The Movement
Monique Tula — Harm Reduction in Massachusetts: An Oral History
When we talk about harm reduction, we often reduce it to a public health framework, [one of] reducing risks,” she told the crowd. “That’s harm reduction with a small ‘h-r’. Harm reduction is meeting people where they are but not leaving them there.”
“But Harm Reduction with a capital ‘H’ and ‘R’—this is the movement, one that shifts resources and power to the people who are most vulnerable to structural violence.” She went on to describe its aims as including: building community for and empowering directly impacted people, or “people who are not seen;” disruption; changing narratives; solidarity; and fighting for social justice.
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Monique supported the underground naloxone acquisition, purchasing supply from Dan Bigg in Chicago. These purchases were primarily funded out of individuals’ pockets. Because Monique had power within her organization, she redirected funds originally intended for research to purchase naloxone. At the time, naloxone was considered drug paraphernalia and possession could be cause for arrest. Eventually she became concerned that distributing naloxone could endanger the staff, the participants, and ultimately the organization. She sought internal approval from the organization’s Board of Directors to continue distributing naloxone. They denied the request, citing lack of information/ evidence about naloxone’s efficacy. She and a board member got to work. They designed a study to demonstrate the efficacy of naloxone and started to build the evidence base. Their research was informal but rigorous and helped lay the foundation for Massachusetts organizations to embrace naloxone.
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I asked Monique whether things have changed over the past 30 years. Yes and no, she replied. Yes, because HIV is no longer the crisis it was, syringe access programs are more commonplace, paraphernalia laws are less strict, and Good Samaritan Laws and naloxone standing orders are in place. And no because the circumstances underlying drug use are the same and just as virulent. There is not enough investment in basic needs, adequate food, shelter, and education. Without amending these social ills, harm reduction, a mere band aid, cannot truly “work.”
