Harm Reduction in Hard Times: What Safety & Care Around Drug Use Can Teach Us During COVID-19

In the waning months of 2019, I sat in a friend’s home in East Oakland, looking down at defunct Oakland Coliseum, and the house lights flickering on in the twilight. I was there, ostensibly, to celebrate a friend’s birthday party. But as the evening slid into night, and gentle inebriation from La Croix wine spritzers began to take hold, small bags began to be pulled from pockets, their chalky contents poured onto trays, tested for fentanyl, then cut into lines and inhaled. We were each handed an inch and a half long trimmed segment of a plastic straw, to prevent cross contamination. This, in the home of a sex worker, with two healthcare professionals on either side of me, felt safe. It felt safe to do drugs that had been hammered into my social consciousness as always dangerous, as always a step away from death. As writer and activist Dean Spade outline in their 2020 piece “Solidarity Not Charity” for Social Text, “Mutual aid is a form of political participation in which people take responsibility for caring for one another and changing political conditions, not just through symbolic acts or putting pressure on their representatives in government but by actually building new social relations that are more survivable.” Mutual Aid is not just about making a one-time donation, but about building a politics that is concerned with the safety and wellbeing of others, naming “the failures of the current system” and showing an alternative. And because of the safety protocols that we observed, I glimpsed what ensuring that safety might look like.

In the early months of the pandemic’s grip on the United States, I saw a graphic float across a friend’s Instagram story. Set in Barbara Kruger-esque text, the words “Guys Are Hooking Up During The Pandemic. Are You?” sprawl across a digital graffiti background. I tapped through to find the account Fagdemic, their bio a concise “Hot Work in Hard Times: fag harm reduction for coronaworld.” Seeing this account felt like being pulled through my phone screen; I wanted to reach out, wanted to peel off the layers of shame I felt for wanting to touch a stranger, to do drugs in a room with strangers, to be around strangers in a time of so much wanton isolation. For those unfamiliar, harm reduction, as defined by the International Harm Reduction Association, is a strategy of both policy and social programs “which attempt primarily to reduce the adverse health, social and economic consequences of mood altering substances” for individual drug users as well as their broader communities, without requiring a decrease in drug use. Harm reduction’s adoption as a viable set of socioeconomic and healthcare practices have been hotly contested because of decades’ long Drug War propaganda – the Mayor of Charleston, West Virginia, used his public platform to rally support for shutting down a needle exchange clinic just two years after it had opened.

When a gay men’s sexual health organization in Ontario decided to deal more coherently with substance use in the queer community, they called on two self-described “notorious drug using fags” to produce a video for them. But many of the most helpful, albeit transgressive parts of the video, such as speaking to an individual’s drug dealer about sanitizing practices, were edited or cut out in favor of a more conservative, abstinence forward approach on drug use. Frustrated with having to push a political message they didn’t feel aligned with, the two founded Fagdemic, and set out to produce information, messaging, and safer use tips for their broader community. For them, “starting with the language our community is already using,” around drugs, paraphernalia, and safety practices goes a long way to destigmatize the advice being given; the harm reduction tools are coming from inside the community, instead of a patronizing non-profit or ideologically-driven organization.

This strategy, of intercommunal language use to reach audiences not otherwise accessible, is notable in the work of New York City-based DISH (Do It Safe Heaux) which provided supplies for safer usage primarily to black and brown drug-using trans women. But this practice, of meeting people exactly where they are at, begins decades ago, with foundational work by John Paul Hammond, a queer Black man. Growing up in a North Philadelphia family of Quaker activists, Hammond became involved with ACT UP, and in 1992 helped to establish Prevention Point, a needle exchange clinic that has helped to prevent an estimated 11,000 new HIV infections since its founding. Dr. Lauretta Grau, associate research scientist at the Yale School of Public Health, met Hammond in 1997 and said that, while his passion was activism, he was also an exemplary researcher. “He was on a multi-site project we were doing of active injectors as part of our research field team, and he was a very wonderful, careful, systematic researcher,” he said. “He did a lot of epidemiological research for us and was a wonderful, wonderful colleague. He was reliable, he was fastidious and he was organized. He was an extremely bright man.” Because of Hammonds’ experiences as both a drug user and as a researcher, advocate, and harm reduction activist, he was able to reach community members and individuals who would not otherwise be receptive to answering a university researcher’s questions.

