In 2007, Jackie Pollard watched the beginnings of the nation’s opioid crisis take shape.
“So many of the kids that were dying went to school with my kid and I knew them,” Pollard says. “I used to lose a lot of sleep.”
By 2016, Summit County had reached a peak in devastating, long-term overdose trends. That year, 2,400 people experienced overdoses in Summit County, 296 of which proved fatal.
That’s when Summit County Public Health launched Summit Safe Syringe Exchange, which provides free, safe and clean supplies to people who use drugs, along with access to testing and counseling. The agency also connects syringe exchange clients with housing and health care resources. By law, the program is anonymous.
Project DAWN, launched by Summit County Public Health the same year, is designed to saturate communities with naloxone — which reverses opioid drug overdoses — and train community members to recognize the signs of an overdose and administer naloxone, also known by the brand name Narcan, quickly and effectively.
Both programs are part of a larger movement to incorporate harm reduction strategies into the way officials address drug use and addiction in Akron. Both programs have continued to operate during COVID-19 under modified health and safety protocols.
Syringe exchange programs aren’t so different from other harm reduction practices, like using sunscreen or wearing a helmet or life jacket, Pollard says — ”except we’re trying to limit the negative effects of IV drug use.”
At four weekly syringe exchange clinics, Pollard says Summit County Public Health staff members distribute supplies like syringes, tourniquets, cotton, bleach, neosporin, Band-Aids and fentanyl test strips.
In 2016, the program handed out 2,340 clean syringes free of charge. By 2019, the number of syringes distributed had jumped to nearly 193,000.
“Harm reduction is [an attempt] to reduce the spread of bloodborne illnesses — Hepatitis A, B, and C, HIV. And that’s good for everybody in the community, because it’s so contagious and it’s so deadly and it’s so expensive to treat,” Pollard says.
Pollard’s syringe exchange team is made up entirely of people in recovery themselves. They follow up with clients after they receive supplies and offer them access to treatment, counseling, housing and health care resources.
Andrew Noga is a recovery coach with ARC Recovery Services, which partners with Summit County Public Health to staff the Summit Safe Syringe Exchange program.
Not so long ago, he was a client himself.
Noga has three years of recovery from heroin, crack cocaine and fentanyl. After working a string of jobs in the food service industry, Noga says his work as a recovery coach seemed like a logical next step. Reba McCray, director of ARC Recovery Services, helped him earn his recovery coach certification.
“It’s really kind of a dream job for me,” Noga says. “Because it’s just helping people, and that’s the kind of been the job I wanted ever since I got sober.”
Tangibly, Noga helps make sure his clients aren’t sharing or frequently reusing syringes, helping to slow the spread of disease. But he says the best part of the work is connecting with people who just need to talk.
“My job is really all about building relationships,” Noga says. “I have a list of people I call every week, give them services for any STD testing or anything like that. As a recovery coach, I give them all kinds of resources — whether it be housing, or they want to go to rehab, or they just want to talk.”
“Not everybody answers,” Noga adds, “but the ones that do and want to talk, it’s about building that connection and planting that seed. If you plant a little bit of hope, just a little bit at a time, it will go a long way.”
Overdoses are up in Ohio in 2020, but down in Summit County
Even when clients don’t seek treatment, Pollard and Noga say syringe exchange programs are still associated with a decrease in infectious disease transmissions, a decrease in discarded syringes in community spaces and fewer overdoses altogether.
According to data from Summit County Public Health, there were at least 875 overdoses in Summit County during the first nine months of 2020, down 22% from the same time last year.
Pollard believes Summit County’s relatively stable numbers are a sign that harm reduction work is working — a trend that’s also identifiable in data collected by the state.
According to Harm Reduction Ohio, a nonprofit organization that pushes for drug policy rooted in harm reduction strategies, 22 of Ohio’s 88 counties are currently served by syringe exchange programs through their own health departments, or by health departments that operate syringe exchanges in neighboring cities or counties.
