Opioids History of Harm Reduction

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History of Harm Reduction in Minnesota

Minnesota has needle exchanges, and we have Sue Purchase to thank for laying the groundwork for this work.

Sue was introduced to intravenous drug use in her early 20s. She left her husband who was dealing cocaine and returned to Minnesota. Her family emphatically told her how important it was to go to chemical dependency treatment. Facing her addiction wasn’t an option as she was terrified to jeopardize the care of her children.

Sue would rinse out her syringe to get a little extra out and share needles. She knew that having access to clean needles was a good starting point for her, and for many women like her. Sue first learned about the idea of harm reduction in the late 80s and it introduced her to another way of thinking.

Sue Purchase and Toni St. Pierre, a labor and delivery nurse who lost custody of her children due to drug use, started working on getting a needle exchange going in the Twin Cities. They started Women with a Point. “We had a point to make, and a point to give” Sue explained. “The reasons that women come to drug use are unique and have to be acknowledged in service-delivery.”

They started with a home delivery service, available 24/7. Sue would meet other pregnant or parenting women at the mall parking lot, coffee shop, shelters on Curry Avenue, or high-rise apartments. She’d bring condoms, socks, and needles. In the first year, Sue and Toni passed out 10,000 syringes. Within four years, they had passed out 200,000 syringes. At a time when anything other than abstinence-based only programs were blasphemy to even talk about, Sue and Toni were true innovators. “It was controversial, revolutionary, and it saved lives,” Sue explained. At first they operated out of the trunk of Sue’s car, and eventually had a storefront.

Sue’s view of harm reduction is that is respects all positive change, meets people where they’re at, and makes space to “show up, be real, talk about difficult things, and have an open dialogue.” They had conversations about what it was like to meet their drug needs, while simultaneously being a successful parent, making it through the day, and supporting their family financially. They understood that substances were these women’s first line of defense, and had become their best friend, from sexual assault, domestic violence, mental illness, and other forms of trauma. They worked in a way that was respectful of the relationship that women had formed with the substance. “It was serving them in some way, and we had to understand that, before we could ever start talking about a different way of making it through life.”

Eighty-five percent of women in drug treatment facilities have survived a primary trauma (e.g. sexual assault, physical assault), and many women have layers of trauma. Sue explained harm reduction as “impromptu, on the spot conversations, responding without judgement, and showing compassion and understanding. Women are raised to be everything and do it all so well—what if you lose the ability to do that? There is so much shame.” Harm reduction acknowledges that active users are valuable right now. “You don’t have to reach the bottom before you can get better, and you don’t have to be sober or even want to get sober to be treated with respect.”

Harm reduction is in no way a green light to use, nor does it minimize the risks of using. “Sometimes people think—oh harm reduction, you’re encouraging people to use. Quite the opposite. If you’re going to use, then use more safely. I educated people—don’t share cookers, cotton, water, or needles. And we’d talk about what else they could do while actively using to take care of themselves. Do you have medical care? Prenatal care? Healthy food?”

Over the years “Minnesota Department of Health funded us for almost every single dollar we asked for, which was f*cking phenomenal!” Sue started a group called “How to Manage a Habit on a Budget” and it was funded through the Minnesota Women’s Fund. Sue encouraged, “Trust your crazy ideas. You know where we need to go. And the getting there will happen.”

Sue Purchase presented at the 6th Annual Harm Reduction Summit at White Earth.

Currently Minnesota has Syringe Access and Disposal via pharmacies and Syringe Services Programs (SSP). SSPs have a wider array of services that usually include HIV, Hepatitis C, and Syphilis testing, as well as support and assistance in accessing recovery services.

Please visit the Opioid Dashboard for more information on opioid overdose death, nonfatal overdose, use, misuse, substance use disorder, prescribing practices, supply, diversion, harm reduction, co-occurring conditions, and social determinants of health.