But there have also been real bright spots—including harm reductionists’ ongoing efforts to build collective power here, and an unprecedented harm reduction conference that increased that momentum.

In South Carolina, syringe service programs like the one I operate exist in a legal “gray area,” and it can be difficult to find the political or financial support that leads to fruitful outcomes.

These situations can make you feel like you’re stuck in place, getting nowhere.

For example, supporters who work for large agencies or funding organizations are usually fearful to do too much internal advocacy, due to stigma. It can be hard to break through to the decision-makers whose backing could win real progress.

And if someone in a leadership position does support the cause, their willingness to advocate for big change usually gets averted by the fear of losing funding or becoming unpopular with their board.

These and other situations can make you feel like you’re stuck in place, getting nowhere.

That’s why it was so enormously encouraging when a harm reduction conference—a first-of-its kind event, directly confronting the barriers faced by South Carolina harm reduction—was held in my home town of Greenville.

PRISMA Health, the state’s largest employer and hospital system, took the initiative to organize and host it: The South Carolina Harm Reduction and Syringe Service Programs Symposium.

It was led by the director of PRISMA’s Addiction Medicine Center, Dr. Alain Litwin. Alain has been a tremendous catalyst for the growth of syringe services in Greenville, and a champion for harm reduction in the health care system. He brings a wealth of drug-user health knowledge and experience from his time at Albert Einstein College of Medicine in New York City. He and I have been collaborating on different projects for several years.

The June 9 event featured presentations, panels and break-out groups. Over 200 people registered, many of them local. They were people with lived experience, harm reductionists, addiction professionals, social workers, health care professionals, academics, medical students, pharmacists, public health workers, to name a few—as well as state agency bureaucrats.

The day’s objectives included outlining the evidence to support SSP, highlighting innovative national models, and discussing legal and policy issues in South Carolina, with reference to experiences in other states.

We also aimed to develop a collaborative action plan for expanding syringe services in South Carolina.

I would be lying if I said I did not get some pleasure from watching state agency directors shrinking with embarrassment.

Speakers included Dr. Kimberly Sue, then–medical director of the National Harm Reduction Coalition; Dr. Brianna Norton, medical director of OnPoint NYC; Najja Morris-Frazier and Brendan Cox of Law Enforcement Assisted Diversion (LEAD); and Jon Zibbell of the Research Triangle Institute (RTI).

Those of us with direct experience of SSP also included A’zhane Powell of Fyrebird Recovery, which operates a newly founded South Carolina SSP; Robert Childs, former director of North Carolina Harm Reduction Coalition; and myself, representing Challenges Inc.

Panelists including (from left) Robert Childs, the author Marc Burrows, and A’zhane Powell

While the event was unique, it was not actually the first harm reduction conference in South Carolina. In March 2020, NASTAD hosted its annual Southern SSP Institute in Charleston. We were fortunate to have it, and it shared valuable harm reduction information. Yet without certain stakeholders, with few members of state agencies in attendance, it was hard for that event to shine a light on the most pressing harm reduction issue here: the legality of SSP.

This issue was front-and-center at the Greenville Symposium.

Corey Davis of the Network for Public Health Law presented a particularly compelling policy brief, outlining why state legislation does not leave SSP outside the law.

I would be lying if I said I did not get some pleasure from watching state agency directors looking on with solemn stares, shrinking with embarrassment, as he made his case. His evidence defied the usual message we’ve been told by state government: that SSP are illegal.

“A breath of fresh air in an environment still struggling to embrace evidence-based practices.”

Another stand-out presenter was Christina Dent, founder of End it for Good. She described her experience as a southern Christian conservative-turned-drug policy reformist. Her message obviously resonated with the audience, and was a perfect strategic fit for our context in South Carolina.

In their individual ways, all of the presenters did a fabulous job of bringing home the importance of SSP and real harm reduction work, and people in attendance were left asking why we aren’t doing more in our state.

“Change comes slowly, and harm reduction is facing a tremendous amount of resistance,” Michael Crouch, a person with lived experience and addictions professional who has spent most of his life in South Carolina, told me afterwards.

Calling the event “a breath of fresh air in an environment still struggling to embrace evidence-based practices,” he praised the detailed focus on SSP and discussions of wider drug policy. Altogether, he said, it “made me feel like there is hope for South Carolina.”

