This story is excerpted from “Harm reduction is shown to help, but rising skepticism threatens life-saving programs” by Sara Wilson, on Colorado Newline on June 20, 2024. You can read the full article here.
A few days per week, Richard volunteers at the Harm Reduction Action Center in Denver. He passes out snacks, helps people with the coffee station and gives hygiene products that the clients, many of whom are experiencing homelessness, need to stay healthy.
In many cases, the 36-year-old also offers people sterile syringes, clean pipes and other supplies to consume illicit drugs.
Two years ago, Richard, who requested Colorado Newsline use only his first name, walked into the doors of the single-story, nondescript building on the southeast corner of 8th Avenue and Lincoln Street as a client himself, looking for supplies for his methamphetamine addiction and gear to survive on the Denver streets.
“If it wasn’t for a place like this, I probably wouldn’t be here today,” he told Colorado Newsline during an interview at the center. As he spoke, people walked through the center on their way to a Thursday afternoon health education class on hepatitis C in the back of the building.
“There’d be many times where I would come in because I didn’t have anywhere else to turn. And I’d come here and they would help me,” he said. “They’d bring me back to myself so I could get back on my feet.”
HRAC operates one of about 20 syringe access programs in Colorado. The center runs under a harm reduction model by providing clean syringes and other paraphernalia, free opioid overdose reversal medication and information about the safest way to use drugs, all in an effort to prevent overdose deaths and the spread of communicable diseases.
Employees and volunteers meet clients where they’re at — often during the throes of active substance use disorder — and stand patiently ready to offer referrals to addiction counseling and medication-assisted treatment. The goal is to keep people alive and safe until they are ready to seek recovery. In the meantime, HRAC personnel will give them a cup of coffee and educate them about the risk of disease from using dirty needles. They’ll offer them a quiet place to rest and recharge.
“The number one substance use treatment admission requirement is that people have to be alive,” said Lisa Raville, HRAC’s executive director.
In a society where people who use drugs are consistently othered or disregarded, her philosophy is one of humanization and measurable progress, even if it’s through baby steps: “I’m just glad you’re here and I’m rooting for you. How can I support you for a healthier and safer you today? What’s something positive that you can do today? Then we all get to win, and then we can build on those successes.”
Harm reduction is an evidence-based approach backed by public health experts, doctors and community leaders. While the method has gained traction over the past decade, with more states allowing syringe access programs and overdose reversal medicine like Narcan becoming widely available, leaders fear a potential policy regression amid rising skepticism over its effectiveness and increased visibility of the effects of substance use disorder in cities across the country.
In Colorado, state lawmakers this year for the second time voted down a bill that would have allowed local governments to authorize overdose prevention centers, where people could use illegal drugs under medical supervision in case of an overdose. Pueblo’s city council, an increasingly conservative body, approved an ordinance in May that prohibits needle access programs in the city.
Research consistently shows that syringe access programs, in conjunction with other intervention measures, reduce HIV transmission. Experts warn that closure of such programs could lead to increased disease transmission among that population, more needle litter in cities because there would be fewer safe disposal sites, and fewer people accessing resources for treatment.
“There’s a backslide right now, unfortunately,” said Mary Sylla, the director of overdose prevention policy and strategy at the National Harm Reduction Coalition, referring to the national landscape.
“We’re seeing pushback of these syringe service programs primarily,” she said. “I think what is happening is homelessness and substance use are colliding with this public health intervention. Folks, locally, are thinking that if homelessness and drug abuse exist, and syringe service programs are the place the people experiencing those things are likely to congregate — people would rather not see the problem. So closing the programs is one way to push those programs back underground.”
That analysis is similar to the thinking behind a Pueblo ordinance from May that seeks to ban syringe access programs in the city. Led by Council member Roger Gomez, the ordinance defines the programs as nuisances “detrimental to the health or safety of the inhabitants” of Pueblo.
It specifically calls out improper disposal of needles and puts partial blame on the two syringe access programs that operate in the city, Access Point and the Southern Colorado Harm Reduction Association. The council framed it as a littering issue with an added danger to the public, and members frequently brought up anecdotes of residents getting poked by dirty discarded needles at playgrounds and parks.
“If you’re handing out needles and not receiving back the same amount you’re handing out, then that goes against what the community believed was going to be taking place. Now, we have littering and we have needles all over. We have business owners and teachers cleaning up the mess created by the user, who isn’t responsible enough to dispose of their own needles,” Council member Regina Maestri said during a work session about the ordinance ahead of the May 13 vote.
The ordinance passed on a 5-2 vote and briefly went into effect when Mayor Heather Graham signed it. The ACLU of Colorado then sued the city, however, and a judge issued a temporary restraining order on enforcement of the ordinance until the lawsuit’s first hearing in July. The lawsuit alleges that the 2010 state law allowing syringe access programs supersedes any municipal ordinance against them.
That means the two programs can operate for at least another three weeks.
“There’s definitely some concern, across the board statewide, for the state of harm reduction in Colorado,” Christine Charron, prevention services manager for Access Point Pueblo, said in an interview before the lawsuit was filed. “We’re at a weird time where we need to wait and see how (state law) holds up against other things the state has allowed for local decision making. Everyone is feeling a bit of unease.”
Colorado has allowed syringe access programs since 2010. In 2020, the law was amended to allow experienced organizations with certain qualifications to operate a program without board of health approval.
Access Point Pueblo opened in 2014 and offers its syringe access program three days per week. It is the main provider of harm reduction services in southeastern Colorado and one of six Access Point programs operated by the Colorado Health Network across the state. Those other locations are in Denver, Colorado Springs, Fort Collins, Grand Junction and Greeley.
Across all six locations, Access Point distributed over 1.5 million syringes between October 2022 and October 2023, according to CHN data. Pueblo’s location accounts for nearly 570,000 of those syringes. The network recorded about 1.2 million returned syringes over the same time period. It also recorded 1,031 self-reported overdose reversals.
“Unlike a lot of businesses or nonprofits, we actually hope that participants graduate out — not that we lose them to overdose, but that they graduate out of engaging with us because they’ve gone through recovery and are no longer using,” said Mike Mansheim, CHN’s chief strategy officer.