Harm reduction recognizes that substance use is inevitable and saves lives by giving people the resources they need to survive.
By Greta Stuckey
Emergency opioid response kit in New Paltz, New York. Source: Greta Stuckey
Sitting in her Syracuse office, Carolina Diaz hands out needles, testing strips, and Narcan to clients with substance use disorders. The clients often tell her that they aren’t ready to stop using drugs. Diaz smiles and listens. They may not yet be able or willing to stop, but she knows their visit is likely a first step on their journey to recovery.
“We meet people where they are,” said Diaz, harm reduction manager at ACR Health on West Genesee Street in Syracuse. “I'm not going to push treatment or abstinence on someone. What I'm going to do is a motivational interview with a client and when they are ready, I can start providing the services they need.”
Substance use isn’t a new crisis in the United States. One of the first studies of morphine addiction came in 1875 by Levinstein which looked at the addictive nature of substances. However, in recent years the crisis has caused more deaths. Since 2013, overdoses have become more prevalent because drugs like fentanyl are often found in the illicit drug supply, according to the CDC.
In 2022 alone, the CDC estimates that about 105,000 people died of drug overdoses. Instead of getting people to stop using drugs, harm reduction focuses on lowering the risks of substance use by giving people life-saving resources.
In New York state, syringe exchange programs have proven to decrease the spread of HIV infections related to injection drug use, as reported by ACR Health. In addition, people who use the Syringe Exchange Program are five times more likely to go to substance use disorder treatment, according to Diaz.
After establishing a relationship with clients, Diaz often makes referrals for them to get mental health counseling and substance use treatment. Harm reduction resources at ACR Health also include fentanyl testing strips, Narcan training and overdose prevention programs.
“I think the common misconception is that we're enabling people to use drugs,” said Diaz. “Yet, we are reducing the risk of overdose by providing Narcan, and drug-checking services, such as testing strips.”
ACR Health also has a mobile unit that works to get harm reduction resources into local Syracuse neighborhoods, especially those with high rates of homelessness. Access to resources is critical for drug users because the majority of today’s street drugs are laced with Fentanyl, according to Mariah Senecal-Reilly.
As the Substance Use Initiatives Coordinator at the Onondaga County Health Department, Senecal-Reilly’s program focuses on harm reduction strategies. One initiative they have takes place in the local Syracuse schools and teaches students resiliency-building skills and self-regulation techniques. Senecal-Reilly says the program has shown reduced rates of substance use and mental health challenges in kids who participate throughout the school year.
“Almost everyone knows somebody who has struggled with substance use disorder,” Senecal-Reilly said. “Our numbers for overdose fatalities reflect the breakdown of the population within our community. People think that substance use disorders only impact one type of person, but it's so widespread across all genders, races and social classes.”
Similar to ACR Health, the Onondaga County Health Department also has a mobile syringe unit and provides Narcan training to the public. Narcan is a life-saving drug that reverses or reduces the effects of an opioid drug overdose.
In recent years, Senecal-Reilly said the health department has seen more people taking substances laced with fentanyl and other synthetic opioids without their knowledge, leading to high overdose rates. In 2021, about 83% of opioid-related overdose deaths involved synthetic opioids like fentanyl, according to the CDC.
“People are not typically prepared to be ingesting an opioid so they may not have Narcan in their household,” Senecal-Reilly said. “People should test every substance because if there’s fentanyl in their drugs, they are at very high risk for a dangerous overdose.”
Drugs outside of the opioid category like meth are also being laced with fentanyl, according to Alexandra Punch, the director of the Lerner Center for Public Health. There is also a non-opioid tranquilizer called xylazine that is increasingly being found in the illegal drug supply which is leading to higher overdose rates, according to the CDC.
While Punch said that harm reduction has always been important, she believes it's even more critical now because of the increased risk of overdose with fentanyl and xylazine in the drug supply. On Sept. 23, there were 69 reported overdoses in Onodoga County, according to the Health Department’s overdose tracker. It marks the highest number of overdoses in a single day this year.
“Safe consumption sites are desperately needed across the entire country,” said Punch. “Syracuse is no exception. The reason that safe consumption sites don't exist is completely political. So until you solve the policy issues that surround harm reduction practices, there's nothing organizations can do beyond advocating for those policies.”
Supervised consumption sites are controversial. They are designated places where people can use pre-obtained drugs under the safety and support of trained staff, according to the National Harm Reduction Coalition. Currently, the only official safe injection site in the United States is located in New York City. The site run by the organization On Point NYC allows people to use drugs they have in a safe environment where they are given clean resources and monitored for overdose symptoms.
Harm reduction proponents believe safe consumption sites are critical because they connect drug users to recovery staff. In addition, On Point NYC says they save lives and reduce the stigma surrounding substance use disorders by treating all people with respect. Those who oppose safe consumption sites often think it encourages and enables drug use.
“Addiction is a neurochemical, physical and habitual issue,” said Punch. “It's all-encompassing on an individual and they deserve to be treated with respect. Oftentimes I think people don't want to view it that way because it's easier to just see them as criminals.”
Substance use disorders are complicated and care is highly personalized. Harm reduction opens a path to treatment. It’s not guaranteed, but it’s a starting point. The approach allows people to get help in a judgment-free space. Harm reduction isn’t recovery, but it helps keep drug users safe and alive along their journey.
“We thrive on providing transformational versus transactional services to our clients,” Diaz said. “Through the relationships that we create, people who use drugs can have a better life.”
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