I felt the same way. And this energy has carried over into my harm reduction work in the past six months.

But the Symposium was much more than a morale boost. Remember the day’s objective of an action plan?

June 9 also served as a kicking-off point for the newly re-formed South Carolina Harm Reduction Coalition, which seeks to build on this momentum into expanded statewide advocacy and public education for harm reduction and drug-user health policies.

In the work I do, any day a person does not have to share or reuse a syringe is enough to keep me going. But if I have hope for a better 2024, it’s because of the collaborative power among advocates that I have witnessed in our state this year.

All photographs courtesy of Marc Burrows

The post Why I Have Hope for South Carolina Harm Reduction in 2024 appeared first on Filter.

Challenges Inc. and Fyrebird Recovery are considered to be the only two SSP currently operating in South Carolina. In late 2022, they began forming a statewide harm reduction coalition. A small but growing number of us now meet regularly. We come from a range of professional and lived experience, but all of us have been working in harm reduction one way or another.

We knew that we had shared priorities. One of the issues at the top of our agenda has been combatting fentanyl misinformation. All of us had individually been sharing harm reduction knowledge through various public speaking engagements over the years, but a unified presence makes our messaging stronger and more cohesive. When we talk with politicians or public health institutions about the lie that is “fentanyl touch overdose,” or explain that fentanyl has not been found in cannabis, they know our words have the weight of a statewide coalition behind them.

Across the country, drug-induced homicide laws are being drafted and in many states already exist. A bill to create such a charge was introduced in the South Carolina State Senate on January 10, then to the House on February 28. A collective of like-minded and compassionate people armed with knowledge of the devastating harms of these laws is needed now more than ever.

With a conservative state legislature that rejected Medicaid expansion, support for treatment and recovery is sparse; government support for true harm reduction services is nonexistent. Like harm reduction workers in other states across the country, we are concerned with the way South Carolina’s opioid settlement funds are being allocated. 

As a statewide coalition we’re able to not only appear stronger from the outside, but pool resources and better meet our needs from the inside.

While our two SSP receive no government funding at all, we cannot sit on the sidelines while hundreds of millions of dollars go to abstinence-based groups claiming to offer harm reduction when in reality all they offer are fentanyl test strips and Narcan. These are essential components of safer use, but they cannot be considered harm reduction on their own, removed from the much larger engine of harm reduction resources and education meant to go with them.

We call that kind of work “lowercase” harm reduction. Harm Reduction Lite. It’s a threat to all of us. Groups apply for government funds for blood-borne disease testing and treatment, but then once they receive it, they can’t actually find people to test and treat because they’re not in community with people who use drugs. They receive “harm reduction” funds to distribute Narcan and fentanyl test strips, but don’t know how to properly explain their use.

Harm reduction is a growing presence in South Carolina, and it’s taken years of grassroots organizing to get here. As more organizations begin to incorporate harm reduction services and resources into their work, it’s important that they have a guiding voice shaped by those of us who have been doing the work all along.

Our coalition is still in its early days. Even our name is still evolving, as—like many other harm reduction workers around the country—we navigate the process of merging older efforts with new ones. There are other states with similar SSP policy (or lack thereof) as South Carolina, and rural areas and harm reduction deserts where there may not be any real infrastructure to support collective work. But in these places, too, there are likeminded people to build one.

As a statewide coalition we’re able to not only appear stronger from the outside, but pool resources and better meet our needs from the inside. More shared knowledge—and more power—than when we do this work alone.

Roland Martinson, Kate Curran and Torrie Jordan coauthored this article.

Image via South Carolina Department of Alcohol and Other Drug Abuse Services 

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This is the advice we’re supposed to give people when their dope tests positive for fentanyl. It’s also great advice if it somehow doesn’t have fentanyl, which is why harm reductionists have been saying it for years, regardless of whether anyone had fentanyl test strips.  

There’s a lot of hype right now around FTS, the $1 rapid drug-checking tool that simply reveals whether or not a sample contains fentanyl. They certainly have a place in overdose prevention, but how often are they really telling us anything new?

Opioid-naive people are not generally the ones being told to use FTS, but they might be the ones who could actually use them.

