Andrew Miller has a healthy fear of “the blues” – a colloquial name for fake oxycodone pills that contain fentanyl.
And although he candidly empathizes with those experiencing addiction, noting, “I’ve been a user most of my life,” he says “blues” are not the answer.
“It’s Russian roulette,” he said. “Every time you take a hit, you might as well be playing Russian roulette and putting a gun to your head.”
So he carries Narcan, the brand name medication that can quickly reverse an opioid overdose. For Miller, it is not a matter of choice anymore.
“I’ve got friends that are on the blues,” he said. “And it’s sad because if somebody falls out (overdoses) and you don’t got it, then they can die on you. I’ve had to Narcan three or four people now.”
As Miller told the The Durango Herald he had used Narcan once in the last week, Sierra Roe interjected: “Since I’ve seen you – just once?”
She makes a note.
Roe is the coordinator of San Juan Basin Public Health’s Opioid Risk Reduction Program, and Miller is one of the program’s participants. He has shown up four or five times to stock up on Narcan and other supplies that reduce the harmful impacts of drug use.
The program, which launched May 12, connects people not only with overdose reversal and prevention tools, but also with resources to limit the spread of infectious disease, education and referral to recovery resources and other forms of health care.
“Harm reduction programs fill in a really large gap between prevention work and treatment work,” said the program’s supervisor, Ashley Gonzalez.
The upcoming International Overdose Awareness Day on Aug. 31 is intended to raise consciousness of resources to reduce the harm of drug use – a mission that also guides the ORR program’s ongoing work.
And already, its impact has been immense. In the program’s 14 weeks of operation, its participants have administered 14 lifesaving doses of Narcan.
Harm reduction is a public-health forward approach to curbing drug use that is gaining traction nationwide because of a growing body of evidence supporting its efficacy.
The SJBPH Opioid Risk Reduction program is open for four hours one day each week.
When a participant arrives, Roe or Gonzalez conduct a brief intake questionnaire to gather basic information, although the conversation often drifts to other health-related topics.
The program is an opportunity to connect participants with other resources such as health care navigation, and mental health care and the sexual health clinic.
In the 14 weeks the program has existed, 10% of its participants have actively asked to be connected with recovery organizations or medical assisted treatment opportunities. Staff members say the number is likely to rise as the community becomes acquainted with the program, a process that can take up to a year.
At the conclusion of the intake conversation, participants are free to peruse a lengthy table filled with supplies. Sunscreen, toothpaste and condoms are available alongside pipes, needles and sharps containers.
The program can also conduct HIV testing on the spot and connect participants with testing for hepatitis C and other transmissible diseases.
Staff members say the approach is about meeting people where they’re at.
“We understand somebody is using drugs,” Gonzalez said. “We want them to have access to tools to be safer with that, and allow the opportunity to build a relationship with them to be a resource when they are ready to choose that there’s additional services that they’re in need of.”
The tools the program provides – Narcan, fentanyl test strips, clean needles, pipes and snorting supplies – are proved to reduce the harmful impacts of drug use.
“This helps, at least it gives them an option to keep clean,” Miller said. “It’s got its pros, it’s got its cons.”
Despite overwhelming evidence showing the benefits of such programs, the stigma around them can jeopardize the longevity of harm reduction efforts. As a result, SJBPH staff members are meticulous and guarded in their discussion of the program.
The Herald opted not to disclose the location of current operations to protect participants’ privacy.
Funding drawn from state grants aimed at reducing HIV transmission supports the ORR, as well as a $331,187 grant from La Plata County’s American Rescue Plan Act.
Public health officials say the ORR operates in alignment with best practices outlined by national organizations. Gonzalez and her colleagues also visited other successful programs across the state.
The SJBPH program is the only one of its kind in the region. Alamosa, across the Continental Divide, has the next-closest resources.
“It was odd,” said a participant named Shadow, recalling his first time visiting the ORR.
