Harm Reduction Hacks in Focus: Space Hacks
Background and Process
Space Hacks is the product of a series of surveys, qualitative interviews, and a community editing process.
Balanced Imperfection (BI) began the Space Hacks project by researching existing databases, tool kits, and other resources regarding space management, trauma, trauma-informed care, transformative and restorative justice, de-escalation, and so on.
Based on this background review, BI designed a survey for harm reduction frontline staff and other folks who have worked in harm reduction spaces.
Using insights from the 180 completed surveys, BI interviewed twelve longtime leaders in harm reduction who had managed, or were currently managing, fixed-site harm reduction spaces, including drop ins, OD prevention sites, syringe access services, and MAT programs.
BI completed on-on-one interviews with 18 harm reduction leaders possessing a combined experience of some 330 years. Interviewees all had a minimum of 10 years working in harm reduction, with the most senior interviewees having worked over thirty years in harm reduction. The average experience level was 18 years.
Interviewees were from across North America. Those interviewed were disproportionately from either the Northeast or Pacific coast, which dovetails with the over-representation of these regions during the early days of the movement. Many have also worked nationally and internationally on harm reduction efforts around the globe.
One hundred percent of respondents had done direct service work as outreach workers or syringe access workers, and all respondents had also been a site manager at a fixed-site harm reduction program. Over half (55%) had also been, at one time or other, participants in programs they later either worked for or managed, and about 90% had worked in executive leadership roles including organizations with a national scope.
The size of the programs varied wildly; some interviewees managed fixed-site harm reduction programs that had up to 800 participants per day while others had programs that managed as few as 100 participants per week.
Interviews lasted between 67 and 128 minutes, comprising a total of 939 minutes of interviews, and took place between March 15 and May 16, 2024. Interview questions were divided by the three main sections of the final project: prevention, immediate response, and long-term response. All interviews were securely recorded and transcribed by artificial intelligence, and contemporaneous notes were kept via an on-line survey filled out by the interviewer.
These were then analyzed for the themes, individual insights, and best practices reported in Space Hacks.
Using these survey results, insights, background research, and experience, Space Hacks was designed, written, and edited. Finally, a community editing process took place that vetted Space Hacks and Space Hacks in Motion for content and accuracy.
Finally, all of the edited material was published in our PDF, this website, and launched for community use.
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“The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
Mayor Jim Kenney -
“One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
Charles M. Blow -
"Letting go gives us freedom, and freedom is the only condition for happiness. If, in our heart, we still cling to anything - anger, anxiety, or possessions - we cannot be free."
Thich Nhat Hanh -
"Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
Fred Rogers -
"Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
Martin Luther King Jr. -
“In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
-
"We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
Jules Netherland -
We need to play that game where we require politicians to finish every sentence denouncing supervised injection facilities with the phrase, “and that is why I think injecting alone in a McDonald’s bathroom is better.”
Jonathan Giftos -
"What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured."
Kurt Vonnegut Jr. -
"Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
Dominique de Villepin -
"One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult. "
-
"The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
Judith Lewis Herman -
“When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help. That's the message he is sending.”
Thich Nhat Hanh -
"Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
Gabor Maté -
“Identify five things that you can see, four things that you can touch, three things that you can hear, two things that you can smell and one thing that you can taste.”
-
"I describe my experiences as a nurse volunteer at the overdose prevention site as “being in the right place at the right time doing the right thing.” And that’s exactly where I want to be as a nurse: working outside the system to make a real difference in people’s lives, showing up in the community when it matters most and challenging rules that directly contribute to the overdose crisis, and exposing government inaction by being part of the solution on the ground. For me, this is what nursing is all about."
Marilou Gagnon -
“Boundaries help me to give all that I can and still come back tomorrow.”
-
"We live in a world in which we need to share responsibility. It's easy to say "It's not my child, not my community, not my world, not my problem." Then there are those who see the need and respond. I consider those people my heroes."
