hi my name is Alison Newman I'm at the University of Washington addictions drug and alcohol Institute um thank you so much for being here today for our webinar Herm ruction 101 from yesterday to today our presenters today are Emily huo and Lupe ortado I'm super excited to have you all here um just a few webinar legistics this is um a zoom webinar which means only panelists and hosts can share video and audio please enter your comments and questions in the chat and Q&A um those should be enabled and it should be so that um you all can also see people's questions and respond to them so you know if you know a lot about this topic already and someone has a question feel free to to enter that and I think most importantly be respectful and be curious so I am going to hand it off to my wonderful colleague Emily um she is going to talk about the history of harm reduction theory and key principles Emily is with the Washington Department of Health and someone I work with regularly and really appreciate and enjoy so thanks Emily so much for being here today thanks for having me good morning everybody um uh Alison if you want to go to the next slide um I am uh at the Department of Health as Allison mentioned I uh work in the office of infectious disease and manage uh SE uh several teams focused on hepatitis C uh drug user health and integrated infectious disease testing and that's HIV STI and hepatitis testing um our drug user health Team I just to give a quick overview um we provide harm reduction subject matter expertise um to Sister agencies as well as within the department um we work closely with the healthcare Authority on um Statewide planning efforts um that address care and coordination um and harm reduction services for people who use drugs we involved with the state opioid and overdose response plan um and we coordinate some partner engagement and mobilization efforts aimed at improving systems um to serve people who use drugs we also work with if not all most of the syringe service programs in the state um through uh in kind a supply clearing house that we offer um also many programs have contracts with our office and we provide uh capacity building support and uh and technical assistance and training um and then we also uh coordinate the Statewide overdose education and Noak Zone distribution program and support agencies that want to distribute nck Zone um to community members and particularly the people most likely to witness and respond to opioid overdose which are people who use drugs and their friends and family um next slide oh so I'm going to talk a little bit about some context for harm reduction in the United States um and uh I like to start with thinking about why some drugs are legal and others are illegal um and uh really you know many illegal drugs um have been used for thousands of years um things like opium cocoa psychedelics and cannabis which I know is now legal in Washington and many other states but wasn't until recently um have been made illegal and their legal status is not based on any scientific assessment of their relative risks um it has everything to do with who is associated with these drugs uh so the first uh anti-narcotic law in the United States was an ordinance in San Francisco in 1875 that was that banned opium smoking and opium dens it did not mention other forms of opium such as opium tonics or uh or other formulations so it was very specifically criminalizing the Chinese community in San Francisco uh use opium through smoking and had sort of uh places called opium dens that uh where consumption took place and this really played on unfounded and racist fears um that Chinese men were going to use opium to seduce white women and although white women constituted the majority of opium users through the use of patented over-the-counter medicines um the law was specifically targeted um at this community and framed in a way that was um very much uh an effort to undermine Chinese men and the Chinese Community broadly next slide and uh the first anti-cocaine laws uh started in the early 1900s in southern states and they were really directed at black men played on racist tropes the New York Times had a headline negro cocaine fiends in 1914 and the idea um behind this Trope was that black men were inciting violence attacking white women and and somehow using cocaine made them resistant to fatal wounds and uh this might resonate if you are of my age there was a lot of conversation about PCP making people superhuman and that they uh could resist uh arrest and uh battle through this there's no basis in science for these things but these are sort of the messages that have propagated and you'll also see this sort of theme uh using white women and the fear of attack against white women as a way to undermine uh communities so you see that used a lot um and the first anti-cannabis laws um shortly thereafter in the 1910s and 1920s directed at Mexican migrants and Mexican Americans uh really founded in a fear of immigration after the Mexican Revolution and a lot of framing as the marijuana Menace so really a a a thread you can see in these early drug anti-drug laws uh that were really targeting um specific uh racial and ethnic communities and based on xenophobic and racist fears next slide so I should say I'm giving a very quick and dirty uh historical perspective on some of uh our early policy responses to drugs this is by far uh just the surface there's a lot more to this so if everyone anyone sort of is thinking I'm oversimplifying this um I am but it's for lack of lack of time and there's a lot of reading um and information on this that's fascinating um I am jumping