ROANOKE, Va. – This article is part of “Solutionaries,” our continuing commitment to solutions journalism, highlighting the creative people in communities working to make the world a better place, one solution at a time. Find out what you can do to help and subscribe to our Solutionaries channel on YouTube. We’re looking at solutions to the drug problems our communities are facing.
Drug use continues to be an issue across the country. But one of the solutions is harm reduction.
It can be a controversial topic as some say it’s enabling people to use drugs but others say it’s saving lives.
The Substance Abuse and Mental Health Services Administration explains harm reduction as “an evidence-based approach that is critical to engaging with people who use drugs and equipping them with life-saving tools and information to create positive change in their lives and potentially save their lives.”
We’re taking a look at the evidence and limitations of harm reduction.
“I’ve probably been drinking since I was nine and using hardcore drugs since I was 11,” said Courtney Downs.
Now at 42 years old, Downs has been sober for nearly four years but it’s taken years to get there and a lot of losses along the way.
“Throughout my active using, I lost my nursing license and ended up homeless here in Roanoke,” said Downs. “Right before I got clean, I was hanging out with some people that were early participants of Virginia Harm Reduction Coalition, and even though I wasn’t a direct participant, they Narcan-ed me with the Narcan that they received.”
She credits the Virginia Harm Reduction Coalition (VHRC) with saving her life.
“I wouldn’t be here today without it,” said Downs, who now works for the same organization as a Hepatitis C patient navigator.
Her job includes working with program participants, getting them tested for Hepatitis C, and giving out drug reversal medication and safer use supplies.
“Harm reduction is love,” said Danny Clawson, the Executive Director of Virginia Harm Reduction Coalition. “Harm Reduction isn’t just about throwing syringes at people. It’s about building strategies and tactics to use safer so that we can keep people alive, so they can get the help they need.”
Four times a week anyone, from anywhere, can get free supplies from the VHRC that range from overdose reversal spray to safer smoking kits, and a connection to education and treatment options. There’s a mobile outreach van that travels to different locations and an office space with a food pantry and testing rooms for various diseases.
“If you are in a member of a harm reduction program and are accessing services through a harm reduction program, you’re five times more likely to enter substance use treatment,” said Clawson. “It’s right there in the name. We’re trying to reduce the harms associated with drug use because, for a long time, the philosophy was ‘You gotta let them hit rock bottom. You got to let them lose everything before they crawl back up out of the bottom of the barrel.’ I don’t know if I ever subscribed to that philosophy. But even if that philosophy were true, rock bottom these days is death. People aren’t surviving rock bottom, and you can’t recover if you don’t live. Our primary goal is to keep people alive long enough to get the help they need.”
Virginia only has 12 Comprehensive Harm Reduction sites where needle exchanges are legal. Our region only has two and both of those are in Roanoke. People drive from two hours away and they will serve anyone who shows up. Clean needles help prevent the spread of diseases like HepC and HIV. It’s also saving taxpayer dollars because Clawson said 90 percent of their participants are on Medicaid.
Volunteers are vital to the effort. We were there as volunteers packed life-saving Naloxone intermuscular kits that had syringes and vials of the overdose-reversal drug.
|Name of Group||Location|
|Scott County Health Department||Gate City|
|Strength in Peers||Harrisonburg|
|Smyth County Health Department||Marion|
|Strength in Peers||New Market|
|Minority AIDS Support Services, Inc.||Newport News|
|Minority AIDS Support Services, Inc.||Norfolk|
|Chris Atwood Foundation||Reston|
|Council of Community Services||Roanoke|
|Virginia Harm Reduction Coalition||Roanoke|
|AIDS Response Effort||Winchester|
|Wise County/City of Norton Health Department||Wise|
“Everything I see, the work being done, is super important and saving lives every day and helping to put these folks on a path towards getting a little better,” said Joe Bryson, a regular volunteer, who said he was going to get emotional talking about his experience. “The people on the staff here and the way they treat and respect folks and their participants in the program, it’s just great. It’s so much about respect and humility, that any of us could be there and how these people or participants could could be any of us. That takes some humility to take that view.”
Bryson said he got interested in the volunteer work because he read Beth Macy’s books, was new to Roanoke, and looking for something to get involved in.
Macy’s spent the last decade writing about the opioid crisis and published two books: Dopesick, which was turned into a Hulu series, and Raising Lazarus.
