Over the course of producing three seasons of The Response podcast, we’ve explored how natural hazards and other disruptions disproportionately impact marginalized communities at length.
But one population we haven’t discussed before is people who use drugs. There is still so much stigma associated with using illegal and legal drugs despite the fact that it’s a normal part of life for millions of people worldwide.
This year, our team at Shareable has been working with Higher Ground Harm Reduction to explore how community-based harm reduction programs (and people who use drugs) are impacted by, preparing for, responding to, and recovering from climate-related and other systems-disrupting emergencies (like the pandemic).
As part of this research, we’ve conducted several interviews and disseminated a national survey to Harm Reduction service providers, and have produced a report that will be coming later this month.
I recently spoke at length with Christine Rodriguez, the executive director of Higher Ground Harm Reduction. Among other things, we touched on her personal journey, what harm reduction actually is, how the current climate of disasters has impacted this work, and why we need to have more compassion for one another.
Next week, we’ll bring you part 2 of this special series with an audio documentary exploring the impact of disasters on harm reduction through the experiences of community service providers in California, Florida, and Puerto Rico.
In addition to reading the full transcript of the interview with Christine Rodriguez below, you can listen to this conversation on The Response Podcast:
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The Response from Shareable.net, is a documentary film, book, and podcast series exploring how communities are building collective resilience in the wake of disasters.
Below is a transcript of the episode, modified for your reading pleasure.
Tom Llewellyn: I’m wondering if you can describe what harm reduction is from your perspective?
Christine Rodriguez: What is harm reduction is kind of a hard question to answer in some ways because there’s no singular accepted definition. Generally, we talk about two sides of harm reduction, one being the practical strategies and interventions that we put in place for folks to stay safer when they’re using drugs or trading sex — interventions that were created by people who use drugs and people who trade sex and were later researched and found to be effective. So it’s also, critically, a social movement that came out of AIDS activism traditions of doing whatever it takes to regain the tools to save each other’s lives — and to save your own life, if you’re someone who uses drugs or if you’re someone who’s a sex worker. That social movement aspect of it is really, really important. It’s hard for me personally to have a nonpolitical harm reduction. My harm reduction is very political and is grounded in liberation — liberation for folks who use drugs and for folks to live their best lives as safely as possible.
Tom Llewellyn: As you’re saying that I’m just hearing so much overlap with mutual aid and solidarity work.
Christine Rodriguez: Mmhm. Absolutely.
Tom Llewellyn: The idea of horizontal services…a lot of times work which can be considered social work or health-based or charitable work can be very top-down. One of the things that really stands out to me is how horizontal harm reduction work seems to be.
Christine Rodriguez: Yeah, I think that when harm reduction is being done right and being done well it’s very community-based, it’s very grassroots. It’s led by and for people who use drugs, folks who use or have experience with drug use in their lives are doing the work. It can be very top-down. I’ve seen it be top-down and it isn’t as effective when it looks like that, unfortunately. But the history of harm reduction is a history of mutual aid — particularly for some of our more well-known interventions between certain services programs and the locks on distribution. Those interventions came directly from drug-using communities working to save each other’s lives and to save their own lives, and was done and is still done in some places at risk of arrest and harassment and violence. And folks do it anyway because it is that important and it is effective.
Tom Llewellyn: The legality issue is something that really stood out to me as we’ve been doing this work — how many places it seems to still be illegal to do needle exchanges, to provide basic medical services and support to a growing community. Especially as we’re now coming to grips with how large the opioid epidemic is across the United States, especially globally, but specifically focusing on the United States. The fact that there are still so many barriers to this work is incredibly striking.
Christine Rodriguez: It is. And it’s one of the few areas of public health where I’m shocked over and over again at how much wonderful research is out there to support our work and how little that seems to matter sometimes when you have all these cooks in the kitchen feeling like something will be an outcome of an intervention or feeling like something should work this way, and it doesn’t. There’s a lot of resistance to the research and a lot of stigma around the work. And I think that’s unfortunate because the work is grounded in values that I find are shared no matter where I’ve been doing this work in a few different states around the country — it’s grounded in compassion. It’s grounded in a lack of judgment. It’s grounded in, loving care and kindness for our neighbors. And it’s not a coincidence to me that compassionate interventions tend to be effective interventions. When we are able to recognize each other’s humanity and the restrictions that keep the work from aligning with best practice, that is based on stigma and nothing else really — it’s just so tragic when that starts to get in the way of the work.
