How We’re Building Collective Harm Reduction Power in South Carolina

March 2, 2023

Most harm reduction work plays out in legal gray areas, but in South Carolina that’s all we know. There’s no state legislation that authorizes syringe service programs (SSP) to operate, but there’s nothing banning them either. Syringes aren’t criminalized as “paraphernalia” here. 

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 


Marc Burrows

Marc Burrows, MSW, LMSW, CPSS, is a former IV drug user; founder of the first syringe service program in South Carolina, Challenges Inc; and currently the chair of the South Carolina Harm Reduction Coalition. In his work, Marc advocates for drug policy reform and expanded access and reduced thresholds for evidence-based interventions including syringe services and medications for opioid use disorder. He lives in Greenville, South Carolina.

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