Jennie Chenkin has been working as a Patient Navigator at University Hospital in Newark, New Jersey since last winter. Her primary responsibility is to ensure that people coming into the Emergency Room with issues related to opioid use are able to get the care they need, by facilitating communication between patients and providers, and giving patients ongoing support as they navigate an often scary, and always complicated experience.

As an essential employee at the hospital, she had been continuing to go to work during the COVID-19 crisis at the time of our conversation. On her way home one evening, we spoke on the phone. “I do my best to get to work, do what I have to do in the ER, and limit contact as much as possible. I don't have the luxury of social distancing on the job, but neither do many of our patients.”

Jennie's work extends far beyond her role as an essential employee. Prior to starting her job at the hospital, she co-founded the New Jersey Harm Reduction Coalition (NJHRC), an organization dedicated to promoting the health and rights of New Jerseyans who use drugs. NJHRC both directly provides and advocates for expanded access to evidence-based harm reduction resources like naloxone, Medicine for Addiction Treatment (MAT), and syringe access. This complements Jennie’s work at the hospital, where she specializes in working with people who use opioids. Outside it, she's an expert on the local impact of the overdose crisis, and a tireless advocate for the innovative approach of harm reduction as an alternative to the criminalization and stigmatization of people who use opioids.

“New Jersey has seven harm reduction centers - more commonly known as syringe exchanges – and a population close to 9 million. Kentucky, for example, has a population of 4.5 million, and around 60 harm reduction centers. These numbers do not match up. There is a distinct lack of resources from the state here, particularly when you compare it to the resources of other states that have been acutely impacted by the overdose crisis,” Jennie explains.

In 2020, between January and February, there were 536 overdose deaths and 2,381 recorded incidents of naloxone administrations in New Jersey. The total of drug-related deaths in the state was just over 3,000 in 2019, and there were 3,990,809 opioid prescriptions dispensed. (Much like the data on COVID-19, these numbers are an underestimate due to systematic errors in data collection.)

COVID-19 brings new vulnerabilities for people who use opioids, which pandemic responses must take into account. “In general, people are not injecting heroin so much as they are inhaling it nasally, which in itself can cause respiratory complications. Not to mention opioids (as well as other substances like methamphetamine and alcohol) slow down your breathing, which, combined with a respiratory vulnerability or infection, could easily lead to an overdose. Add to that the fact that stigma and socioeconomic factors prevent people who use opioids from accessing resources such as harm reduction supplies or substance use treatment, and you can start to see how much more vulnerable people who use opioids are to COVID-19. ”

Before statewide lockdowns, social distancing and economic uncertainty, opioid use in the United States was already declared a public health emergency by the federal government. In 2017, opioid overdose deaths peaked at a little over 70,000 and have started on a sluggish decline, down to 67,000 in 2018. In contrast, this is about double the amount of motor vehicle related deaths in each year respectively. Yearly overdose deaths consistently exceed the 58,220 American casualties of the Vietnam War. Now, with our medical system under an unprecedented burden, opioid users face compounded adversity and a shortage of resources.

Jennie and the other members of the New Jersey Harm Reduction Coalition, unable to continue to deliver harm reduction supplies by on-the-ground distribution, have not given up. Using their community contacts, they are able to distribute this essential resource by mail. “We set up a phone number that people can call or text, and say 'I would really like some naloxone, this is my address' and we pack it up and send it! Supplies are going fast – within just a few weeks of rolling out the phone number we’ve mailed out around 250 naloxone kits which each have 2 doses in them. That’s ten times the amount we distribute in person on a busy day in the community. We also recently became the NEXT Naloxone affiliate for New Jersey which allows people to confidentially request naloxone and get trained online, at https://www.naloxoneforall.org/newjersey. New Jersey is now one of 28 states with a NEXT Naloxone affiliate, because while in-person connection is great, we know that even on the other side of COVID-19 not everyone is going to be able to travel for naloxone and that confidential home delivery might be their preferred option. We’re hoping to be able to take on some volunteers in the coming months to help us sustain this massive, but crucial, effort.”

Jennie and her team have plans to scale up distribution, using their network of volunteers, and secondary distributors who can facilitate naloxone distribution in their communities and networks. With community support and a commitment to the human dignity and bodily autonomy of everyone in our state, the New Jersey Harm Reduction Coalition is among the many organizations that are taking an innovative approach to public health challenges.

If you can, please support New Jersey Harm Reduction's effort.

Author’s note:

Thanks for reading! This is part of an ongoing project that Jennie and her team have very graciously agreed to do. Stay tuned for a longer write-up on NJHR and updates in the future!