Things People in Rural Areas Can Do to Advocate for or Practice Harm Reduction

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Read more like this at Tennessee Harm Reduction.

Unfortunately, rural Tennessee is home to just one syringe services program, and that’s over on the border with North Carolina. Here, we’ve got no harm reduction infrastructure.

Many people struggle to advocate for their causes in the first place — options of getting involved are often limited and out of touch for most — and since there aren’t any programs, resources, or existing harm reduction-related infrastructure here for drug users like me, what can we do to advocate for harm reduction?

And, before I get started, note that this doesn’t just apply to rural Tennessee. You can apply these things anywhere, though they’re all do-able things for people in rural areas — even those that don’t have harm reduction infrastructure in place.

Giving Supplies to Other Users

In rural areas, at least in my experience here in rural West Tennessee, drug users like me often don’t have access to things like clean syringes, naloxone, fentanyl test strips, or tourniquets. Providing people who use drugs with harm reduction supplies helps them live longer, suffer less physical harm, and improves their experience while using.

If you’re in a rural area, you’re unlikely to find all of these supplies locally.

So, where do you go about getting them?

If you can afford to buy supplies, purchase them from online sellers. If you can’t, like me, source them from mail-based supply distributors like NEXT Distro, run by Jamie Favaro out of New York. I’ve used NEXT for about two years now, if not longer, and can vouch for Jamie personally.

Giving Out Syringes Is a Big Deal in Rural Areas

Injection drug users like me often only use drugs of choice intravenously, forcing us to source syringes somehow, someway.

Since syringes aren’t often sold by pharmacists here in Tennessee, it’s harder for people who inject drugs to find syringes. By making yourself a source of harm reduction supplies like syringes, you help expand access to a seriously-restricted commodity in syringes. That means the work done by one person — potentially you — is more meaningful in rural, underserved areas, so don’t think that one person is unable to make a difference.

Also, in areas where legally-sourced syringes are scarce, people often turn to the black market. They either purchase syringes from fellow users, dealers, or — and this sounds like the best option to me — family members. Black market syringes, even if you trust the seller, are never guaranteed to be clean. Just a few days ago, I asked for a syringe from a fellow intravenous drug user. They told me it was clean, but, when I inspected it just before drawing up water, I found it had been used. Whether by deception or mistake, syringes from sources other than pharmacists, medical suppliers, or syringe exchanges scare me.

Non-Injection Users May Not Need Syringes, But They Certainly Need Other Supplies

Snorters, smokers, and other non-injection drug users — oh, I remember the days — usually don’t need the oftentimes-medical supplies (e.g., syringes, naloxone, tourniquets, alcohol swabs) that injecting drug users users do. One reason for this is that the main resource provided by syringe exchanges or syringe services programs is syringes.

Even many exchanges fail to provide non-injection drug users with supplies, increasing the risk of disease transmission and other health problems, as well as the likelihood of having a less-than-ideal experience using.

Even though they’re widely available, you should still provide straws to snorters. By the way, if you didn’t know, snorters and sniffers (which are the same thing) use intranasally — so, don’t get confused if you see that term somewhere.

Crack pipes and meth pipes are must-haves for crack and meth, users, respectively. People who smoke pills or heroin use often use aluminum foil and pen tubes or straws to smoke their drugs of choice.

Giving Supplies to Dealers

Yes, even though dealers don’t always use what they sell, dealers also need supplies. In my experience, dealers are less likely to be receptive to distributing syringes, fentanyl test strips, meth bubbles, crack pipes, or other supplies.

By pushing the narrative of building a competitive advantage by acting as a one-stop-shop or potentially being customers’ only available source of harm reduction supplies. Also, although dishonest, you may be able to improve dealers’ likelihood of accepting syringes if you tell them that other dealers nearby give out syringes and/or other supplies for free.

Even though you might feel bad about providing syringes and other supplies to dealers — or even fellow users — who sell syringes rather than giving them out for free, it’s still better to stock dealers with harm reduction supplies than not. It’s not ideal, sure, but at least they contribute to increasing an area’s supply of syringes.

