As executive director of the Harm Reduction Action Center, Lisa Raville knows a lot about the community of injection drug users in Denver. The harm-reduction method calls for promoting a syringe-exchange program, including clean needles and safe disposal sites for those needles. Raville wants to bring medical-level facilities to the metro area so that users can inject safely.
On February 23, Raville will join other harm-reduction experts from EmBOLDen Alliances, the Drug Police Alliance and the Global Livingston Institute to talk about safe injection sites and other methods for supporting safer drug use and saving lives on a global scale. In advance of that event, Westword spoke with Raville to learn more about this method of harm reduction.
Westword: What are you going to contribute to the conversation on international strategies for harm reduction?
Lisa Raville: I'm talking about supervised injection facilities, an evidence-based way that has worked internationally for people who inject drugs. Supervised injection facilities are operating in 68 cities globally, and the only one in North America is in Vancouver. If you're homeless, you're either publicly injecting or injecting in business bathrooms, and we're losing a lot of people — we're in the midst of an overdose epidemic. This is the Harm Reduction Action Center's advocacy agenda for 2017.
What is a supervised injection facility? Why is it so lifesaving for the population using injection drugs?
Nobody gets HIV or Hepatitis C if they inject in a medical facility with medical staff present; they don't share or reuse syringes or supplies. They have the opportunity to properly dispose of their syringes right there, so it will decrease inappropriately discarded syringes around the city. Most important for us, nobody has ever died of an overdose in a supervised injection facility, because these facilities are monitored.
People get a period of time in a sterile cubicle to inject. The average injector injects three to five times a day, which is low — that's a heroin user. If they are injecting cocaine, they are injecting twelve to fifteen times a day. When you're homeless, you're either publicly injecting outside or in a business bathroom. That's why we're trying to reduce the harms associated with people injecting in alleys and things like that; it can cause a lot of bacterial infections for folks.
In January, we lost seven participants in a two-week period, six of those to overdose. That's a lot for us. From the coroner’s report for 2016, we lost 174 people in the city and county of Denver to overdose; in 2015, we lost 129 people. Denver is pretty average when it comes to users and overdoses, but we actually have many tools a lot of rural communities don't. We have access to Naloxone [a drug used to block or reverse the effects of opioids, which can stop an overdose]. We have 127 law enforcement departments in the state carrying Naloxone right now, which is really great. There are also about 400 pharmacies that people can walk into today and get access to Naloxone virtually over the counter in our state. We've been very progressive to make sure we can do those things.
We're also very supportive of LEAD — Law Enforcement Assisted Diversion — which is happening in six cities. There's some money sitting in the governor's budget potentially that could push forward with LEAD, and that’s basically diverting people who use drugs and sex workers to services instead of incarcerating them — because that doesn't work for anybody.
How does supervised injection fit in with the harm-reduction model of treating and working with people who use injection drugs?
Well, it's a really good gateway to treatment opportunities. Right now in the state of Colorado, nobody can get into substance-abuse treatment today. What we're dealing with is something smack dab in the middle of reality, and I think we can be very clear that if stigma, shame and incarceration worked with drug use, we would have wrapped this issue up years ago. All it has done is drive use underground, where people have gotten preventable, chronic diseases such as HIV and Hepatitis C and died of overdose. We're looking to do something different; we're looking at international strategies happening in a whole bunch of cities in six countries that are finding supervised injection to work. We believe that we need to be able to try that here — not only in the United States, but in Denver, Colorado, because we deserve better.
We want to make sure that our folks get factual, correct health information and have a safe space. We want to make sure that they are not dying in business bathrooms and someone who makes minimum wage who is just trying to clean the bathroom before their shift is over isn't finding a dead body, and that is exactly what is happening in our community. Not only is that very traumatizing for mothers and family members and people who love the person who died of an overdose in that bathroom, it is incredibly traumatizing for someone who has to work there every day and relive that.
Really, this is a larger community effort: We want to make sure people are safer and healthier. The problem is, we are able to give them all the tools to inject drugs safely except the place to do it safely, and that means it is usually rushed and hurried and in an alley or a public bathroom. We know that business owners aren't trying to be bathroom monitors. This would take [injection sites] out of the public sphere and [put them] where [they are] supposed to be — in a medical facility. It is a medical issue and a public-health issue.
Supervised injection sites fit into harm reduction because it reduces the harms associated with drug use in our community, but also reduces the harms associated with the larger community. We know people are dying in Whole Foods bathrooms and 7-Elevens; sometimes, people overdose, and thankfully, someone does find them and saves their life. But that can be incredibly traumatizing, too.
We don't normally do this sort of community-awareness event; we usually do two fundraisers a year and then work with people one-on-one to cultivate safe outcomes. But I think it is important for the larger community to hear that there is more to be done, and why not share what is going on around the world? This is reality: We know what is going on, and we want to reduce the harms associated with it — not only for the people who use drug,s but people who live in the community with people who use drugs.
You said this isn't an event the Harm Reduction Action Center usually puts on, but it would be so great to be able to get out on front of this issue by arming the public with information and options. What do you hope comes from telling the community about something like supervised injection sites?
A lot of this will be seed-planting for those who are already aware of harm-reduction methods. But what is important for us is that we're able to have these larger conversations so we can start working with folks and helping them cultivate the message. These are the people who end up bringing this information to dinner parties and places where we're never invited or able to access.
Every year we get a bunch of great, young student volunteers at the Harm Reduction Action Center in the fall, and every Thanksgiving they go home and tell their family and friends what they're up to. When their families find out they're volunteers at a syringe exchange, they flip out. These volunteers aren't always armed with all of the data— all they may know is that it is public health and what we're doing makes sense. They are left feeling like they don't have the tools to feel confident in standing up for harm reduction; this is why we feel like having a community event will be helpful for everyone.
People often shut down and just think, "Drugs are bad." That's a magical world to live in, one where you don't have to think for one more second about it. That's a privilege. But you know what? Our people are dying, and we can do better.
From personal experience, you may not know injection drug use is happening around you until it involves someone close to you. It would be great to be able to have more public conversations before it gets to that point.
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SHOW ME HOW
That's the thing: I don't want this to have to affect everyone personally for you to care about it. We see mothers all the time whose adult children have died of overdose and they feel like they need to do something, and they tell us that they would never have reached out to [harm reduction advocates] before. What if we could get to those folks before that happened?
Also, media coverage often focuses only on recovery, and you know what? That's not what it looks like all the time for many people. But that doesn't mean those people don't have worth today.
Lisa Raville and other harm-reduction experts will gather at 6 p.m. Thursday, February 23, at the First Unitarian Church for Harm Reduction and International Development: A Global Perspective for Advocating for People Who Use Drugs. The event is free, and Sexy Pizza will provide dinner. For more information, find the Harm Reduction Action Center on Facebook or visit the facility's website.