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  • Writer's pictureAbby Ann Ramsey

The changing face of harm reduction

It emerged as a philosophy for managing sexual health and substance use disorders. But increasingly, its practitioners—like the Georgia Harm Reduction Coalition—are promoting a more holistic vision of wellness, drawing connections to housing, nutrition, immigration, and more.

 
The Cooper center offers basic health screenings, medication-assisted treatment, and infectious disease treatment through an outreach mobile clinic. Pictured are Pete Clark and Meshaya McClung. | Photo: Alyssa Pointer

Not long ago, a woman named Kay showed up at the Memorial Drive offices of the Georgia Harm Reduction Coalition. Unable to secure a job in Atlanta, where she’d recently moved to escape domestic violence, Kay had initially turned to the GHRC for help managing her substance use disorder. 


Shortly after her visit, Kay (we’re using a pseudonym to protect her privacy) enrolled in a medication-assisted treatment program and began to take advantage of other services. Meshaya McClung—who, until recently, was a lead linkage specialist at the center—connected clients like Kay to resources like food, housing, and healthcare to provide them with the stability they need to manage other challenges they may be facing. McClung said after a few months of support, her client had a new job and was close to securing housing for her family. Kay’s story, which employees are still watching unfold, is just one of countless stories of Atlanta residents who have been able to get on their feet with the help of GHRC.


The GHRC opened the Cooper Center a year ago in a beige brick office building on Memorial Drive. | Photo: Alyssa Pointer

Navigating the cost of living in Atlanta can be challenging. The median price of a one-bedroom apartment is $1,595 a month. Groceries are getting more expensive. Problems like these can quickly compound for people like Kay, who was not only dealing with the same rising costs as everyone else but also substance use disorder, which can be deadly and itself expensive to safely navigate. Even though it's now available over the counter and at a lower cost than it used to be, the price for a two-dose box of Narcan—an opioid overdose treatment—is still $45. “People that I see on my day-to-day are struggling just with basic needs [like] transportation and food,” said McClung. She explained that, when clients have to choose between basic needs and a potentially lifesaving resource like Narcan, “they’re just gonna try to survive with their basic human needs.”


“People that I see on my day-to-day are struggling just with basic needs [like] transportation and food.” —Meshaya McClung

The GHRC, which operates four centers in Georgia, opened the Cooper Center a year ago in a beige brick office building on Memorial Drive. Though somewhat new to this particular area, harm reduction has been around for decades. It gained ground in the U.S. in the 1980s during the HIV/AIDS crisis and the war on drugs, as a response to abstinence-based solutions; the philosophy is, basically, rather than attempt to change people’s behaviors, a solution is to simply reduce the harms associated with those behaviors. 


While some forms of the harm reduction movement deal almost entirely with substance use, organizations like the Cooper Center use the philosophy to reduce risks associated with mental health crises, sex work, barriers to food and healthcare, homelessness, and pregnancy—all while doing their best to keep the cost of surviving as low as possible.


 

Harm reduction is somewhat controversial—despite research showcasing its efficacy—and the substance-use component of it looms large in people’s minds. It sprouted up from social justice movements in the U.S. in the late 20th century but has since spread internationally, with HIV/AIDS testing, safe injection sites (facilities where workers monitor people as they use illegal drugs to ensure their safety), syringe services programs (which provide people with sterile needles and syringes to prevent the transmission of things like bacterial and fungal infections and HIV), and medication-assisted treatment (which treats people with substance-use disorder with medication and therapy). 


“There’s a lot of political discourse around harm reduction. There’s always people saying, ‘You’re enabling people to use drugs,’” Cooper Center Director Pete Clark said. “We’re not. People are using drugs; we’re minimizing the risk. It’s being realistic. The basis of harm reduction is meeting people where they’re at.”


“The basis of harm reduction is meeting people where they’re at.” —Cooper Center Director Pete Clark

Clark describes harm reduction as a continuum: People move through stages at their own pace, reducing the risks associated with their situation or behavior along the way. For example, if someone is injecting drugs several times a day, the first step might be to reduce the number of times they’re injecting. From there, Clark says, people can move from injecting to smoking, therefore taking away the risks of using a needle. Smoking poses a risk to the lungs, though, so after reducing the number of times drugs are smoked each day, the next step could be to put the drug into a liquid form for the person to drink. “You’re still doing drugs, but you’re moving along that harm-reduction continuum to get to the point where people may or may not say, ‘I don’t want to be doing this anymore,’” Clark said.