“We already know that our dope has fetty in it,” said participants at our mobile syringe service program in Greenville, South Carolina, when I posed this question.

That’s the sentiment among many people who rely on illicit opioids where fentanyl has taken over the supply. There are of course many opioid users who want the certainty that comes from physically seeing a sample test positive, and for whom FTS represent bodily autonomy.

But what about other people who use drugs, the ones who rely on stimulants or just use illicit drugs occasionally? Opioid-naive people are not generally the ones being told to use FTS, but they might be the ones who could actually use them.

Imagine a teenager trying heroin for the first time, or someone picking up cocaine for a party. They aren’t staring down withdrawal, or resigned to the reality of having no safer alternative. A positive FTS means more to someone who isn’t expecting it. Someone opioid-tolerant gets the choice of fentanyl or withdrawal, and faces harm on both sides. Someone opioid-naive gets the choice of fentanyl harms or no harms at all.

Making FTS available in high schools would require conversations about drug use that are more open and honest.

But making FTS available in high schools would require conversations about drug use that are more open and honest than what’s currently mainstream in our culture. School boards, like addiction treatment programs and health departments and churches, usually have an abstinence-based philosophy rather than a harm reduction one. They therefore object to something like FTS on principle, because acknowledging them would mean acknowledging that teenagers use drugs.

We educate teens on how to safely drive a car, and in at least some places how to safely have sex. We educate them on safe alcohol use through established social norms that match the consumption to the setting. Bloody Marys at brunch, a few beers while watching a game on TV, wine with dinner—these are all learned behaviors that subtly moderate alcohol consumption and encourage non-problematic use. Alcohol was once prohibited, and we’ve seen how much safer it is to acknowledge it instead.

South Carolina does not have authorized syringe service programs. But in 2021 when such programs were authorized to purchase FTS using their federal funding, the state approved certain organizations to distribute FTS as well as illegal “paraphernalia”—cookers, cottons, alcohol pads, sterile waters—despite no change in legislation.

If the state can suddenly use federal funds to purchase harm reduction supplies without waiting to legalize them, why didn’t it happen years ago?

Photograph by Kastalia Medrano

The post Give Fentanyl Test Strips to People Who Could Benefit Most appeared first on Filter.

I was also impacted by stigma. I was scared to tell my girlfriend and embarrassed in front of my family. The guilt and shame I experienced from having hep C greatly contributed to my using drugs addictively for several more years, and made coping with emotions in early recovery nearly impossible.  

Finally, in 2014, after 10 years of living with hep C and three years recovered from addiction, I obtained health insurance that paid for the then-new drug Harvoni. I took one pill a day for 90 days and it saved my life.  

My treatment cost somewhere in the ballpark of $100,000. A sterile syringe could have cost about 10 cents.

When I was using drugs, the only way to get a syringe that I knew of was to buy it on the street from the same people selling the drugs. They sold them for $5 each. But either we wouldn’t have the extra money or there wouldn’t be any for sale, in which case my friends and I would share. It’s maddening to think now of how much damage hepatitis C caused in our lives, and how it could have been prevented with a few pennies.

Overcoming Cultural Obstacles

About three years ago, having long been in recovery and having worked in the addiction field, I started looking at the situation where I currently live, in Greenville, South Carolina.  

I found out that pharmacies here rarely sell syringes without a prescription, and that there were no formal syringe exchange programs in the entire state. South Carolina is one of the leading states for new cases of hep C. It was then that I decided to start my own syringe program.

South Carolina is a Red state with a church on every corner, and some consider Greenville, located in its northwest corner, to be the center of the Bible Belt. This is a place where sex education is still controversial. Greenville is home to Bob Jones University, a well-known evangelical and conservative institution, with a history of racism.  

As well as anticipated community pushback, I had to consider the possibility of legal action. South Carolina’s relevant laws are somewhat ambiguous (syringe distribution is allowed for “legitimate medical purposes,” but there is no specific reference to exchange programs).

Many people have been kind. A local pharmacy donated a few hundred syringes. A doctor gave me a box of sharps containers.

With all this in mind, I set out to learn, research, network and discover ways to accomplish my mission. I asked the advice of my mentor, who works for a program in Asheville, North Carolina, about an hour north of here. He had been operating a syringe exchange there for almost 20 years before it became legal. His advice was to prioritize gaining community support. So far, his suggestion has been fruitful.  

