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Addiction Harm Reduction Providers Battle 'Dual' Epidemics

A young man with his girlfriend stood in the shade under an awning at the side of an RV truck parked near Barnard Park in Hartford on a recent Tuesday morning. Holding a bag in one hand and reaching through an opening in a screened door with the other, he dropped empty, used syringes into a medical waste bucket.

“Eighty-eight, eighty-nine, ninety,” he counted, each needle making a thunk as it disappeared into bright red plastic. 

Carlos Santiago and Annie Plourde, ambassadors with the Greater Hartford Harm Reduction Coalition, began to put together a bag of supplies: clean needles, alcohol wipes, tourniquet ties, Band-Aids and other things that someone who injects drugs may need to stay safe while using.

“Do you need Narcan?” Plourde asked.

“No, we got it,” the man responded.

These days, they’re also handing out bags with masks, gloves, hand sanitizer and soap.

“Hey, do me a favor?” Santiago asked the woman, whom he regularly sees at the site. “Stop touching your face. Here,” he said, handing her a bag of chips and a blue surgical mask.

“Ah, I know, thank you,” she said before walking away with her boyfriend, back into the heat.

The ambassadors are out at sites across the region every week to provide people with harm reduction and syringe services, which are designed to protect people who use or inject drugs in active addiction from disease transmission and fatal overdoses. 

They also distribute naloxone, the opioid reversal medication, provide education and connect people with shelter, food, health care, counseling and addiction treatment, if clients want it. 

Credit Joe Amon / Connecticut Public/NENC
Connecticut Public/NENC
Ambassador and driver Carlos Santiago watches for clients from inside the Greater Hartford Harm Reduction Coalition mobile RV.

Before the pandemic, many of services were offered with hugs, handshakes and close one-on-one communication and interactions, but the COVID-19 outbreak has forced organizations to rethink how they can maintain their services without putting people at risk, staff included.

“It actually just plunged us into a dual pandemic, or epidemic if you will, because we’re still right in the middle of an opioid epidemic,” said Mark Jenkins, GHHRC founder and executive director. “So remaining open [and] staying safe being the first and our primary goal, how would we do this? There were too many what ifs.”

Studies show that syringe services programs, which distribute clean needles to people in exchange for their used ones, cut down HIV transmission by half nationally, according to the U.S. Centers for Disease Control and Prevention.

The programs have improved access to primary health care and made new injection drug users five times as likely to enter treatment for a substance use disorder.

But social distancing and COVID-19 precautions have caused about 43% of syringe programs nationwide to scale back services, according to a recent CDC survey. It has advocates and experts in the field concerned about the short- and long-term health outcomes for people who use drugs.

“We made sure we told people of the possibility of closure, limited hours. But the closer we got to that, we realized that if we completely closed, there would be really adverse effects for the people we serve,” Jenkins said. “We already deal with a population that was already on the fringes of society and they lost many services, everything from using a restroom, going to a shelter or food pantry to eat.”

Credit Joe Amon / Connecticut Public/NENC
Connecticut Public/NENC
Ambassador and driver Carlos Santiago loads a bag for a client from a mobile kit at the Greater Hartford Harm Reduction Coalition mobile RV site.

The GHHRC stayed open, but it limited the hours and days of its brick-and-mortar site on Albany Avenue. It added more mobile van and truck services, stocked up on personal protective equipment, and added education about COVID-19 to its services.

Jenkins said they’ve also adopted strict protocols around cleaning and social distancing in order to protect not just their clients from the virus, but their staff as well.

Programs and other organizations around the country have been grappling with the same challenges, said Daniel Raymond, deputy director of planning and policy at the national Harm Reduction Coalition.

He said there’s especially a concern over how increased isolation is affecting people who are struggling with addiction.

“Nobody was really able to anticipate how long this would play out or the twists and turns this pandemic has taken,” he said, “and so the big question is whether the supplies, the strategies, the tools, the resources people have been using to protect themselves from HIV and other infections and overdose risks that worked last year will be sufficient in this time of heightened isolation.”

Raymond said the ability of organizations and programs to adjust and continue providing services to people can depend on how robust programs were before the pandemic, with some faring better than others.

He also worried that the pandemic might erase some of the progress that’s been made over the years in reducing disease transmission, overdoses and drug use through harm reduction and syringe services programs.

“I think that’s the big fear, is that despite our best efforts that we start slipping backwards,” Raymond said.

Credit Joe Amon / Connecticut Public/NENC
Connecticut Public/NENC
Ambassador Annie Plourde hands out new syringes, a mask and a little food at the Greater Hartford Harm Reduction Coalition mobile RV site in Hartford on Aug. 11.

By 10 a.m., Plourde and Santiago, both in addiction recovery themselves, had already seen more than 70 people at the RV site in Hartford. By the end of their shift at 2 p.m., they expected that number would rise above 100.

Plourde said their small team works together to stay safe while out in the field. And despite the risks, that’s exactly where they want to be.

“Every once in a while, we’ll have to be like, ‘hey, hand sanitize, go wash your hands.’ We catch each other,” she said. “We’re a family. We do what we can. We try to keep each other safe, try to keep them safe. It’s not easy, by any means.”

They don’t know what the coming months will bring, but the duo said they know it’s important to be out helping people who may otherwise be left to battle addiction, homelessness and the pandemic alone.

“We do what we can to work with people and to help them, but out here, as far as COVID, I hope we see an end to it soon. Doesn’t look like it,” Plourde said. “It baffles me. I never thought this would be the world that I would live in, but it is, we’re here, and the only thing we can do is stay as safe as possible.”

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