Harm Reduction With Heart, A 101

I am now serving as the Harm Reduction Faith Coordinator for the state of Ohio as part of Faith In Public Life. These remarks were read at the Harm Reduction Ohio conference “Family Matters” on April 6th, 2019.

Good morning! It’s so great to see everyone here. My name is Blyth Barnow, I am the new Harm Reduction Faith Coordinator for Faith in Public Life in Ohio. Faith in Public Life is a national network of clergy and faith leaders who are united in the prophetic pursuit of justice and the common good. I am excited to be part of their efforts to reduce both overdose deaths and the prison population here in the state of Ohio.

I was raised in Northeast Ohio in a small suburb called Berea but for the past 11 years I’ve been living out in California in the Bay Area. But as we know, Ohio gets into your blood. So while I’ve always claimed Ohio as home, I’m excited to finally be moving back.

I have been doing harm reduction work with the National Harm Reduction Coalition, and most recently with Faith in Harm Reduction, Faith in Public Life, and a project I founded called Femminary.

As we kick off this incredible conference I’ve been asked to ground us in some basic Harm Reduction principles. For me, Harm Reduction, has been a living concept. Which means it changes and evolves, as I change and evolve. There is no universal definition, but there are some common understandings.

Harm Reduction International says, “Harm reduction refers to policies, programmes and practices that aim to minimise negative health, social and legal impacts associated with drug use, drug policies and drug laws. Harm reduction is grounded in justice and human rights – it focuses on positive change and on working with people without judgement, coercion, discrimination, or requiring that they stop using drugs as a precondition of support.”

This is a good, broad, overview of harm reduction work. But I’ve really loved how the National Harm Reduction Coalition has been breaking it down recently. They talk about risk reduction and lowercase h harm reduction, which speaks to the programs and services we provide, and capital H harm reduction, which is a philosophical and political movement focused on shifting power and resources to people most vulnerable to structural violence.

Risk reduction is the tools and services we provide to reduce the risks of potential harm. Things like:

  • Providing sterile syringes or other safer injection supplies or running a syringe access program.
  • Distributing naloxone or narcan, a medication that can reverse an opiate overdose.
  • Things like, doing wound care
  • Distributing fentanyl testing strips and checking the local drug supply
  • Offering sterile pipes and other safe smoking supplies.
  • Operating safe consumption rooms also known as overdose prevention sites
  • Providing accurate, hysteria free, information about the risks and benefits of drugs

These are just some of the many things we do to reduce risk.

Because harm reduction is a deep commitment to the health and well being of our communities. Even if the laws haven’t caught up to us yet. It means we do not allow people to suffer or die preventable deaths even if the law creates barriers by saying that we need special permits to distribute naloxone or that syringes can’t be distributed in certain counties. Powerful and necessary harm reduction work is being done both above and under ground.

Basic harm reduction, lowercase h harm reduction, knows that to do our best work we have to do more than reduce risk. We must also combat shame and stigma. Which means that we must understand that a person is always more than their drug use and that distilling a person down to just one thing is a violation of their humanity. And anyway, in my experience, often a person’s substance use is actually the least interesting thing about them. We have to go deeper, know more.

We must also understand that not all people who use drugs are addicted to drugs. In fact, many aren’t. And even if a person is navigating addiction, they are still more than just an “Addict”. So we must speak about them accordingly.

Harm Reduction is a reclaiming of our individual and collective dignity. It is a form of great respect. So to be successful people have to have autonomy and choice. Coercion, strips people of their dignity. So consent has to be foundational to our work.

Harm Reduction is not just an alternative road to sobriety. Sobriety is not harm reduction’s end goal. Health, wellness, connection, and community is harm reduction’s end goal. Which can be achieved with our without sobriety. Harm Reduction understands recovery as any positive change that moves people towards these goals.

Captial H harm reduction means centering those who are most impacted both in service provision AND in leadership. Which means that our leaders are people with lived experience and people who use drugs. It requires us to redirect resources to those who are most targeted for violence, primarily, people who use drugs, people doing sex work, people of color, people who are queer, transgender, lgbt, or gender non-conforming, people who are marginally housed, people living in poverty.

Which, let’s just pause here for a moment, and name that that list includes soooo many of us in this room. We are not the few. We are the many. It is time for us to act like it.

Capital H harm reduction asks us to understand and transform the SYSTEMS that are causing harm and putting people at risk. Systems like white supremacy.

Drug restrictions and drug policy were first created as a means of criminalizing migrants in this country. A trend which we know continues today. The war on drugs has criminalized and incarcerated huge percentages of people of color. Mass incarceration in this country is largely fueled by the war on drugs and the war on drugs is largely fueled by white supremacy.

We live in a time where white Midwestern youth are being leveraged against communities of color. This paternalistic desire to protect our virtue, our purity, our abstinence, has fueled dehumanizing immigration policy and increased criminalization of communities of color. The subtext always being that people of color are responsible for the production and sale of drugs and are therefore a threat to innocent white children.

White supremacy has used this lie to devastate communities of color while simultaneously abandoning many white communities. Because the truth is that white supremacy has never been concerned with the well-being of white people. It has only ever been concerned with the concentration of white power. It is why it makes all these demands on behalf of white children but then allows them to die without access to community distributed naloxone.

