Streetwise drug outreach program works to save lives, build trust among Roanoke substance users
The Virginia Harm Reduction Coalition makes stops around Roanoke three times a week in a black cargo van. They carry Narcan, syringes, tampons and pads, and other supplies, both drug-related and not. On either side of the van is a printed slogan. One side reads, “Community Care,” and the other, “We love you. Be safe. Carry Naloxone.”
They’re one of only two mobile drug outreach providers in the Roanoke area. They do their work on Mondays, Wednesdays and Thursdays. The other, the Drop-In Center, does its outreach on Tuesdays and Fridays.
Harm reduction is drug outreach that isn’t focused necessarily on abstention, but on keeping people with substance use disorder alive. With powerful synthetic opioids like fentanyl more readily available than heroin, the goal is to keep drug users as safe as possible.
On a uncommonly moderate Wednesday in February, with temperatures well above 60 degrees, the van made two stops, the first on Belmont Avenue, a few blocks from the Tazewell Avenue overpass where many homeless Roanokers camp, the second on Bennington Street.
The employees and volunteers for the coalition refer to the people who come to take supplies as “participants.” Some participants use drugs, some know people who do. Some are homeless, some are not. Some have jobs, some don’t.
The Belmont Avenue stop is the busiest of the day. Participants came at a steady pace, sometimes lining up. Most have memorized the stops and times for both the coalition and the Drop-In Center. The ones in the know remind friends and people they see on the street, or pick up extra supplies.
Last year, the coalition’s Belmont Avenue spot was a few blocks away at a storefront. When someone broke a window at the store after hours, the owner asked them to stop using the space, stating the owner’s insurance wouldn’t allow them to use the parking lot.
“I’m not sure if everyone who used to come by knows we’re here yet,” Ariel Johnson, Director of Patient Navigation, said of the new spot.
The distribution process goes by quickly. Most participants pick up clean needles and Narcan/naloxone, used to revive people who are overdosing. In the process they’re asked a few pertinent questions. “Have you overdosed since the last time we saw you?” “Have you Narcanned anyone else?”
On this day, most participants said they hadn’t used Narcan on themselves, but a few had used it to revive others.
Participants are given a choice for what kind of Narcan they are given. There are both nasal, used like any nasal spray, and intramuscular, an injectable form that, much like an EpiPen, can be injected into the muscles on most parts of the body.
The application isn’t pleasant. Narcan can cause a person to feel the symptoms of withdrawal immediately: nausea, chills and vomiting, among others.
“It don’t feel good, but they’re alive,” One participant says, picking up supplies.
Harm Reduction is especially important in the wake of the COVID-19 pandemic.
In 2020, overdose deaths in Roanoke more than doubled from the previous year, from 33 opioid overdose deaths to 80, according to data from the Virginia Department of Health. Overdose rates continue to climb, and while counting isn’t finished for 2022, 82 overdoses have been recorded for the first three quarters of the year, the most of any year for which data has been gathered.
The rising death toll is part of a statewide trend. From 2019 to 2020, Virginia saw a 17% increase in overdose deaths from opioids, both synthetic and not, going from 1,298 deaths to 1,915. In 2021, there were 2,229 deaths from opioid overdose in Virginia, a record for the state.
People with substance use disorder were already isolated before the pandemic made access to food and public spaces either difficult or nearly impossible. Even organizations built on outreach, such as food banks, soup kitchens and free clinics, reduced hours and capacity.
But even at the height of the pandemic, the Virginia Harm Reduction Coalition was handing out supplies that kept people alive.
Johnson recalls a day in 2021 where she and another worker who had contracted COVID-19 found a way to do their outreach without social distancing.
“We both ended up doing the hand-out in full hazmat suits,” Johnson said.
The Virginia Harm Reduction Coalition has been active in Roanoke for six years. It started out as a “grassroots operation,” according to Johnson, which she went on to clarify means the entire operation was run out of the founders’ trunk.
“They would go out into the community giving out supplies,” Johnson said. “From there it grew into what you see today.”