Many people have been kind. A local pharmacy donated a few hundred syringes. A doctor gave me a box of sharps containers. The local AIDS organization donated condoms, cookers and educational materials. Thanks to all of the donations I received then and since, it probably cost me only about $300 to get the program started.

A look of appreciation came over their faces. It was a magical experience.

It started in 2017 with just me, handing out these donated supplies from the trunk of my car in a gas station parking lot, in a Greenville neighborhood where I knew many people were injecting drugs. Initially, people were hesitant to engage with me, especially out in public, but a few of them actually took what I was giving out.  

It was interesting to watch their reactions when they realized what I was doing. They had never seen or heard of a syringe exchange before. When they saw that I wasn’t judging them for taking the syringes and was simply offering them help for free, a look of appreciation came over their faces. It was a magical experience and is still my favorite part of the job.

I continued showing up on Fridays for several weeks to give out my services, and it grew from there. The nonprofit program, which I named Challenges, Inc, now operates daily and has a team of volunteers that distribute to that area on a daily basis. I also have peer distributors in different towns who help out. It’s great to have so much help, although running the operation now takes more administrative time and organizational skills than I imagined.

Today, Challenges, Inc is mostly a mobile service. People contact us and we decide on a place to meet. I make deliveries all over the area, usually meeting in business parking lots. For people who are too far away to drive, I mail the supplies to them instead (another area in which laws can be ambiguous).

An Inspiring Response

A few months after opening, I was featured in South Carolina’s largest newspaper, the Post and Courier. The story brought lots of attention and to my surprise, it was mostly positive. Many people posted about it on social media, and for every person who attacked the idea, there would be two more who showed their support. Local news has continued to be supportive, and with each story, Challenges, Inc gets a little more funding for supplies and harm reduction awareness spreads.

I was amazed at the community response.  It seemed like people were so tired of hearing about the “opioid epidemic” that they were willing to try something that might have seemed to them outlandish (although evidence for the efficacy of syringe exchange is long established).

I hear stories of people using the same syringe for over four weeks or more.  

Ever since, I have continued operating South Carolina’s one and only formal syringe services program. We offer clean syringes and other drug-using supplies, along with naloxone and treatment resources. We have partnered with several treatment providers in the local area who are willing to work with my participants. We have also made connections with ancillary services to provide food, clothing, HIV and hep C testing, medical care and more.

The people we serve come from all demographics. What they have in common is a lack of access to clean syringes, which forces them to share needles and use old ones repeatedly. I hear stories of people using the same syringe for over four weeks or more.  

We have 24 overdose reversals reported to date. That’s 24 families who still have their child, parent, or loved one in their lives. As a person who has experienced the loss of a loved one, this is all the feedback I need to continue doing this work.

I set up a website and a Google listing for people to find Challenges, Inc. The NASEN syringe exchange directory has also been extremely helpful.  It turns out, a lot of people do Google searches for “syringes near me.” Most people either find Challenges that way or by word of mouth. Once we got some attention online, other harm reduction coalitions started sending me naloxone and other supplies. The support from the harm reduction community has been unbelievable.

When you show people how to take care of themselves, they start to believe that they are worth taking care of.

Strangely enough, the people who have given me the most pushback have been my closest friends. At first, they were confused as to why I was doing this work and seemed uncomfortable with the thought of me handing out syringes on the street. IV drug use, blood-borne disease and overdose are not easy topics for most people to talk about. Slowly though, they have become more accepting.

My biggest fear has been the police. Since the laws are unclear, I am never quite sure what will happen. Will I get arrested one day while handing out supplies? Will the cops see me on the news and come find me? I picture them breaking down my door and confiscating my supply of naloxone. Luckily, I have an attorney who supports the cause and is willing to represent me pro bono if I have a problem. So far, I have not had to use his services.

The people I serve are what keep me going. This work helps to empower a population that often thinks very low of itself. It’s like they think that since they are using drugs, they are supposed to feel like shit. The stigma caused by drug prohibition is responsible for this—but harm reduction can reverse it.

When you show people how to take care of themselves, they start to believe that they are worth taking care of. It’s a process that I went through myself.

Photo via Wikimedia Commons

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