Just about everyone in the Tenderloin knows Dre. With a big heart and charm to spare, he’s something of an elder in his community – the community of people who use drugs on the street.

Dre got into heroin at 13, when an older man, a mentor, injected him at Dre’s request. His mother had left the family when Dre was 6 – “a wound deeper than any knife can cut or bullet can go” – and from age 9-11 he’d been in a center for emotionally troubled children. His father, a military man, was often absent. 

On the streets of Oakland, “I found my fast life … and with a fast life, a man needed something slow.” The fast life eventually led to addiction, prison, and homelessness.

Now 55, Dre has graduated from more than one abstinence-based treatment program. He’s gotten something from every one. He’s also relapsed after each. “I became aware that I would suffer this disease all my life.” 

Drug use is something Dre manages every day, but it doesn’t define him. He is a longtime activist who advocated at City Hall for a minimum wage increase in the 1990s, Project Homeless Connect in the early 2000s, and now for safe injection sites. He shares his knowledge with younger people.

“God is keeping me around for a reason, and I think that reason is to help.”

The opioid crisis has woken Americans up to the fact that anyone can have a substance use disorder – and no one deserves for it to be a death sentence.

It can be frustrating seeing a person sitting on a sidewalk, apparently homeless, injecting drugs in public view. But they too are human beings, often vulnerable, and worthy of dignity. We want to move past frustration and punitive measures and move toward evidence-based solutions that give people the tools they need to climb out of the worst parts of their addiction. We need solutions for a person using substances to help cope with the horrors of living on the streets, and we need solutions for those who became addicted to prescription opioids after a car accident – and everyone in between. 

Harm reduction encompasses a wide spectrum of solutions, ranging from helping someone become completely sober (abstinence) to giving someone food, water, or a place to sleep so they can safely come down from their current high. The important thing is that harm reduction works to keep people safer and healthier.

Across all of our subthemes, we will look both at laws and policies and at work being done on the ground to help people with addiction on a daily basis – both are necessary for us to truly protect health and safety for everyone affected by addiction. 

Overdose prevention via naloxone distribution. Naloxone (also known as Narcan®) is an inexpensive drug that safely and quickly can reverse an opioid overdose, saving someone’s life. It doesn’t produce a high, and is non-addictive. Increasingly, law enforcement officers and community workers, such as librarians, have been trained to reverse overdose using naloxone. But, as most opioid overdoses occur in private settings and are witnessed most often by a friend, partner or family member, distribution to people in the community rather than just healthcare providers and first responders is critical to save lives. 

Despite the overwhelming evidence supporting naloxone distribution, many barriers remain. By the end of 2014, only 8% of U.S. counties had an overdose prevention program. Even in states with these programs, the vast majority have no state or federal funding for the programs, and cannot meet the local need for naloxone distribution.

Sterile syringe access and disposal. San Franciscans see syringes discarded on the streets, and often reasonably conclude that syringe access programs are at least partially to blame. But research simply doesn’t bear that out. In fact, when people get their syringes from a syringe access program they are significantly more likely to dispose of their syringes properly, and many syringe access programs (including in San Francisco) also include local pickup teams. 

Besides actually removing syringes from the streets, more than 20 years of research has demonstrated that these programs are effective at reducing unsafe injection practices, preventing the spread of HIV and hepatitis C, and linking people who use drugs to substance use treatment and support services. Despite widespread endorsement by the American Medical Association, National Academy of Sciences, CDC, and World Health Organization, syringe access and disposal programs are still inaccessible in a lot of states, with 20 states either providing no access at all, or limited access in only one or two cities.

Syringe access and disposal programs can also be sources of many other related services, such as naloxone distribution, drug checking strips (e.g. to test drugs for the presence of Fentanyl), vaccinations, case management, and basic medical care. 

“You can't get clean if you're dead.”

Tracey Helton Mitchell
AUTHOR, The Big Fix

 

Drop-in safe spaces. Many community agencies providing harm reduction services have drop-in locations that serve as places for people who use drugs to sober up safely, with dignity and out of public view. Yet these are difficult to sustain. Neighbors frequently resist the presence of drop-in spaces, and many funders are unwilling to provide support. During recent meetings of the San Francisco Methamphetamine Task Force, launched by Mayor Breed, one of the key recommendations has been a “Meth Sobering Center” where people can go when they are high, giving them a place other than the street to sleep, eat, and safely recover.

Supervised consumption sites. Supervised consumption sites (also known as Supervised Injection Facilities or Overdose Prevention Sites) are controlled health care settings where people can more safely inject drugs under clinical supervision and receive care, counseling, and referrals to services, including drug treatment. Research consistently shows that these sites are effective at preventing overdose-related deaths: in a large multi-site assessment of all the supervised consumption sites throughout the world, not a single person had died of an overdose despite millions of injections. Supervised consumption sites have been shown to be cost-effective, and to reduce rates of crime, public injection, and HIV and hepatitis C transmission. They are also a space from which linkage to treatment can effectively occur.

Photo of Safer Inside demonstration site by Iran Narges and Glide Foundation

Regardless of the evidence, both federal law and the California criminal code currently make it impossible for cities to legally operate a supervised consumption site. While advocates were hopeful that Assembly Bill 362 would pass during the 2019 legislative session, making it possible for San Francisco and Oakland to legally pilot supervised consumption sites, the bill’s sponsors recently pulled it from consideration until next year.

Drug education resources for teens. Part of harm reduction is about delaying onset of initiation. Initiation of drug use prior to age 18 is significantly associated with the development of a substance use disorder as an adult. There are numerous evidence-based strategies to prevent early initiation of drug use, ranging from providing positive alternatives for youth to initiatives to change the environments that put youth at risk. Examples of universal interventions include policies—such as the setting of a minimum legal drinking age or reducing the availability of substances in a community—and school-based programs that promote social and emotional competencies to reduce stress, express emotion appropriately, and resist negative social influences.