Tom Llewellyn: You mentioned having done this work in multiple states and I know you’ve been involved with harm reduction for a very long time. I’m wondering if you can tell me a little bit about how, why, and when you started doing this work?
Christine Rodriguez: Sure, that is also a hard question to answer. When, how, and why did I begin doing this work? The when is easier. I got my formal introduction to harm reduction as a movement and as professional work in Washington, D.C. at an organization called HIPS, which is still thriving there. That was around 2003, I believe, at this point, 2006 maybe. And so it’s been maybe 13 years since I’ve been involved in harm reduction work.
Why? It just clicked. I’ve been introduced to harm reduction before that time without realizing it. The formal introduction to harm reduction, more than having to convert me to the cause, gave me language to describe how I think we should show up for other people in this world. It gave me language to better understand other people’s and my own drug use. It gave me jargon — it clicked immediately. I drank all the Kool-Aid once I met harm reduction. And that was basically it. I struggle to imagine working in another field.
And the why? It really is work that very much aligns with the values that I was raised with in terms of treating other folks the way that you would want to be treated in any given situation and being compassionate and being loving to other folks and to doing whatever it takes to get people what they need to make their own best choice in their own circumstances. So that’s sort of the broad strokes of when, why, how.
Tom Llewellyn: And after having done that work for so long, I’m wondering what led to this new focus — and what led to the creation of higher ground harm reduction?
Christine Rodriguez: I had been thinking about disasters broadly for a while. Disaster response work is really intellectually interesting to me as well. But really, it was when hurricanes Irma and Maria hit in Puerto Rico a few years ago. It was devastating to the island and it was a really unsettling experience to be part of the diaspora away from family and not be able to reach anyone and wondering what’s going on and if are they alive…what is happening out there?
And it was in really stark contrast to when Hurricane Harvey hit the United States around the Texas, Louisiana area —the response from the harm reduction community was instant. Folks were reaching out and asking, “How can we support the continuity of services for your participants? How do we make sure you have enough supplies?” There was a lot of mutual aid going on and being publicly organized, and it just wasn’t possible when it happened in Puerto Rico. As our current president helpfully pointed out, Puerto Rico is surrounded by water. You can’t just drive a bunch of supplies over to the island. And so it really left me wondering and hurting for what’s going on with our islanders who are experiencing homelessness. What about folks who are really vulnerable using drugs, who may or may not have access to treatment, who may or may not have access to sterile supplies? What happens when folks’ lives are disrupted in such an intense and far-reaching way?
I talked to a number of organizations about this intersection, and it seemed that folks were really interested and understood that it was an issue — there just isn’t a ton of capacity since the community is relatively small and the overdose crisis is so overwhelming. It seemed like there wasn’t capacity to provide any focus on that intersection. And so I thought why not start a small project? Nothing serious. I don’t want to be an executive director, to have ‘executive director’ on my resume. I thought a small nonprofit project would allow grant funding and those sorts of things, and also offer a novel lens into the community and its issues — both as it as it relates to disaster response and preparation and recovery, but also another lens to demonstrate the utility, the vitality, the necessity of these programs who often didn’t have much disruption to their services. It was about how do we do it, not do we, which we saw happen around the country with covid. It wasn’t a matter of do we close or stay open? It’s ok, this is happening, and so now how do we pivot and how do we make sure the services aren’t disrupted? And so that was my impetus to start this little project and see what might come of it.
Tom Llewellyn: I’m wondering if you can go into a little bit more detail about some of the things that you wanted to learn from doing this research.
