“For me,” says Jose Martinez, “harm reduction means opportunity.”
The opportunity to see a doctor, to get a job, to get information and non-judgemental support. The opportunity to stay alive.
Today, Martinez is the capacity building and Hepatitis C coordinator for the National Harm Reduction Coalition, but his first encounter with harm reduction was as an addict living on the streets of New York City at a drop-in center.
“You could just hang there all day,” he says. “That’s what I did. Somebody found something in me, and from there, my life changed.”
Martinez eventually got sober, but that’s not necessarily the goal, according to Madeleine Evanoff, a harm reduction specialist with Boulder County Public Health.
“The essence of harm reduction is radical acceptance,” Evanoff says. “You show up how you are, and you’re perfect how you show up. You should be able to decide what you do and don’t put in your body. You should have all of the tools you need at your fingertips to keep you safer when you choose to do that.
“We’re about building people up to live the best life possible for someone, and if that includes somebody continuing to use drugs, that’s OK.”
Realistic vs. idealistic
Harm reduction is a “pragmatic” response to the overdose crisis — more than 13,000 Coloradans have OD’d in the past decade, according to the state department of public health — Evanoff says, one that recognizes “we will never live in a world without substance use.”
“The reality that substance use has been around for thousands of years, used for a myriad of different reasons, and not all of those are harmful.”
Harm reduction can still lead to sobriety, Evanoff says. “We are most often the first people someone approaches when they are wanting recovery.”
But it takes time.
“You have to build trust and rapport,” Martinez adds. “What we do say is always be prepared with information, because just giving the information will help, period, whether they come back to you or not.
“Let’s help you stay alive so if you do have a future not using, you have that there.”
The Works
Harm reduction practices are common outside of the drug sphere. As Denver-based Harm Reduction Action Center notes in its Harm Reduction 101 educational video, interventions such as seatbelts and parachutes make potentially dangerous or deadly activities (driving, skydiving) safer for those who choose to engage in them.
When it comes to drugs, harm reduction involves lessening the impacts of substance use and the government’s response to it. That means curbing overdose deaths and the spread of disease and death, yes, but also the over-incarceration of marginalized communities and the criminalization of substance use, poverty and mental illness.
The efficacy of harm reduction as a whole is difficult to assess because the approach is general and encompasses multiple policies and programs. But a 2006 review of more than 650 scientific articles found that harm reduction policies such as syringe programs lower the rate of HIV and other infectious diseases in cities by an average of 18.6%.
Portugal, which decriminalized all drugs in 2001, saw a 90% reduction in HIV infections among drug users — now the lowest rate in Europe and 50X lower than U.S. rates of infection. Harm reduction is also credited with Australia's low rates of HIV, relative to the United States.
Boulder County’s harm reduction program, The Works, was established in 1989 in response to the HIV/AIDS pandemic. It is the third-oldest harm reduction program in the country, according to Evanoff.
Today, The Works hands out sterile supplies for drug use; administers rapid testing for HIV and other communicable diseases; provides access to overdose-reserving naloxone; educates the community with free trainings and presentations; provides street outreach in Boulder, Longmont, East County and mountain communities and operates three 24-hour dropboxes for used syringes.
To Martinez, the most important piece of harm reduction is the emphasis on outreach — bringing services and supplies to where people need them — and peer support and leadership.
“It’s so privileged and really out of touch to create a service without consulting with the community, and then go to the community and say, ‘This is what we’ve got to offer.’”
An on-the-ground presence also keeps the response as fluid as the ever-changing drug scene. Although fentanyl is dominating the news cycle, conditions on the street have moved on to other substances, Evanoff and Martinez report.
“We are really just creating the scenario where as soon as one substance becomes criminalized enough, another substance is going to take its place,” Evanoff says. “Fentanyl is not going to be the last substance we encounter that causes an immense amount of unneeded death.
“The best practices with harm reduction that really, truly keep people alive — drug checking, overdose prevention centers — these are things we really need to rally around, because ultimately those are the things that are going to create the impact we need.”
Reduce your risk
If you’re using drugs or substances, Boulder County Public Health shares these tips for staying safe(r):
- Don’t use alone (If you are, call the Never Use Alone hotline at 800.484.3731)
- When with others, take turns using
- If you haven’t used in a while, your tolerance will be lower. Use less.
- If combining drugs, use the opioid first
- Don’t mix with alcohol or other downers
- If injecting, start with a tester shot
- Smoke or snort instead of injecting (it lowers the risk of disease, infection and overdose)
- Use fentanyl test trips on all drugs
- Carry Narcan
How to help
Boulder County doesn't utilize volunteers for The Works program, but Evanoff is happy to refer residents to Denver programs that do. Visit bouldercounty.gov/families/disease/the-works-program for more info and to contact staff.
Another way to help is by "educating yourself," Evanoff says. "It can be so valuable to learn about the drug war. Learn about racialized drug policy. Learn about trauma and SUD. Learn about how to administer Naloxone. Learn about how mental health and substance use disorder often go hand in hand
"The more people we can get educated about these issues, the more we can chip away at this stigma."