A closer look at how the harm reduction strategy plays out in Minneapolis

NINA MOINI: In Minnesota, deadly drug overdoses doubled between 2018 and 2023. And in Minneapolis, those deaths are disproportionately represented. In 2022, Minneapolis had nearly a quarter of the opioid deaths in the state, while the city only makes up 8% of the population of the state.

On the front lines of trying to prevent deadly overdoses in Minneapolis is a group using harm reduction strategies. They were featured in a new story and photo essay by local photojournalist Tim Evans. His essay, called "What Harm Reduction Really Looks Like," was co-published in The Nation and The Economic Hardship Reporting Project. And Tim joins us now. Thank you for being here to share your work with us, Tim.

TIM EVANS: Yeah, absolutely. Thanks for having me.

NINA MOINI: And I've gotten to work with you a lot over the years because we're lucky to have you do some freelance work time to time with NPR. But I've seen firsthand just how much you care about people and really capturing the nuance of what is going on in people's lives. So when your project is titled "What Harm Reduction Really Looks Like," that doesn't surprise me because you're a really, really good journalist. So I just had to say that, but I wondered what got you interested in reporting on this story and this topic in particular?

TIM EVANS: Well, thank you for that. Very kind. And, yeah, I mean, initially, I began working on this project officially in 2023, kind of August, September. But I had been interested in the overdose crisis and epidemic, really, for a few years before then.

Every year, 100,000 people at this point die from overdose. That number had been growing for a number of decades leading up to a few years ago, when it crossed the 100,000 threshold. And but there wasn't a ton of reporting that was happening, at least I hadn't seen in recent years, about sort of the status of where things are at and what kind of responses were happening as a result.

The reporting that I had seen in the past oftentimes focused on some of the more horrific aspects of overdose. Oftentimes, you see photo essays that look at the horror of people who are in the grip of addiction. That was important reporting and that was important work, but it didn't really focus as much on sort of the solutions that are being implemented to try to address that. So that was what guided my interest in this project.

NINA MOINI: Sure. And would you talk a little bit about just what harm reduction looks like, how it's different from addiction treatment? Because we hear the term used a lot. We need to practice harm reduction. What does it mean, and what does it look like?

TIM EVANS: Yeah, it's a really good question. So harm reduction is, in general terms, the set of practices that's just aimed at mitigating the known social and physical risks associated with drug use and sexual activity. So the goal is to minimize harm. And in practice, what that looks like on a street level is that can be anything that people who are in active use need, feel like they need, in order to use more safely.

So that can be the distribution of naloxone, which it's an opioid reversal drug that's often referred to as Narcan-- which is the trademark name-- that's very popular. That can be providing people with access to treatment, guiding people towards treatment. That can be safe use supplies. That can be a number of different strategies, on-the-ground level, to kind of just make use as safe as possible.

And I think that's at the heart of what harm reduction is, different than drug treatment or recovery treatment. People who are implementing harm reduction on a grassroots level and sort of on the front lines, their primary focus isn't to direct people into treatment. That's certainly something they would support when people express a desire for it.

But it's really, harm reduction is really rooted in trying to support people who are in active use, to make that active use as safe as possible in a really non-judgmental way. And non-judgment and participant autonomy and supporting people how they feel like they need to be supported really is at the heart of the practice of harm reduction, which its origins trace to communities who are oftentimes marginalized and have had their health concerns ignored by the medical infrastructure and institution, and people who have experienced a lot of stigma within that system.

And harm reduction is trying to overcome all of those barriers and supporting people who really struggle to seek support otherwise for economic reasons or social reasons, or just the stigma of drug use. I mean, if you're--

NINA MOINI: Right.

TIM EVANS: --dealing with addiction, it can be really challenging for you to even ask for help.

NINA MOINI: Right, right. And meeting people where they're at in the moment to ensure that they stay alive in that moment as well. So you were with Southside Harm Reduction Services. They were implementing some of these harm reduction practices that you're talking about. Why do you think that their approach is helpful? What were you seeing out there that was really helpful?

TIM EVANS: Yeah, I mean, a lot of the people who work in the more grassroots harm reduction movement are people who have a history with substance use or housing insecurity. And though not everybody in the movement has that background, a lot of them do. And it shows. It shows in the way that they engage with people.

Again, like I was mentioning before, non-judgment is a really huge part of their work. And when you have people who have lived experience that reflects the struggles that people who are in addiction and kind of at that intersection of addiction and housing insecurity are dealing with, they bring a level of empathy and a level of understanding that's really hard to replicate otherwise.

And it's truly like, they come. They're not there to cast shame or judgment. They're there to provide you with the support and supplies that you need in order to be safe in your decisions and in the choices that you're making. And if that's active drug use, then that's active drug use. And that's a really unique set of characteristics.

And another aspect with Southside Harm Reduction in particular, there are a number of organizations in the Twin Cities and in Minnesota and across the country that implement a variety of harm reduction practices. That includes clinics. That includes hospitals.

But what's unique, I feel like, to some of these more grassroots harm reduction organizations is that they're really meeting people where they're at in a very literal sense of the word. They're doing deliveries, and they're doing outreach on street level that provides access and reduces barriers that otherwise can prevent people from seeking care.

So I mean, Southside Harm Reduction in particular, they do deliveries across the city on a weekly basis where they will receive phone calls from people who are requesting clean new supplies, Narcan, other resources that they provide. And they are driving around the city and doing drop-offs to people anonymously so that people who feel stigma don't have to feel like their personal information is going to be tied up into their seeking support. And that's a huge barrier for a lot of folks.

NINA MOINI: So I know that there are people-- because I've done a lot of reporting on housing insecurity, the encampments that seem to pop up in the exact same places or a couple of blocks away. That intersection of drug use and housing insecurity was important for you to highlight. There are people who say that harm reduction is like enabling somebody who is in their addiction. What do you hope people take away from your reporting project?

TIM EVANS: Yeah, I mean, so touching on the housing insecurity element encampments, local encampments, and how that's kind of dealt with, there's a really interesting statistic that I had seen that people who are in active use and unhoused are six times more likely to die from overdose than people who are inactive use and low-income, but housed. So the housing element of it is a really central part in preventing harm.

And there's a number of reasons why that's the case. There's so many risks involved when you're unhoused and dealing with isolation and exploitation, vulnerabilities related to that. And just using alone is probably the biggest risk factor, because if you're using alone, you're not in a position to administer Narcan to yourself, obviously.

So providing that kind of stability can be really huge. And so that's an important part that I want people to walk away with, is that the intersection between housing insecurity and drug use is really, really important.

NINA MOINI: Yeah. What do you want people to take away from the project?

TIM EVANS: Yeah, I mean, I would say the work that's being done right now on a grassroots level is extremely important. It does not outright replace treatment intervention in other ways of reducing overdose risk.

But it is no doubt playing a central role in reducing death and reducing harm and impact. And it's really admirable work, and it's really difficult to do. So I think the people who are doing it are showing incredible amount of resilience and persistence and care. And I just have a lot of admiration for what they put into it.

NINA MOINI: Tim, thank you so much for coming on and sharing your work with us. We really appreciate it.

TIM EVANS: No, thank you. I appreciate you putting some attention on this issue.

NINA MOINI: Thank you. That was photojournalist Tim Evans. We'l have a link to his story up on our website, mprnews.org.