ahead several decades to the 70s when uh President Nixon declared a War on Drugs uh he dramatically increased the size and the presence of federal drug control agencies and pushed through measures such as mandatory minimum sentencing and no knock warrants and if you're paying attention to the news in the last several years no knock warrant is what was used um in the situation of the murder of Brian Taylor um uh and uh there are a lot of criticisms of no knock warrants um and mandatory minimum sentencing but that really those measures were really pushed through and enhanced during this period um of the start of the quote unquote War on Drugs um Nixon temporarily placed marijuana or I should say cannabis in schedule one which is the most restrictive category of drugs pending review by a commission that he appointed and then the commission unanimously recommended decriminalizing The Possession and distribution of cannabis for personal use but Nixon ignored the report and rejected the recommendation so again you can see sort of an anti-science uh thread and uh one of his top AIDS John Erman uh he he claims that he didn't say this but there's a a journalist who recorded this and put this in a book um and confirms that he did say it um and this quote is uh you want to know what this really what this was really all about and what this is is the War on Drugs um the Nixon campaign in 1968 and the Nixon white house after that had two enemies the anti-war left and black people you understand what I'm saying saying we knew we couldn't make it illegal to be either against the war or black but by getting the public to associate the hippies with marijuana and blacks with heroin and then criminalizing both heavily we could disrupt those communities we could arrest their leaders raid their homes break up their meetings and vilify them night after night on the evening news did we know we were lying about the drugs of course we did next slide so I'm not going to show this video but I do highly recommend it's short less than four minutes uh from the drug policy Alliance and it's a history of the War on Drugs um from prohibition rush and it's narrated by Jay-Z and has these really great illustrations um by Molly Krab Apple so if you get a chance to watch it it talks a bit about uh a perspective on New York some of the New York State uh laws in in particular um also around um the response to cannabis and cannabis legalization and sort of who that's benefited and who that hasn't benefited um so just a recommendation to watch uh at your leisure after the webinar and just to note also it has some of the information is a little out of date but I think still very relevant so why why I think this sort of historical lens is important is that we have to recognize the racist and xenophobic foundation on which US drug policy's been built so that we know how that impacts People's Health and the response to people who use drugs how we build Health Equity um so you know our history is our present um and so understanding that I think is really critical and you know a lot of our current drug policy is not so different from where we started it's built on the same Foundation um in terms of uh what guides our work as well thinking about harm reduction uh not just in relationship to drug use but also sexual health and that um kind of sex positivity is sort of the sexual health friend of harm reduction um thinking about things being safe consensual and informed um we really frame uh the work as non-judgmental anti-criminal isation and addressing stigma and shame and I know Lupe will talk a little bit about language but using things like person first language for example um and then you may hear harm reduction framed as any positive change um it's any positive change as defined by the person making that change um and I I'm not 100% sure but I think this idea of any positive change as defined by the person making that change both were sort of popularized by Dan big who's a real hero um of Overdose response and the harm reduction movement he really helped popularize Nock Zone distribution to community members in the US um and Dave purchas who H founded the Tacoma needle exchange which was the first government supported uh syringe service program in the country here in Tacoma so I think they really Dan said any positive change and then I think Dave added this as defined by the person making the change um you'll also hear harm reduction framed as meeting people where they are and then a new addition is really but don't leave them there really help guide people support people along a path to um Better Health wellness and whatever positive changes they identify next slide so um this is really some principles of harm reduction that come from the harm reduction Coalition um and I just I'm not going to read this whole slide to you there's a link but just to note there's sort of two ways we can think about harm reduction one is around a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use um the other is sort of as a movement for social justice that's really built on a belief in and respect for the rights of people who use drugs so I'll talk a little bit more about about the difference and similarity between those two ideas next slide um again principles uh one that I wanted to highlight I'm not going to read all of these but or two that I want to highlight one is that really harm reduction is about accepting For Better or Worse that Lit meaning legal and illicit meaning illegal drug use is part of our world and choosing to work to minimize its harmful effects rather than simply ignoring or condemning uh condemning drug use