Harm Reduction Hacks in Focus: Space Hacks
Hacks for Preventing Escalation
There are 71 hacks in this section
Why Prevention?
Preventing escalation is the responsibility of each harm reduction leader
Every single leader that participated in Space Hacks, and many other experts, ALL assert that the best way to de-escalate an escalating situation is to do so well before the escalation ever presents itself. In fact, it is estimated that 90% of escalated situations can be prevented, which is why this is the largest section of Space Hacks.
Preventing escalation is the responsibility of each harm reduction leader and organization, as well as each staff person, volunteer, and even participant.
For a variety of reasons, situations that escalate to the point of chaos are not uncommon at harm reduction service sites. First and foremost, harm reduction service participants are likely to be highly traumatized and suffering from extreme stress—which are also huge risk factors for chaotic drug use. Participants may also be sleep deprived or hungry, which is so well known to cause emotional outbursts that we invented the word “hangry” to describe it. In addition, many people face the stresses of stigma, being unhoused, chaotic drug use, systemic oppression, having limited social connections, and few if any resources, making for a stressful and volatile mix.
People who are suffering from trauma and stress are reactive because they are almost always in an activated amygdala state, which means that their emotions and stress hormone levels are heightened, rendering them both more emotional and less likely to be able to react rationally to adversity or conflict.
Moreover, many participants are also suffering from mental health conditions which may leave them confused, agitated, and/or combative, as well as, chronic illnesses which may also interfere with typical reactions and will certainly increase stress.
Leaders expressed that knowing this helps them not personalize, and maintain empathy, when participants become emotionally dysregulated or move toward escalation.
In terms of programmatic and/or management responsibility, escalation prevention includes:
- Personal Escalation Prevention
- Practicing Harm Reduction
- Building Community
- Physical Environment /Set-Up
- Organization Boundaries and Policy Setting
- Team Cohesion and Communication
- Training and Education
This section is made up of the following categories:
Personal Boundaries
Posted in Personal Escalation Prevention.
The most important first step when it comes to preventing escalated situations is having a good sense of personal and professional boundaries when doing the work.
Resilience Building
Posted in Personal Escalation Prevention.
Because so many of us are so similar to the folks we serve, including the trauma we carry with us, and because it is now recognized that extreme stress impacts people who care for people experiencing that trauma nearly as much as the people directly impacted by that trauma, it is essential that people in […]
Practicing Harm Reduction with Self
Posted in Personal Escalation Prevention.
Harm reductionists are pretty good at forgetting that the advice we give others—that change takes time, that incremental change is best, that chipping away at a problem is the only way to change, that change is possible and desirable.
What is Big H, Big R Harm Reduction?
Harm reduction is often thought of as merely the provision of risk reduction supplies and health education, but those practical strategies are sometimes called little ‘h’ little ‘r’ harm reduction because, according to almost every harm reduction expert spoken to, those intervention methodologies are only the lubricant for the real spirit of harm reduction that helps people change and creates spaces where escalation is less likely to occur.
Hacks for Practicing Big H, Big R Harm Reduction
That spirit of harm reduction, it is believed by many, is also essential to providing the kinds of services that result in people being twice as likely to enter treatment for SUD if they’ve accessed harm reduction than if they haven’t.
The 4-C’s Hack
The 4-C’s of harm reduction outreach were originally the 3–Cs, and were developed by Christian Crump, then of John the XXIII syringe access in Salinas, California, and later modified to include the 4th by Catherine Swanson and Roxanne Butterfield.
Edie Springer’s Worker Stances for Clients Who Use Drugs & Harm Reduction Worker: Best Practices
Harm reduction immediately resonated for Edie, who was herself a former drug user and methadone patient. Faced with the devastation of HIV’s impact on drug-using communities, Edie fully embraced harm reduction and trained hundreds of harm reduction workers who have carried her legacy with them. She developed these worker stances in 1996 and they have been shared among many of us in the harm reduction community for generations.