Don’t Forget About Laypeople — They Often Need Naloxone

When it comes to supply distribution, many people have drug users in mind. However, since people who use drugs know family members, coworkers, neighbors, and friends who don’t use — it’s almost like drug users like me are normal people! ;^) — laypeople often have a need for naloxone, if not other supplies.

I’ve approached neighbors, non-drug-using friends, family members, and even strangers about naloxone. First, I usually tell them what naloxone is and how people who don’t use drugs still may have a use for it. I should note that, even as a known drug user here in rural Tennessee, where drug use is often looked down upon, I’ve experienced a fair deal of success in distributing naloxone to laypeople.

Note that NARCAN, the name-brand nasal spray formulation of naloxone, will be more widely accepted than intramuscular-use naloxone kits. This is due to a stigma surrounding syringes, even if they’re not used for illicit drug use.

However, since NARCAN is more expensive than naloxone kits, which include generic vials of injectable naloxone, you may not be able to get your hands on NARCAN. Personally, I don’t believe NARCAN is worth the extra cost, though if money isn’t an object to you, I recommend buying NARCAN.

Distribute Educational Material in Your Local Area

It’s okay if you don’t want to make your own brochures, pamphlets, or other hard copies of educational materials. I’ve got some here, on Northwest Tennessee Harm Reduction, my website, though you can find them plenty of other places online, too.

Make sure to fact-check whatever you find and run it by a few harm reductionists to make sure you’re passing on good information.

Whatever you find, make sure the information is entry-level, basic stuff. If I converted this article into a brochure, for example, do you think most readers in rural areas would already know what “harm reduction” means? They probably wouldn’t.

Make sure it’s about the basics of harm reduction, like my “All About Harm Reduction,” found at the link above, brochure, or other broad drug-related topics.

If you’re giving out material to people who use drugs, consider finding or creating material that includes safe using practices. Further, since there are so many harms associated with injection drug use, you can better serve the at-considerably-more-risk population of injection drug users.

You can share this information online, but by putting brochures, infographics, and other physical forms of educational material, it’s more likely that people will check it out than if they see it online. Also, since most people don’t look up drug-related stuff online — and since those who do usually don’t look up that many drug-related things — you’re better off distributing these materials in person than online.

Before printing another organization’s information off, ask them if they’re willing to mail you copies for secondary distribution. Since secondary distribution of information and supplies are widely supported by harm reductionists, you might be surprised at how many organizations are willing to provide you with already-printed material.

Educate Others About Drugs in a Harm Reduction-Positive Manner

Of course, if you spend time around other drug users, you’ll have great opportunities to educate them about safer drug use practices. If not, consider going to online-based platforms about drugs like Reddit’s r/Opiates subreddit, Bluelight, or other drug-related forums.

By “harm reduction-positive,” I mean things that support reducing negative consequences associated with drug use. Check out the Harm Reduction Coalition’s Principles of Harm Reduction here to make your own call about whether your educational efforts are harm reduction-positive (HR+) or not.

While educating someone about drug-related topics that have nothing to do with safety might be satisfying for you or conducive to improving the general knowledge about drugs people use, doing so might not meet HR+ principles. Put simply, things that are HR+ are those that advance the rights of people who use drugs or reduce the potential harm done to us.

One Last Thing You Should Know

We’ve all seen people support various causes on social media. This seems to be especially popular on Twitter, but it can happen anywhere. Just know that social media is largely ineffective for carrying out advocacy.

Are you a part of the harm reduction community or any others that are drug-related? You might be sharing your ideas within an echo chamber.

Frame your posts in the wrong light or use improper wording? You might not positively influence people with opposing views.

Come across as divisive, all-knowing, pretentious, or objectively superior? Opposite-minded people’s views may be further strengthened.

Even if you don’t bother anybody, your posts are likely not to be meaningfully adopted by anyone on social media, rendering your time useless.

For these reasons — and many others that I don’t have time to share here — try to stay away from social media to advocate for our shared cause.

Long-term drug user, writer, practicing harm reductionist. Lifelong resident of rural Tennessee. Director of Tennessee Harm Reduction.