ve been giving out about 50 pounds of clothes a day. So if you think about how much a hoodie costs and how much that would benefit somebody to not have to spend $12 at Walmart to buy a hoodie, what could that $12 do for them when they’re given back the agency to decide what they’re going to spend their money on? I really like to get away from the bootstraps narrative of, “You just spent your money wrong that you probably didn’t deserve in the first place.”
Nish – Harm Reduction Specialist
Sex Workers and Allies Network
Director of Advocacy at Sex Workers and Allies Network (SWAN)
One of the longer-term legislative campaigns we’re working on is building towards decriminalization of sex work. I also hold meeting with our SWAN members to hear about what kind of advocacy they would like to see. A big issue has been dealing with the police—harassment from the police is a really common complaint.
We have great high-level support from the police department and there are some officers that we have great relationships with. But when it comes to the entire force, even though the New Haven police department doesn’t arrest for prostitution right now, there is still really intense stigma against sex workers, people who use drugs, and people on the streets in general. So people will be harassed while they’re out working, or threatened, and it’s rare to see accountability for that. We want to see that change.
Most of the people we work with are survival sex workers or street-based sex workers. There are a lot of misconceptions about sex work, like that anybody who is engaged in it is being trafficked and needs to be rescued. So the support people want to give is, ‘Let’s get you out of sex work first,’ when in reality the reason most people do sex work is because they have needs like housing, food, or supporting their family. Sex work is the best option for them to meet those needs, so getting somebody out of sex work without doing anything else to meet those needs is actually not going to help them.
Rev. Dr. Charles F. Boyer – Salvation and Social Justice Founding Director
Sex Workers and Allies Network
Phil Costello is the Clinical Director of Greater New Haven Healthcare for the Homeless, Cornell Scott-Hill Health Center
When I started working with SWAN, I realized that a lot of the people on the street were women I had known from the shelters and soup kitchens. But as much as I’d been doing medical care for them, they had never told me about doing survival sex work. Many of them were relieved when they finally saw me here because they were like, ‘Now he knows and I can be honest and get better care.’ Learning this very personal information opened my heart more to these men and women and motivated me to really advocate for them.
Medical and nursing students are the future of how people will be taken care of in our communities, so the more that we can expose them to humanity and the social barriers to care, the more they can effect change when they become doctors and nurse practitioners and physician assistants.
This is why it is so important that their initial learning experiences be grounded in personal connections that break down stereotypes about sex workers, people who use drugs, and people on the street. Too see the struggles some of our patients endure and the strength required just to get through the day will hopefully change the culture of healthcare and create a network of empathetic supporters.
As a medical provider, one of the things I’d like to see is a sobering center so that those who are intoxicated can go there instead of the ER. In New Haven, if somebody is intoxicated the police don’t arrest them. They call an ambulance which is great because the person doesn’t get arrested. The problem is, the ER is not a place where they have the time, the training, or the bandwidth to handle people who are intoxicated. Sometimes that leads to their emotional filters coming down, creating a not favorable experience for the patients. But if you could take that away from the ER, you could hire people with the training, empathy, and desire to care for people in that state and improve their health outcomes.
Tracy Pugh Senior Program Manager Overdose Prevention Program, Vital Strategies
Project SAFE collective member
When people think of harm reduction, they think of needle exchange programs. That’s really important and we do that, too, but there’s all these other life needs that people have. People are really hungry for community and this house gives them the opportunity to have that. Even the nap room expands what harm reduction is because people we work with are for the most part homeless and spending nights outside and are exhausted. So just having a few hours of uninterrupted sleep when they can recharge and then be woken up by a person handing them a cup of tea or coffee, that’s so lovely. It can help people feel better in their bodies and make clearer decisions.
Esther Mae Rosner, Program Officer for Overdose Prevention Program Vital Strategies
Yashica is a Client Services Coordinator at Wellness Services
We didn’t think we had an issue with opioid use in our people of color communities until we got a surveillance report that said 40 percent of the people who died of overdoses in 2020 in Genesee county were people of color. But less than 5 percent of the people accessing our program are people of color so we’re trying to reach this community and make sure that the word is getting out.reach
I’m not really sure where the disconnect is if people don’t know about our program or don’t trust the program or maybe they can’t get to the program so we’re trying to bridge that gap. A lot of these people need our services but may not know we exist so it’s really important for us to be out in the community and let people know what we’ve got going on.
We’re trying to prevent STIs, HIV, and overdoses in the community. We test for HIV, hepatitis C and the most common STIs, and we have syringes, condoms, and safe sex kits that we give out.
Sometimes we get a bad rap because all people hear is that we’re enabling drug use. But it’s going to happen so the least we can do is supply people with the tools to prevent diseases from spreading. We might not be able to prevent an overdose, but by distributing naloxone, we might be able to save someone from dying from an overdose. That’s what our prevention program is all about.
Daliah Heller, Director of Drug Use Initiatives at Vital Strategies