Creating and Defining Community
Posted in Community Building.
Over and over, harm reduction leaders interviewed for Space Hacks centered the creation of community as central to their efforts to create safe, humane harm reduction spaces services that are trauma-informed and minimize the potential for escalated situations.
Hacks for Developing Internal Community
Posted in Community Building.
Building internal community means building relationships based on your shared values as a part of a harm reduction organization.
Practical Hacks for Team Building and Community Unity
Posted in Community Building.
Beyond the abstract instructions for building community, like practicing equity and being fair, are some very concrete suggestions on building community.
Hacks for Developing Larger/External Community
Posted in Community Building.
Your external community is made up of the larger community around you, such as neighbors and other community members. It is imperative that you make allies with people in your larger community, city, county, health jurisdiction, and/or your state, to help ensure that things do not escalate with the larger community either.
Being Neighborly: Right Outside Community Relations Hacks
Posted in Community Building.
Your neighbors adjacent to your sites are some of the most important allies to develop. These folks can be an asset, or a liability, and the choice is partially predicated on how you approach them and how responsible a community member you and your organization are in the community where you set up shop.
Preparing for the Worst: Hacking NIMBYs
Posted in Community Building.
No matter how friendly we are and how good our intentions, there may be people in the community who are hostile to the work we do with people who use drugs and other marginalized community members. Therefore, it’s imperative that in addition to being warm, friendly, inviting, and transparent as much as possible, we also prepare for the worst.
Types of Fixed Harm Reduction Service Sites
Posted in General Space and Service Management Hacks.
When thinking about creating safer, more humane, trauma-informed harm reduction spaces, it’s important to begin by assessing the kind of space that you have. Not all harm reduction sites are the same, and each have their own challenges as well as assets to consider.
Types of Mobile Service Harm Reduction Provision
Posted in General Space and Service Management Hacks.
Mobile harm reduction services come in many forms—each shaped by local needs, available resources, and the creativity of the people providing care. From backpack outreach to vans, bikes, and home delivery, these models offer flexibility, build trust, and reach people who may never visit a fixed site. This section explores the unique strengths and limitations of different mobile approaches
Building Better Policies in Harm Reduction
One of the most important steps when considering the development of harm reduction services is to think about expectations, including what boundaries you’d like to set for behavior. In organizations, these boundaries are often formalized as policy. 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
Policy Creation Hacks
Creating effective policies in harm reduction work means grounding them in your mission, being thoughtful about their impact, and ensuring they’re both practical and inclusive. The tips below offer a starting point for organisations looking to build policies that reflect their values, meet external requirements, and genuinely support the people they serve and work with.
Participant Advisory Boards Hacks
In addition to traditional Boards of Directors, many harm reduction agencies have other bodies for democratic control of various aspects of an organization, especially ones where participants can share responsibility and power with the organization
Physical Setup & Design
It’s important to think about the physical set-up and design of the space—be it a fixed site or mobile service—in order to minimize escalation.
Hacks for Defining Your Physical Parameters
Multiple harm reduction leaders talked about the importance of developing a sense of the physical parameters of your site. This refers to the amount of territory around you that you’re willing to be responsible for in terms of cleanliness and/or de-escalation.
Trauma Sensitive Spaces
In terms of physical space design, there are three important things harm reductionists need to bear in mind when creating harm reduction spaces, vis-à-vis trauma.
Disability Awareness
A disproportionate number of people who suffer from a disordered relationship with substances also suffer from a physical disability. By some estimates, twice as many people who use drugs have a physical disability as the rest of the population.
Universal Precautions and Workplace Safety
Though not all harm reduction organizations or programs are in need of universal precautions or OSHA considerations, most are. It’s important when setting up a harm reduction space to take into consideration the important and real risks of harm reduction work. This includes the potential for entry and exposure to blood-borne pathogens as well as airborne pathogens.