The Devil Strip analyzed the state of Ohio’s overdose data and found that in the 66 counties where syringe exchange programs are not accessible via health departments or approved by health boards, overdoses in the first nine months of 2020 increased by more than 12% compared to the first nine months of 2019.
Conversely, of the 22 Ohio counties that serve residents via syringe exchange programs, overdoses are down by nearly 3% over the same period.
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Still, overdose and overdose mortality data are nearly impossible to predict. For example, Jefferson County in the Upper Ohio Valley operates robust harm reduction programs via the county’s health department but saw a nearly 58% spike in overdoses over the last 9 months. Fayette County, despite a notable absence of syringe exchange and other harm reduction programs, has seen an 80% decrease in overdoses year over year.
Spikes and drops in counties that appear to be statistical outliers could be caused by any number of factors, Pollard says, including the presence of fentanyl and carfentanil in drug supplies. Because illicit drug markets aren’t regulated, it can be difficult for people who use drugs to know exactly what they’re using. Often, that uncertainty increases the risk of experiencing an overdose.
But in Summit County, where overdoses are down by 22% compared to this time last year, Pollard believes the Summit Safe Syringe Exchange has contributed to the county’s shrinking number of overdoses. When people who use drugs have access to programs that teach them strategies meant to keep them safer and healthier, they tend to follow them, Pollard says.
“If we really want to help people, then we have to figure out how we’re going to meet them where they are,” Pollard says. “Typically, if they went someplace [else], they would probably get lectured or shamed. [At the syringe exchange], we just say, ‘Let’s see what you’ve got and let’s help you get connected with whatever care it is you need.’”
Additionally, since January, Pollard says Project DAWN has trained 842 people to recognize the signs of an overdose and administer Narcan immediately through its short online training course. It has distributed 2,832 units of Narcan by pickup and mail order at no charge.
There have been at least 1,024 known overdose reversals in Summit County since January. The actual number, Pollard says, is likely even higher.
Harm reduction is gaining traction among public health officials
In the early 1970s, Pollard was a social work student at the University of Akron, volunteering at a house that provided a safe space for people who used drugs. It was there she first encountered harm reduction strategies, including identifying pills and creating a supervised space for people who use drugs.
Today, Pollard is part of a movement among public health officials seeking to convince Americans to think about drug use and addiction as a public health issue rather than a criminal one. As a philosophy, harm reduction acknowledges that determining factors like poverty, homelessness, hunger, abuse, mental illness and racism each affect how, when, and why a person may use drugs.
“I feel like we’re kind of in this place where we’re in the middle of a paradigm shift,” Pollard says. “People are uncomfortable talking about it, because in the 1980s we got brainwashed on: ‘You just have to let people hit their bottom. People have to be ready, otherwise you’re just enabling them.’”
But Pollard says those common adages don’t hold much truth when it comes to opiate addiction: “We can’t afford to sit around and wait for people to hit bottom, because bottom is dead.”
Pollard is encouraged by the progress she sees in Summit County and elsewhere.
“I used to lose a lot of sleep, but I feel a little better because we’re getting some strategies out there,” Pollard says, smiling. “We’re pretty proud of that.”
Noga, too, says he’s encouraged by what he sees in the community.
“Even when [clients] come back after so many months and they’ve relapsed and they’re all sad, it’s like, ‘It’s okay. Let’s just see what we can do. Are you ready? Could we get you some help?’ And if they’re not, that’s okay,” Noga says. “Then let’s just talk.”
When clients arrive at the syringe exchange, no matter how long it’s been, Noga says they’re greeted with joy and empathy: “These are still people. I was still just like them. I was probably worse than a lot of them,” Noga laughs. “My record will show you.”
“But we understand,” Noga adds. “We’re realists. We know not everybody is going to get sober, and there’s going to be casualties along the way. But whatever we can do to help [people] out now, that’s what we’re here for.”
H.L. Comeriato covers public health at The Devil Strip via Report for America. Reach them at HL@thedevilstrip.com.