Tim McCaskell, one of the most notable queer activists in Toronto’s history, also contributed deeply to work around harm reduction, helping to mentor the two men who started Fagdemic and so many others in the Toronto queer activism scene. His work spanned decades, beginning with AIDS ACTION NOW!, as well as serving as a spokesperson for Queers Against Israeli Apartheid. But in January 25th, 2019, McCaskell penned an op-ed for Now Toronto about the dangers of crystal methamphetamine use in the gay community. The byline, “I lived through the worst years of the AIDS epidemic… once again everybody’s pretending nothing is going on with the explosion of queer people experimenting with crystal meth during sex” and the contents of the article shocked so many who had trusted McCaskell to be a voice championing harm reduction. “That was especially kind of shocking coming from somebody we’ve learned so much from,” said Jonathan of the collective Fagdemic. For the Toronto-based harm reduction duo, instead of preaching the same old moralizing narratives, the work should involve “building solutions in our own healthcare modality.” The building of this modality of harm reduction should not just conclude with a politics of survival, of distributing naloxone or fentanyl test strips and calling it a day. For Fagdemic, and those interested in an abolitionist vision of harm reduction, building a politics which acknowledges how layers of marginalization impact your health outcomes, and still goes “beyond just surviving to actually enjoying our lives and accounting for those health disparities,” is the goal.

Over the summer of 2020 and into the Fall, protest camps, space collectivization efforts, free community fridges, and the distribution of harm reduction resources, PPE, and masks to those on the West Coast affected by wildfires, became more prominent than ever before. New York’s Abolition Park, an effort initially started as ‘Occupy City Hall’ became a site of communal organizing, education, and care. In Dean Spade’s writing about mutual aid projects, because they create spaces “where people come together based on some shared need or concern,” and end up encountering and working closely with people whose lives and experiences differ from theirs, they “cultivate solidarity.” Cassie, one of the organizers who was present at Abolition Park, spoke about acting not from a mindset of scarcity, or of lacking resources, but of abundance, in which “we can give everything to each other.” For her, any mutual aid project has to foreground those without resources, those “who are cut off from accessing means of life.” Nikki, a young unhoused transgender woman who began staying at Abolition Park, remarked that the life-affirming services AP offered not only allowed her a respite from the harassment she experienced on the street, but a chance to feel full and supported. She felt both politically aligned and socially cared for at AP, telling Gwynne Hogan of Gothamist “at the end of the day, [the] community takes care of the people”. Nikki’s participation in the aforementioned article seemingly led to her arrest by plainclothes NYPD officers, putting the demands of AP’s communal care and abolitionist framework even more starkly in contrast with systems of carceral justice and policing.

Abolition Park and the organizers present there worked tirelessly to create medic tents, a power charging station for people to charge their phones, and a People’s Bodega that handed out PPE, cleaning supplies, “just everything else that folks needed.” AP also hosted an eviction defense workshop with longtime tenants’ rights organizers – lessons which have become crucial, as major rent relief stalls or is denied to the majority of those who apply for it. Organizers at Abolition Park established a reading group centered around M.E. O’Brien’s Junky Communism essay that was turned into a zine and distributed. The essay, and the politics of harm reduction as a strategy of leftist organizing contextualizes, traces how syringe exchanges were a technique developed by activists in the 1980s that, despite often being illegal and organizers risking arrest, helped to combat some of the most severe devastation of the AIDS epidemic. O’Brien’s experience working at a syringe exchange, helped them to see “how harm reduction had helped politicize their experiences, transforming individual misery into a collective practice of solidarity and a basis for social critique.” For organizations like the Young Lords and the Black Panther Party, the political question of how to support, educate, and organize members of the working class who used drugs and could not reliably hold down a job was of utmost importance. While many leftists and organizers interested in respectability saw “junkies unable to maintain stable employment” as having no place in revolutionary organizing, Cassie speaks to the reality of being a queer person with a holistic view of radical work. “I know how to use Narcan out of, like, absolute necessity… This is like waking up and breathing.” She continues, saying “We live in a community that is structured around a lot of addiction. We need to have that compassion and love for ourselves and for our friends and for each other.”