Christine Rodriguez: I wanted to get a better sense from this what folks’ experiences were. The range of what a syringe service program or a harm reduction program could look like is so enormous. It could be a single person with a backpack doing outreach on foot or it could be a million-dollar annual budget organization. So with the diversity in the community, even with some similar components or some commonalities, there’s still so much diversity. And the geographic diversity of our country is wild. The number and types of disasters that people have experienced are many. And so before just sort of assuming knowledge about folks’ experiences through those disasters and folks’ needs, in particular, we wanted to do a little research and survey the community to see what have you been through. And based on what you’ve been through or what you expect to go through as climate change creates more erratic weather, you know, what do you need? What kind of support do you really need and which are superfluous, which actually create a burden versus create space for helping or space for doing work differently. I’ve worked in capacity building and technical assistance for a number of years, so supporting programs is sort of where my wheelhouse is. And I thought that this might go a little way into giving us a better idea of what folks’ experiences are, what they needed in these hard times. Aside from money, which is the constant, of course.
Tom Llewellyn: I think one of the things that really stood out to me from doing this research was just how relevant it became as we went on because when we started working on this project, it was before the pandemic. And there was some concern about how many groups that we were going to be trying to talk to and interview and get responses from for the survey would have experienced disasters in the past and what their disruption level had been. And except for a couple of outliers, every single person, every single organization that we talked to has been impacted by covid. And I mean, it’s not surprising because everything everywhere has been impacted. But what I think was interesting to me was that with that in mind, there was still only a relatively small — less than I would say 50 percent — number of the people who responded which had official covid response plans. And very, very few had any kind of a formalized disaster response plan in general, despite a huge percentage of respondents having been impacted by disasters in the past.
And so that definitely stood out to me — that there is a lot of need in that space. And especially looking at what the current capacity is for most of the organization. Close to twenty-five percent of organizations either had somebody on staff, on their board, as a volunteer that had some amount of previous disaster response — only about twenty-five percent of respondents. So even though organizations are facing these disasters, there’s not a lot of capacity there.
Christine Rodriguez: Yes, folks are really wrapped up in the programmatic side of the work and with the overdose crisis having gotten to the point that it has now — with over 70 thousand deaths annually — it’s just relentless. And so disaster preparedness and response work is really important. When everything is going smoothly and the weather is cooperating, what would make you say, “No, let’s stop everything we’re doing and do this administrative work right now and get this plan on paper. You don’t do that. You wait and you’ll cross that bridge when you get there. And having the knowledge that people both want to but don’t have the capacity to put these plans in place is really helpful and informative for those of us who are doing support work to be able to provide templates or checklists or anything that can smooth the process out or make it a little bit quicker so people can get back to that daily work of saving lives.
Tom Llewellyn: And just the size of most harm reduction programs was also interesting to me. From the research that we did, I think it’s close to like 60 percent of harm reduction programs have less than 10 staff, with close to 30 percent having no paid staff whatsoever. So, when you look at those numbers, of course, there is a great need there and not necessarily a lot of capacity for doing anything else besides the day to day work.
Christine Rodriguez: Exactly. This is really a labor of love for a lot of folks. A lot of these folks are doing this work unpaid or paid very minimally, and certainly insufficiently, and trying to stay afloat, trying to keep enough supplies on hand. The work that goes into doing is pretty relentless. And so the slowing down time is harm — I think it’s hard for folks sometimes to justify and hard to fit in. And I get that. And so if we can offer folks anything to make it a little easier, especially if you’re on an all-volunteer basis and this isn’t your bread and butter necessarily. We expect a lot out of programs and they deliver on shoestring budgets. And so we, as a collective, really need to do more to support these programs, whether it’s funding or assistance…or funding. I’m constantly impressed by the amount and type of work that gets done by these programs with just unbelievably minimal budgets.
Tom Llewellyn: And that’s where that love for it really comes in —when you feel really strongly about something you’re doing, you find the resources — or you make the time. You go above and beyond for it. And that’s definitely something that I’ve seen across the board while we’ve been doing this research.
Christine Rodriguez: Yes, yes. One of the things I love about harm reduction is the dedication that folks have. And there’s a flip side to that and you don’t want to burn out or anything like that. And folks need more vacation time and they need more support that way. But the dedication to making the work happen — I’ll always be astounded by the creativity that the community has.
Tom Llewellyn: I’m wondering, have there been specific things that have stood out to you from going through this process and doing this research that had been unanticipated? Or was the hypothesis that you had proved to be correct?
