A Visit to VOCAL, a Vital Hub of New York Harm Reduction

    Four days a week, no matter the weather, people gather outside a door on 4th Avenue in Brooklyn, near the Atlantic terminal, smoking and chatting. Many have made their way there after stopping at a nearby methadone clinic.

    Some aren’t coming to stay. At the front desk, peer educator Darryl Robinson stands in front of several plastic drawers that line the wall. Each has a label: condoms, wound care, Ziploc bags, cookers, ties, lubricant, smokers’ kits, alcohol pads, band aids, water.

    One man comes in, shows his enrollment card and asks for “Ties, just ties,” before rushing out with what he came for.

    The site, which I visited over a period of several weeks, is operated by VOCAL-NY (Voices Of Community Activists and Leaders). Working primarily with low-income communities of color, it hands out over 50,000 sterile syringes a year among all those other supplies, and provides overdose training, counseling and more. Although based in the city, its work is statewide.

    VOCAL turned 20 this year. The organization was originally called NYCAHN (New York City AIDS Housing Network), but changed its name in 2010 to reflect its multi-issue approach.

    “Our members always recognized that HIV/AIDS was not an isolated health issue but rather a symptom of institutional injustices rooted in race, gender and economic inequalities,” states its website. “VOCAL-NY was formed to shift attention from treatment to addressing the root causes of the epidemic, like homelessness and incarceration.”

    Accordingly, VOCAL doesn’t just provide harm reduction services. Its members also engage in empowering community organizing and direct activism for health equity and better laws. 

    Despite the value of this work, Jeremy Saunders, VOCAL’s co-executive director, tells me, a touch surprisingly, “We don’t want more VOCALs.”

    “Imagine this,” he explains: A government that brings a fragmented treatment system together. Medicine, doctors, therapists, recreation and education for all. A tailored recovery plan for everyone who needs it. No one jailed for drug use or addiction. No one falling through the cracks. 

    “VOCAL is a band aid,” says Saunders. “A band aid that’s falling off.”

     

    A Bathroom in Constant Use

    Behind the front desk, a hallway leads to the drop-in center with a table and couches, which is filled with participants from 10-5 every day. There’s a constant hubbub of conversation. 

    People can participate in various drop-in sessions throughout the day: drug user health groups; harm reduction groups; defense groups; writing groups. On Fridays, there’s a music group and a 3 pm movie. Robinson and other staffers, wearing distinctive black VOCAL hoodies, prepare pizza or sandwiches for lunch. Almost always, there are so many participants that space is scarce. But they make it work.

    The bathroom is a key area, and it’s always in use. A staff member, Evelyn Milan, explains to one man that he can do whatever he wants outside the center or inside the bathroom, but not in front of everyone else. “Whatever you do inside the bathroom is your business,” she says, “but don’t pull anything out in here.”  

    You need to sign up for the bathroom first, and a staff member calls your name when it’s your turn. There’s a maximum of 10 minutes per visit, and the bathroom is checked and sanitized by staff before and after each use. 

    Hand-written posters inside and on the door explain that syringes must be disposed of in the syringe containers provided—and to please wash your hands. The bathroom also has an intercom and buzzer so staff can keep checking on occupants, and a naloxone kit hangs by the door. 

    “We kept working till he turned a lighter shade and finally came to.”

    Staff knock on the door to check on occupants every three minutes. If at any point there’s no response, they let themselves in. If an overdose occurs, the staff member will immediately administer naloxone while giving the person a chest rub. Another staff member will evacuate the drop-in center and call an ambulance. The few participants who have overdosed at VOCAL have all been revived.

    “It has gotten a little bit harder because of the fentanyl,” Milan says. “From my experience, it takes a little bit longer for people to come back.” She once found a participant who had gone blue in the face, and it took 12 minutes and three doses of 4 mg Narcan [naloxone] to bring him back. 

    “But thank God, we were all there, so that when it happened, we could give him an ambu bag. We had another peer providing rescue breathing. We talked to him and stimulated his body and attached a pulsometer to his body. We kept working till he turned a lighter shade and finally came to.”

    Next to the bathroom is an office where staff members can speak with participants privately, and work to package harm reduction supplies and plan upcoming sessions or events.

    Sometimes, the street bleeds into VOCAL’s safe space. One time, someone owes someone else money. A woman jumps on another participant. Darryl Robinson gets in between the two. “This happens sometimes,” Robinson says. And then it’s okay again.