GHRC locations give clients Narcan—an opioid overdose treatment—for free. | Photo: Alyssa Pointer

From 2019 to 2021, Georgia saw the number of opioid-related overdose deaths increase by 101 percent. Amid a national drug-overdose epidemic that claimed the lives of nearly 110,000 people in the U.S. in 2022, even the smallest harm-reduction steps can contribute to saving a life. Clark noted that, recently, over about six weeks, the Cooper Center mobile team performed 45 drug overdose reversals. GHRC locations also give clients Narcan for free.


While syringe-exchange programs and medication-assisted treatment are still central to their work, the GHRC’s expansion of services follows a recent, widespread trend to make harm reduction more intersectional. In addition to funding and supporting reproductive healthcare access, the West Virginia organization Holler Health Justice expanded its scope of work “to meet ​​additional health equity needs of Appalachians” and provides free emergency contraception and hygiene supplies in addition to harm reduction materials and services. Social media users like @nalgonapositivitypride use the philosophy when discussing eating disorders. East Tennessee Harm Reduction not only provides overdose resources but also advocates for tenants’ rights and hands out cold-weather kits to unhoused people. The idea of mutual aid—volunteering for one another while seeking to address the root causes of inequality—took off during the pandemic and is frequently discussed alongside harm reduction.


The Cooper Center connects clients to clothes, food, and shelter because the inability to meet basic needs can quickly compound a client’s problems: If they lack housing, for example, staying on their medication can be difficult. McClung sometimes even arranged transportation to doctor’s appointments. “The linkage program really focuses on trying to support them in the least overwhelming way,” she said.


Photo: Alyssa Pointer

Applying for financial assistance—like food stamps or the Housing Choice Voucher Program—can be a long and difficult process. McClung helped explain those complicated systems to clients. “They’re already in a crisis situation, so a lot of people just don’t have the ability at that moment to do extensive research on these things,” she said. “Being able to take just that off their plate, giving them information that they can clearly understand and then go execute is a big chunk of relief for them, which can just help keep them motivated to keep meeting their goals or to continue on.”


The Cooper Center offers some healthcare, but it cannot provide everything a family or individual needs. It can, however, connect them to resources elsewhere. Clark prioritizes working with free or low-cost organizations and has partnerships with Emory University, Grady Memorial Hospital, and Mercy Care. The linkage service itself is free, but finding affordable and accessible external resources for clients presents a challenge at a time when many businesses—especially nonprofit organizations—are understaffed. Clark said when he came into his role at the GHRC, nearly 100 organizations were working with unhoused people; only about 10 of them still exist and can accept new clients.


Clark said when he came into his role at the GHRC, nearly 100 organizations were working with unhoused people; only about 10 of them still exist and can accept new clients.

Some of the barriers keeping residents from securing housing or jobs are everyday things that Clark said many people take for granted: a driver’s license or a birth certificate, access to transportation or the internet, speaking English as a first language. The Cooper Center works to break down these barriers by helping people obtain documentation. Much of the staff speaks Spanish, and there is a translation line for clients who speak other languages. They also offer basic health screenings, medication-assisted treatment, and infectious disease treatment through an outreach mobile clinic.

 

Basic shelter, though, presents a challenge. McClung said she’d like to see more government-provided emergency housing for clients on the brink of homelessness. She was saddened last year to see the City of Atlanta return $10 million in emergency rental assistance to the federal government because they could not distribute it before the 2022 deadline. She had clients who desperately needed that help: “A lot of [what we address] could be prevented. Some people just need a month or two of help and then they could get back on track.”


“A lot of [what we address] could be prevented. Some people just need a month or two of help and then they could get back on track.” —Meshaya McClung

With so many clients visiting the clinic, often brought by word-of-mouth referrals, the Cooper Center is starting to see results—not only through overdose reversals but also through the stories of clients who got back on their feet because they were connected with basic resources. 


“On a daily basis, we’re reminded what we’re doing is life-saving,” Clark said. “But there’s still so much more we need to do.”

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