Christine Rodriguez: I think what was most surprising so far about some of this research is the variability in folks’ experiences. I imagined there being perhaps a little more commonality, but I think it really just brought home the diversity of our nation. I expected all drug supplies to be disrupted, for instance —to be impacted somehow. And in some cases places that wasn’t the case. In some places, there was virtually no disruption to the drug trade. And, our colleague Rafael Torruella in Puerto Rico, I will always remember Hurricane Maria shut everything down, he says, except, of course, the drug trade, Thriving and unbothered by the hurricanes. And in some places, there were really, really severe disruptions that have had really devastating impacts on folks. And so I think it’s really that nuance and that complexity that I was really interested in seeing, because you think you can just know and create resources that will work for everyone. But these programs are really so individualized according to the needs of their communities. I’ve always known that the circumstances in communities can be so different — but it really is very striking to see on paper.
Tom Llewellyn: Yeah, as we were going through the results of the research, I definitely remember just seeing the diversity of programs — of scale, of the budgets and lack thereof, of the number of volunteers and/or staff members or lack thereof, the types of disasters that are being faced. Like you’re saying, the impact that only a third of people that had responded to our survey said that the access to drugs was impacted in a high way? I was definitely expecting that to be higher as well.
Christine Rodriguez: Indeed, I was, too. Although what I wasn’t surprised by was seeing the range of innovations that came from the community and the creativity with which folks just pushed through and then figured it out among themselves and in partnership with their participants — that didn’t surprise me, that was very gratifying to see. It was very gratifying to see — even though it can be very, very stressful on the ground. I’m continually impressed by folks’ ability to figure out the work.
Tom Llewellyn: Yeah, I definitely saw that dedication as well. Because not only have we been doing this survey, but in doing all the interviews that we did beforehand, just hearing all those more qualitative experiences…it was clear that for people that are doing harm reduction work, they’re already facing so many barriers. In a lot of cases, it’s like working in a disaster zone all the time. The other thing that came up that I really started thinking about a lot was people’s answers about whether or not that they have some sort of a disaster response plan. I feel like probably more harm reduction service providers have that plan already — they just don’t realize it because they’re just implementing it every day. And so it doesn’t seem they think, “Ok, well, maybe I don’t really know how to act in a disaster…” Or because they’re thinking of it as something that’s externalized, thinking of it as something that is a “natural disaster” or a natural hazard — which becomes a disaster — because you’re on the front lines of an ongoing, evolving social disaster every day.
Christine Rodriguez: Absolutely, absolutely. It’s overwhelming because of how layered that is. It’s a disaster on top of the overdose crisis, which has been — and crisis feels like an overused word at this point and doesn’t really convey the magnitude of what’s going on — but layering that crisis on top of a disaster, on top of, communities that are experiencing blight in their towns, — whether it’s rural or urban — folks who are experiencing police violence very often, folks that are experiencing stigma and homelessness…unfortunately some of it seems like business as usual in some ways. But in others, it’s completely novel and requiring of new creative strategies and pivots. But I think folks have the plans. I think they’re in people’s heads. I think folks are probably concerned that their plan is not appropriate or the best or up to standards. And I think that folks would be really surprised to learn that they’re doing just as well as any of us could in these circumstances. But, you know, folks know how to do the work. They just need the resources to be able to make it happen.
Tom Llewellyn: Yeah. I think of what Nick Farr refers to as “the long disaster,” and there’s a great quote, “The long disaster responder doesn’t rush in because they’ve been there all along working within existing networks and fostering communal efforts to prepare for the durable disasters on the horizon.” And so like you’re saying, it’s hard to think of it as using that word crisis when it’s just been going on for so long…this is a long disaster. And those that are on the front lines of it doing harm reduction work have been there building those networks and those relationships.
Christine Rodriguez: Yes, exactly.
Tom Llewellyn: And so from that perspective, I feel like people doing this work are far beyond more prepared for the next level, those acute disasters that come up, than people that are doing a lot of other types of work.
