Author: The Fix

“Harm reduction is on the front lines [of drug overdose] but we have to argue for our existence and the lives of the people we serve. That is unconscionable.”

In August 2018, Hillary Brown received a bizarre notice from the city of Asheville. The small syringe exchange program that Brown ran three hours a week in the backroom of a bookstore was ordered to shut down within 30 days for operating an illegal homeless shelter.

At first, 31-year-old Brown, the sole employee of harm reduction nonprofit Steady Collective in western North Carolina, thought it was a joke. Every Tuesday since 2016 the Steady Collective had visited the backroom at Firestorm Books to hand out sterile syringes, condoms, and overdose prevention supplies to people at risk for overdose and drug-related infections.

Syringe Exchange or Homeless Shelter?

Separated from the bookstore by a curtain, the backroom is dimly lit and bare except for a couple of red-cushioned church pews against a wall and two gray folding tables where Brown lays out the supplies. The room contains no food, no beds, no bathrooms, and no showers. People who stop by to stock up on supplies rarely linger more than five minutes. And many of them do have homes.

Brown followed up with the notice, which had been served to the building’s other tenants as well: Firestorm Books & Coffee, 12 Baskets (a small free-lunch program operating in the basement), and Kairos West, a community center run by the Episcopal Church. All four tenants were accused of violating zoning laws having to do with the operation of a homeless shelter in the city’s rapidly gentrifying west end. A $100 per diem penalty would be levied against all tenants if the Steady Collective did not cease operations within 30 days.

The initial notice of violation seemed bizarre, but it was only a hint of the ongoing legal battle it would spark.

Within the 30-day grace period, the city withdrew the notices of violation from 12 Baskets and Kairos West, leaving Firestorm Books and the Steady Collective to face the legal hurdles alone.

Remarkably, Firestorm Books, which could have easily saved itself by asking the Steady Collective to stop coming on Tuesdays, chose to dig in for a fight, risking its 10-year business history and the livelihood of its four employees.

Beck, one of Firestorm’s co-owners, explains that the Firestorm team see themselves as “community organizers first and business people second.” Throwing a community nonprofit out to save their own skins would run counter to their business and personal ethos.

Lucky for Firestorm and Steady Collective, local attorney John Noor offered to take the case pro bono. Noor has worked the case since September and helped secure meetings between city management and the Steady Collective.

Attracting the Wrong Kind of People

According to Brown, during one meeting to make the case for why a small once-a-week syringe exchange should not be classified as a homeless shelter, a city official commented: “It’s less about what you do and more about who you serve.”

Brown considers this a rare—and likely accidental—moment of honesty. The city wasn’t arguing against the need for the program or its efficacy. (There are mountains of evidence that point to syringe exchange programs as safe and effective for reducing bloodborne disease transmission and overdose death). And Asheville is in desperate need of help. Its surrounding county, Buncombe, has one of the highest overdose rates in western North Carolina. The Steady Collective, one of the few programs in the city that attempts to mitigate the overdose crisis, reported 719 successful overdose reversals since 2016—no other program in the county can claim those results.

But as the city official admitted, it’s not about what the program does. It’s not about science or results or lives saved or providing resources to a population in desperate need. No, the city’s concern is the program attracting the “wrong kind” of people to a rapidly gentrifying part of the city; the eyesore of folks who might look homeless gathering on a street that is trying hard to look hip. And the fear of what “those people” might bring.

Asheville’s tactics mirror similar efforts by other cities and states, including Los Angeles, Charleston, Claremont, and Lawrence County, to shut down syringe exchanges. “Zoning violations” are a favorite tool, as are concerns about discarded needles (a problem that can be addressed through syringe disposal bins) and policymakers’ personal discomfort with the idea of harm reduction.

“At a time of crisis we are having resources taken away,” says Brown. “Harm reduction is on the front lines [of drug overdose] but we have to argue for our existence and the lives of the people we serve. That is unconscionable.”

