First, Do Less Harm: Fighting the Opioid Epidemic in Harlem

In the summer of 1996, Will Robertson was in the Five Points neighborhood of Atlanta when  he noticed a woman whose walk was familiar to him. He grabbed her by the shoulder and yelled, “Why’d the hell you lie to me? Why’d you make me think that you were dead?” The woman, unaware that her stride had reminded Mr. Robertson of his wife, who had recently died, and also unaware that he was high on crack cocaine, gave him a hug in return.

This was how Mr. Robertson’s journey to Harlem United began, he said.

Founded in a church basement during the height of the H.I.V./AIDS epidemic in 1988, Harlem United has worked to help black and brown communities in crisis; today, many of its clients struggle with opioid addiction. The organization was an early adopter of harm reduction programs, like needle exchanges. Harm reduction practices attempt to reduce the negative effects of drug use first, before introducing clients to additional resources to help lessen their drug dependency over time.

With the advent of the syringe exchange programs, users with H.I.V./AIDS dropped to less than one percent of the drug injection population, according to Mary Brewster, director of harm reduction services at Harlem United.

Mr. Robertson said he had moved to Atlanta to put the pain of losing his wife and child in an accident behind him. While he was there, his parents died, within a year of each other. A Brooklyn native, he returned to the city in 2006, but didn’t arrive at Harlem United until 2013, still struggling with drug use, but wanting help. “One minute you have a big family, the next you have nobody,” said Mr. Robertson, 58. Programs he had tried before had taken the Tough Love approach, he said.  

“They called me a bad person. I was never a bad person, I was just a person going through something” he said. “Harlem United didn’t want to leave me where I was at. This program helped me to talk about what I was going through.”

Today, Mr. Robertson works as a peer educator helping people who are struggling as he did.

As H.I.V./AIDS rates have declined, Harlem United has adjusted its use of resources. What was once only a syringe exchange service, now offers free fentanyl detection strips, overdose prevention training, AIDS prevention education, supplies for hormone and drug injection, sex worker safety training, housing services and more.

Mr. Robertson says his clients remind him of himself. Though Harlem’s black population is declining, and the public face of the opioid crisis nationwide has mostly been young white adults, most opioid users at Harlem United are older, black men.

“When I talk to some of my clients in this room, I try to reach the core of the problem of what they’re going through,” Mr. Robertson said. “Say one of my clients don’t have their G.E.D., I have a connection down the block. I’ll say,  ‘Let’s go work on your G.E.D., but while you work on your G.E.D., instead of shooting up this much, let’s do a little less.’”

During the crack epidemic, many urban law enforcement officials adopted the rhetoric of former President Richard M. Nixon’s so-called war on drugs, which criminalized drug users. Some health advocates suggest that increased support for harm reduction models today has only been possible because of the current epidemic’s reach into white communities.

“This is a health issue now,” said Francisco Rodriguez, 56, a policy advocate for Harlem United. “When you look at the white population, it’s hitting their back door now. It’s in their backyards. So it went from a criminal act, to a health issue. That’s because the people who have the money deemed it necessary.”

In New York City, 1,441 people died of overdoses in 2017 the deadliest year on record. The health department does not provide a demographic breakdown of the victims, citing privacy concerns.

Studies and public health officials say they have found success with safe drug consumption sites in cities in Europe and Canada. The New York City Health Commissioner, Mary Travis Bassett, has supported the idea. Mayor Bill de Blasio publicly supported a pilot program for safe injection sites as a strategy to lessen opioid use and overdose deaths in the city. But both are just catching up with Harlem United, which has has supported methods like this for nearly 30 years.

Francisco Rodriguez, 56, a wellness advocate and peer educator at Harlem United, a community health center, prepares to set out for Marcus Garvey Parkin Harlem. Alejandra O’Connell-Domenech/NYT Institute /

Mr. Rodriguez’s work involves lobbying politicians to pass legislation in support of harm reduction measures on behalf of Harlem United. He and Mr. Robertson helped push New York City Council Bill 1443, which requires homeless shelters to offer naloxone training for employees, among other things.

Though many harm reduction organizations advocate for legally recognized safe consumption sites, public health workers say the the sites are not an end-all. They are, health workers say, just another harm reduction option.

Mr. Rodriguez said Mayor de Blasio’s public support for safe injection sites is a win, but he said he was not convinced that the pilot program will be successful.

Outside researchers will observe the safe injection facilities to conduct a study on their effectiveness, according to Stephanie Buhle, the assistant press secretary for the New York City Department of Health and Mental Hygiene.

To Mr. Rodriguez, the idea of outside researchers is questionable.

“Everybody here knows about harm reduction, this is what we do,” he said. “I’ve gone into shooting galleries, during the day time, trying to reach people. I can identify what the community looks like.”


Correction: May 31, 2018

An earlier version of this article incorrectly stated the involvement of outside researchers. They will observe the facilities to conduct research.