and then the other I wanted to or the the other two is affirming people who use drugs themselves as the primary agents of reducing um that uh people who use drugs uh share need to uh share information and support each other um and that they're the real agents of change um and then recognizing the realities of poverty class racism uh social trauma I'm sorry social isolation trauma sex-based discrimination and other social inequalities that these things affect both people's vulnerability to drug related harm but also their capacity for effectively dealing with drug rated harm so just uh you know you can read all of these are all really amazing principles um but wanted to highlight a few next slide and Emily I see one question I'm just going to jump in with um from meline how would you discussed the topic of a racist drug policy foundation with people who may currently have racist ideologies and may be defensive about this issue I think that's a good sort of clarifying question that's a really good question um I guess I would interrogate with them that question of why some drugs are legal and some are illegal and ask them to think about that um and when we think about legal drugs such as to you know nicotine tobacco um alcohol are we basing the the their legality on their relative risk to health versus other drugs or uh or something different um because when you start to interrogate um just opiates generally are not particularly dangerous if regulated um used uh according to regulated instruction um what makes them dangerous is the context of criminalization unreg ulation not knowing what's in your drug Supply um uh unregulated Market that's very uncertain so I think I would maybe ask some questions but I would love to see what people put in the chat because that is a really big question and really um important and you know I having worked in direct service but it's been a long time certainly had to work with folks who came with very bigoted um attitudes to our programs and you know we still wanted to meet them where they were and provide them service um and it can be a real challenge so great question um all right so uh what I did want to give a little attention to is what um the harm reduction Coalition sort of frames as Big H Big R harm reduction versus little H little r harm reduction and then this sort of third idea of risk reduction and to frame this up very quick I've noticed there's a lot of cognitive dissonance about um what kind of quote unquote harm reduction is okay and what which isn't um some of that is sort of my drug use is okay but this other kind of drug use is not okay so my wine drinking at night my coffee drinking in the morning um my going to The Dispensary for gummies or whatever those things may be those are okay but um uh taking that fentanyl pill snorting cocaine using ecstasy those are not okay and so there's some cognitive dissonance there and some of that may be based on sort of our ideas of and our you know um sort of non in unconscious bias around who's using these drugs how they're using them uh race and class issues um the other cognitive dissonance I've been noticing a lot of is uh it's it's okay to provide mocone and Fentanyl test strips but it's not okay to provide uh glassware pipes or syringes um sort of it's okay to provide Noone INF fental test strips these are things not involved in the actual process of consuming drugs but when we're talking about supplies that would actually be used in the consumption of drugs process uh some people get really uncomfortable um and so I've just I'm I'm just noticing this cognitive dissonance I'm actually thinking is there like an article I could write about this because I find it very interesting um but I I frame this as I talk about Big H Big R harm reduction and little H little r har reduction to say that big H bigr harm reduction is really that philosophical and political movement it's focused on shifting power and resources to people who are most vulnerable to structural violence so it's really around giving power to people who use drugs letting them lead help them letting them design programs and Lead those programs um giving folks agency voice and that recognition that the change agents are the people most affected by the issues little H little r harm reduction I think is what most of us are familiar with which is really around a fundamental approach and belief to how to provide services to people who use drugs so really not being judgmental um really helping meet people where they are but not leaving them there supporting people on a path to any positive change as they Define it what I am seeing a lot of what's being called harm reduction but is actual risk reduction is when we're just providing tools and services to reduce potential harm and so an example is a alone vending machine um is great or passing out safer drug use supplies those are great tasks and activities and ways that help people reduce risk they may not necessarily be harm reduction activities if they're not grounded in an approach and a fun fundamental belief in how to provide those services in an equitable person first um empowering way then they may be risk reduction services and I think that's what we're seeing a lot of and I I hope that distinction is is makes sense um but just sort of handing people supplies is a great risk reduction activity but if it's not coming with client centered education partnership conversation engagement um then it's it may not necessarily be a harm reduction activity next slide Emily are there any final wrapup kind of comments I I got through that in the time I wanted to um no I just I think Lupe will