In the last few years, the growing rates of drug overdose have lowered American life expectancy for the first time since the peak of the AIDS crisis. As reported by the American Medical Association, millions of Americans with difficult relationships to substance use have been struggling beyond the difficulties produced by the pandemic, because it has so “complicated access to basic resources” like medical care, resulting in an increase in drug overdose related deaths. Even in San Francisco, an epicenter of the AIDS crisis and a city which has harm reduction institutions like St.James Infirmary and the San Francisco AIDS Foundation, overdose deaths are outpacing deaths from COVID-19. O’Brien writes how, “As the crisis of capitalism and working-class life deepens, insurgent movements will need to grapple with drug addiction.” By refusing the implied disposability of drug users, and the isolation or ostracization of those assumed dangerous because of drug use, we must “move towards a communism not based on the dignity of work, but on the unconditional value of our lives.” Cassie notes that, for those drug-using individuals who were present at Abolition Park, after receiving the sorts of care made freely available, they began doing fewer substances because of the level of communal support they were surrounded by and had access to. The act of giving someone else the tools and material resources necessary to change their life has been the driving mission behind the Portland Sex Worker Resource Project, which aimed to “provide low barrier financial support to Sex Workers affected by COVID.” Prioritizing Black, Indigenous, and Trans sex workers, as well as those who live at the intersections of those identities, requires identifying that margnialized sex workers “face disproportionate violence within the industry… Black SWERS are more likely to be arrested, more likely to be assaulted by the police and/or clients, and more likely to be murdered by the police and/or clients.”

For Kat and Saiya, the organizers of PSWRP, it’s been difficult “telling people “no” when you truly believe they deserve everything they’re asking for.” But while the project’s work has functioned on a limited budget and has not been able to fulfill every request they’ve received, they have been able to distribute $5,000 in microgrants, assisting 40 people with $200 in material support. Everyone who applied for a microgrant received funds, and in establishing a low barrier application system, were able to help Sex Workers who previously may have been turned away by state agencies or non-profits with more complex bureaucratic processes. Mutual aid work in the state of Oregon may also be buoyed by the recent passage of Measure 110 which means that “state’s residents will no longer face arrests or prison sentences for carrying small amounts of drugs like cocaine, heroin, oxycontin and methamphetamine.”

This encouraging step towards decriminalization signifies one step away from a carceral system that punishes drug users or sex workers with jail time, but fails to include the necessary steps of expunging records, freeing those convicted of drug offenses, and allocating revenue from sales taxes towards social programs for those previously convicted. As Emily D. Warfield, an MSW researcher said concerning the overlap of the two communities, “Any drug policy win is also a big win for sex workers, not just because of the overlap in drug users and sex workers but because it indicates the public is willing to rethink criminal punishment as a solution to economic and social problems.” This movement away from rampant carcerality is encouraging, although the trap of feigning reform in the guise of forced rehabilitation still remains. For Saiya, the Portland Sex Worker Resource Project has always centered the needs of the community, and establishing trust in organizers takes time – but they are intent to be “an ember, not a flame.”

A few years ago, while showing an ex around my hometown, we slid into the single occupancy bathroom of a crummy gay dive bar, the same crummy gay dive bar I had been going to since I turned 21. She pulled out a small container of cocaine, scooped out some with her long acrylic nails, snorted, and then turned on her heel to walk out of the bathroom, leaving me with the bag in one hand. A year or so afterwards, I was in the bathroom of a crummy Oakland dive bar that had come to feel like a second home, warmed by the presence of the first deep trans friendship I had made in the Bay Area. They pulled out a bag of cocaine, we each did some, and walked arm in arm to a house party just a few blocks away. But once there, they left me to ride out the high alone, my face numb, my fingers cold. And when I told them a short while later, still in the throes of a dull throbbing nose, that I needed to go home, they let me walk, by myself, into the predawn darkness. For O’Brien, “revolutionary politics must embrace the many broken and miserable places inside ourselves.” It is precisely from these sites of anguish, hurt, and pain “that our fiercest revolutionary potential emerges.” There are moments in which drug use has felt wrapped in the shame and stigma that isolate people in those moments of most crucial need. And there are moments in which people are met where they are at, with communal care and abundance offered to those who most desperately need it, enabling people to do so much more than just survive.

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Sloane Holzer

Sloane is a writer & leatherdyke about town. She lives in the Bay Area and is interested in social histories, community building, and care work.

Sloane has written 6 articles for us.


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