“You’ve got to build the lily pads to help people cross the pond to get there,” said Macy about understanding how harm reduction works and the trust built between drug users and providers. “I saw it happen to numerous people, homeless people living in tents, now sober for the first time in their adult life. I saw it happen over and over. It’s this approach of bathing people in nonjudgement, love, social support and connections to care that actually works.”
The author went on to say, “If you’re waiting for somebody to hit bottom, the bottom has a basement, and the basement has a trapdoor. In an era of fentanyl, the bottom is death. We’ve got to make the treatments and the connections to care easier to access than the dope. That’s the bottom line.”
Much like us as we were researching harm reduction and drugs in southwest Virginia, Macy asked if there was a magic solution during her reporting.
“Certainly the federal government could do ‘x’ and then we begin to work on that treatment gap. But what I learned was public health and the way we treat addiction is very much part of each community’s basket of gifts. The way they do it in New York is not going to fly in Roanoke, Virginia, is not going to fly in Wise, Virginia, or Lee County, Virginia. We’re not gonna have a safe consumption sites. What can we have here? We can have needle exchanges and Harm Reduction Centers,” Macy said. “They’re gonna keep using. This idea that just putting people in jail might make the politicians look good because they can say ‘Oh, look, see what we’re doing about the opioid crisis’. It just doesn’t work.”
Also a hurdle – skepticism in many communities about harm reduction and concern about enabling drug users.
“We believe that every single one of our participants has the potential to turn their life around to become healthy and happy and connected into their communities. But they can’t do that if they’re dead,” said Clawson, who understands people saying syringe programs are enabling. “I was raised with that same philosophy. What I say to those people, is that a harm reductionist will never try to glorify the use of drugs or minimize the real harms associated with injection drug use, because we see it every day. We are very clear on the impact of drug use, not only on a community but on an individual level. And what we are here to do is to love those people and say, ‘You are worthy of that love’, and take care of them and support them so that they can make the changes in the life in their life that they need.”
There are limitations to how successful harm reduction can be in the community. Clawson said limitations include the climate of the community, funding, and support.
“When people get to know us and get to know our program and know that we’re not just throwing syringes at people and leaving them to their own devices, that we’re providing comprehensive wraparound care to support, not just their needs to stay safe while they’re using drugs, but their housing needs, their mental health needs, their treatment needs, you know, we’re trying to provide a holistic response to this,” said Clawson. “We’re really lucky to be in an area that is incredibly supportive. We kind of see ourselves as the on-ramp. Then once they’re in a different place, and they don’t need our harm reduction resources, we can then hand them off to agencies that are better equipped to help them with their recovery journey.”
The VHRC gets rid of 100,000 syringes safely every year. Last year, they gave out more than 20,000 doses of Narcan and know that reversed at least 2,000 overdoses based on what program participants report back.
We asked the Virginia Department of Health about drug use and the number of preventable diseases. The Roanoke City & Alleghany Health District (RCAHD) statement reads:
“We are concerned about cases of hepatitis C and HIV in our residents, as far too many people have been diagnosed with these preventable diseases. While these diseases are still too common, our local RCAHD rates of newly identified cases have stabilized over the past three years. At the same time, we are also monitoring concerning state- and local-level increases in sexually transmitted infection (STI) activity, such as a rise in syphilis cases. While STIs are not directly linked to drug use, we believe some of the increase in STIs may be connected to other risk factors, such as high-risk sexual behavior that can be associated with drug use.”
Below is the local data for HIV and HepC in RCAHD from the last five years. RCAHD includes the Alleghany Health District (Roanoke County, Salem, Botetourt, Craig, Alleghany, and Covington) and the Roanoke City Health District:
|2018||2019||2020||2021||2022||YTD 2023 (as of 6/30/2023)|
|Chronic Hepatitis C||Roanoke City HD||344||370||182||163||123||68|
|Chronic Hepatitis C||Alleghany HD||178||281||225||181||125||54|
|HIV||Roanoke City HD||14||8||17||10||13||7|
*Data is suppressed if there are between 1-5 cases.
This article is part of “Solutionaries,” our continuing commitment to solutions journalism, highlighting the creative people in communities working to make the world a better place, one solution at a time. Find out what you can do to help and subscribe to our Solutionaries channel on YouTube.