Advocating for harm reduction-based approaches to care for people who use drugs

GHJP understands harm reduction as foundational for health justice for people who use drugs and their communities. As such, we work to support and advocate for harm reduction-based initiatives in New Haven. For the past several years, this has included collaborative projects in support of the Sex Workers and Allies Network (SWAN), a harm reduction organization led by and for current and former street-based sex workers, and to support organized networks and collective action of harm reductionists across the state, with the goal of strengthening connections and collaborations between harm reduction practitioners, advocates, and scholars.

In 2020, the GHJP, SWAN, and other allied groups addressed letters, press releases and memos to the City of New Haven, including letters to Mayor Justin Elicker, Community Services Administrator Dr. Mehul Dalal, and New Haven Police Chief Otoniel Reyes, calling for immediate actions to protect the health and rights of marginalized persons, including people who are homeless, living in poverty, using substances and/or engaged in sex work, during the COVID-19 pandemic. A coalition of local, statewide, and Yale-affiliated advocacy groups held a press conference calling on Governor Ned Lamont and mayors across Connecticut to implement comprehensive COVID-19 plans addressing the crisis in CT jails and prison as well as the needs of people experiencing homelessness, people who use drugs, people with disabilities, and street-involved persons, including sex workers. A local Connecticut paper refused to run our ad with the New Haven Harm Reduction Working Group asking Governor Lamont to release incarcerated people from prisons and jails in CT at risk of COVID-19.

GHJP faculty and Clinic students co-authored a memo describing the scope and limitation of the power to mandate quarantine and isolation under Connecticut law, with a particular focus on the implication for the treatment and rights of New Haven's most vulnerable residents. The Yale Program in Addiction Medicine, Global Health Justice Partnership, the Sex Workers and Allies Network, and Crackdown also collaboratively developed, based on work by 3D Research, a resource offering guidance by public health and harm reduction experts to substance users on how to stay safe during the pandemic and minimize risk of COVID-19 infection.

GHJP and a group of harm reduction advocates and homelessness service providers have organized to establish a harm reduction-based winter shelter in New Haven. The lack of a harm reduction-friendly homeless shelter, i.e. a shelter where harm reduction supplies (such as syringes, pipes, etc.) and drug consumption are explicitly allowed or implicitly tolerated, represents a significant barrier to finding shelter for unhoused individuals who use drugs in New Haven. GHJP Clinic students in Fall 2021 and Spring 2022 researched harm reduction policies, shelter models, key legal issues, and public health best practices to develop memoranda that can serve as a resource for existing shelters or used towards the creation of new facilities.

In Spring 2022, GHJP partnered with the Fair Haven Harm Reduction Group, a diverse set of Fair Haven community stakeholders, to identify strategies to address the needs of three groups in the Fair Haven community: people who use drugs (PWUD); street-based sex workers; and day laborers in the Fair Haven neighborhood. Through conversations, focus groups, and surveys, including a bilingual survey effort to measure Fair Haven residents, employees, and business owners’ perception of public safety, harm reduction, and the impact of public drug use in the community, the Group identified a strategic response: establish an Engagement Center to serve these populations via a harm reduction model. The results from the survey underscored the need for a space in Fair Haven for respite, connection to clinical care, opportunity for service connection, and serve as a “one-stop shop” for judgment-free harm reduction services in the neighborhood.

In July 2023, the GHJP hosted a day-long workshop with harm reduction and service providers, people with lived experience, academics and policymakers on “Where is the Gender in Harm Reduction in New Haven?” This workshop developed from GHJP’s close collaboration with community organizations in New Haven whose work underscores the importance of gender-responsive strategies in evidence-based harm reduction efforts, and the need for communication, collaboration, and collective action in defining public-facing recommendations for responding to specific issues faced in New Haven more broadly. GHJP conducted background research in the lead up to the workshop to develop primers on harm reduction, and how reproductive justice and gender justice can inform harm reduction approaches, as well as relevant data challenges for gender and harm reduction in Connecticut. GHJP Clinic students are working to develop the workshop conversations into a public-facing report.

GHJP provides coordination support to the Connecticut Harm Reduction Working Group, an informal network of harm reduction practitioners, advocates, and scholars started by GHJP Co-Director Gregg Gonsalves and Director of Harm Reduction Research at the Yale Program in Addiction Medicine Ryan McNeil. The aim of the Working Group is to provide a space for harm reductionists to connect to share knowledge and resources, identify key needs and barriers for harm reduction across the state, form new collaborations, and coordinate joint advocacy. In early 2021, the Working Group penned an open letter to Governor Ned Lamont, Department of Mental Health and Addiction Services, and Department of Public Health urging them to use American Rescue Plan funding to address enduring barriers faced by harm reduction service providers, and invest in innovative, evidence-based, harm reduction-based approaches to drug treatment and overdose prevention.

GHJP has also been a key member of the Statewide Harm Reduction Action Group, a group of harm reductionists across the state, by providing support in writing, advocacy, and research. This group was the key audience and organizing partner for a virtual workshop for harm reduction services providers and allies across Connecticut in Fall 2022 on “Overcoming Barriers Toward Overdose Prevention Sites in Connecticut.” The objectives of the workshop were to familiarize participants with ongoing legal, political, and social barriers to OPS, and to build community between different players invested in different areas of harm reduction service provision in order to further the movement for OPS. The workshop was hosted by GHJP Clinic students, moderated by GHJP Co-Director, Gregg Gonsalves, and joined by local and national expert/practitioner panelists.

GHJP is also currently participating in a working group of public health and legal practitioners to explore avenues to change local policy on the use of urine drug screening for probation determinations, and move away from carceral approaches to addiction. On December 12, 2022 GHJP co-sponsored a webinar panel with the SEICHE Center for Health and Justice and Northeastern's Health in Justice Action Lab : The Intersection of Addiction and the Criminal Legal System: Drug Screening for People on Probation and Parole. Panelists and experts discussed the impact and questioned the utility of urine drug screening, and explored opportunities in both medicine and the law to align criminal legal practice with the science of addiction medicine.

GHJP has, further, partnered with a coalition of harm reductionists, people with lived experience, public health researchers and advocates, and addiction medicine providers in work to address media misinformation and stigma. In June 2022, this coalition identified negative or misleading media coverage on drug use as a significant barrier to the expansion of harm reduction efforts in Connecticut. In Fall 2022, GHJP Clinic students conducted a survey of PWUD and their loved ones, addiction medicine providers, harm reductionists, and service providers on what they believe to be some of the biggest issues with local media coverage of drug use and addiction. In conjunction with coalition members, students also conducted a qualitative review of The Hartford Courant’s coverage on addiction and substance use, developing in the process a research methodology that can be applied to assess other publications, with the hope of creating a public-facing rubric that can be used by anyone who would like to investigate whether their local media is reporting accurately on drug use or further marginalizing people who use drugs (PWUD).