Overview of Disease Transmission and Universal Precautions
Infectious diseases have always been humanity’s companions and are spread in a myriad of ways. Direct contact infectious disease transmission occurs when there is physical contact between an infected person and a susceptible person, such as with a sexually transmitted disease or respiratory illness. Indirect contact transmission occurs when there is no direct human-to-human contact. Indirect contact occurs from a reservoir like a used surface or objects, or from vectors such as mosquitoes or ticks.
Universal Precautions: Handwashing
Proper hand washing is crucial to preventing the spread of infection, and staff and volunteers are encouraged to wash their hands several times a day and are instructed to do so before and after each shift and after handling any used supplies.
Universal Precautions: Gloves
Medical gloves should be worn whenever handling exposed or used supplies, especially those that might be used to prepare or use injection drugs such as syringes, cottons, cookers, tourniquets, and ascorbic acid. Gloves should be changed often, especially between activities or participants.
Universal Precautions: Footwear & Attire
To help prevent needlestick injury and pathogen exposure, harm reduction workers should always wear closed shoes while working. Flat shoes that are comfortable for walking, made of leather or another heavy material, are also recommended but not required.
Universal Precautions: Syringes & Supplies
In general, exposed syringes, that is, unpackaged, unused single syringes, and safer injection supplies such as cottons, cookers, tourniquets, etc. should always be treated with universal precautions. This means that staff and volunteers should never handle them without gloves and/or proper precautions, even if they are capped. Syringes that are still in containers such as boxes or bags are not subject to universal precautions.
Universal Precautions: Environmental Cleanup
Harm reduction providers should, as a matter of course, include environmental cleanup of syringe litter and paraphernalia in and around where they provide services.
Universal Precautions: Surface Safety
These guidelines outline simple, practical steps for surface cleaning that support the health of both participants and staff.
Post-Exposure Prophylaxis Hacks
Though largely unsupported by scientific evidence, the dangers of needle stick injury loom large in the popular imagination. As a result, the emotional response to needle stick injury can be intense even if, statistically, the risks are quite low. For this reason, if no other, it’s essential that harm reduction organizations be prepared for how they might deal with such an eventuality.
Universal Precautions: For Droplet or Airborne Pathogens
During air- or droplet-borne disease outbreaks such as COVID, harm reduction staff or volunteers are required to follow all normal universal precautions and wipe down all surfaces used by more than one person, including pens, clipboards, chairs, desks, cabinet fronts, floors, doors, steering wheels, and so on, at the beginning and end of each shift with a broad spectrum anti-microbial surface cleaner.
Misconduct: A Word About Words
Posted in Hacks for Policy Violation Prevention.
It is challenging to describe behavior that may be outside of social norms, unethical, or dangerous without entirely stigmatizing the person doing the behavior. The very language itself is designed to describe these behaviors entirely in moral terms.
Misconduct Prevention Hacks
Posted in Hacks for Policy Violation Prevention.
When talking about misconduct, which includes violence, threats of violence, theft, vandalism, or otherwise harmful, antisocial or even criminal acts in harm reduction organizations, it’s important to view them from a slightly different lens than is typical.
Hacks for Service and Supply Management
Many of the harm reduction leaders that were interviewed for Space Hacks talked about how critical it is to effectively manage services, supplies, and inventory in order to maintain community tranquility. It may not feel intuitive, but OGs report that ineffective management of supplies is the number one potential flashpoint for escalated situations during harm reduction services.
Hacks for Service and Supply Exceptions
There are always going to be exceptions to the rule of thumb about consistency regarding service provision. At times, certain participants will need to be treated differently than other participants. For example, people who are pregnant may be treated differently, elderly people may be treated differently, people who are providing satellite exchange services to large community groups may also be an exception or have special privileges.
