Southern West Virginia Harm Reduction Gets Creative to Survive the Pandemic

Harm reduction projects are struggling under the pandemic, resources are harder to get, access requires more hoops, but for local projects operating on the mutual aid model, the pandemic has required them to get creative.

Southern West Virginia Harm Reduction was founded in November of 2019, and since its development has created responsive services for rural drug users and sex workers. Founder L moved from southeastern Kentucky to a West Virginian community that has no legally operating harm reduction efforts for drug users.

“Fayette county has a syringe exchange program through their health department,” L told me, “maybe one around Morgantown, even in Charleston they used to have one and closed it down. The safe laws are not considering the safety of people who use drugs intravenously or otherwise.”

Most harm reduction efforts are not federally supported, no federal funding can go to needle exchanges, and only 38 states operate needle exchanges. In 2018, almost 50,000 people died in opioid related deaths in West Virginia. The opioid crisis that’s referenced in coverage of drug use in America, and Appalachia in particular, is linked to the Sackler family’s opioid empire that concentrated in working class communities. Doctors distributed Oxycontin and other highly addictive opiates, and the snowball effect of that treatment amounted to profiting on addiction and death. Personally, I’ve gotten to watch people I grew up with picked off by drug use and villainized for it.

In rural West Virginia, heroin and meth use are the most common. “We’ve seen an increase in the IV use, and since the pandemic we’ve seen a lot of overdoses that I think are related to fentanyl,” L said.

SWV Harm Reduction has expanded their work since the pandemic. They deliver Naloxone (Narcan) and other safe injection supplies, and “since the COVID 19 pandemic, aside from giving out supplies, we also do an herbal first aid, specifically a certain kind of salve that’s good for intravenous drug users because they have a lot of abscesses, it helps with infections.” L has also partnered with SOAR West Virginia to distribute PPE, masks, and hand sanitizer. No-contact drop-offs are a lot of porch drop-offs or pickups. “We’ve hid supplies in bushes, we’ve had to get creative, and a lot of people know me and know to drop by.”

According to L: “I can’t speak for all harm reduction efforts, and I think the impacts can be different depending on who you’re doing outreach with or who you are centering, but here in rural West Virginia, it’s a small community; the impact is so apparent.”

Since November, the organization has administered naloxone to over fifty people, saving their lives. “This work has really set a precedent for people who inject drugs that they don’t need to reuse needles or buy and sell theirs on the street,” L said. “There’s a safe place and safe people they can go to get them for free. Little things like using an alcohol prep pad before using, and passing out emergency contraception to people who do sex work; we’re just setting a precedent for public health.”

Small rural communities tend to have fewer resources or none at all. Combine the reliance on one another with the further stigmatization of being active drug users, and you have a community ripe for the introduction of mutual aid.

“What I think is really beautiful about it is that people who use drugs are truly interested in mutual aid and they want to help each other,” L told me. “It’s been really effective in building neighbors-helping-neighbors mutual aid effort.”

Mutual Aid, for those who are learning about this for the first time, is an anarcho-communist theory of support popularized by Peter Kropotkin where cooperation is more important to competition (there won’t be a quiz on this, I promise). The goal is to have the community come together and take care of their own without the flaws of distribution the local government and non-profits can struggle with.

The organization itself is built out of mutual aid. Volunteers with cars offer to drop off supplies, for example. The team is organic. A lot of members are in early recovery or active users, some are in and out of jail, and in and out of transportation access and so the network keeps building. The misdemeanor of possession of controlled substances comes with a ninety day to six month jail sentence, which then increases with further offenses. So the organization is often dealing with the challenges of building a coalition while the local laws actively try to dismantle their work.

L hopes in the future to have other bases in other counties to better distribute safe use supplies to people, and often tries to make supplies for other areas: “There’s a lot of people here who live in shacks and maybe don’t have running water, but there’s people living in Charleston who live on the streets so we try to make enough to help them as well as our own efforts.” And because the organization isn’t a non-profit, it allows for a lot of flexibility on how money gets spent but it cuts off access to certain kinds of public funding.

