Editor's note: In conjunction with our continuing coverage of the opioid crisis in Colorado, we reached out to Harm Reduction Action Center executive director Lisa Raville to learn more about the use of heroin and other drugs in the Mile High City. This is the fourth post in the series. Click to read our previous pieces, "The Four Main Reasons People in Denver Overdose on Heroin," "Denver Homeless Shoot Meth in Winter So They Won't Freeze to Death" and "'Every Bathroom In Our Community Will Continue to Be an Injection Site.'"

Many different types of Denverites inject heroin and other drugs. But many of them fit within the same general demographic category. In the words of the Harm Reduction Action Center's Lisa Raville, "We have cornered the market on 25- to 34-year-old males."

Indeed, more than 40 percent of HRAC participants are in that age range, followed by 35- to 44-year-olds (about 25 percent), those 45 and older (approximately 18 percent) and people 19 to 24 (15 percent or so), with fewer than 5 percent between thirteen and eighteen. The overwhelming majority are white, with much smaller numbers of Hispanics and African-Americans represented. Only 28 percent of clients are housed, with 35 percent classified as homeless and another 37 percent considered unstable.

Moreover, 5.8 percent of female participants report that they have exchanged sex for money, drugs or a place to stay, as compared to 3.3 percent of males. And 37 percent of all clients had no health insurance at the time of intake.

The dangers such factors pose are underscored by national and local casualty figures.

"In the United States, we lost 64,000 people to all drug overdose deaths in 2016," Raville says. "In Colorado, we lost 912, and in the City and County of Denver, we lost 174. Of that 174, at least twenty died outside in an alley, in a park or in a business bathroom. I say at least twenty, because a lot of times the place of death is listed on the coroner's report as 'unknown,' which makes me think it was probably outside. I only count the ones that are known. But there are a lot of unknowns."

[Update: Following the publication of this post, we were contacted by Ann Cecchine-Williams, deputy director of the Denver Department of Public Health and Environment. According to her, "The Office of the Medical Examiner rarely lists 'unknown' as the place of death and would only do so if we thought the body had been moved after death." However, there's also a "place of injury" category, designated as the location where the event that led to the eventual death took place.]

"We know that in 2016, we lost two people in business bathrooms," Raville goes on. "We also know that in the first part of 2017, we lost at least four in business bathrooms. So I'm a little concerned about what the numbers are going to be for all of 2017 when they're finalized."

The Harm Reduction Action Center is doing everything it can to reduce such fatalities. Between February 2012 and the end of 2017, according to HRAC, the facility has served 7,292 unique clients — making it the largest syringe-access program in Colorado — and taken part in 95,724 syringe-access episodes. During that period, the center made 42,933 referrals to programs offering substance-abuse treatment, mental-health resources and more, trained 2,053 people in overdose prevention and saved an estimated 754 lives.

EXPAND Assorted supplies available to participants at the Harm Reduction Action Center. Photo by Michael Roberts

The drugs most frequently injected over the previous thirty days by injection drug users who come to the center are led by heroin (51 percent), followed by meth (50 percent), mixtures of heroin and meth dubbed goofballs (15 percent), the heroin-and-cocaine blend called speedballs (11 percent), cocaine (7 percent) and steroids (2.8 percent).

The center also tracks crack use, which pales in comparison to that of injection drugs. Approximately 26 percent of participants smoked crack in the previous year, with 44 percent of those having shared a crack pipe in the thirty days before they came to HRAC.

One of the center's main charges is to prevent the spread of disease through the use of shared needles — but for many clients, the damage has already been done. An estimated 22 percent of HRAC participants say they have hepatitis C, and another 17 percent aren't sure, while 3 percent have tested positive for HIV and 13 percent don't know.

Like access to new syringes, sterile water is a key to preventing these figures from growing worse.

"All drugs need to be made as blood-like as possible, so you need sterile water," Raville says. "But when you don't have access to sterile water, it doesn't mean you don't inject. It just means you use some other form of water: toilet-tank water, river water or saliva, probably in that order. Hepatitis C lives in water, sometimes for as long as 62 days. So we believe the increase in hep C in our community is because of the water — because when you're homeless, you either publicly inject outside in an alley or a park or in a business bathroom. A lot of times, my folks will prioritize a business bathroom for three main reasons: access to water, so law enforcement won't come up on them and so kids won't see them. They're very clear about that: They don't want kids to see what they're doing."

For these reasons, water is on hand in many forms at the Harm Reduction Action Center.

"Obviously, we want folks to have access to sterile water," Raville confirms. "But we also give out bottles of water, because we want people to remain hydrated in general, and it can be difficult for them to obtain even drinking water in our city. If you're homeless or you're a drug user, there's a lot going on for you, and if we can help, we try to help. We have socks here as well, because a lot of times people will walk around the city for days and days and days, and that can mean blisters on their feet. But we also have a foot bath. Sometimes when I don't know how I can support you, I'll say, 'Would you like to soak your feet?' And just to be able to soak your feet in warm soapy water for a few minutes feels really good."

After all, water is life.

The Harm Reduction Action Center is located at 231 East Colfax Avenue; it's open from 9 a.m. to noon. The phone number is 303-572-7800. Click to visit the HRAC website.