Introduction and Acknowledgements

Harm Reduction Hacks in Focus: Space Hacks / Space Hacks in Motion (HRH-SP) was written by Catherine Swanson, MPH, of Balanced Imperfection under contract with the National Association of County & City Health Officials (NACCHO) for the Centers for Disease Control and Prevention (CDC), with assistance and editing support from Simon Knaphus JD, Shira Hassan, Roxanne Butterfield, Billy Perez, and Sol Rodriguez.

Ms. Swanson was excited to expand the work of the popular Harm Reduction Hacks brand, initially developed for NASTAD. This project expands on resources provided in that work and the many years Ms. Swanson has spent training harm reduction leaders in best practices for managing harm reduction services, preventing escalated situations, and responding to incidents when they occur.

Like the original Hacks, Space Hacks hopes to save others in harm reduction from some of the trial and error that many of us had to go through to understand what “best practices” are for managing fixed-site harm reduction spaces.

Also similar to the original Harm Reduction Hacks, Space Hacks is not comprehensive. There is simply no way to encapsulate every single bit of wisdom in the harm reduction community around de-escalating situations, so if you see a glaring omission, please forgive us and feel free to let us know!

The author would also like to acknowledge the dedicated and beautiful work of Nigel Brunsdon Photography, and his long-running practical site Injecting Advice. He makes the world more beautiful in so many ways just by existing.

This toolkit represents the synthesis of the invaluable opinions, experiences, and knowledge of nearly 500 harm reductionists. The author and sponsors of Space Hacks would like to gratefully acknowledge those leaders, old and new, who took the time to share their insights and experiences, either through contributing to one of our surveys or agreeing to be interviewed. We hope we do them justice and, in turn, ensure that other folks in harm reduction can create safer, more inclusive harm reduction services with better tools and insights than many of us had.

I am especially grateful to the folks who agreed to be interviewed and/or participated in the community editing process, including:

This project is dedicated to John Day and Scottosaurus, two longtime healthcare activists at the Berkeley Free Clinic in Berkeley, California—the longest running volunteer, peer-led clinic in the world.

The Free Clinic, as it is affectionately known, has trained generations of folks who have gone on to careers in healthcare and adjacent fields.

Scottosaurus was a member of the Free Clinic, providing healthcare services and access to healthcare information on then-radical topics such as “VD-venereal disease” (STIs) and drugs when the internet didn’t exist and this information was impossible to come by, from 1971 until his death in 2008.

John Day was a four-term combat medic veteran newly returned from Vietnam when he had a negative but catalysing experience at a local health center that treated him poorly, largely for being a gay man.

John went to the Free Clinic to start a program expressly focused on gay men’s health—one of the first in the world—in 1976, called the Gay Men’s Health Collective (GMHC).

These two men handled the lobby of the Free Clinic for decades, essentially a drop-in space like any harm reduction space. They handled hundreds if not thousands of escalated incidents in the Free Clinic lobby, and the author is grateful to have been their mentee and learned from them the best of best practices for ensuring safe, de-escalated services that don’t leverage authoritarianism to be successful.

And finally, a huge thank you to everyone providing harm reduction services to vulnerable people with kindness and compassion. Never forget that you and your work are vitally important.

The world is still a better place because you are in it.