What I’ve learned is that [syringe exchange programs] are everywhere,” says Jamie Favaro, founder of Next Harm Reduction. “Even if we’re unsanctioned, unfunded, there are underground syringe exchanges across this country. And I’m finding out about new ones every day.”
Yet even all of these are not enough; there are still many people who can’t access them.
“What about someone who lives in a small town?” asks Favaro. “They went to high school with their pharmacist, maybe people know they have a history of drug use… If they’ve relapsed, they’re going to be using in secrecy because of shame and stigma, they’re using one syringe 20 times until the tip breaks off.” Some people may not feel comfortable openly walking into a syringe exchange or obtaining needles from a pharmacy.
That’s where Next Harm Reduction comes in. The nonprofit, based in New York City, was founded in October 2017. It distributes free harm reduction supplies, like syringes and naloxone, to people throughout New York State, and provides online educational resources for people who use drugs. Next Harm Reduction runs two programs: NEXT Distro, which aims to replicate some of the resources and support of a typical syringe exchange program; and Next Naloxone, which exists to provide the overdose reversal drug to people in rural and suburban communities.
Next Harm Reduction is developing an encrypted online system. In the meantime, Favaro explains, “the method for folks to access supplies now is to reach out to me via the ‘contact us‘ link or via email, text, Signal, Whatsapp or social media: Reddit, Instagram, Facebook, etc. I send them an anonymous enrollment via an unlisted URL.”
Next Harm Reduction is the first official state-wide operation of its kind. Although naloxone is now available without prescription in many states, the FDA still classifies it as a prescription drug—and federal law prohibits mailing prescription drugs and syringes except in certain specified circumstances. One loophole is if the project is part of a state-sanctioned program: Next can legally mail naloxone because it is a registered Opioid Overdose Prevention Program in New York State; it run its peer delivery syringe distribution service through VOCAL-NY. Anyone who accesses those services from Next is enrolled as a participant in VOCAL.
“Syringe exchange programs often encounter nimbyism and other obstacles to their existence,” says Favaro. “We skirt that issue by providing services online for people to access in the comfort of their own home.”
Her grand vision? “Syringe exchange for all.”
That’s not to say that Next wants to replace on-the-ground programs. “I believe that in-person services are always best,” Favaro says. So another component of Next is helping connect people to physical harm reduction centers near them—and not just state-sanctioned ones.
Favaro is constantly “doing investigative work” to connect people to all sorts of services. “Walking into a syringe exchange program when you haven’t been before, or don’t know anyone involved can be a daunting experience.”
Favaro brings nearly two decades of harm reduction experience to the project. After working at Tapestry Health in Massachusetts and Citywide Harm Reduction in New York, she founded Washington Heights Corner Project in 2005, a community health center that offers supportive services, including syringe exchange, to people who use drugs. Until recently she worked as a senior advisor at the Harm Reduction Coalition, before leaving to work full-time on Next Harm Reduction.
She isn’t just a social worker, and activist; she’s also a person who uses drugs, which gives her valuable insight into the needs of the people Next serves.
I think it’s very scary for people who don’t know that syringe exchanges are warm, supportive, caring environments.”
“As someone who has walked into a syringe exchange … it’s really nerve-racking,” she says. “Every time I walk into an NEP as a participant, I am scared—my heart is racing. I’m afraid someone is going to call me out, or confront me. And that’s as someone who has run a needle exchange program. I think it’s very scary for people who don’t know that syringe exchanges are warm, supportive, caring environments.”
Right now, Next is working with all the official needle exchange programs in New York State, as well as many underground ones, seeking to break down barriers and increase access for the most vulnerable people.
But Favaro wants to expand nationwide. The hope is that Next is creating something in New York for other states to adopt. In 2019 Next will be expanding to Maryland, which requires county-by-county approval. After that, Favaro wants to roll it out to “Eastern Kentucky and Tennessee, where the overdose rates are phenomenal and the resources are not available to people who use drugs.”
Operating in each state requires its own tailored approach. “The drugs you use in different regions and different states are different. An educational video for someone who receives supplies in upstate New York is not the same as for someone in Tennessee, or Nevada.”
As Next Harm Reduction’s website explains, “Mailing harm reduction supplies isn’t new. People who use drugs, organizations that serve [them], and community activists have been mailing syringes and naloxone for longer than we can say.”
Next was particularly inspired by the work of Tracey Helton, a woman once described by CNN as the “heroine of heroin.” Helton works in public health in San Fransisco and is now on Next’s board. During the 2016 Harm Reduction Conference in San Diego, Favaro heard Helton speak about the work she was doing, mailing naloxone from her living room to people across the country, operating outside the law.
“My brain exploded,” Favaro says. “I became very interested in how we could scale up and formalize the work she had been doing, in order to ensure that people across the country who live in communities wheres there’s no syringe exchange programs can still receive harm reduction services.”
“What that means,” she continues, “is not just the supplies that someone would walk into an SEP and receive, but also the education, resources and support that come along with being a program participant in a syringe exchange.”
“There are people who don’t have access to naloxone who are actively using drugs.”
Sending harm reduction supplies by mail is a service that’s clearly needed. “We’ve had over 20 naloxone reversals in the past three months,” Favaro says. And she points out something that is obviously true, but still shocking in 2018: “There are people who don’t have access to naloxone who are actively using drugs.”
According to the most recent data from the Centers for Disease Control and Prevention, 70,237 people died of drug overdoses in 2017—the highest number recorded for a single year in US history. The number of drug overdose deaths in the US was so high that it significantly contributed to an overall drop in life expectancy. Yet according to Next Harm Reduction, 93 percent of US counties have no syringe access program.
Given the crisis we are in, it’s frustrating to Favaro that “people are still stuck in old ways of thinking about needing to create brick-and-mortar programs.” She says that “with caution,” though. That’s because, she explains, she doesn’t want to encourage or condone “folks who don’t come from the school of harm reduction and drug user health,” who “are looking to capitalize on the opioid epidemic by creating ‘solutions’ that are not based in supporting people who use drugs.”
“Right now there’s so much funding around the opioid epidemic, folks that don’t have experience in on the ground work are capitalizing and exploiting resources that would be better utilized if they went towards harm reduction and syringe access and low-threshold buprenorphine access.”
“Harm reduction folks and people who use drugs know what we need to do,” Favaro says, “but we don’t have the money to do it.”
She has raised enough money to build the infrastructure of the project, but still needs funding to carry out daily operations, and to purchase and mail supplies.
Next is hoping to partner with state programs, and is applying for a SEP-waiver in NY state so it can operate independently, rather than just through VOCAL. They’re also raising money through a gofundme account.
“We believe everyone who uses drugs should have the resources and ability to keep themselves as safe and as healthy as possible,” says Favaro. “This includes physical and emotional health.”
Photos via https://nextdistro.org/home/ and https://www.instagram.com/nextdistro/