Panel discussion addresses history of harm reduction in Asheville

Harm reduction, an evidence-based set of practices that reduces harm among people who use drugs, is a key part of the U.S. Department of Health and Human Services’ Overdose Prevention Strategy.

But harm reduction wasn’t always embraced in Buncombe County.

“I was brought to a room at one point as a county employee, with major county and city staff, and basically told to shut up,” Amy Upham, who worked as opioid response coordinator for Buncombe County Department of Health and Human Services (BCDHHS) from 2019-21, told an audience at Pack Memorial Library last week.

Upham was one of the panelists who gathered to discuss the history of harm reduction in Western North Carolina, alongside WNC AIDS Project (WNCAP) prevention educator Michael Harney and Buncombe County homeless program manager Lacy Hoyle. Buncombe County Special Collections, an archival facility within Pack Memorial Library, organized the event.

In her introduction at the beginning of the June 5 panel, librarian Carissa Pfeiffer noted a somber coincidence: June 5, 1981, was the date the Centers for Disease Control and Prevention published a report about five cases of what was then referred to as pneumonia. The fatal illness was eventually identified as human immunodeficiency virus, or HIV.

Panel moderator Abigail K. Stephens also noted that Harney donated notebooks, issues of the Community Connections newsletter and letters about the AIDS crisis and harm reduction to Special Collections in 2017. Many of these items, including a 1994 letter from former President Bill Clinton on White House letterhead responding to a letter from Harney about AIDS, were on display before and after the panel.

Harm reduction here

Harney came to Asheville in 1992 and became involved in harm reduction through his friendship with the late Marty Prairie. Prairie “became my boss, my friend and my mentor,” Harney said.

Part of Harney’s work focused on safe sex, particularly among men who have sex with men. As documents from Harney’s Special Collections donations noted, many men who had sex with men were married with families, didn’t consider themselves gay or bisexual and therefore didn’t consider themselves at risk for HIV. (Harney’s focus on safe sex earned him the nickname “the Rubber Man.”)

Intravenous drug use, which can spread HIV and hepatitis B and C, was also hitting Asheville hard. During the 1990s, Harney recalls “tripping over needles downtown.” A trip to Baltimore, where Johns Hopkins University was conducting a study about syringe exchange programs, inspired Harney and Prairie to start the Needle Exchange Program of Asheville (NEPA). NEPA now operates out of WNCAP.

NEPA existed in Asheville before North Carolina legalized needle exchanges in 2016. Although it was not yet state-sanctioned, Harney said he made a point to introduce himself to new faces in local government. “I think being openly active made a difference,” he said. “Even in the early years, all the mayors always knew about us because we went and spoke to them. All the chiefs of police — I was always introducing myself. I always said, ‘My name is [Michael], and I’m doing the needle exchange in Asheville, and I won’t give you my power. I will not.’ And so I never did.”

Local opposition

In addition to NEPA and another nonprofit that operates a safe syringe program called Steady Collective, Buncombe County introduced a harm reduction program of its own.

Upham, who is now executive director of Blue Ridge Pride, worked to establish the safe syringe program at BCDHHS, which was the first one at a health department in Western North Carolina. She also helped establish a naloxone program, which distributes the overdose reversal drug, and co-authored a grant to bring a community paramedicine program to Buncombe County Emergency Medical Services. The community paramedics program launched as a pilot in 2020. It has continued to expand, adding a post-overdose response team to connect people to social services after an overdose, and has begun initiating medication-assisted treatment for opioid use disorder.

However she faced opposition around harm reduction practices, especially in relation to syringes. Upham said it was “really hard” to get support for sharps disposal containers, which are secure boxes where people can safely dispose of used syringes, to be placed around the county.

“I thought getting needle boxes was going to be the easiest thing [when I was hired at Buncombe County],” Upham said. “We’ll order some, no big deal. It’ll be great. It’ll solve everybody’s problem.” Instead, there was a lot of pushback, with many organizations and businesses not wanting sharps disposal containers on their property. “The stigma that’s out there is so strong,” Upham said.

Later in the panel discussion, Upham said that opposition among Buncombe County government employees reduced when people received training about harm reduction, including how to protect themselves. She laughed as she recalled training sanitation workers on how to protect themselves from hepatitis C. “​​I trained waste management workers at the top of the county dump, with vultures flying overhead,” she recalled.

As a current employee of Buncombe County, Hoyle shared, “I feel very fortunate that I’m working for the county and that there is a lot of support for harm reduction efforts across the board.” She added, “I think a lot of opposition has more to do with not knowing and not understanding, and maybe the fear of the unknown, too.”

The future

Harney was adamant that getting help — whether it’s for safer sex, for substance misuse or for treating illnesses — needs to be easy. People need to meet their most immediate needs first, he said, explaining that lack of transportation, hunger or not knowing where to sleep that night can all be deterrents for people who might otherwise seek help.

“I think that we have such an easy thing to do and we can’t ever do it easy,” Harney said. “We always want to make it hard. We make it hard on people to … meet certain demands of our agencies, sometimes, in order to get the services.”

More education about substance use disorder, harm reduction and homelessness is needed throughout the community, the panelists agreed.

Hoyle described being contacted by individuals who oppose the plans for a low-barrier shelter the county and city are developing.

“There are some people who think that folks who are not sober don’t deserve a place to be,” Hoyle said. “So I just try to really just engage people in conversations and ask them, ‘If you don’t think [people who use substances] should be in a shelter, for example, what do you think we should do?'”

Hoyle continued, “And every time I have asked that question, immediately folks say, ‘Oh, well, they do need a place to be. So I think what you’re trying to do is really great.'”

The audience laughed in response.

“I think it’s about having really simple conversations like that and providing education all the time,” Hoyle said.