Fred Rogers -
“Many of the harm reduction leaders interviewed talked about the importance of not having too many policies and involving your participants in the development of policies—especially those that impact them directly.”
-
“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
Audre Lorde -
"If you question harm reduction works, I can’t help but wonder if you have ever actually seen what happens in these spaces. We promote health safety and dignity, and it works. It is simple, beautiful and changes peoples lives."
Haven Wheelock -
"One of the most important things we can do as advocates is to define & make concrete the vague terms used by politicians. What does it mean to “take a public health approach”? What you mean when you say “treatment”? Politicians rarely know. Our job is to make it plain for them."
Jonathan Giftos -
"Opponent’s of syringe service programs and harm reduction in general typically remark that it “sends the wrong message.” The message they are referring to is, “We love you and want you to be safe.”
Christopher Abert -
"We have to be ready and able to reach clients where they are, not where we want them to be”
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"There isn’t a way things should be. There’s just what happens, and what we do."
Terry Pratchett -
“As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
-
"Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
Fred Rogers -
“People who cause harm are often also survivors of harm. If we want to address the roots of violence, we have to honour both truths.”
Danielle Sered
- “The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
- “One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
- "Letting go gives us freedom, and freedom is the only condition for happiness. If, in our heart, we still cling to anything - anger, anxiety, or possessions - we cannot be free."
- "Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
- "Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
- “In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
- "We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
- We need to play that game where we require politicians to finish every sentence denouncing supervised injection facilities with the phrase, “and that is why I think injecting alone in a McDonald’s bathroom is better.”
- "What should young people do with their lives today? Many things, obviously. But the most daring thing is to create stable communities in which the terrible disease of loneliness can be cured."
- "Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
- "One of the problems that arises with the term “people who use drugs” is that it is intentionally pluralistic in its embrace of ALL people who use drugs—from recreationally to deeply problematically. This makes using it to talk about the things that especially impact people who are using drugs problematically very difficult. "
- "The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
- “When another person makes you suffer, it is because he suffers deeply within himself, and his suffering is spilling over. He does not need punishment; he needs help. That's the message he is sending.”
- "Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
- “Identify five things that you can see, four things that you can touch, three things that you can hear, two things that you can smell and one thing that you can taste.”
- "I describe my experiences as a nurse volunteer at the overdose prevention site as “being in the right place at the right time doing the right thing.” And that’s exactly where I want to be as a nurse: working outside the system to make a real difference in people’s lives, showing up in the community when it matters most and challenging rules that directly contribute to the overdose crisis, and exposing government inaction by being part of the solution on the ground. For me, this is what nursing is all about."
- “Boundaries help me to give all that I can and still come back tomorrow.”
- "We live in a world in which we need to share responsibility. It's easy to say "It's not my child, not my community, not my world, not my problem." Then there are those who see the need and respond. I consider those people my heroes."
- “Many of the harm reduction leaders interviewed talked about the importance of not having too many policies and involving your participants in the development of policies—especially those that impact them directly.”
- “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
- "If you question harm reduction works, I can’t help but wonder if you have ever actually seen what happens in these spaces. We promote health safety and dignity, and it works. It is simple, beautiful and changes peoples lives."
- "One of the most important things we can do as advocates is to define & make concrete the vague terms used by politicians. What does it mean to “take a public health approach”? What you mean when you say “treatment”? Politicians rarely know. Our job is to make it plain for them."
- "Opponent’s of syringe service programs and harm reduction in general typically remark that it “sends the wrong message.” The message they are referring to is, “We love you and want you to be safe.”
- "We have to be ready and able to reach clients where they are, not where we want them to be”
- "There isn’t a way things should be. There’s just what happens, and what we do."
- “As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
- "Anything that’s human is mentionable, and anything that is mentionable can be more manageable. When we can talk about our feelings, they become less overwhelming, less upsetting, and less scary. The people we trust with that important talk can help us know that we are not alone."
- “People who cause harm are often also survivors of harm. If we want to address the roots of violence, we have to honour both truths.”