‘We have to do something different’
As state’s fatal drug overdoses climb, harm reduction is one way to save lives
The evening started with a delivery.
Chris Ortiz and Rodger Clark drove to one of the many motels lining the Berlin Turnpike, a busy divided road in Newington, on a recent Friday. In the parking lot, a woman in fishnet tights handed the two outreach workers a bin containing 200 used syringes as she excitedly told them about an upcoming visit with her family.
It was a regular twice-a-week transaction. Ortiz grabbed his clipboard, noting the exchange as they caught up. Clark grabbed 200 new clean syringes from a large storage container in the van’s back seat and gave them to her.
Providing clean needles is just one form of harm reduction for people struggling with drug use. State officials and nonprofit organizations employ this public health response to keep people who use drugs safe and alive as Connecticut sees deadlier drugs in the mainstream supply and hundreds of overdose fatalities a year.
Harm reduction is meeting people who use drugs where they are and providing sterile equipment – such as clean syringes and pipes – as well as fentanyl test strips, methadone, wound care kits and naloxone, the generic form of Narcan that instantly reverses an opioid overdose, to help those who use drugs stay safe.
The practice also comes with a stigma; there are complaints that harm reduction techniques enable or promote drug use, state Public Health Commissioner Manisha Juthani said. However, the reality is that someone who uses harmful substances will shoot up regardless of whether they have a clean or a dirty needle, she said.
Also, they can’t recover or receive treatment if they’re dead.
“Death is final,” said Mark Jenkins, founder and executive director of the Connecticut Harm Reduction Alliance. “We have to do something different.”
The Hartford-based nonprofit strives to keep what it calls its participants, many of whom may have a physical or psychological dependence on drugs, safe and relates with them in whatever they’re going through, Jenkins said.
The organization has five vans, each sporting two erect, bright orange flags on each side, letting passersby know they’re open for business. The silver van Ortiz and Clark drove had large white letters on the windows, explaining their mission exactly: “This van saves lives.”
In the van’s back seat, Ortiz and Clark keep a bulky container, dubbed the “Rover,” that holds all of their supplies. A separate container holds up to 1,000 of the used needles; it typically fills up at least once a night.
For anyone who interacts with the outreach workers, “they’re going to be treated in a nonjudgmental fashion,” Jenkins said. “And, when they are ready for things like treatment, whether it be inpatient or medication-assisted treatment, that they know they’re going to be able to come to us.”
Harm reduction specialists also serve as familiar, friendly faces to those who may otherwise see nothing but chaos in their lives.
Ortiz and Clark, who are employees of the alliance, know most of their participants well, coming across only one unfamiliar face on that particular Friday evening. They also typically know exactly what that person needs – usually either a handful of clean syringes or a sterile pipe.
The outreach workers said they have known the woman at the motel for two years, but the organization first started working with her when she was living in a tent in Bristol.
Though they know she’s using drugs, they also know the woman is in a much better place than before. She has a roof over her head and is rebuilding relationships with her family. Ortiz and Clark ensure she uses drugs in a safe manner and will be there for her if she’s ever ready to get treatment.
What is Connecticut doing?
State officials have pushed various forms of treatment and recovery for those with a substance use disorder for years. Meanwhile, the opioid epidemic dug its claws into the nation, taking more than 80,411 lives in 2021 – with 1,405 of those deaths in Connecticut, according to state data.
More recently, though, the messaging has shifted and health officials have been promoting harm reduction techniques, which include handing out sterile paraphernalia or providing information to minimize the potentially harmful effects of drug use.
“All of these harm reduction modalities actually save lives,” said Juthani, Connecticut’s health commissioner. “It’s reducing harm, meeting people where they’re at and potentially giving people that opportunity to think about buprenorphine, methadone, trying to get out of the cycle.”
Jenkins formed the Connecticut Harm Reduction Alliance, originally the Greater Hartford Harm Reduction Coalition, in 2014. After doing outreach for years, he was frustrated with other organizations, feeling as though they were doing the bare minimum.
“There is such a demonstrated need, and such an evident need,” he said. “There’s no mistaking it.”
One of the most important harm reduction initiatives is making naloxone abundant statewide. The life-saving medication, which can reverse the effects of a drug overdose, has been available by prescription and, recently the U.S. Food and Drug Administration approved it for over-thecounter sales. But health officials said the over-the-counter product won’t be be available anywhere until the summer.
But health officials remain focused on blanketing the state with as much free naloxone as possible to help keep people alive.