Hacks for Service and Supply Interruptions
As with exceptions, supply interruptions can be handled with the same transparency and communication. Be explicit with people about why the interruption is happening and tell them when it might be over. Be sure to remain equivocal if you aren’t sure about things. Authentic ambiguity is preferable to disingenuous certainty.
Hacks for Community Member Agreements
Community member agreements are shared agreements regarding behavior expected of everyone who participates in a harm reduction site or service. The primary rule all harm reduction leaders talked about was the need to treat everyone with respect.
Hacks for Participant Grievance Processes
At their most basic, grievance procedures provide a formal mechanism for your participants to have their concerns, grievances, and voices heard and taken seriously. Too often, participants are re-traumatized by the provider/participant power imbalance when provider perspectives are given deference—in other words, when providers are automatically believed.
Hacks for Misconduct Processes
Misconduct procedures must be equitable and consistent with clear mechanisms for appeal, ensure that all parties are heard, and that issues, when they do arise, are dealt with individually as much as possible.
Hacks for Overdose, Overamp, & Medical Emergencies
In addition to the necessity for policies for service and supply management, community agreements, grievance, and misconduct processes, another essential set of policies harm reduction leaders consistently recommended were protocols for dealing with potential overdose, overamp, and medical emergencies such as heart attack or stroke.
Hacks for Pre-Service Prep in Fixed Sites
Posted in Space Management—Fixed Site Specific.
A well-prepared site sets the tone for the day and helps everything run more smoothly. Whether it’s organising supplies, tidying the space, or checking in with the community, taking time before opening ensures that both staff and participants feel supported.
Hacks for Waiting Room or Lounge Management
Posted in Space Management—Fixed Site Specific.
Waiting areas are often the first part of a service space that people experience, so setting a calm, welcoming tone matters. A few simple practices—like clear signage, consistent expectations, and light refreshments—can help reduce tension and support a respectful environment.
Hacks For Bathroom & Shower Management
Posted in Space Management—Fixed Site Specific.
Bathrooms and showers are essential services in many harm reduction spaces—but they also come with unique safety, privacy, and accessibility considerations. Creating clear expectations, preparing for medical emergencies, and designing with compassion can help ensure these spaces remain safe, dignified, and functional for everyone who uses them.
Hacks for Laundry Management
Posted in Space Management—Fixed Site Specific.
Laundry access can be a vital part of supporting dignity, health, and comfort—especially for people navigating unstable housing. With a few clear guidelines and the right supplies, laundry services can run smoothly while remaining welcoming and respectful.
Hacks for Locker Management
Posted in Space Management—Fixed Site Specific.
Lockers can offer a rare sense of security and stability for people who carry their belongings with them. To keep the system fair and functional, it’s important to have clear expectations, consistent rules, and a plan for managing demand.
Notes About Clinical Space Management and OD Prevention Spaces
Posted in Space Management—Fixed Site Specific.
Some harm reduction spaces require specialised knowledge, regulations, and infrastructure that go beyond the scope of these general tips. Clinical spaces and overdose prevention sites in particular involve complex planning, staffing, and compliance considerations.
Hacks for Mobile Shift Prep
Posted in Space Management—Mobile Services Specific.
This refers to the groundwork that must be laid before services take place, and should be updated regularly/at least once a year regarding what supplies are needed.
Hacks for Personal Safety and Boundaries During Mobile Outreach
Posted in Space Management—Mobile Services Specific.
Personal safety during mobile outreach has a slightly different dynamic than brick and mortar spots with walls and lots of people. Mobile outreach by definition takes place on the street, in peoples campsites, in trap houses, and in other environments where misconduct is simply more likely.
Hacks for Vehicular Outreach
Posted in Space Management—Mobile Services Specific.
Running harm reduction services from a vehicle adds mobility and reach—but also comes with its own set of logistical challenges. From packing and maintenance to mapping routes and finding parking, thoughtful planning helps keep things smooth and sustainable. Make sure the bags and/or vehicles are packed leaving enough time for transiting to your locations. Create […]
Hacks for Outreach On-Foot/Backpack
Posted in Space Management—Mobile Services Specific.