L grew up in central Appalachia “from a pretty poor and working class background” and now lives in a similar community, “a decaying coal town that’s stuck in 1970.” But survival has made the community rich in mutual aid. “A lot of organizing and activism has left these folks behind, a lot of people here are just trying to get a ride to the doctor, and they’re used to helping one another out. It’s how they’ve survived. It’s different in other places in Appalachia for sure, places that are a little more resourced, this culture is less common. [But here] they know they have to help each other survive.”

L is transgender and while Southern West Virginia Harm Reduction doesn’t specialize in helping specifically queer people, “all of our work has a queer lens and framework. We have all the dating apps that say to hit us up if they need supplies.”

The organization also focuses on safe sex education and advocacy. “It would be hard for me to teach straight people safe sex practices because I don’t know those as well,” L laughs an d tells me.

As for being trans in rural West Virginia, L has found it just takes a bit more talk. “It’s interesting being trans and living in a rural southern community. I mostly use they/them pronouns, and around here that’s been shaped by what’s realistic and I’ve turned into one of those transgender people who’s gender is ‘just call me whatever you want.’ I certainly wouldn’t put that on anyone or say that’s how other people should be, but it makes it a little easier to relate to people.” An important part of local work is meeting and serving your neighbors and L has found that in their specific communities, gender doesn’t feel like as big a deal. “Folks that are really under resourced, they care less about gender things than people that have more.”

Safety for queer people in rural communities is really heavily based in resources. Money is security and mobility, and without any, queer people are more likely to have to stay in abusive situations or be at greater risk for death or harm. Moving to a city isn’t feasible or doesn’t solve the problem. “I can feel alien in progressive spaces because of my accent,” L said, “or because I’m poor, or I’m not from the city.”

When L experienced a break-in and all of their harm reduction supplies were taken, support poured in and they were able to restock, which shows just how important this work is to the community and to the people who’ve built the organization. ‘I want this organization to feel like it belongs to them because it does and it wouldn’t be shit without them”

There’s a lot of misconceptions about drug users. “I think a lot of people think that giving out safe supplies enables drug users, or they’ll be like ‘they’ll just use that to buy drugs’ or something like that, and it erases the fact that there are clean supplies going to someone and that person is safer for that.” Harm reduction is radical. GoFundMe doesn’t allow fundraisers for harm reduction supplies, and a lot of the work operates in grey areas of legality, but it’s important. “If you live somewhere when drug use is criminalized, that isn’t a reason not to do it. It’s a form of civil disobedience”

Support Southern West Virginia Harm Reduction by donating to here and here and follow their work here.

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Lauren Parker

Lauren Parker is a writer based in Oakland. A graduate of Hiram College's Creative Writing program, she has written for the Toast, the Tusk, Ravishly, The Bold Italic, Harlot Magazine, Hoodline, and plain china. She's the winner of the Summer of Love essay contest in the Daily Californian, the Vachel Lindsay poetry prize, and a was featured in Bennington College's Best Undergraduate Writing series in 2012. She is a producer on the monthly literary series Cliterary Salon, and the author of the zine My Side of Our Story. Follow her on Twitter: @laurenink.

Lauren has written 11 articles for us.


  1. Amazing work. The pandemic has been terrible for fentanyl poisoning up here in Canada. The closed border means the supply is so limited dealers are just mixing in whatever. The province is trying out safe supply but lots of wanker doctors in more rural areas won’t prescribe it. Good luck to everyone involved in any way with harm reduction advocacy. You are saving lives.

    • Agreed. What is also terrifying is that fentanyl isn’t only being mixed into heroin/opiates/opioids, but coke and other stimulants. I personally have known more than a few people that have gone to use what they assumed was cocaine and subsequently OD’d on fentanyl.

      People who are working in harm reduction are legitimate heroes. I would love to get involved.

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