Christine Rodriguez: Absolutely, I think people are operating in crisis mode constantly, just constantly — which shouldn’t be the case. It’s exhausting. And that feels exactly right, the long disaster. And it’s those relationships that folks build in communities that make harm reduction programs so incredibly effective at pivoting and adapting to these more traditionally thought of disaster circumstances.
And mutual aid is required. Partnerships — you can’t do the work without them. And in particular, those relationships that folks build with their participants, with their clients. Those relationships built on trust and respect. That’s how they’re able to still, when possible, find folks after disasters. They’re able to get back in contact with people. They’re able to still do outreach and provide materials to people who are very vulnerable and really need it. Where other programs struggle to even think about how — and while they’re thinking about how, harm reduction programs are still out there doing it.
Tom Llewellyn: Yeah, well, you know, I think as we’re starting to wrap up, what in your mind comes next?
Christine Rodriguez: I would love to see a few things come next. Support for programs who are doing this work in whatever way they find most useful. Whether that be practical disaster planning support, whether that be templates for what those look like, maybe a different mechanism of funding folks. The funds that come through need to be flexible. I’d love to see a greater flexibility in funding. I’d love to see funding support the purchase of actual supplies. In a lot of cases it doesn’t, right? And that’s what folks need to get out to the community. I would love to see harm reduction programs and syringe service programs taken seriously and really given the service provider respect that I think they all deserve. The professional and community respect for the work that they’re doing that is incredibly vital and crosses a bunch of communities, whether it’s just folks using drugs, whether it’s folks who are also experiencing homelessness, whether folks are trading sex.
I mean, it’s not that you don’t know people who do drugs or trade sex — it’s that you might not know that you know people who do drugs and trade sex, right? This is our community and I think that these programs provide vital services and I’d love to see them recognized as such. It has been a struggle for some folks in jurisdictions where certain services are not legal per se or whether they’re begrudgingly legal in some jurisdictions. Folks have had to struggle to be deemed as essential service worker to get back out there during Covid. And there shouldn’t be an argument to be made there. There shouldn’t have to be a struggle there. So yeah, I’d love to see less stigma and more support.
Tom Llewellyn: Do you feel like that stigma is dissipating as the epidemic crisis has grown to the level that it is? Or do you feel like there’s just or nearly as much stigma as there was 20 years ago?
Christine Rodriguez: I think there’s less stigma now, with the caveat that it hasn’t improved as much as I think we’d like to think. I think harm reduction — especially harm reduction-based and community from a grassroots perspective done by people who use drugs, led by people who use drugs — I think that there is still incredible stigma around that as public health has essentially co-opted these interventions from the community. There’s a different sense of them now as being sort of professional public health interventions. Naloxone is much more accepted, certain services programs — it depends where you are, whether or not what the stigma looks like around that.
But I don’t think we’re there yet. Especially when our programs are serving folks who are extremely poor, folks who might be living on the streets, folks who are queer, who are black and brown. All of these oppressions layer on top of each other. And even as there’s more acceptance for some of the work drug use continues to be criminalized everywhere now — except Oregon, which was a big win. And there is just some very deep-seated disdain for people who use drugs. It keeps the majority of folks who use drugs with no issue from outing themselves as people who use drugs. There’s no benefit to sharing that information. So we don’t get to see the range of experience and nuance in drug-using communities.
I would love to feel like that stigma has gotten better, but it’s just so powerful and the misunderstandings about harm reduction are so powerful and so prevalent that I think folks everywhere still really struggle, except in very few jurisdictions that have thrown their support behind the work. It is still very difficult. And I know some people who don’t care and I’ll tell people what they do. Others don’t want to discuss their work at all in casual conversation because of the stress of that conversation, the stress of that stigma that you’re going to feel immediately, “You do what for who?” It is incredibly disappointing that something like drug use has been spun out by the media and by our government as societal evil, when it is really just a societal fact — and we just have to deal with it as such. I just don’t understand sometimes what could be wrong with more compassion and what could be more supportive than allowing people to make their own choices and get there in their own time. You can’t force change or else I would be on a completely different exercise regimen and all manner of things. But you can’t force it. There’s still far too much stigma for my taste out there.
