Boxes of Narcan, the opioid overdose-reversing medication, sat piled high on tables near candy canes and cupcakes during Charm City Care Connection’s holiday party last week.

About a dozen people who stopped by the celebration decorated pretzel wreaths with icing and sprinkles, and picked out a gift from under the tree (hats and gloves for adults and arts and craft kits for children). Some restocked on food, warm clothing and, if they needed them, supplies such as sterile needles and pipes.

It was the first winter holiday party that the harm reduction organization has thrown since reopening its drop-in center about a month prior. For years, reopening fully to the public has been a priority for the staff.

Charm City Care Connection primarily serves residents of East Baltimore and is one of several harm reduction organizations across the city. Its clientele is made up of some of Baltimore’s most vulnerable residents, many of whom don’t have a stable place to live, struggle to find their next meal and use drugs.

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The COVID-19 pandemic had forced harm reduction organizations in the city to pivot in how they provided services, as the United States saw a record number of fatal overdoses. Though working through the pandemic “felt like building a plane while you’re flying on it already,” harm reduction organizations learned important lessons through the challenges, according to Katie Evans managing director of SPARC Women’s Center, a Johns Hopkins University-affiliated organization that serves South and Southwest Baltimore.

Putting those lessons into action, harm reduction groups have found different ways to adapt to the new normal, where the risk of COVID-19 is ever present.

During the holiday party, all participants wore masks and got their temperatures checked at the door. Among them was 56-year-old Jean Hawkins, who arranged pretzels in the shape of a Christmas tree, which was topped with a tinsel-wrapped Hershey’s kiss, then precariously glued them together with red and green icing.

“This is my first decoration for my apartment,” she declared.

Attendees of the Charm City Care Connection (CCCC) Holiday Party recieve wrapped gifts for themselves and their children, as well as a tote with the CCCC logo on it. (Marie Machin for the Baltimore Banner)

On Friday, she moved to a new apartment with the help of Charm City Care Connection, which paid the security deposit. Hawkins had most recently been staying at a residential behavioral health treatment center in north Baltimore.

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Case managers made sure Hawkins filled out all the necessary paperwork and kept in touch the whole way through, she said, “They wasn’t gonna let me fail.”

“I got new family and new friends here,” Hawkins said in a sing-song voice, before turning solemn. “I’m serious, that’s how they treat me. I love that, that’s how they treat everybody.”

Hawkins has taken full advantage of the community events that the drop-in center has hosted since it re-opened. She has attended bingo games and gotten her nails done at a ladies’ day. In addition to helping her find housing, case managers have connected her with a therapist, she said.

“When I come here, I can talk to people, and they just don’t judge. They just accept people,” she said.

What is harm reduction?

Hawkins’ story is an illustration of how harm reduction can change lives.

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The approach prioritizes saving lives and improving the health of people who use drugs, while decreasing the stigma around drug use and addiction. The idea is that the criminalization of drugs and pushing abstinence-only does not stop people from using drugs or address the ways that substance use negatively affects people’s health; rather those traditional approaches cause harm through incarceration and stigmatization.

Harm reduction is “not ‘drugs are fine, people can do it,’” said Evans of SPARC Women’s Center. “No, drugs have a lot of harm, and here are the ways we can reduce harm because we know drug use is part of our world. It’s not how do we eliminate drug use, it’s how we be safe along the way.”

In practice, harm reduction strategies can incorporate implementing free syringe programs, training people on how to use naloxone to reverse opioid overdoses and doing what the drop-in center does — providing a safe space where people know they can relax, find community and seek help without judgement.

The drop-in center at Charm City Care Connection is a place where people can get some hot food and coffee, do laundry, take a shower, nap and relax. They can also get safer drug use supplies, such as sterile needles, clean pipes and wound care kits. If they need help with other services, such as finding housing or obtaining government identification, case managers are on site to help.

Employees of Charm City Care Connection bring in a large narcan delivery on December 22, 2022. (Marie Machin for the Baltimore Banner)

The importance of relationships in addressing overdoses, addiction

Bakari Atiba, a community leadership specialist at Charm City Care Connection, said that in addition to the organization’s other services, events hosted by staff contribute to a core part of the mission.