Growing up in a white working class town I watched as my friends feverishly worked to obtain the american dream. A dream that felt promised to them, even if not consciously, largely because they were white. As white people we are told that this country works for us and if we just work hard enough we can do anything we want. So when we could not pull ourselves out of the struggle and poverty that shaped our day to day, we did not think the system failed us, we thought we failed ourselves. And I watched as that feeling of failure, which is rooted in white supremacy, tricked people I love into believing they were unworthy. A pain they sought to ease with substance use which, without access to harm reduction information, ultimately claimed many of their lives.

Talking about white supremacy and racial justice is not a secondary issue and it is not an issue that only impacts communities of color, though they are the primary targets. Harm reduction requires the tough work of reclaiming dignity. And white supremacy is a collective wound to our dignity. Ignoring it in our work leaves behind a key aspect of both harm reduction and overdose prevention.

So just to recap…basically harm reduction is a common sense approach to drugs and drug use, and so people who actually used drugs are the common sense leaders.

These are some practical answers to what harm reduction is. But I think many of us know that in practice Harm Reduction is so much more. Harm Reduction is a philosophy, a way of being.

But the tricky part is that harm reduction requires us to engage our own healing. Many of us came to harm reduction after experiencing loss, trauma, or isolation. I know that is true for me, and I have found that harm reduction asks me to have a systemic understanding of deeply personal pain.

And I confess that I did not come to this movement easily. In fact, I kind of came kicking and screaming. Sometimes, literally screaming.

About 10 years ago I was asked by my mentor Maria Chavez to prepare a workshop on harm reduction for the domestic violence agency we used to work for. I told her very clearly that she had the wrong girl. I knew it was my job to lead trainings but I told her that it was very unlikely I would be able to do the topic any justice.

The truth is, I was angry. Which is really to say, I was scared. I didn’t want drugs anywhere near people I cared about, because I wanted the people I love to live. And I didn’t want drugs anywhere near me because drugs and danger had often been connected in my life. Drugs meant the danger of losing my housing, my food, my physical safety. But just as pressing, drugs meant grief, worry, loss. And I was already so tired.

So as a good mentor does, she nodded, understood where I was coming from….and then told me to do it anyway. She knew the baggage I was carrying but she also knew that I deserved to be free of it. She understood what was keeping me from compassion, but she also knew that our clients deserved better. So I read up and I did the presentation the best I could, and it was…….not good. In fact I was so freaked out that my left arm just stopped working half way through the presentation. I had to literally scoop it up and hold it while I talked about the importance of meeting people where they are at, but making sure you don’t leave them there. I am a better person today because Maria did just that for me.

I was 20 when I lost a former partner to an overdose. And after his death I was filled with a unique kind of furry. I was so angry that he was gone. I blamed him for using. I blamed myself for not saving him. I blamed his parents for their theology. But most acutely, I blamed the person that had been with him the night he overdosed. Because when he began to overdose they left him. But 10 years later, when I first started working at the Harm Reduction Coalition, that person died of an overdose too.

It wasn’t until then that I began to understand that it was not individual “bad” choices that killed the people I cared for. It was a systemic issue. It was that the system was “bad”.

For example, I didn’t know that naloxone existed until 10 years after my partner died. But I trust that if they’d had it on hand, they would have used it that night. And in hindsight I can see that the person who left him did so because they had a child and they could not afford to go to jail and they probably worried that their child would be removed from their custody. But I trust that if a comprehensive good samaritan law had been in place, that person wouldn’t have left him that night. I trust that if policy and society had treated them either of them like their lives were valuable, that they might BOTH still be alive today.

One of the deepest regrets of my life is that I know I added to the shame and stigma that each of them carried. I did not know any better. I grew up in a family that was deeply impacted by chaotic substance use and I was told that abstinence was the only way out of that hurt. I was told that recovery required will power and that supporting the people I love only fueled their disease. I was told that people who use drugs were untrustworthy and dangerous. I was told that my love had to be tough.

I thought I was doing the right thing. But when I found out that there was another way…I was overwhelmed with a sense of guilt and regret that I am still recovering from. Learning about harm reduction and naloxone, meant also sitting with the reality that the people I loved died for absolutely no reason. It also meant feeling like I could have done more to prevent their deaths, and so their deaths were in part my fault.

This is what happens when we leave harm reduction interventions out of public discourse or we create barriers to things like naloxone, testing strips, or sterile equipment. We lose brilliant and wonderful people for no reason and we force families and loved ones to shoulder an unbearable weight of regret, that ultimately they are not responsible for. It is cruel, it is unjust, and it is fixable.

We cannot continue to layer grief upon grief upon grief. We deserve better than that.

Harm Reduction is a radical act of love. It asks us to forgive ourselves and forgive each other. It calls us to healing and demands justice. Harm Reduction means that nobody gets left behind. Harm Reduction means that we do not allow each other to suffer or die unnecessarily. Harm Reduction means that we commit to leading the moral conscience of this country, even if laws have to work to catch up to us. We do not wait to give people the tools they need to save their own lives. We do not wait to claim our worth.

I am so grateful to be in this room and in this movement with each of you. Over the next few hours I know each of us will receive some bit of healing and some bit of challenge. May we rise to greet each of them with grace, care, and compassion. May we meet ourselves and each other just exactly where we are at.

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