Fighting City Hall to Help Drug Users

Earlier this month I traveled to Asheville to witness the state’s largest legal battle over syringe exchange with my own eyes. The day I visited, Brown and a volunteer were in Firestorm’s backroom riffling through bags of packaged syringes, condoms, Band-aids and naloxone, a medicine used to reverse opioid overdose.

Although Brown remained calm throughout our interview, the past few months of legal battles have taken an emotional toll.

“What is really exhausting is to hear [the city] debate people’s dignity,” Brown said. The legal process “has undone me in ways I wasn’t prepared for.”

Brown described the frustration of having people come into the exchange crying over the loss of a loved one to overdose who “can’t talk about the loss [outside the harm reduction program] because they are engaged in a criminal activity.”

And the whole process hasn’t exactly occurred in the open.

“The city of Asheville wants to talk behind closed doors and go through their rules. They don’t want the public to know [what they are doing],” said Brown.

In March, after months of legal wrangling, the city finally made an offer: the Steady Collective could operate under the classification of “medical clinic” if they kept a physician on site during all hours of operation.

Brown described the offer as a slap in the face. The tiny exchange can barely afford a single employee to run operations. To pay a supervising physician—when the only real task is to hand out non-prescription supplies from the back of a bookstore—is a non-starter. (Notably, the Steady Collective operates another exchange on Wednesdays out of a church in a non-gentrifying part of town; the city has not required that location to keep medical personnel on site.)

Thanks to legal help, the Steady Collective was able to counter the offer and settle for an agreement to keep a nurse on site. They are the only syringe exchange in the state with such a requirement.

The day I visited, Vanessa Bourgeois was the on-site nurse. Bourgeois works weekends at a local hospital but volunteers on Tuesdays for the Steady Collective where she puts packets of syringes and condoms in plastic bags and hands them across the table to participants—hardly work that requires a nursing license.

The absurdity of the predicament is not lost on her.

“This is not a situation that needs a nurse,” she says bluntly. “Harm reduction is appropriate for laypeople.”

Though she is happy to support the Steady Collective’s work, she denounces the city’s actions as “part of the narrative to make people who use drugs seem dangerous or scary.”

Because Bourgeois volunteers her time during exchange hours, the Steady Collective and Firestorm Books are no longer under threat of being shut down. But to Brown, their work is far from over.

Asheville Impedes Harm Reduction Efforts

Asheville, a city often touted as one of North Carolina’s “most progressive,” has shown little evidence of progressive thinking towards drug users in any of its major government facilities. When North Carolina legalized syringe exchange in 2016, Asheville police responded aggressively, ripping up the ID cards that syringe exchange participants are required to carry by law.

In 2018, Mission Hospital, the largest medical facility in Asheville, implemented a draconian policy against drugs users: If any patient is suspected of IV drug use, regardless of the medical condition for which they are being seen, hospital staff will confiscate their electronic possessions, refuse them visitors, and keep a staff member in the room at all times to supervise them.

And the City of Asheville Planning Department has not given up their war on harm reduction. The city plans to write syringe exchanges into the zoning code, which would allow the city to impose restrictions on their locations. Brown believes fighting against such legislation is “the most important issue facing harm reduction in the state” and urges other programs not to be complacent.

Asked what the Steady Collective would do differently if faced with the situation again, Brown says that the organization would be more aggressive about raising public awareness of the city’s actions and mobilizing people to fight back. At the time, the concern was that drawing too much negative attention to the city would disrupt the negotiation process. But now Brown sees that there was never much negotiation to begin with.

To other harm reduction programs facing similar threats, Brown advises: “Be more vocal about the process. Invite other people in. Organize the community to fight back. Mobilize medical professionals and faith leaders.”

North Carolina accomplished a great feat when it legalized syringe exchange programs in 2016. But the real work still lies ahead. We still live in a world that stigmatizes and devalues the lives of people who use drugs. Until this changes, every harm reduction program in every community is at risk. People who use drugs and their allies must stick together. Stay vigilant. And be ready for the fights when they come.

Maribel Lopez and Hillary Brown at the church location

View the original article at thefix.com