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DEBUNKED Special Feature: Harm Reduction During COVID-19

“Essential services” is one of the 2020 buzzwords that it is very unlikely any of us were thinking about before the global pandemic. But in March, as COVID cases began to spread throughout the U.S. and as business and organizations began to shut down, defining what had to stay open became crucial. 

Heather Bush, the syringe exchange program coordinator for the Utah Department of Health, said she knew the services syringe exchanges provide in Utah were essential, and she was grateful state officials agreed. 

“I contacted the team here in Utah and said, ‘Hey, what do I need to do to make sure that syringe exchange stays open, that it's listed as an essential service?’ and they were just like, ‘whatever, it's an essential service, it's fine,’” Bush said. 

Syringe exchanges are part of the harm reduction efforts to reduce death and disease related to drug use in Utah. The philosophy behind harm reduction is people do risky things whether or not they should, which means reducing those risks is usually more effective in saving lives than simply expecting people to stop risky behavior. 

For the opioid epidemic, it looks like giving people clean needles in exchange for their used ones or providing free naloxone, a drug that reduces overdoses. For COVID-19, it looks like wearing a mask, social distancing and washing your hands. 

And so, even though the syringe exchange harm reduction services are essential, these have to be done right now within the pandemic-related harm reduction efforts. 

“Even before there was even really talk of masks or mask mandates for the county, our providers started wearing masks,” Bush said. “And we actually got some donations of disposable masks that they could then give to their clients. Some of them didn't have access to masks just for while they're out and about, let alone when they come to exchange.” 

Other safety measures included many syringe exchange sites ending Hepatitis C and HIV testing because this had to be done in close prozmintey, while some sites switched to testing methods that allowed for distance. Marks were made on the ground to help people know how far to stand from one other. Contact was reduced as much as possible when providing people items, such as syringes, which Bush said they have been distributing more of than ever before. 

“Even though we've been giving out more syringes, providing more services, having more clients, the return ratio has actually gotten better,” Bush said. “More people are bringing back their syringes. And so, it's really close to one for one, like the closest we've ever been in the four years, we've been doing syringe exchange.”

With safety measures, most syringe sites in the state were able to stay open. But this does not mean that everyone’s needs are being met or that all solutions are equitable. For example, helping people access recovery options or social services has gotten really hard.

“With this shift of everything moving to online, that basically eliminates everything for our clients, because they're not as likely to have access to something like the internet. Where that's, you know, maybe more convenient for some people, it just makes it impossible for our clients. And that's really frustrating. Like, it's hard to see somebody who's super willing, and wanting to receive some help, and not being able to refer them anywhere,” said Georgia Gregerson, the syringe exchange program manager for the Utah Harm reduction coalition. 

She said she understands the restrictions and wants to make sure clients are kept as safe as possible, but it does not change how sad the situation is. 

Gregerson, who is in recovery herself, said personally and for the other people in recovery she knows, the pandemic has led to very dark times, the kind of times that make people want to use more substances. 

“The whole source of addiction is usually this overwhelming sense of but ‘like, it's not going to be okay,’” Gregerson said. “And, and so to have the world confirm that feeling, like you know, ‘no, it really isn't going to be okay.’ Like, really, there is something bad happening. And we don't know what's, what's going to be the solution and like when it's going to be over and how we're going to fix it. That's a really scary place for someone who's already driven by 1,000 forms of fear, right?”

But Gregerson said there has been a flipside as she has watched some people get creative in how they connect. 

For example, while the online meetings may not serve everyone’s needs, Mindy Vincent, the founder and director of The Utah Harm Reduction Coalition, said as an additional service, learning how to hold these meetings may be a silver lining of the pandemic.  

“We're going to continue to offer services and the way that they're being offered now. As well, as you know, when we can return to in-person, we will do that,” Vincent said.

Vincent noted it is already challenging for most everyone to balance things like taking care of themselves, going to work and parenting. Adding outpatient treatment to the mix can create scheduling issues for many people, but these treatments are necessary for recovery and often court required. 

“We have found  that through these modalities of treatment, we're able to help ease some of those burdens, especially the scheduling burdens,” Vincent said. “We're finding a lot of people are actually more engaged, because we're able to tailor it to them.”

Personally, Gregerson said not being able to fall back on seeing people in person, has forced her to become intentional about reaching out to others regularly, something her sponsor has always wanted her to do. 

“It has helped to know that if I don't take ownership over the communication, and like if I don't really take ownership over my recovery, there aren't those sort of like natural processes that I can fall back on that will do it for me,” Gregerson said. “Like, you know that like a giant AA meeting with 100 people would do. So I think it's actually in a way made my recovery stronger because I have to be more of an active participant in it.”

Heather Bush, the syringe exchange program coordinator for the Utah Department of Health, said she knew the services syringe exchanges provide in Utah were essential, and she was grateful state officials agreed.