On September 17, the Centers for Disease Control and Prevention authorized a Maine syringe service program (SSP) to do what it had already been doing for several years. Church of Safe Injection (CoSI) will now be legally delivering hypodermic syringes to five municipalities: Bethel, Dixfield and Rumford—small Oxford County towns with populations of a few thousand each—and the larger cities of Lewiston and Westbrook.
CoSI has been operating since September 2018, when founder Jesse Harvey started distributing syringes out of his car and organizing the community into what he envisioned as a national movement. It offered unsanctioned syringe services—all 100-percent mobile, no brick-and-mortar base—until September 2020, when Harvey died of overdose. He was 28.
“The fall of 2020 was a shitshow,” Zoe Brokos, CoSI director of operations, told Filter. “Just grieving, and COVID, and trying to figure out what we were going to do.”
Kari Morissette, who had been trained by Harvey, took over as executive director. Brokos resigned from Portland Public Health Division, where she had worked for the past decade, and joined her. They weighed their options. They tried to imagine what Harvey would want, for the participants and for CoSI as a whole. They agreed that the pros of running an unsanctioned program were no longer outweighing the cons.
“We were too hot,” Brokos said. “There was news [coverage], people knew we were doing illegal exchange. It was starting to jeopardize our relationships with community partners, but most importantly the folks accessing our services. We didn’t want cops showing up and arresting them. It was getting really obvious, and it was getting hard to do the work.”
Finally, they arrived at their decision: They would suspend all unsanctioned programming, and they would pursue certification with the CDC.
“Up until Jesse died, he was deeply conflicted with the idea of certification and what it meant.”
All five outreach locations were chosen based on where CoSI members had connections and knew there was need—Morissette is from Rumsford—but also where they could count on the most support from residents. There wasn’t much room for error.
“When we first reached out to the CDC and said we were interested in certification,” Brokos said, “they were sort of like, ‘Oh. Okay. You’re gonna have to mend a lot of bridges. Jesse did a lot [of damage to government relationships] and you’re gonna have to really prove yourself.’”
Harvey, once prominent figure in Maine’s recovery community before finding his way to harm reduction, had recognized the benefits of authorization but loathed the bureaucracy it entailed, and the lack of political will to make it better. He had been increasingly harassed by local authorities and had made highly public condemnations of them in return (including as a Filter contributor). Brokos believes the way he was treated in the final months of his life contributed to his death.
This is why CoSI had to suspend unsanctioned programming and keep a low profile while the CDC application was pending. For the past year, the organization’s services have been limited to naloxone distribution and mutual aid to keep participants connected to other operators while everyone waited.
“Up until Jesse died, he was deeply conflicted with the idea of certification and what it meant,” Brokos said. Specifically, he balked at one law to which CoSI would have to comply if authorized: 1:1 exchange.
“Jesse was so compelled to operate without certification because he was absolutely infuriated by 1:1.”
Though the CDC has advised against it, numerous authorized SSP across the country are hobbled by 1:1—the mandate that participants can only receive as many new syringes as they bring in used, and in the most extreme cases only one new syringe per visit. It is a deeply cruel, anti public-health restriction that keeps people who inject drugs at elevated risk for HIV, hepatitis C and bacterial infections like cellulitis and endocarditis. The vastly superior policy is needs-based syringe distribution, which is exactly what it sounds like.
In the early weeks of the pandemic, Maine Governor Janet Mills (D) issued an executive order temporarily suspending a number of restrictions on harm reduction work, an emergency intervention being rolled out similarly in other states.
In addition to being able to adjust their hours and outreach locations without waiting for state approval, and to ship supplies through the US Postal Service, authorized Maine SSP workers were for the first time liberated from 1:1. During the pandemic they have operated as needs-based, and seen for themselves how much safer, more effective and more humane it is.
In July, Gov. Mills signed into law LD 994, decriminalizing syringes for drug use. But though syringe possession was struck from the state criminal code, it was not similarly amended in the state operating rules for SSP, which are regulated through a separate law by the Department of Health and Human Services.
Filter reviewed an email from one of LD 994’s lobbyists expressing that because 1:1 was still suspended at the time LD 994 became law, SSP operators had expected it to stay that way.
For months, Brooks and Morissette had pursued authorization knowing that it would have made Harvey apprehensive, but believing that it would not include the one part he objected to the most. Instead, when CoSI became authorized, it also became bound by 1:1. The pandemic suspension had expired three weeks earlier, on International Overdose Awareness Day. It’s not clear why.
“The reason why Jesse was so compelled to operate syringe service programming without certification is because he was absolutely infuriated by the 1:1 law,” Brokos said. “He saw directly how damaging it is, and was like, ‘Fuck it, I’m gonna do what’s right.’ And so it’s really hard to be at this point now.”
In its first year as an authorized program, CoSI will focus on the basics: building up the organization and making it sustainable. As Lewiston and Westbrook are larger than the other three locations, and face higher incidence of overdose and blood-borne disease transmission, Brokos envisions running outreach to both a few times a week. Lewiston has authorized services through statewide SSP Maine Access Points (MAP) but only during business hours, so CoSI will fill in some of the gaps. The other four locations have never had any legal syringe programming.
“It was a brilliant idea, seeing it as a church.”
“We are really thankful that COSI is part of our community,” MAP Executive Director Hilary Eslinger told Filter. “And we are thrilled that they have been certified by the state to provide syringe access. We have to stick together as harm reductionists in Maine.”
All CoSI services will be mobile, as they always have been. Down the line there might be a van, but for the moment things will run the way they did when Harvey was alive—filling someone’s car with whatever inventory will fit, driving out to meet a point person and setting up a table. The outreach schedule hasn’t been decided yet, but will be posted to Facebook and Instagram.
Once things are up and running, Brokos and Morissette can hopefully turn to adding a few more sites, and more services for the queer community, assuming they figure out how to get enough money.
Harvey had handled all the fundraising. Brokos and Morissette ran out of money a few months after he died. The administrative work of picking up the pieces has often been jarring and sad. The CoSI PayPal is still tied to his bank account. Sometimes they have to write the final reports for grants awarded in his name. To this day, they don’t know who most of his funders were.
“He was brilliant,” Brokos said. “It was a brilliant idea, seeing it as a church. Now, [we’re] making sure we never stray too far from what he saw for this organization. Because that was such a difficult part—how do we move forward without the person who created this? All of it was still so new.”
Top photograph of Jesse Harvey courtesy of Church of Safe Injection. Bottom photo courtesy of Zoe Brokos.