really take you all to the kind of the next piece of this which is really the Practical I sort of sat in the theoretical um and so I'm excited to learn from Lupe and hear what she has to say um and then happy to answer questions at the end so thanks yeah thank you so much Emily and I'm GNA hand it over to Lupe ortado with the downtown Emergency Services Center I really enjoyed getting to no Lupe putting these together and I'm so appreciative that um you're able to be here with us today thank you thank you ausen and good morning everyone um my name is Lupe herado um I'm a peer counselor at the D at DEC downtown Emergency Services Center and I work with otn which is the opio treatment Network um we provide mud to people um who who want to make a change to their drug use or people who just want to mitigate um withdrawal symptoms I've also worked at the Tacoma needle exchange which um Emily mentioned uh as a community health Outreach worker I've I sit on the anti-sigma committee with the Tacoma Pierce County Health Department and I volunteer with the key project so I'm going to be talking about harm reduction in practice today um so next slide so after what Emily talked about and while I'm talking I I want you all to think about what does harm reduction mean to you um have you practiced harm reduction and what does it look like to mitigate harms I want you to think about how can you compa Al support someone in their lifestyle even if they are causing harm to themselves next slide so I'm a person with lived experience um and I can really relate to this this picture in this slide harm reduction Saved My Life um I've had experiences over the years with people family members courts treatment centers um requiring abstinence of me and I never had the recovery that other people expected harm reduction made me feel seen and heard for the person I am and not for my drug use and when we put conditions and demands on people we failed them from the beginning harm reduction understands that abstinence is not for everyone and in a journal of addiction medicine study estimated that 2.2% of individuals with UD will experience one in five years of absence in their life so why is success in recovery measured by abstinence when it isn't a reality for 97.8% of us um would you have a surgery if the success rate was 2.2% you know uh would you have this surgery if if your job was dependent on it if your housing was dependent on it and your freedom so harm reduction provides an empowering approach that and Equity to people who use drugs next slide so harm reduction mindset how do we implement the harm reduction principles in our encounters um how do we meet people where they're at it's important to to support people and safe drug use but also to provide low barrier services so remove requirements from Services provide trauma informed care and flexible structures at your organization with where and how you meet people who use drugs um so mobile services and Outreach um and it's important that we remind ourselves that the work we do is for the people we serve and not for us um and to to use person centered language which I will talk about in the next slide so people who use drugs are stigmatized in so many different ways and these negative attitudes beliefs and stereotypes cause harm to people and keep them isolated and vulnerable um stigma keeps people from asking for help or accessing services and we need to remember that our words Drive our thoughts our actions and our behaviors and eradicating stigma requires new language that recognizes and validates individual over experiences over um their lifestyle their behavior a medical diagnosis that they live with and so we put the person first um instead of saying a homeless person we we we always say a person experiencing homelessness or someone who's living unhoused um to to confront stigma we have to call it out when we hear it um call it out in your daily life and and people that are around you um and educate people on the harm that stigma causes okay next slide so there aren't safeguards in society to empower and support people to use drugs without punitive measures um and these punitive measures usually bring about deeper harms of drug use a loss of Freedom loss of status um and social network so drug user unions um so that's big H Big R like Emily talked about they're collectives of people who use drug drugs harm reductionists people with lived experience who take action to support the rights of people who use drugs demand Equity advocate for social J or social justice and bring about uh bring about awareness of harm reduction movement so some of the things that drug user unions advocate for are um the deregulation of the methodone structure which is traditionally been very punitive um advocacy about safe Supply um and safe consumption sites policy change um to support the health and and wellness of people who use drugs and bringing back to those harm reduction principles we focus on person centered goals like Emily said change is defined by the person changing and progress is determined by the expert which is the individual um listen to what people have to say listen to what they've lost lost in their lives listen to what they want their life to look like um and create a a space where they feel seen and understood next slide so living unhoused is a truly traumatic isolating and home hopeless experience trying to get your needs met every day and trying to survive constant ly with being exposed to victimization discriminate discrimination assault arrest and death so meeting people where they're at is not the same thing as showing up where they are it's