People who use drugs and their loved ones can access supplies that reduce the risk of overdose and spread of infection in intravenous drug use through the Harm Reduction and Needle Exchange Program in Sebastopol.
Inspired by the program at West County Health Center’s (WCHC) Third Street House in Guerneville, this program operates out of WCHC’s West County Teen Clinic at 652 Petaluma Avenue, Suite F.
“The truth is, people who are going to use are going to use and we’re just making it a safer experience because we care about our community members,” said Texas Miranda, peer education specialist and primary leader of the program. Texas prefers to go by their first name.
Services are free and available Monday through Thursday, 1:30 p.m. to 5 p.m., though Texas said they’ll answer the door any time if they’re still in the building. From their perspective, there isn’t anything particular about Sebastopol that moved WCHC to set up the program besides expanding access to these resources wherever they are.
“I think it’s just always helpful to have another place to get needles, get safe using supplies, get things that you need,” Texas said. “The more the merrier is at least my mindset with needle exchange and harm reduction.”
The program shares the main entrance with the teen clinic that provides free and confidential sexual and behavioral health services for 12- to 25-year-olds, though people who come in for safer-use supplies barely come into contact with others.
“You might see someone walk past you on their way to a patient room, but there’s not any contact happening there, really,” Texas said.
West County Teen Clinic’s main waiting lounge is festive, ringed with couches and a couple tables under creative wallpaper, but “for people who are strictly here for harm reduction supplies, they’re not waiting at all. I have a cabinet and I just run to the back and grab whatever you need and then I bring it out to the front. It’s very fast,” they said.
Otherwise, people can head to another waiting room in the clinic or receive supplies outside or from their car.
“I’m willing to do whatever is comfortable for them,” Texas said.
Meanwhile, the teen clinic operates as a confidential one-stop shop of sorts, where patients can check off on paper that they’d also like to receive harm reduction supplies during their visit.
These days, Texas said a steady trickle of one or two people per day come in looking for harm reduction supplies, jumping sometimes when patients arrive in groups. Word is slowly getting out by word of mouth, flyers and recent Instagram posts.
“And I can’t even count how many people come in for teen clinic stuff and end up walking out with harm reduction supplies,” they said. “Even if they’re not walking away with supplies, they’re walking away with education around that topic, which is super important. We do harm reduction work every day. We don’t necessarily get rid of harm reduction supplies every day.”
Most youth ask for fentanyl strips and Narcan, how to use them and when to administer Narcan to reverse an overdose. “Since our demographic is so young, mostly people under 26, we see people who are concerned about their safety and their friends’ safety. People are using at a younger age and they are being smarter about it,” said Texas.
Younger people also don’t tend to need as much technical and scientific information to take action in a drug-related emergency, they said. “At the end of the day, if your friend is overdosing and you know how to put something in someone’s nose and save their life, that’s really f—ing valuable. That’s really awesome.”
Some people take the stance that making safer supplies and education available promotes drug use, but Texas found that this perspective misses some of the point of harm reduction and the nature of the clinic’s work.
Visits to the West County Teen Clinic are entirely consensual, without staff encouraging anyone to experiment. “These young people are initiating the conversations themselves, and I think that’s super important,” Texas said. “We have a space that feels comfortable enough to ask these questions and no part of that is us being like, ‘Do you want to know about drugs? Do you want to know about all these things?’”
The fact that teens are starting the conversation “is a really good sign,” they said. “Your kids are around things that are dangerous and they’re doing their best to navigate that in the best way they can. And that makes me so happy. They’re being super smart and being proactive. And a lot of our kids, they’re not using, but they know that their older sibling is.”
Texas defines harm reduction as ultimately love and care for one’s community, showing up in all kinds of ways. “This whole clinic is harm reduction. It doesn’t have to be about drug use. We’re preventing teen pregnancies, we’re preventing the spread of STIs,” they said. “Talking about mental health is suicide prevention. Having spaces where people feel safe and comfortable, having food in the kitchen is so much harm reduction work.”
According to Texas, people mistake harm reduction for promotion as soon as drug use enters the conversation, but the reality is people who want to use drugs will find a way to do it. “Why not provide them with things that aren’t going to kill them?” they asked. “There are really unsafe ways to use drugs and then there are safer ways, and that doesn’t take a lot of the risk out of it. Obviously, it’s still a thing that is not foolproof, but why not take some of the risk away and show people that we care about them at the same time?”
The needle exchange program puts personal “sharps containers” in the hands of people who use intravenous drugs. Inside, there is a section for fresh needles and another for used needles, built so it’s harder to remove the used ones. “So, if someone is pretty desperate to use something that’s dirty, they’re not going to be as accessible to them,” Texas said.
Texas noted that fentanyl strips can prevent overdose and Narcan can reverse overdose, and both are safe using supplies even if they don’t administer drugs themselves.
Sometimes, Texas assembles kits for safe-using that include supplies like fentanyl strips, Narcan, and for people who inject drugs, a couple packs of 10 needles in whatever gauge they need, cottons to filter whatever drugs the individual is drawing into their body, tourniquets, sterile water, cookers and alcohol wipes.
They also provide smoking kits that contain straight pipes and bubble pipes to lower the risk of sharing pipes when people have open sores, chapped bleeding lips or pipe burns on the mouth and spreading blood-borne diseases, like viral hepatitis and HIV.
The program does not distribute supplies like sterile needles to anyone who isn’t using them — people who want to be prepared in an emergency receive fent strips, Narcan and a pamphlet explaining their uses.
“People of all ages and all walks of life have a need for harm reduction supplies,” they said, so stereotypes of users aren’t going to be very accurate. Furthermore, Texas said they don’t dig into patients’ personal lives at the clinic, unless the patient wants to discuss anything.
“I’m just getting the supplies out for a community member who is seeking them and if you’re seeking them, it’s for a reason and I don’t need to know what that is,” they said.
Looking into the future, Texas said staff are working towards establishing disposal services for the used needles that accumulate as people drop them off at the Sebastopol site. People can exchange used needles for new ones in Guerneville and Sebastopol, but so far, Texas has to drive sharps containers of used needles to Guerneville where a collection service takes them away.
