Blue-skied days in Charlottesville, the ones where there’s nary a cloud in sight, tend to get hot, fast. Those lethargic days where time moves slower than beads of sweat dripping from foreheads and elbows and the backs of knees, the days where everyone prays for a breeze. The ones where no one leaves the house if they don’t have to, but life can’t always wait.
Earlier this month, volunteers with Cville Area Harm Reduction gathered at a shaded picnic table in a public park on one of those days. They talked about some of the folks they serve, offered condolences to a fellow volunteer whose friend recently died of an overdose; they’d all been there before, too many times. They talked about how this weather causes overheating, undernourishment and dehydration, all things that increase a person’s chance of a drug overdose, so, it’s especially important for them to raise enough money to stock up on supplies as the temperatures rise. And they talked about how to continue getting the word out about their harm reduction efforts.
Volunteers Jordan and Morgan, who did not want their last names used, co-founded Cville Area Harm Reduction (formerly Jefferson Area Harm Reduction) in 2017. “We were both drug users, junkies — whatever you want to call it — and we realized that the services of Charlottesville weren’t providing services toward people who were using, namely clean syringes and Narcan,” or naloxone, a medication that can counter the effects of an opioid overdose, said Morgan.
Since then, the group has operated via word of mouth and by social media. Its Instagram profile (@cville.harm.reduction), which helps with community outreach, gives a clear, quick rundown of its offerings: “Mobile Harm Reduction – Charlottesville, VA. Narcan & clean works. FREE- No questions asked.” The profile also includes both a phone number to call for delivery, and a PayPal address for people to donate and fund supplies.
As defined by the National Harm Reduction Coalition, “harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.” It is not harm prevention, or harm elimination, said Jordan. Instead, harm reduction operates on the fact that people do, and will continue to, use drugs, either illicit or prescription. (It should be noted that illicit drugs are unregulated, which means every batch of drugs is different. That, in combination with the fact that each individual person reacts differently to a drug, and that conditions as seemingly insignificant as how much someone weighs or how much they’ve had to eat or drink that day, among other factors, only contributes to the peril of use.)
“As long as we live in this kind of society,” said Morgan, drug use is a given. “Our goal is to make sure that people are using safely. Using safely and reducing overdose.” To reduce harm.
Every community needs such efforts, including our region. In 2020, data show that there were more than 64 emergency department visits for overdoses per 10,000 people throughout the region (Charlottesville and Albemarle, Fluvanna, Greene, Louisa and Nelson counties), said Region Ten Coalition Director Rebecca Kendall.
Data show that throughout our region, “emergency department visits for overdose [had] been decreasing from 2015 to 2019 but increased in 2020,” said Kendall. And it’s important to note that this data only includes emergency department visits for overdoses; it does not include data on how many people are using drugs or how many overdose and do not visit the ER (not all overdoses are fatal — Narcan can help with that).
Last year, both emergency department visits for overdose as well as drug usage spiked in March, April and May — at the start of the COVID-19 pandemic — said Kendall. Statewide data on EMS administration of Narcan, as well as overdose deaths during the pandemic, show “that overdoses increased through July 2020 and then began to decline a bit. Data for our localities was similar for the most part.”
When someone can’t see their future — say, when a global pandemic kills millions of people and injures millions upon millions more while leaving others unemployed or homeless or in crippling medical debt — getting high is a way to feel good when hope is all but gone, said Cville Area Harm Reduction Volunteers. The pandemic deepened many of the inequities in our society that have existed for a long time, issues that lead many folks to use drugs in the first place.
“What are you going to do with $100, $200, even $500?” asked Jordan. “If that’s your only $500 and there’s not any more coming, what are you going to do with it? You’re not going to build a new life with it. I understand why people are like, ‘$100? Let’s get high.’ Or, ‘My stimulus came, $1,200. I can’t really do anything with that, it’s not regular. Let’s get high.’”
“Yes,” said Morgan. “Buy some cool things and the rest goes to getting high and feeling good.”
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Cville Area Harm Reduction offers help in a few different ways.
Most tangibly, it encourages physically safer drug usage by offering clean works: syringes and lancets (needles), safer use kits, sterile water, filters, cups, tourniquets, cottons and cookers. Re-using any of these materials can lead to skin infections, which can lead to abscesses and systemic blood infections … and sharing these materials can increase one’s chance of contracting Hepatitis C, HIV and other viral and bacterial infections.
Alex estimated that Cville Area Harm Reduction purchases and hands out about 5,000 syringes per month.
Cville Area Harm Reduction also provides free naloxone/Narcan, which can help reverse an overdose. And a few times, they’ve offered Plan B (the “morning after pill”) — and that, too, was popular.
Generally, all of these things are less expensive, and require fewer overall resources, than an ambulance ride, an ER visit, a treatment program for Hepatitis or HIV or raising a child, said Morgan.
Folks who contact Cville Area Harm Reduction don’t just pick up supplies for themselves, said the volunteers, though they estimate they currently serve between 40 and 50 people directly (and thus even more indirectly). Folks pick up supplies for their friends who hesitate to reach out, even though the group has established itself as a trustworthy, non-judgmental resource that does not share information with anyone outside the group.