What it is today, beyond a traveling supply hub, is a conduit with at least some connection to everything someone with substance use disorder needs to stay alive. When a person who comes to the van is injured, one of the workers can make a referral to the Fralin Free Clinic at the Rescue Mission of Roanoke, the Bradley Free Clinic, Carilion Clinic’s peer program, and others.
If someone qualifies for Medicaid, the coalition can help them sign up. If someone needs housing assistance, they can help them find a program. If someone wants to enter a residential treatment program for drug use, the coalition can help get them into one of several, both in Southwest Virginia and throughout the state.
Johnson had already been working in community outreach in central Virginia for years when she crossed paths with the coalition. She felt immediately like she had to get involved in the kind of work they were doing.
“I kept coming back,” Johnson said. “I was obsessed with the way they worked.”
Four years later, Johnson is one of the most vested figures in the organization. She’s a known face to participants, many of whom greet her like an old friend as they stop to pick up supplies.
Participants know who works for the coalition, and they trust them.
Alina Lemire, one of the regular workers at the coalition, was in a major car accident in late January. The accident left her in the hospital for more than a week, and caused the coalition to cancel outreach for one week.
Nearly every participant, while picking up supplies, stopped to ask how Lemire was feeling, many asked to send her a message.
“I hope she gets better,” one participant said. “Tell her I miss her face.”
Phil Anderson, who started working with the coalition in October, said that the trust they’ve built with participants is essential to the success of their outreach.
“They come to pick up what they need, and it’s transactional,” Anderson said. “But we’re as empathetic as we can possibly be, and for some, it’s the only time in their day where they get that.”
Empathy is key to everything the coalition does.
Courtney Downs joins Anderson and Johnson later in the day, during their Bennington Street stop. She started working for the coalition at the same time as Anderson, last October.
Downs has been involved in outreach for two years. Prior to that, she was in a treatment program after having used opioids for many years.
She has a story she’s particularly proud of, where she was drunk under the overpass on Tazewell Avenue, and a TV news reporter interviewed her.
“I was angry about something or other,” Downs said.
Two years later, she was being interviewed about her outreach work by the same reporter.
“I told her, and she was like, ‘No way!’ ” Downs said. “She actually pulled up the footage from when he talked to me.”
Downs was never a participant with the coalition directly, though she said they had a hand in keeping her safe.
“I’d been Narcanned with their Narcan,” Downs said. “They helped me stay alive.”
Now, working with the coalition, participants still recognize Downs from before her outreach days, an invaluable thing when trying to build trust with people for who trust is hard to come by.
Troy Patterson used opioids for two years. He “put the needle down” 30 months ago, but still picks up supplies from Virginia Harm Reduction Coalition for the people he knows that still use.
On Wednesday, Patterson parks on Bennington Street to pick up a bag full of supplies.
Patterson said that he believed the work the coalition does is the most effective way to help people who use drugs. Particularly, the empathy they show and trust they build among participants is key to reaching people.
“It’s hard to have a support system with people who’ve never used drugs,” Patterson said.
Trust is a major part of harm reduction, and something that’s hard to build among people who use drugs, and have been pushed out of their community, or their family, as a result.
“A lot of people here are dealing with schizophrenia or other mental health disorders,” Johnson said. “And drug paranoia on top of that makes it harder to build trust.”
Outside factors make it harder to build trust, too.
During the Belmont Street stop, police park across the street, staying for a large portion of the outreach. Nearly every day when there’s outreach work happening at the WIC, there’s a watchful police presence from a distance, workers said. Any law enforcement nearby scares some participants away, many of whom leave immediately after seeing a parked police vehicle.
Harm reduction is difficult to do full time. Working against the distrust of participants, and a lack of understanding from people who don’t have any experience with addiction can take a toll.
“I’m burnt out from looking at despair in the face all the time,” Anderson said. “It’s not something I want to do with the rest of my life, but I feel like I’m one of the only people with the experience and the trust of people out here to do it.”
Narcan spray might soon not require a prescription.