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“It’s one thing to just throw resources at a community,” Atiba said. “It’s another to build relationships. When you build relationships, you have a certain level of trust and you can better help them navigate the barriers they’re facing.”

COVID-19 hasn’t made it easy for most people to build and maintain relationships. The pandemic disrupted support systems and treatment and led to isolation, which, Anne Langley, the group’s executive director, speculates has been one of the drivers of a spike in overdose deaths.

“One of the safety measures we encourage clients to take is to use with other people, so if they overdose, there is somebody there,” Langley said.

Last year, more than 107,000 Americans died from drug overdoses, a record number. In Maryland, more than 2,800 people fatally overdosed in 2021, with Baltimore City being hit the hardest, according to Maryland’s Opioid Operational Command Center. Overdose data from the state, as of August, show about a 13% decrease in fatal overdoses this year compared to the previous 12 months, but the number of drug overdose deaths is still higher than pre-pandemic levels.

“Building relationships, making connections is important and the effects of isolation during COVID illustrate that,” Langley said.

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Though Charm City Care Connection continued to host outdoor events and hand out food and supplies at the door and through its mobile outreach van, the organization wasn’t able to build the same connections as before, according to Karla Yaroshevich, assistant manager of harm reduction.

“During COVID it got kind of transactional and less personal so we’re trying to bring the personal aspect back,” she said.

Overseeing the daily operations of the center is Raichelle Johnson, harm reduction manager, who everyone calls “Ro.”

She tries to organize a party for clients for every holiday as well as other important milestones, Johnson said, because she knows many don’t have others to celebrate with. She started at the organization as a volunteer in 2019, after seeing most of her family members use drugs. Two years ago, her older sister passed away after living most of her life on the streets, Johnson said.

“I could get everybody else into treatment, I could get everybody else help, but I couldn’t … help my sister,” Johnson said. “So that just makes me push harder, just to help as many people as I can.”

Meeting people where they are

Across the city, SPARC Women’s Center faced similar challenges as Charm City Care Connection during the pandemic and came away with a different strategy, according to Evans.

Before COVID-19 hit, the organization also had a lively drop-in center on Pigtown’s main street, Evans said. But instead of focusing on bringing back the community space, SPARC Women’s Center workers are bringing services out to the community.

“The main takeaway for us is we need to leave the building and stay out,” she said. “If people need something, we go to them on their own terms.”

The organization’s delivery program started in April 2020, shortly after the city locked down to slow the spread of COVID-19. Evans remembers the two-person outreach crew scrambling to find personal protective equipment and working 12-hour delivery shifts. Their list of participants grew from nine households to 100 by the end of the first summer.

Today, vans go out to neighborhoods in south and southwest Baltimore five to six times a week to serve 300 people, Evans said, delivering supplies and services to a variety of locations, including “cars, abandoned houses... [and] drop spot locations for people who don’t have an address or a phone.”

The group’s office in Pigtown is more of a drop-by center, nowadays. It’s no longer a space where people hang out, but anyone seeking healthcare, legal services and case management can stop by and be seen the same day, she said. Many clients live far away from Pigtown, in neighborhoods such as Curtis Bay and Brooklyn.

In addition to safer drug use supplies, SPARC’s Women’s Center also delivers suboxone, a prescription medicine used to treat opioid use disorder, and provides mobile health services, such as STI testing, birth control and pregnancy testing.

The organization has embraced mobile outreach because staff can consistently reach people who probably would not have come to the center on their own and it helps to build rapport, Evans said.

“We got to talk to people during the daytime, in their own own space, where they’re more comfortable,” she said, adding, “It reduces a lot of barriers.”

Another silver lining of recent years, Evans said, is that harm reduction organizations across the city have become more collaborative.

“Once the pandemic hit, we looked around and said, ‘Oh, we can’t do this by ourselves,’” she said. “It feels like we’re all trying to work on the same thing …It’s important for us that the whole city gets what it needs.”

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