about meeting people at their level and helping them overcome their barriers um Outreach and mobile sites overcome the barrier of um isolation and transportation um going to where people are and bringing what they need providing hygiene supplies wound care supplies syringes pipes offering medical and dental services um community resource navigation um advocacy for safety and stability for individuals living unhoused so when I say that I mean you know be present at encampment sweeps encampment sweeps inhibit people's ability to connect with Community Access resources build stability and establish belongings be present and hold City officials and law enforcement accountable for the structural violence that they're participating in um housing first model so at DEC we have the housing first model which the housing first model is about providing stable and permanent housing as the first and primary intervention um to people experiencing homelessness regardless of their mental health substance use or other challenges next [Music] slide so individuals in the commercial sex tra face constant threat of sex-based violence police persecution and murder and the harm reduction movement has always included further furthering the rights in legitimacy and safety for people who engage in sex work some examples of this are special medical um services so access to sexual health clinics access to contraceptives to prep testing for HIV HEC and STI um bad date lists uh when I used to work I used the bad date list it's an online or um publication of incidents where people who have engaged in sex work were violated assaulted um robbed and it's a way to to keep yourself aware of your surroundings um and build a community of people who who are looking out for sex workers um safety planning engage with people about how they work where are they working are they working on the street are they online are they do they have a pimp are they working alone or with someone else um community support groups self-defense classes as well as legal support um for the protections for protection of the rights of sex workers next slide so current narratives around harm reduction perspectives and experiences are often from white people about white communities and this leaves out this excludes The Works of of uh black harm reductionists people who use drugs um and it excludes also the harms of racist drug and criminal legal Health Care policies um which exasperate racial disparities so even we hear about the fentanyl epidemic these this is also we also see a lot of images of white people and white people's experience but this leaves out a big portion from 2015 to 2020 the black men or the r R of black men dying from opioid overdose increased by 2ou 213% and this needs to be talked about um bipo harm reduction centers racial Equity around the harm reduction framework and this includes undoing the harms of colonialism which place indigenous people First Nations matis and Inuit at higher risk of harmful substance use so I'm going to play a little clip of this video um where uh a woman is talking about how she brings her culture into um implementing harm reduction in her community when we talk about people's healing journey I mean moving forward I don't mean reducing their drug use I don't mean stopping drug use I mean engaging in culture and and building the relationship with self and getting to know yourself through here gay cast clal n Mar scow um my traditional name is clock walth which means copper breaking women it was a name that was given to me from my grandmother uh from the health sick Nation up in Bella um my English name is mar scow and I was born and raised uh in Port Hardy on Vancouver Island I am registered to quag Nation I try to keep culture at the center of my approach to harm reduction I believe that low barrier and no barrier access to culture really makes a huge difference when I talk about people who are actively using substance quite often we are pushed to the margins of society and we're kind of walking along the outskirts and when we're forced into isolation or don't have access to basic necessities or things like culture um we can often fall down a hill and it's so hard to get back up so for me I believe that everybody should have access to traditional land-based healing to smudging to prayer to drumming they should be able to be around it regardless of their relationship with substance I being like you can't come here because you're using drugs it's very difficult for people because it's a you're taking away their identity name is k sedore and I'm from territory um use them pronouns and my main title is just working as a pure supervisor at the um overd those prevention sites it's very difficult thing to be a drug user in culture and ceremonies and stuff like that because it's you get called out on it you get shamed for it so by providing com production it just will show you that you can participate in these ceremonies without being ashamed of it g Lup was that the clip you wanted me to that's good okay thank you what a great video though I watch the whole thing and recommend other people do as well yes please please check that out I I have a link in in um in the end of my slides okay next slide so syringe service programs traditionally called needle exchanges um have been around since the late 80s early 90s in response to the increased rate of HIV AIDS through IV drug use and sex so needle exchanges have been proven effective in reducing the spread of bloodborne disease promoting safer injection practices connecting with people use drugs um and providing access to Social and Health Care Services they play