Every day, Darrel Burrell and his team of outreach workers set up a card table near a known drug –dealing site.
Every day, they hand out about fifty kits containing condoms, Narcan, an antidote for an opioid overdose, and fentanyl test strips.
And every day they teach the people they meet how to check their drugs for the extremely lethal fentanyl, the lead cause by far of opioid overdoses in Maryland, health officials say.
Sometimes, someone will come over to their card table and pick up a pen or a lighter with the slogan, “Take it Slow” – a phrase that encourages those who are addicted to slow their intake of dangerous opioids.
That mentality – along with the fentanyl test strips and Narcan – are part of what public health experts call “harm reduction.” By reducing the harm from drug use, they say, you help an addicted person live another day, a day that person may start on the path to treatment.
Yet, there are those who are addicted to opioids who want the extremely deadly fentanyl – it’s cheaper than heroin and provides a higher high.
So, what does the path from addiction to harm reduction to recovery look like?
Darrel Burrell, who works for Bmore POWER, part of Behavioral Health Systems of Baltimore, says he and his team understand addiction from a unique perspective. Many on the staff have been on the other side of this table. They know what it’s like to chase a deadly drug. And what’s it like to be out here alone.
“A lot of people don’t come out here,” he says, “to offer the narcan, to offer encouragement, just to offer a conversation with the people…still on the cuff.”
That sense of being alone makes it very difficult to research the options available for treatment, he points out.
Burrell and his team are called “access points” – people who can help those with drug addictions easily find help.
When folks pick up a lighter, they might also spot the literature about treatments programs or housing or counseling that’s also on the table. But outreach workers, like Roichelle Johnson, don’t push the topic.
“I can’t make them take a kit – they gotta take it," she says. "I can’t make them go recovery – they gotta want it.”
Johnson says she never tells someone to stop using opioids. She doesn’t think that’ll help. Instead, she calls out “Free Narcan”. And with that approach, she says, she’s reached quite a few people – and when they start talking, they begin building relationships.
“The next time they see us they might tell us – ‘I used that kit and saved somebody’s life.’ And they want another.”
And sometimes, Johnson says, sometimes they come back – wanting something more..wanting treatment.
“We have a handful of people who are not using right now because we helped them get into treatments," she says. "They go, sometimes not right away but they do go.”
She says the handful of people now in recovery represents progress.
But it’s complicated.
Burrell says just because someone is in treatment, it doesn’t mean that person is “in the clear” from addiction. That's why the team sometimes set up near a popular methadone clinic. They’re trying to reach those who have relapsed and might be turning to the most lethal drug on the streets right now.
Methadone, used in addiction treatment, blocks the high from heroin. But not from fentanyl.
“The person might be on the methadone program but they still taking the fentanyl because they feeling the fentanyl over the methadone,” Burrell explains. “They still looking for that dope feeling but they getting it from the fentanyl. It’s replaced the heroin.”
Health workers began distributing fentanyl test strips in Baltimore several weeks ago. They’re coming to other jurisdictions soon.
Maryland health officials say they plan to distribute some 66,000 test strips throughout the state by the end of the year.
So, will access to fentanyl test strips - and all the other tools of harm reduction - lead someone to treatment?
Well, said one health worker, they’ll work – in some instances and to a certain degree.