Harm Reduction in the Time of Coronavirus

We have never had the luxury of being innocent to viruses nor epidemics. Our most codified histories trace the emergence of harm reduction in the United States to the grassroots mobilization against the wildfire ravages of the AIDS crisis among people who use drugs through community education and syringe exchange programs. More recently, mainstream narratives of harm reduction coalesce around collective action to stem the overdose epidemic through naloxone distribution and other user-centered strategies to maximize safety in the midst of stigma, criminalization, and precarity.

But harm reduction was never just about the drugs or the deaths or the diseases; we are more than the auxiliary or stepchild of public health. Our richest work embraces much deeper and more diverse genealogies. Harm reduction is heir to the multiple legacies of the communities and struggles we come from and move through, the hybrid wisdom that emerges from communal survival in the face of threats of being dispossessed, disenfranchised, displaced, disappeared.

As we confront COVID-19/SARS-CoV-2, let us remember the gifts of harm reduction:

We are exquisitely skilled at navigating risk: Our communities’ perception and experience of risks have never been one-dimensional. By necessity, we become adept at calibrating our precautions against health threats against our potential exposure to arrest, rejection, isolation, withdrawal, discrimination, child separation, violence, trauma, and a myriad of other harms. We are well-versed in navigating the day-to-day, hour-by-hour trade-offs that life in the margins — or specifically, life in the crosshairs of the violence of inequality and injustice — entails. The bitter and beautiful truth of harm reduction has taught us to live with the prospect and reality of loss, and still keep going against the tide of despair. Perhaps not all of us will make it, but we increase our collective odds when we reject the impulse to ignore the risks while refusing to catastrophize the consequences. We know all too well how to develop tactics for moving forward when the perfect, risk-free choice is closed off to us. Our collective skills as the explorers and mapmakers and guides to treacherous landscapes of risk will serve us well in navigating this new terrain.

We have a strong ethic of redistributing resources: The material foundation of harm reduction is a commitment to mutual aid in the face of scarcity. We take our direction and inspiration from people who use drugs who, in the face of another’s suffering, respond with generosity. Over the last three decades, we have shifted hundreds of millions of syringes, millions of doses of naloxone, tens of thousands of fentanyl test strips, and countless other supplies to people in need. We share our food and water, hygiene supplies, socks and warm clothing, physical and virtual spaces. We have created formal and ad hoc networks to move supplies across state lines and borders, routing around laws and regulations when necessary. We call our networks and partners in through grassroots fundraising. Harm reduction has never had enough, but we have practiced for this moment and we are ready.

We already know how to weave community: The cruel irony for stigmatized groups of calls for social distancing lies in its echoes of isolation, invisibility, and abandonment. When you are already labeled as dangerous and disposable, social and structural forms of physical and symbolic distancing are enacted through eviction, expulsion, exclusion, relocation, deportation, incarceration. Yet even against the weight of these forces and threats, people who use drugs find each other and make community. Even against, and especially against — community not only fosters camaraderie and collective identity, but also mobilizes a vital network for circulating information, resources, and support. Community is not just a byproduct of harm reduction; community is the medium through which harm reduction moves and operates. At our best, we rally against exclusion, attuned to the workings of trauma and stigma, attentive to the hazards of self-defeating demands for purity and respectability. We are collectors of contacts, connoisseurs of connection, and we cannot allow ourselves to interpret appropriate calls for social distancing into a mandate for loneliness and withdrawal. This is a moment to savor and strengthen our ties, even if through phone and text and group chat and email and video. In the midst of our precautions against exposure and transmission, it is our sociality that may be our salvation.

There are many tasks and challenges and dilemmas that lie ahead; for so many of us, these were already perilous times. I remind myself of our gifts, of the resilience and joy to be found in our shared harm reduction culture and values, in order to reconnect to a greater sense of purpose: crisis has always spurred harm reduction to grow and innovate, and this is a moment to build together. We have come too far, survived too much, to retreat in the face of this new epidemic. We may not come out of this unscathed, but we have the opportunity to come out of this stronger. I look forward to building with you.

Note:

Now would be a great time to donate to your local/state harm reduction group (check the NASEN map for syringe exchange programs), drug user union (learn more from the National Urban Survivors Union), and/or sex worker organization (learn more from Sex Workers Outreach Project USA). If you have something left over, consider donating to my organization, the national Harm Reduction Coalition.

Resources:

COVID-19 Guidance for People Who Use Drugs and Harm Reduction Programs — developed by Higher Ground Harm Reduction, Reynolds Health Strategies, Harm Reduction Coalition, and Vital Strategies.

Pod Mapping for Mutual Aid — by Rebel Sidney Black, adapted from work by Mia Mingus & the Bay Area Transformative Justice Collective

Coronavirus and drug harm reduction — from Transform Drug Policy Foundation

Coronavirus: Wisdom from a Social Justice Lens — Healing Justice podcast with JD Davids, strategist and storyteller, The Cranky Queer; Evvie Ormon, a healer, facilitator and generative coach from Emergent Phoenix Consulting; Crissaris Sarnelli, MD, a primary care/family doctor and healer from Harlem NY; Elandria Williams, executive director and trainer, PeoplesHub; and the words of Dori Midnight

Online recovery support group meetings — from Unity Recovery & WEconnect

Coronavirus Resources — from National Health Care for the Homeless Council

COVID-19 National Emergency Response: Immediately reduce person to person contact in MAT services — from CA BRIDGE

Coronavirus Resources — from American Society for Addiction Medicine