Street outreach is one of the most direct and personal ways to connect with people who might not otherwise engage with services. Often done on foot and out of backpacks, this work requires careful preparation, deep respect for people’s space, and a strong sense of safety and teamwork.
Hacks for Harm Reduction Home Delivery
Posted in Space Management—Mobile Services Specific.
Home delivery can be one of the most meaningful and trusted forms of harm reduction—bringing care directly to people in the places they feel safest. It also requires a high level of discretion, respect, and planning to protect confidentiality and ensure safety for both participants and workers.
Hacks for Bicycle and Other Alt Vehicle Service Delivery
Posted in Space Management—Mobile Services Specific.
Using bikes, carts, or other alternative vehicles for outreach offers flexibility, low costs, and a smaller environmental footprint. While the core principles remain the same as other forms of mobile harm reduction, there are a few extra considerations to keep things rolling smoothly.
Service and Supply Management Hacks for Mobile Services
Posted in Space Management—Mobile Services Specific.
OGs repeatedly report that ineffective management of supplies is the number one potential flashpoint for escalated situations during harm reduction services, because it can make people feel like they are treated unfairly. Because of this harm reduction leaders had special suggestions for managing services and supplies during mobile service delivery.
A Note About Mobile Trauma-Informed Service Delivery
Posted in Space Management—Mobile Services Specific.
“Trauma-informed care” is somewhat more complex in mobile harm reduction delivery because workers don’t have complete control over the environment in which they’re working.
Hacks for Setting the “Vibe” & Community Ambassadors
Posted in Not So Obvious Escalation Prevention Hacks.
A less tangible quality leaders talked about that helped create de-escalated spaces was setting the “vibe of the space”—that is, setting the emotional tone as friendly, warm, and inviting.
The Sugar vs. Bass Hack
Posted in Not So Obvious Escalation Prevention Hacks.
Another intangible hack offered by harm reduction leaders was the idea of what one called “sugar” and “bass”. What they meant was ways to use tone, inflection, and voice to help diffuse and reinforce the impact of enforcing community agreements or boundaries.
Hacks for Training & Cross-Training for De-Escalation
Posted in Space Management—Mobile Services Specific.
It may seem odd to think of training or cross-training as have anything at all to do with handling escalated situations in harm reduction spaces, but in fact, it is invaluable for all staff to be trained and cross-trained.
Hacks for System Building & “Proceduralization”
Posted in Not So Obvious Escalation Prevention Hacks.
“Proceduralization” is a term coined by harm reductionist Haley Coles to describe the process of creating and, critically, writing down exact protocols for a variety of different tasks and services. These are step-by-step written instructions for how to do everything in the space, from passing out supplies to cleaning the restroom.
Hacks for Kids at Site / During Service Provision
Posted in Special Issues.
The first thing to know about having kids at site is that most harm reduction workers are not mandatory reporters. This is not true of harm reduction workers who also happen to have certain kinds of licensure; however most people who work at harm reduction programs are not mandatory reporters, which allows them the discretion to not report if they see children in situations that would trigger mandated reporting for some licensed professionals.
Hacks for Youth Participants
Posted in Special Issues.
Like kids at site, the first thing to know about youth participants (12-18) is that most harm reduction workers are not mandatory reporters. This is not true of harm reduction workers who also happen to have certain kinds of licensure.
Hacks for Preventing Beef
Posted in Special Issues.
Some of the most escalated situations in harm reduction spaces are conflicts between participants that are pre-existing and have nothing to do with the site.
Hacks for Avoiding Having Police at Site
Posted in Special Issues.
It should be self-evident that having law-enforcement at service sites with criminalized populations would discourage those populations from coming there for services.