     

    A Safe Place to Be

    Whenever I ask participants for follow-up interviews, they say I can come back and talk to them at any time. “I’m here every day,” they say. And mostly, they are. They know that at VOCAL, someone is always looking out for you.

    Darryl Robinson only started working at VOCAL in late 2016, but he was a participant for over 15 years before that. “I started coming in here to stay off the streets.” After years in and out of Rikers, and on and off the streets, he found VOCAL to be a sanctuary. 

    Just having a safe space to be in is a major factor for many of New York’s most marginalized drug users. Many I spoke with (though VOCAL asked me not to identify or directly quote anyone) talked wearily of having to constantly move between institutions. 

    After spending nights at shelters or halfway houses, they are often obliged to show up first thing at the methadone clinic in order to drink their medication under the eye of a nurse. Late mornings and early evenings, there are libraries for staying warm. In the summer, there are parks. 

    “This room probably has 1,000 years of time in it, but everyone has a good heart.”

    Harassment by law enforcement is routine, and life is sometimes interrupted by incarcerationfor possession, dealing, trespassing, or any of the other things that people without much private space, or other forms of support, may become involved in.

    “This room probably has 1,000 years of time in it,” says one drop-in session facilitator. “But everyone in this room has a good heart, I know it.”

    Many participants arrive after being introduced by friends. Peer educators and outreach workers also recruit people from the streets. 

    When anyone in need walks through VOCAL’s doors for the first time, an enrollment advisor will sit down with them to ask some basic questions about their past and current drug use and other life circumstances. They then receive an enrollment card, and can come back to VOCAL for services or support whenever they need to.  

     

    Many Things to Many People

    Jeremy Saunders talks about how VOCAL has been instrumental in expanding access to safe syringes, overdose prevention training and more. But engaging participants in activism is equally central: VOCAL members often go up to Albany to protest policies related to drugs, prisons, housing, and AIDS. 

    Saunders, who joined VOCAL’s leadership team over a decade ago and has a long history of harm reduction activism and organizing, takes satisfaction in VOCAL’s ability to influence, for example, legislation around syringe exchange. “VOCAL engages people in discoursereally engages them,” he says. “It bridges the ideas of left-social justice analysis with a harm reduction analysis.” 

    Robinson talks with VOCAL participants every day about harm reduction options.  “I can’t stop people from using, but I can help them use safely,” he says. But conversations go much deeper than simple safety advice. With many experiences resembling those of the people he works with, he finds he is able to gain trust and understand needs instinctively. Part of his method lies in silence, he says, making firm eye-contact to empathize and check in.

    VOCAL was very different in the early days, he recalls. “This whole place was a shack, nothing like this, no real walls or offices. People would be using inside. And this crazy old guy lived in the basement, with his cat. He’d never let people in, always caused trouble.”

    “It’s getting cold out there, you gotta be careful.”

    Methadone is a frequent subject of conversation, and so is prison. Formerly incarcerated VOCAL participants make clear that under-utilization of medication-assisted treatment where it is needed most⁠—within the criminal justice system⁠—creates a vicious cycle.

    Some drop-in sessions focus solely on HIV and hepatitis C prevention. A staff member reminds participants to always use clean needles. She also tells them that PrEP and PEP are two medication options to prevent HIV transmission: PrEP (pre-exposure prophylaxis) for people who are at high risk of infection; and PEP (post-exposure prophylaxis) for people who think they might have recently been exposed to the virus.

    “It’s hard out there, it’s never been so hard out there,” Robinson says to one participant. “It’s getting cold out there, you gotta be careful.”

    VOCAL is many things to many people. It provides supplies and advice to directly reduce drug-related harms. It pushes for education and awareness around safer use and treatment. It fights discrimination against people who use drugs, advocating for the right to basic healthcare for all. It calls for safe consumption sites to reduce drug-related deaths. And it provides emotional support and a safe, non-judgmental space for people who find stigma everywhere else they look.

    In a world with equity, social support and better laws, as Saunders said, this wouldn’t be needed. Until then, there is VOCAL.


    Image of VOCAL members via the VOCAL-NY website

    • Jeevika Verma

      Jeevika is a radio producer and poetry editor based in New York City. She recently got her master’s at Columbia Journalism School, where she spent months producing long-form narrative work on the overdose crisis, power struggles within the South Asian community, and the mental health of couples struggling with addiction. Her work has appear in publications including NPR, Ploughshares, Crosscut, The Juggernaut, Homegrown and The Seattle Globalist.

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