He had never encountered something like it before. Shadow used to use methamphetamine and said that although he is sober now, there are still people in his community who use drugs and benefit from the supplies he picks up. The practice of secondary resource distribution is widely accepted as a form of harm reduction.
“The only thing I can really do is try and help,” he said. “My life hasn’t always been like that, so why not try and help now.”
The purpose of the program is to “get in there and protect people – to save lives, and then save lives,” said Rosalind Penney, the director of SJBPH’s infectious disease and clinical care department.
It is a human-first approach: Tools such as Narcan and clean needles can literally save lives; increasing contact with public health officials, testing and referrals to treatment ultimately increase peoples’ quality of life and makes the entire community healthier.
“We have some strong prevention efforts in our area,” said Roe, the program coordinator.
But she says the “neutral zone” – judgment free, compassion-based care – is often missing.
Roe has struggled with substance use herself and leverages that experience to inform her work.
“Being someone who’s been through it, I understand it,” she said.
She said it’s important not to discount the value of the colloquial interaction. The beneficial interface can open inroads with participants and facilitate connections that can lead them to recovery.
“We treat people like humans,” Roe said.
Detractors often criticize harm reduction programs by arguing that they are encouraging drug use with public money.
On a national stage, President Joe Biden has made the model core to his drug policy agenda. It quickly became a political pawn when opponents cried foul, falsely, over federal funding of “crack pipes.” The claim was debunked by nonpartisan fact-checkers.
Studies have shown that facilitating access to clean supplies does not increase drug use.
According to the Centers for Disease Control and Prevention, those who participate in a harm reduction program are more than five times as likely to enter treatment for a substance abuse disorder as those who have never participated in a program. Participants are nearly three times as likely to report reducing or discontinuing drug use entirely.
The participants must abstain from using drugs in the vicinity of the distribution site, and they are prohibited from selling or distributing narcotics and supplies as well. Gonzales said these rules are generally followed because participants recognize the benefit of the program and understand that breaking the rules could imperil its future.
The benefits of harm reduction spread beyond just people who use drugs, to law enforcement and others who interact with participants.
By distributing sharps containers and encouraging needle exchange, the ORR is reducing the number of dirty needles left in public places as well as the prevalence of HIV and hepatitis C in the community.
A study comparing a city with a needle exchange program against one without said program found that there were eight times as many needles that had been disposed of improperly in the city with no exchange program.
Joey LaVenture, the commander of the Southwest Drug Task Force, agreed that harm reduction programs can be beneficial to a community.
“The ones that I think are the most effective, they’re not promoting drug use,” he said. “They’re educating people on the dangers of them and they’re trying to help the people that already have an addiction problem.”
In that spirit, the SJBPH ORR does offer material about the dangers of drug use and resources to those looking to overcome addiction.
Gonzalez also pointed out that the program was designed to meet needs uncovered by an assessment conducted in 2021. The department used a small amount of HIV-prevention funding from the state to research what services would benefit the community.
The needs assessment found that an informal needle exchange had already operated out of the Purple Cliffs camp. It also found that approximately 10,000 needles were being sold over the counter without prescriptions at pharmacies in Archuleta, Montezuma and La Plata counties each week.
“There was a need to follow best practices in syringe access services,” Gonzalez said.
In a region with just two medication-assisted treatment programs and no inpatient substance abuse treatment options, Gonzalez said the ORR fills in just one missing piece on the broader continuum of care.
Shadow and Miller seem themselves subject to the deeply ingrained societal philosophy that there is something wrong about handing out harm reduction materials. They do not want to see members of their community succumb to addiction either.
But they know, better than most, that they can’t stop drug use outright.
Miller put it in stark terms.
“To be able to have a clean pack of needles is nice. When somebody’s like, ‘Oh, let me use your needle,’ I’m like ‘no, no, no, no, don’t do that,’” he said. “I hate giving them out, but I’d rather they use something clean than something dirty.”