Hacks About Weapons at Site
Posted in Special Issues.
People starting out in harm reduction sometimes have concerns about participants possessing weapons at site.
Hacks for Human Trafficking Disclosures
Posted in Special Issues.
The need for support for human trafficking victims is rare in harm reduction organizations; however, you should think of having a plan just in case it does come up.
Hacks for IPV Disclosures
Posted in Special Issues.
Rarely will someone say they’re “being beaten” or “abused”; instead, they may hint by saying that someone ”lays hands” on them, or that they “get into it”, or employ some other euphemism.
Hacks for Third Party Disclosures
Posted in Special Issues.
Dealing with third party disclosures—that is, when someone is telling you they know of someone else who is experiencing, or has experienced, abuse such as intimate partner violence, sexual assault, child abuse, trafficking, or any situation where a third party is being abused—can be frustrating because, as harm reduction providers, our options are limited.
Hacks for Disclosures of Violence or Threats
Posted in Special Issues.
As with any group of humans, some of the people who access harm reduction are violent towards others and, moreover, they occasionally disclose this to harm reduction workers—in part because harm reduction services and spaces offer non-judgmental environments in which people often feel safe enough to disclose their violence, or they may be so agitated that they share their feelings of wanting to commit violence in the moment.
Hacks for Sexual Assault Disclosures
Posted in Special Issues.
Sexual assault is another topic that people will rarely be direct about. Instead, they may talk in euphemisms or even be confused that their experience was consensual when it could not have been, especially for minors.
Hacks for Suicidal Folks
Posted in Special Issues.
People rarely talk about suicide directly, but many of our participants suffer from serious depression and think about suicide a lot.
Hacks for Phone and Cyber Security
Posted in Special Issues.
In an era of increased surveillance and risk for criminalized populations, it is increasingly essential for harm reduction organizations to think about electronic security and hygiene.
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“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.”
-
"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 -
"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. -
"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 -
“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 -
"We have to be ready and able to reach clients where they are, not where we want them to be”
-
"We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
Jules Netherland -
"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 -
"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 -
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 -
“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.”
-
"Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
Gabor Maté -
“One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
Charles M. Blow -
"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 -
“In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
-
"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 -
"Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
Martin Luther King Jr. -
“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 -
“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 -
“Boundaries help me to give all that I can and still come back tomorrow.”
-
"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 -
"Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
Dominique de Villepin -
“Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
Audre Lorde -
"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 -
"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 -
"There isn’t a way things should be. There’s just what happens, and what we do."
Terry Pratchett -
"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. "
-
“As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”
- “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.”
- "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."
- "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."
- "The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma."
- “The bottom line is that overdose prevention sites — which exist in more than 100 cities around the world — offer compassion for fellow human beings,”
- "We have to be ready and able to reach clients where they are, not where we want them to be”
- "We don’t need to professionalize the people closest to the crisis. We need to recognise them as professionals already.”
- "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."
- "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."
- 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.”
- “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.”
- "Not all traumas are the result of what happened to you; some are the result of what didn’t happen for you"
- “One doesn’t have to operate with great malice to do great harm. The absence of empathy and understanding are sufficient.”
- "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."
- “In general, it is antithetical to harm reduction best practices to call the police except under the most extreme life-or-death circumstances.”
- "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."
- "Darkness cannot drive out darkness: only light can do that. Hate cannot drive out hate: only love can do that."
- “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.”
- “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.”
- “Boundaries help me to give all that I can and still come back tomorrow.”
- "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."
- "Between an uncontrolled escalation and passivity, there is a demanding road of responsibility that we must follow. "
- “Caring for myself is not self-indulgence, it is self-preservation, and that is an act of political warfare.”
- "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.”
- "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."
- "There isn’t a way things should be. There’s just what happens, and what we do."
- "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. "
- “As always, be transparent with participants about what you have, what you don't have, and/or what's for only special populations.”