Addiction counselor Stephanie Devich points to a Christmas tree glimmering with purple and silver ornaments in the lobby of Valhalla Place, the largest methadone provider in Minnesota. This is not your average Christmas tree. Look closer, and each ornament is etched with the name of a patient who died of an overdose. Minnesota suffered 694 overdose deaths in 2017, representing a 50 percent increase in two years. “Sadly, there isn’t enough room for any more ornaments,” says Devitch. “It’s like a death tree, but I wanted to turn it into something healing, to honor and celebrate the lives lost.”

Though the realities of the overdose crisis are grim, Devich is anything but. “My treatment plans are different than most addiction counselors,” she says. “One of my clients was smoking crack four days a week but wanted to reduce her use. We set a goal for only three times a week. She slowly weened herself down to the point she hasn’t smoked crack in over two years. It works. That’s not what we were taught in school, but I think we have to step outside our comfort zone. Because if someone can feel their goal is achievable, they can find their own version of recovery.”

In other words, it’s harm reduction. And while a state famed for birthing the abstinence-only “Minnesota model” of treatment and the Hazelden Betty Ford Foundation might not sound like fertile ground for harm reduction, it’s most certainly breaking through.

“I want to make sure that nobody dies, especially because of the stigma and shame people face, especially those who inject drugs.”

Devich is in no way your average addiction counselor. Presenting an overdose training one morning, she wears a blue sweater emblazoned with a breakdancing white-robed man and the phrase, “Go Jesus, It’s Your Birthday.”

She and other harm reduction activists across Minnesota have been making naloxone distribution, overdose prevention trainings, syringe exchange programs, advocacy and education their mission. After distributing 66,000 naloxone kits throughout the state, Devich tracked 1,847 overdose reversals from January to August 2018.

Like many counselors, Devich has her own addiction story. She found her own version of recovery from crack cocaine addiction after a stint in prison for six felonies. When I ask her age, Devich jokes that past crack use gave her a youthful glow that makes her look younger than her 46 years. Her office is filled with a pallet of naloxone, stacks of clothing and household donations for clients, dream catchers and a harm reduction barbie, holding a syringe and Narcan vial.

Devich started distributing naloxone and offering trainings after her first client overdosed, in October 2015. Valhalla Place then incorporated this into her job as a therapist. “I want to do whatever I can to educate the community and reduce stigma,” she says. “I want to make sure that nobody dies, especially because of the stigma and shame people face, especially those who inject drugs. They have to have a face and a voice and if they’re not capable of speaking for themselves, or no longer living, somebody’s got to speak for that person.”

When I attend her trainings, Devich charismatically rattles off statistics and information like a sportscaster. She also collaborates with other community leaders and organizations—such as Southside Harm Reduction Services, Natives Against Heroin and the Minneapolis Police Department—to create systemic change.

Given the abstinence-only roots of Minnesota’s treatment industry, the state has come slowly to harm reduction and Devich’s advocacy hasn’t been easy. “We are trying to shift public perspective and show harm reduction helps our community by saving lives,” she tells me. “I think there is public resistance to Narcan and needle exchanges. People say that we are enabling and addiction is just a choice. They think should just suck it up and stop, so why would I give a ‘junkie’ clean needles?” But she says things are improving.

An example of this improvement is evident when I attend a training at Northpoint Health Services, a health and wellness center in North Minneapolis that is home to a recently opened syringe exchange program: In ‘N Out. Devich says North Minneapolis has been the epicenter of recent overdose deaths. In September 2018, a string of 42 overdoses in only 72 hours occured in the Twin Cities due to “Pink Death,” a synthetic opioid otherwise known as U4770.

“The Wall of Forgotten Natives”

One community that has been hit especially hard is Minnesota’s Native American population. In Hennepin County, which includes Minneapolis, this demographic represents roughly one percent of the population, yet makes up 10 percent of all opioid-related fatalities.

In an effort to reduce deaths and increase services, Devich partnered with the group Natives Against Heroin (NAH) and Southside Harm Reduction Services. Together, they did extensive outreach to an encampment of around 200 homeless people in South Minneapolis.

Known as “The Wall of Forgotten Natives,” the camp stood from spring to December of 2018. The city and Native American leaders then opened a navigation center that offers shelter, access to health care and other resources, to which most of the camp’s residents have now moved.

“Harm reduction is the only thing stopping overdose deaths.”

James Cross, who founded NAH, is one of the Native American leaders who has been instrumental in advocating for change. Like Devich, he has a personal history of past addiction. In his case, aged 52 and a former gang member, he has reportedly spent around half of his life in prison.

When I saw Cross speak at an Overdose Awareness Day memorial service in August 2018, he talked about the importance of memorializing loved ones who died, but also of taking action through prevention and distributing naloxone. “Harm reduction is the only thing stopping overdose deaths,” he said.

Filling an Unmet Need

After hearing Cross and Devich highlight the important work of Southside Harm Reduction Services, which provides mobile services in the Twin Cities, I contacted one of the board members of that organization, Brit Culp.

“Southside is only one year old and it’s filling an unmet need,” says Culp. “In the past, there was Lee’s Rig Hub, which was like a speakeasy-style way to connect people with syringes and works. Southside has also brought back the spirit of Access Works and Women with A Point. We follow their model, with mobility and meeting people literally where they are at, doing street outreach, deliveries and getting Narcan out there.” Noting that people who use drugs are responsible for the majority of reversals, Culp points out: “If it wasn’t for drug users, we wouldn’t have harm reduction.”

Outreach and prevention are also important parts of Southside’s work. When Culp recently saw that there had been an overdose at the Seward Community Co-Op Café, a worker-owned, community-oriented restaurant in South Minneapolis, she quickly sprang into action to schedule an overdose prevention and harm reduction training. The Co-op employees were open and enthusiastic about receiving the training, and stocked their first aid kit with Narcan.

[Brit Culp at the Seward Community Co-op Café]

Culp is also an addiction counselor, and brings a harm reduction approach to her work. She notes that part of the reality of being a harm reductionist in a more traditional addiction treatment culture involves a certain flexibility with language. “Being able to call addiction a disease and get some medical support around it is important, and to not see it as a moral failing,” she says, “but it is more of a disorder than disease.”

Like the late harm reduction pioneer Dan Bigg, Culp encourages clients that any positive change is progress.

In their own ways, activists like Culp, Devich and Cross are working hard to educate Minnesotans about harm reduction. The going can be tough, but—as illustrated by abstinence-only Hazelden’s 2012 conversion to medication-assisted treatment—breakthroughs do happen.

True harm reduction advocates foster collaboration, recognizing that this philosophy can complement rather than contradict the state’s sea of abstinence-based programs. “Meeting people where they’re at” should apply not only to people’s drug use, but to differing viewpoints and traditions—an attitude which facilitates progress. During this crisis, lives depend on it.

[This article has been edited in accordance with one source’s request not to be identified.]

Minneapolis photo by Nicole Harrington on Unsplash

All other photos by Tessa Torgeson