Tom Llewellyn: I think you really landed on something there with the idea of compassion — The concept of compassion, the big need for compassion. And unfortunately as evolved a society that we think we live in, what we do have IS a lack of compassion and empathy across the board. And one of the things that I have seen specifically during this pandemic, is a pretty big shift there. This is one of the things that you don’t look at often and what I’ve been talking about lately and really thinking deeply about is that this is the first time in a hundred years that people have recognized, all over the world, are recognizing that they’re facing the same disaster at the same time.
And I use the word recognize because I think we’ve been facing a lot of disasters of inequality, like the economic disaster — we haven’t recognized them as being really the same. We experienced it a little bit during the financial crash in 2008 — that ended up having global ramifications — but it still wasn’t quite the same as what we’re experiencing now with the pandemic. And what I find really heartening is that people are coming out and supporting their neighbors. And not just their direct neighbors, not just the people that are in their same socio-economic classes. People are having greater compassion and having a greater sense of vision of those that are suffering in their communities in a way that I haven’t really seen before in my lifetime. I mean, I have in my neighborhood, in my community, but from a much larger global area, I just haven’t seen it in the same way as we’re seeing it now.
And that idea of the reduction of suffering in moments of crisis and disaster is really something that we’re going to have to focus on a lot more as we face more and more of these climate-fueled disasters. And what I am really, really hoping is that the networks that are being built, you know, the neurons in the brain, like the connection between the environment and the experience of other people around you, that those mental connections are going to stick. Then we’ll be in a better position to face the disasters that are going to be worse than what we’re facing now in the coming years — I really feel like they are coming. I mean, they’re already here. We saw Central America being slammed by two hurricanes recently, one after another, very similar to what occurred in Puerto Rico with Irma and Maria. This is the worst hurricane season on record, we just had the worst fire season in California on record. It’s here. This is no longer the challenge of future generations l— is this is our challenge, whether we like it or not. And the sooner that we recognize that, the sooner that we can really start addressing some of these things.
And even from myself, as I’ve been thinking about the ways that marginalized populations are oftentimes impacted in greater ways by disasters. What are the ramifications of that? Before working on this project, I had no concept of the ways that people who use drugs are impacted — that just never occurred to me. And I don’t think that occurs to most people. And so that’s really been something that I’ve been able to take away from this project. And through doing this, I’ve started to look at a lot of the rest of my work through the idea of being harm reduction. And it’s something that I didn’t have the words for or the understanding for before doing this. One of the greatest impacts on me doing this work is just really seeing that so much of the work that is happening right now in my life is harm reduction. But then, the backside of that is, ok, well, if this is harm reduction work, what are the upstream issues that are not being addressed that are causing these downstream symptoms, that are requiring so much focus? So this has also been kind of an eye-opener for me on that as well.
Christine Rodriguez: Absolutely, absolutely. There are so many, but anything we can do to dismantle the war on drugs is going to be critical — that’s just been such a devastating tool of a racist administration in its time. And that has been carried forward. It’s ineffective and it creates a lot of harm, a lot of pain, and a lot of suffering that really could be entirely avoided. And we got to keep chipping away. We have to keep chipping away.
Christine Rodriguez Podcast Outro
That was Christine Rodriguez.
Our report on disasters and harm reduction will be released next week on Higher Ground Harm Reduction’s website www.hghr.org
Please get in touch if you or your organization are interested in partnering with The Response on a current or future project by sending an email to firstname.lastname@example.org.
As I mentioned before, this was the first episode of our special 2-part series. Be sure to tune back in next week for our audio documentary.
The Response is a project of Shareable, a nonprofit media outlet, action network, and consultancy promoting people-powered solutions for the common good.
Our latest book, “Lessons from the First Wave: Resilience in the age of COVID-19”, is available as a free download at shareable.net.
Support for this project has been provided by the Threshold, Shift, Guerrilla, Clif Bar Family, and Abundant Earth foundations, Shareable’s sponsors including Tipalti, MyTurn, and NearMe, and tax-deductible donations from listeners like you.
Additional funding for this research and 2-part series was provided by Resist, The Emergent Fund, Comer Foundation, NASTAD, and AIDS United.
Until next time, take care of each other.