“People who are using drugs know what they need, and they know how to help each other. They’re just not getting the resources they need to do so,” said Alex. Harm reduction efforts place those resources directly “into the hands of the people who need it most, to be able to distribute it freely. That’s how it’s actually getting into the community of people who need it.” Not everyone is comfortable going to a clinic for these resources, either, said Alex. There’s often the fear of cops getting involved. And not all healthcare professionals treat people who use drugs with respect, to the point where some people who use won’t disclose that information to their doctors, which results in improper and inadequate care.
“They stigmatize you,” said Morgan of the general public. People who use drugs are treated like thieves, assumed to be dirty and weak, she added. “They make you feel trashy and insignificant. That’s what the health system does to people that are poor and need help.”
“The stigma is killing people,” said Alex, because the stigma is usually what prevents them from seeking help.
But since many Cville Area Harm Reduction volunteers are themselves in recovery and have thus experienced much, if not all, of this themselves, they offer a valuable level of sensitivity and understanding, one that even the best health care and mental health professionals cannot always provide.
In Virginia, harm reduction efforts currently fall largely on individual community members and independent groups like Cville Area Harm Reduction (and the Virginia Harm Reduction Coalition) in part because the state limits what public health districts can offer. Needle exchange programs are legal in some states. Virginia is not one of them (well, it’s a bit of a gray area, with potential harm reduction sites requiring individual approval), but “Virginia is coming along with harm reduction,” said Kendall.
In 2020, the state expanded legal protections for people experiencing and reporting overdoses. And health departments are doing what they can to aid their communities. Region Ten, along with the Blue Ridge Health District, plans to enhance and expand its efforts in the very near future, said Kendall, and they’ve already begun offering things like medical lock boxes.
So far, Region Ten’s harm reduction efforts, as well as those of the Blue Ridge Health District, have largely focused on access to naloxone/Narcan. Anyone can buy Narcan at a pharmacy. But people can pick it up for free at either Region Ten on Preston Avenue, or at the Health District office by appointment, but getting Narcan for free at either of these spots requires a certificate showing completion of a revive or rapid revive training session. The trainings are free, but, again, some people who use drugs don’t feel comfortable giving out their personal information or walking into a clinic for help due to the aforementioned stigmas.
The Health District also offers Hepatitis C and HIV testing, and regularly warns the community when particularly potent batches of drugs are circulating through the community (as it did last summer with a fentanyl-laced batch of heroin), which certainly contributes to the overall effort, say Cville Area Harm Reduction volunteers. The independent harm reduction group has worked alongside both the Blue Ridge Health District and Region Ten on various programs, though it’s still difficult, if not impossible, for people to access treatment for those infections.
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It’s difficult to drum up support for harm reduction programs, in part because the general public does not understand exactly what harm reduction is (and is not) and have not yet had to face addiction in any real way in their own lives, said Morgan, whose own family started supporting harm reduction efforts, at least conceptually, when her sister died of a drug overdose. Lack of support also results from the assumption that harm reduction, because it is not harm prevention or eradication, enables people to continue to use drugs. But that’s not the case, said Morgan. People who use drugs are “going to use drugs. You are addicted. You are experiencing poverty, stress, all these outer elements that create these feelings and desires to get high.”
When those feelings and desires strike, said Alex, “nothing else matters. If you’re sick and you have to get high [to feel good], you’re going to do it no matter what.” People tend to ask addicts things like, “Why don’t you just stop?” said Alex, but getting clean isn’t simple or easy. “People agree now that [addiction] is a health care issue, a disease. But they’re not willing to help people unless they’re already clean. And people need the support when they’re using, to not be afraid to ask for help. I think a lot of people who wouldn’t support this kind of thing have the idea that people who use drugs don’t deserve to live.”
“The trauma that some people [endure], or the mental health issues that people have, you just can’t judge anyone for starting to use drugs,” Alex continued. “They call it self-medicating, but it is. It might not lead to a healthier life, but it might help people deal with some serious issues that they have. The main goal of harm reduction is to treat people who are using with dignity and respect and compassion.”
The consequences of not supporting harm reduction are devastating, and Cville Area Harm Reduction volunteers know that specific grief firsthand: They’ve lost friends and family members, and almost their own lives. For a while, Alex lost a friend every few months, but that trend has stopped, not because his friends sought help, but because they died. “All my friends that I grew up with are dead,” he said quietly, staring at the picnic table. “You develop some seriously powerful friendships and connections with people you spend all day with, in the throes of addiction.”
“Like we’ve said multiple times already, people tend to stigmatize users. But these users — these people, these humans — they have the same things we all have in common,” said Morgan, and it’s terribly sad when a person can no longer contribute what they have to offer to the world.
Learn more about harm reduction
Cville Area Harm Reduction
- Providing free and anonymous harm reduction resources
- Instagram (the group is most active on Instagram, posting what’s available, what they need, info on how non-drug users can help drug users, tips on how to recognize an overdose, and much more, on a regular basis)
- Phone: (434) 218-0228
Region Ten Community Services Board
- Providing mental health and substance use services, including Narcan and revive/rapid revive training
- Phone: (434) 972-1800
Blue Ridge Health District
- Providing Narcan, as well as Hepatitis C and HIV testing
- Opioids resources page
Virginia Harm Reduction Coalition
Virginia Department of Health
- web page on comprehensive harm reduction in Virginia
National Harm Reduction Coalition
National substance use helpline: 1-800-662-HELP (4357)
- use website search feature to find meetings near you