a critical role in providing um Distributing supplies and educating on the health and wellness of participants people who use drugs so needle exchanges distribute syringes pipes um everything that goes along with um IV drug use cotton cookers ties Sharps Containers as well as nxone and Naran um pipes are becoming more popular the traditionally it was just syringes but as we're seeing a lot more people smoking um that's being provided um so bubbles hammers stems and foil so wound care supplies um are are given to help stop the spread of ssti soft skin and tissue infections um or any other in injection infections um they also provide access to um referrals and testing for HIV and hepc as well as treatment um they have um referrals for medication for opioid juice Disorder so suboxin methanone sublate Vivitrol these medications help people um mitigate the harm of of their use manage withdrawal symptoms um at the otn where I work I mean there's people who have completely stopped using fentanyl there's people that use suboxin just to get through withdraw symptoms when they don't have anything you know any any of those goals are are totally acceptable and and and um medication for opioid use disorders help people vein care so choosing the right size and gauged um syringe service programs help educate people about um you know vein care practices so how to find a vein know knowing what's a vein and what's an artery how to tie off um you you know strategies about avoiding sharing um equipment and using a new point for every shot syringe service programs also provide overdose prevention education and Community trainings um as well as resource navigation onetoone model at a syringe exchange is the traditional original um model where what you what the amount of syringes you bring back is what you get back in return um the needs-based model is more of a be best practice model uh whatever someone ask for is what they need and that's what they get regardless if they have anything to return um if if funding allows that's the best best um best model for people who use drugs next slide encourage nxone and Naran to everyone participants people who use drugs community members um and and educate people about no loxone and overdose prevention make sure people know about the signs of an opioid overdose and the risk factors some risk factors include you know if a person has left jail or treatment or from a hospital stay their tolerance has dropped and that puts them at risk for overdose as well as um if you have experienced one overdose you're twice as likely to experience another one um Synergy make sure people know about poly substance use and mixing different substances educate people on how to administer Noone and Naran um make sure they know about rescue breaths that's vitally important when someone's in a opioid overdose they are not breathing for themselves make sure people know that the breath is is very important call 911 I'm making sure that EMS has been alerted but also I tell people when you're calling 911 say that someone's not breathing you don't necessarily have to say someone's overdosing you know stigma like I talked about is comes from every place even you know um from emergency services so say someone's not breathing and you need help now um also I I want to talk about you know traditionally we always tell people not to use a loan but realistically people use a loan all the time and I think it's important that we promote safer use even when using a loan and not just tell people to you not use a loan because they do um some some things that you can suggest to people is called the never use alone hotline or use the brave app the brave app is like a virtual consumption site a person can use the brave app and it connects them to a supporter um the res a person can put their rescue plan so if if I don't respond or the line goes dead call my friend they have Naran this is their number or if that if that doesn't happen the supporter will dispatch to 911 um and make sure everyone at your organization knows how to use Naran and has Naran available next slide how do we engage with people who use drug drugs to create relationships that Empower them and build resiliency and Rapport Rapport so take every opportunity to educate um engagement is about education building those relationships um and building that trust transparency be clear about people's choices don't try to leverage things please be be honest and be clear so people can make the right decision for themselves provide trauma-informed care um recognize the the symptoms and signs of trauma expression and provide a safe space for people to to talk about things that have happened to them also you can use the con the risk set setting model traditionally in treat treatment um structures it's been called drug set setting but in harm reduction we know people are using drugs and that's that's not the concern it's the risk of of everything that can come with that so the risk is what is the harm or issue being presented and how does this correlate with behavior is this person at risk for overdose set we talk about a person's mindset what what's what thoughts are they bringing into this situation um how are they feeling have they gotten their needs met today h have they eaten have they slept have they gotten rest um and setting is is about their surroundings their physical environment and where they are who is around them are they at a shelter are they at an encampment are they at their house are police present are community members present is an abusive boyfriend present is someone who owes them money present so thinking about that helps us deliver