CONCORD, N.H. — On a Thursday evening, in a two-story white converted house, a small group of volunteers gathers to put together kits for safe drug use.
Aquila Robinson is one volunteer who considers herself a regular at the weekly sessions, deftly slipping alcohol pads, cookers, tourniquets, and fentanyl test strips into transparent plastic bags to create safe injection kits.
It’s one way the 19-year-old helps herself stay on track with her own recovery.
“Being involved in a group of people that are recovery-oriented but not abstinence based” has really helped her, she said. “There’s zero judgment.”
Volunteers also assemble wound care kits, with materials like bandages, antibiotic ointment, and hand sanitizers.
Those kits are then distributed during the week to people who use drugs in Concord, Manchester, and the tri-city area, which includes Rochester, Dover, and Somersworth, by a grassroots coalition called the New Hampshire Harm Reduction Coalition.
Harm reduction has been gaining traction in New Hampshire in recent years, as an evidence-based way of making drug use safer and healthier and combating the deadly opioid epidemic. Providing clean syringes can be a life-saving measure, according to the Centers for Disease Control and Prevention.
But giving clean needles and other drug equipment is still a controversial proposition, and as the state moves to define harm reduction, some proponents worry about efforts to dilute it — to the detriment of those they are trying to serve.
“Harm reduction needs to always include things like sterile syringes,” said Lauren McGinley, the executive director of the Harm Reduction Coalition. And some people don’t like that or believe these efforts are simply enabling drug use. “I get it,” said McGinley, “those supplies are uncomfortable.”
But, she said, harm reduction can reduce fatal and non-fatal overdoses. And it’s a strategy most people already employ in other areas of their life, she said, pointing to sunscreen and seat belts.
“People are always going to continue doing that activity, but we’ve just taken steps to make it safer,” she said.
“There’s hospital admissions that last for six weeks because of a simple infected wound that could have been prevented with a 10-cent syringe,” she said.
Donna Harbison, the director of care coordination for the coalition, said before harm reduction was widely accepted in the state, people would buy used needles for $5 on Craigslist, greatly increasing the risk of spreading disease.
“Why are we not supporting everyone to be safe?” she said.
That’s what the coalition is trying to do, by using a plus ten syringe exchange, where participants can receive 10 more syringes than they bring. If someone brings 20 used needles, they can receive 30, according to Harbison. It’s meant to prevent infections and wounds by keeping people from reusing old needles.
They also provide injection alternatives, so people can smoke drugs instead of injecting them or ingest drugs rectally. And they distribute naloxone, which can reverse an overdose and save lives.
McGinley said it’s an opportunity to show people who use drugs their health and safety matters whether they use drugs or not. And it moves away from abstinence-only models, which can deny people shelter or care for using drugs and may make recovery harder. It recognizes that accessing treatment can be difficult in New Hampshire, and people use drugs for a variety of reasons.
Syringe service programs have been legal in New Hampshire since 2001, according to the Department for Health and Human Services. Advocates began pushing for harm reduction between 2015 and 2017, and McGinley said thanks to those efforts, they’ve had a seat at the table for the past two years.
Now, there are 10 registered syringe service programs in the state, according to NHHRC. The coalition first received state funding in 2019, according to McGinley, but they no longer do. This year, they were approved to receive $875,000 in the first round of opioid abatement funding. In 2022, participants in NHHRC’s needle exchange reported reversing 1,012 overdoses. Combined with partners in Nashua, Claremont, and Keene, there were a reported 1,564 overdoses reversed statewide.
The coalition distributed 565,239 sterile syringes, and 9,960 safer injection kits across 359 pop-up exchanges, according to its 2022 report. And there were 1,474 unique program participants, who participated in 5,920 exchanges with NHHRC. They also had 5,371 additional exchanges with their own networks.
At a July meeting of the Governor’s Commission on Alcohol and Other Drugs, the chairman Patrick Tufts said numerous elected officials had asked the commission to define harm reduction. He said he would form a short-term working group to take up the question.
“This is a bit of a slippery slope because people see harm reduction in lots of different ways depending on how they approach the topic,” he said at the meeting.
The goal of the working group, he said, would be to bring together a wide variety of people from different perspectives to reach a recommendation. That will be given to both the House and the Senate as they begin looking at bills ahead of the next legislative session.
For Robinson, volunteering with the Harm Reduction Coalition has helped her find a supportive community as she navigates her own recovery.
“You lose a lot of people when you get clean,” she said. Volunteering has been a way to get some new people in her life.
She said she started using substances after she was prescribed Zoloft, an antidepressant, at 15. She said her addiction “snowballed from there pretty quickly.” She moved out of home when she was 17 and spent some time living in her van. She said she was in active addiction for about a year.
She met her boyfriend, Jeremiah Colwell, when both were in a similar stage of recovery. They were both 18. Now they’ve been attending the kit-making sessions together for the past few months.
Colwell said he was around drugs for much of his childhood. “Both of my parents were addicted to meth,” he said. Growing up around drugs was hard, he said, and his own addiction started at around 14. He got kicked out of school and said waking up on the side of the road was part of what convinced him it was time to stop.
Now they offer each other mutual accountability about staying sober. They said it’s scary to think about one of them facing a relapse, but having another person who cares makes it easier when cravings do arise.
“We have to talk about it all the time,” said Robinson, who shares an apartment with Colwell and their cat named Bonnie. “It’s easier to stay clean when you have another person.”
This article was updated to include information about how many people used syringe exchange programs and how many needles the coalition distributed in 2022.