The number of deaths by unintentional overdose doubled from 728 in 2015 to 1,459 in 2022, Connecticut Department of Public Health data shows. And while some people intentionally use fentanyl, the increase in fatalities is partly due to an influx of the potent synthetic opioid mixed into the illicit drug supply.
Only 2 milligrams of fentanyl – the equivalent of a few grains of sand – is considered a lethal dose. And though fentanyl has been around since the 1960s, it has made a recent resurgence. State data shows fentanyl was present in about a quarter of the fatal drug overdoses in 2015. By 2022, it was found in 85 percent of deadly overdoses.
Fentanyl has been found in heroin, cocaine and methamphetamine, as well as in fake prescription pills. It is sometimes added to these drugs because of its potency, which makes drugs “cheaper, more powerful, more addictive, and more dangerous,” according to the federal Centers for Disease Control and Prevention.
Simple cases of cross-contamination also taint the drug supply, Ortiz said, who works with the Connecticut Harm Reduction Alliance.
“Drug dealers don’t have a hygienic code,” Ortiz added.
Fentanyl is present in most of the state’s illicit drug supply, according to Luiza Barnat, the Opioid Services Director for DMHAS.
In response, harm reduction efforts now include distribution of fentanyl test strips. However, this tool has its limits: The strips only detect the presence of fentanyl in another drug, not its potency.
Also, since most test only a portion of their drugs, a negative result “doesn’t necessarily mean all of your drug supply is free of fentanyl,” Barnat warned.
Demand for test strips also decreased because drug users have come to expect fentanyl to be in their drugs, Juthani said. And it’s unlikely that someone who uses drugs frequently will throw them out, even if they test positive for fentanyl.
“If somebody has spent all their money on purchasing a certain drug – unfortunately this is a disease we’re talking about, opioid use disorder is a disorder,” Juthani said. “And the chances that somebody’s not going to use it is probably low.”
The health department is also encouraging people to have someone with them when they are using drugs. And when using drugs suspected of containing fentanyl, have naloxone available in case of an overdose.
Boots on the ground
When doing outreach, Ortiz
and Clark spend the majority of their nights at a bus stop in Hartford.
They park the minivan, which is a beacon to their clients. People flocked to them on a recent Friday evening, fishing used needles out of their backpacks or purses, and exchanging them for new sterile ones.
The CTfastrak bus stop serves as Ortiz and Clark’s most popular spot, but they drive the minivan throughout Hartford, giving out clean drug paraphernalia, naloxone, smoker kits, alcohol wipes and sterile water for injecting drugs (instead of using, for example, toilet water, or alcohol or saliva). They also show to inject and break down their drugs safely, handing out Vitamin C to help prevent infections and vein damage, and teaching other safe injection practices.
The two get multiple calls each night, asking where they are. Some clients have come as far as Massachusetts, and Ortiz and Clark have traveled as far as Avon and Enfield from downtown Hartford. They typically serve at least 40 people per shift, Ortiz said.
That night, one person wearing part of a kitchen work uniform asked for Narcan, the brand name for naloxone. Ortiz said he had two kinds: a nasal spray and the intramuscular injection. He made a note of the unique code on the Narcan container – this makes it easier to identify someone who overdoses – and then explained how to administer the medication.
He also teaches them about Connecticut law – they can’t get in trouble for reversing an overdose – and emphasizes the importance of going to the emergency room after using naloxone because it can wear off in less than two hours.
He also stressed to the resident to put the medication into syringes when they got home; in the moment of an overdose, they will be too panicked to fill them. He advised them to put various syringes in their kitchen, bathroom, bedroom, car, bag and anywhere else it will be easily accessible.
But Ortiz and Clark don’t just give out sterile supplies and educate their clients. They also serve as a healthy social connection to someone who may be going through a turbulent time and provide examples of what second chances can look like.
Jenkins, Ortiz and Clark each has more than 20 years of sobriety under their belts. Since entering treatment, they have dedicated their time to outreach and harm reduction to help others who are going through what they went through.
And, when, if ever, someone is ready to make that leap into treatment, they know how important it is to act fast so that sense of readiness does not wear off.
Ortiz reminisced about a recent client who wanted to go into treatment. He and Clark lowered the van’s orange flags and drove the person to a facility in Bridgeport that same night.
“What separates harm reduction from the other formulas is really that radical love,” Jenkins said. “It’s truly engaging people where they are. It’s knowing that not everybody is looking to stop using, so how do we support them wherever they are.”