harm reduction and improve engagement with our clients and the people we serve next slide so I put this this is the effects of little H little r harm reduction strategies so like I talked about before um providing stale syringes reduces the transmission of HIV and hepatitis C as well as other bloodborne infections um reduces the rate of ssti reduces um visits to the emergency room um Narcan and the lockone helps people uh respond to opioid overdoses and save people's lives um engagement helps reduce stigma um that people who have used drugs experience and um build supportive relationships built on trust that improves the quality of care and well-being but on a bigger scale um harm reduction promotes health and wellness for for all of the whole Community um and it shifts Focus from punitive me measures to public health strategies Fosters a more compassionate and realistic approach to the harms associated with drug use and acknowledges that abstinence may not be desired or achievable for everyone and it strives to dismantle and eradicate stigma next slide and this these are some pictures of me um working in har reduction services so on the left that is me at the G Street encampment um in Tacoma Washington um and then on the right that's me and Ally from uh Tacoma Pierce County Health Department we're at a community Fairing and teaching people about in the lock Zone and opioid overdose well thank you for listening thank you so much Lupe um I'm going to go over a few resources that we've all compiled and then um please put questions in the chat or Q&A so Lupe was U wonderful enough to put all of her resources on these slides and then I have a few others for like further reading um different organizations are like the Washington State serving Services programs directory so so if you want to find a program near you that's an option um other groups are the harm reduction Coalition and drug policy Alliance have web pages including stop overdose. org which I work on and the Washington Department of Health overdose education and nooon distribution web page and then a whole bunch of podcasts which thanks to my colleague Mandy sladkey for finding some of these um this week on criminal they had this episode the Liverpool exchange which is the story of the first Needle Exchange in the UK okay um and they interview Maya salivit who is then you know listed in two of the books we have um she writes really wonderfully about the history of harm reduction um chasing the Scream by Johan Hari talks about the history and impact of the war on drugs and for a really nice language guide um we've linked to the anti-stigma language guide from Tacoma Pierce County opioid task force and this is not an exclusive list of all the harm reduction resources this is what we could think of so I have one question I want to go back to that um Emily answered in the chat but Lupe I'm curious how you would respond um given that we don't define success and Recovery as abstinence how do you find define success and Recovery in this framework um I think that recovery is defined by a transformation um but it doesn't necessarily have to be tied with someone's use you know it it's about making your life how you want it to be um it's about addressing your health this this is how it is for me you know um I I still use drugs you know I take subox in every day um but I also you know give back to my community that's part of of my recovery too is is being there for people who are still suffering um so I don't know if that answers your question but it's it's what the person whoever is defining their recovery that is what their recovery is I think that's a really great response and I appreciate you uh personalizing it and sharing that um we have a question besides caring Naran what can an individual do to further support harm reduction in their immediate community and Emily or Lupe either of you can take this well I guess I would say carrying Noone is a great risk reduction activity um I think in order to really make it a harm reduction activity it might be engaging with community members about them also carrying theoc Zone having conversation but really about building relationship um and trying to um unwind um a lot of the bias we all have around drug use and people who use drugs um and I'll send this to you Allison but I just remembered I have a picture of um Edith Springer was sort of the I don't know some people call her I'm not going to call her the grandmother because I don't know if she would like that but she's definitely the Godmother of harm reduction in the United States and if you read undoing drugs by Maya salvit Edith Springer is featured very prominently in that book um but she wrote a harm reduction workers best practices handout in 1996 and um I just kind of pulled it up because I had forgotten what a great resource This was um but uh really the idea here around harm reduction is that behavior change is complicated and it's a process that happens over time and the key is to develop a relationship with people and Tim candella on my team often says the relationship is the interventions so I'm going to channel Tim but I would say that's things we can do in our community is build relationships and that could be building relationships with people who are very Pro War on Drugs to try to help unpack that and maybe maybe move them along a stage of change it could be building relationship with people who use drugs who need support and uh and love um so I think I think sort of Thinking Beyond just sort of the supplies and the things that can be handed out that certainly are super helpful and often life-saving right um but what are the what are the relationships we can build in our communities that can really um undo some of the things some of our response to drugs that isn't promoting Public Health that is actually maybe doing more harm than good um and that's kind of what I would say to that Lupe is there anything you would add um I mean I agree with what Emily said um you know like call out stigma you we hear it all the time address it and educate people um you know I I think there there's a lot of organizations and agencies in the community that would love the support and you know volunteering of of other community members um you know but I also think maybe just outside of just people using drugs think about the other people other populations that I talked about in the harm reduction and and um promoting social justice you know for for uh by bip Community um supporting the rights and legitimacy for people who engage in sex work um all of these things I I think of course carrying a lock zone is important um but may maybe go out and give it out to people and start talking them to them and also making sure that people know how to use it it I think those are uh really good points and I appreciate it and I see that Chelsea has put in the chat that filter magazine called Edith spinger the goddess of harm reduction um and we have a question from Britney are there any good resources that any of you know of to better educate people on the difference between harm reduction and risk reduction the distinction between the two terms feels really important so if you go to harm reduction. org to the National harm reduction coalition's website they I there's kind of more on that so I would suggest that as a good resource I think for me and I'd be curious Lupe what you think um the distinction is risk reduction is just sort of providing supplies and sort of one-way information to folks um risk uh so that would be risk reduction harm harm reduction is really you may still be providing those supplies and some one-way information but it's really about the relationships it's about the the The Stance um of the folks providing those services and the attitude and the um kind of really putting participants in the driver's seat um really understanding that people may have a lot of feelings of ambivalence about their drug use or their sex work or whatever other things are going on in their lives um and that that ambivalence isn't resistance it's just it's just ambivalence right we all of us experience it um and so really listening to people um being a resource and not directive and so I to me that's the real distinction is one is sort of a one way I'm handing you supplies and information which is fine there's nothing wrong with that um but that is really risk reduction not harm reduction and Britney said thank you that is helpful in my setting I often hear people reference harm reduction when in reality they are talking about risk reduction and Lupe what would you add I I think also just like bringing all those um harm reduction principles into your interactions into your daily life I mean it it's it's important to re really look inside yourself first of all and you know think about things that you've heard or things that you've been through and and kind of work through that make sure that you you think about like how has stigma played a role in my life and I feel like that in a sense helps people you know connect and engage with people who use drugs better um start thinking about it in your own life and then you'll be able to reflect that in your relationships and um and with the people that you serve I think that's a really great response um and Brittney if you want to you can type in what your setting is but you don't have to um I know where you work but um I think we have time for one more question if anyone has questions any final questions I guess I'll give it a second in case people are typing I do just want to say thank you so much Lupe and Emily for doing this webinar I learned so much really appreciate you sharing your knowledge and experience and all these wonderful resources and all these different examples of harm reduction and what it looks like in theory and practice so um all I see so far is this was great thank you so that's not a question but a really nice comment um any other questions that people have for presenters all right and I'll just put in a plug um Emily if you do want to learn more about harm reduction or if your agency wants to learn more about harm reduction uh Emily's team has some great resources and um Lupe is a pretty wonderful presenter so um just throwing out there there are a lot of great people and organizations who can provide training on harm reduction and I really um think it's best to connect with organizations that are doing that work directly um such as surrender Services programs or people doing direct service or groups like Emily's at the Washington Department of Health who are working you know with Sur Services Program so reach out to the people doing the work who are really familiar with the work that's another way that we can really support harm reduction agencies and um the people who are doing harm reduction so um oh the recording is ready um I think we'll send out an email and in the next day or two with the recording ready it should be posted tomorrow just depending on how quickly I get it posted so just one more thank you um any final closing words Emily and Lupe no thank you everyone yeah thank you and um I hadn't met Lupe before this and I'm just so pleased to know you now Lupe so I'm really grateful for learning from you today thank you thank you Emily I feel the same