UP CLOSE | “Meeting people where they are”

UP CLOSE | “Meeting people where they are”

New Haven’s harm reductionists take new approach to drug overdose epidemic
Published on April 3, 2023

Jess saved her friend’s life last year. 

Jess, whose last name has been omitted to protect her privacy, has used intravenous drugs on and off for the last 15 years. That day, she had just gotten high when she began to notice the signs of an overdose in her friend: pale skin, slowed breathing and unconsciousness. 

Jess was terrified, but she was also prepared. She was carrying Naloxone, also known as Narcan, a medication that reverses opioid overdose. After learning about Narcan through a training program in Bridgeport, she knew how to inject the Narcan spray into her friend’s nostril, roll them onto their side and wait for them to recover. 

Without her training, Jess said she might have made the common mistakes that many people do when they witness an overdose, like putting the victim in a cold bathtub — which increases the risk of shock — or leaving them on their back — which increases the risk of aspiration. 

“I’ve used [Narcan] a few times on people,” Jess said. “If I didn’t have it, I don’t know what would have happened to the people that I was with, if they would have still been alive today.” 

Naloxone training and distribution is one example of a growing approach to drug use known as harm reduction. Rather than pressuring people to quit using drugs entirely, harm reduction advocates accept the reality that people use drugs and try to ensure that they do so as safely as possible, a marked change from traditional abstinence-only responses. Studies have shown harm reduction techniques to be among the most effective at reducing overdose deaths and the spread of disease while increasing the number of people who engage with treatment and social services. 

Harm reduction is most commonly associated with efforts to distribute safe drug use supplies like Narcan, fentanyl test strips and clean syringes. But it also encompasses efforts to provide warm clothes and feminine hygiene products, to reduce the criminalization and stigma of drug use and to address systemic inequities in housing and healthcare. 

“There will be behaviors that people do that are risky, but there are ways to support people… and to affirm the fact that their lives have value,” said Emme Magliato ’23, a student ambassador for the Sex Workers and Allies Network, a harm reduction organization focused on street-based sex workers, many of whom use drugs. “In its core, [harm reduction] is a very liberatory practice.” 

Drug overdose deaths have increased more quickly in Connecticut than the national average. (Courtesy of Sadie Bograd)

New Haven was one of the birthplaces of harm reduction in the 1980s, when activists established one of the country’s first needle exchanges to combat the AIDS epidemic. Now, the spread of the opioid epidemic has encouraged a broader acceptance of harm reduction work. 

1,425 people died of an unintentional drug overdose in Connecticut in 2022, including 130 in New Haven alone, as compared to 728 deaths statewide in 2015. Nationally, the opioid overdose death rate has increased sevenfold in the past two decades, from 3.3 deaths per 100,000 in 2001 to 24.7 deaths per 100,000 in 2021. 

Almost all harm reduction practitioners unite around a single catchphrase: “meeting people where they are.” Across New Haven, dozens of actors — from mobile outreach teams to healthcare clinics and homelessness service providers — are striving to do just that. Although they struggle with limited funding, legal constraints and widespread stigma, they continue to promote what they see as a more ethical and effective response to an overwhelming overdose epidemic.  

Delivering supplies, and much more

When SWAN’s gray minivan pulls up at the corner of Ferry Street and Grand Avenue, its doors emblazoned with the words “OUTREACH” and “FREE NALOXONE,” people are ready for it. The nearby lot is a popular site for drug use, and many people approach the van as soon as it parks. 

Magliato hops out of the passenger seat and strikes up a conversation with the first woman in line. 

“Do you need alcohol swabs? Antibiotic ointment? Do you need cookers? Do you need condoms? Narcan?” Magliato asks. While the woman fills her bag, Magliato writes down her birthday and a careful record of everything she takes. 

SWAN distributes safer drug use supplies, but also backpacks filled with warm socks, personal hygiene products and flashlights. (Sadie Bograd, Contributing Photographer)

Inside the van’s trunk is a stockpile of resources to distribute to New Haven’s sex workers, unhoused residents and people who use drugs. In addition to hand warmers, flashlights and medical supplies, Magliato passes out materials that help reduce the risks of drug use. There’s Narcan, a nasal spray which can reverse opioid overdoses. Test strips for fentanyl, the highly potent opioid that was responsible for over 90 percent of Connecticut opioid overdose deaths last year. Sturdy Pyrex pipes, which decrease the chance of injury while smoking crack. Clean syringes, to prevent the sharing of needles and the spread of diseases like HIV and Hepatitis C. 

SWAN and its fellow harm reduction organizations attempt to disseminate these supplies as widely as possible and through a variety of strategies. 

Mobile outreach teams like SWAN’s bring harm reduction materials directly to the people who need them. Their services are deeply valued by the people who rely on them — one woman asked Magliato for Narcan, saying she had overdosed just the day before. 

The New Haven Health Department has also provided harm reduction toolkits to organizations that regularly work with people who use drugs, like the Downtown Evening Soup Kitchen, post-incarceration resource centers and methadone clinics.

“My philosophy is, whenever I go somewhere, I want to make it rain Narcan.”

—Phil Costello, clinical director of the Healthcare for the Homeless program at Cornell Scott-Hill Health Center

Other groups try to make sure that Narcan is as broadly accessible as possible, recognizing that drug use occurs in every community. Kara Sepulveda, public health program assistant at the Quinnipiack Valley Health District, explained that QVHD and the New Haven Health Department are trying to “normalize being prepared for overdose response” by offering naloxone training at a range of locations, from restaurants and warehouses to libraries. Their work may be made easier by last week’s FDA approval of over-the-counter Narcan sales.

“My philosophy is, whenever I go somewhere, I want to make it rain Narcan,” said Phil Costello, clinical director of the Healthcare for the Homeless program at Cornell Scott-Hill Health Center.

Andressa Granado and Kara Sepulveda demonstrate how to use Narcan during a training at a New Haven liquor store. (Courtesy of Andressa Granado)

Frederick Altice, director of the Yale School of Medicine’s Community Health Care Van, noted that fentanyl test strips have also become increasingly important, because they enable people to avoid consuming unsafe drugs and alert others when a dangerous batch has entered the supply. 

Advocates emphasized, however, that harm reduction is about more than just clean syringes and Narcan. 

SWAN helps its members with “literally anything and everything,” said program manager Jaclyn Lucibello, as she prepared to drive a SWAN member to her methadone clinic. Providing warm clothes, tents and menstrual products is another way to help people who use drugs stay safe. Lucibello also emphasized the importance of connecting people to medical care and housing; it’s near impossible to recover from opioid use disorder if you don’t have a stable place to live, she said. 

Combating stigma to keep people alive

Harm reduction advocates distribute as much Narcan as they can. But Narcan won’t help if there’s no one to administer it.

“The way to keep people alive is to not have them use alone,” Costello said. “This is probably the single most important thing for opiate users.”

“The way to keep people alive is to not have them use alone. This is probably the single most important thing for opiate users.”

—Phil Costello, clinical director of the Healthcare for the Homeless program at Cornell Scott-Hill Health Center

In the face of widespread stigma, people often feel pressured to hide their drug use from family and friends, according to Costello. They use drugs alone, making them more likely to die if they overdose. 

Stigma prevents some people from accessing harm reduction supplies at all. That’s one reason why the Community Health Care Van is trying to establish three harm reduction vending machines across the city. Altice explained that these “user-friendly and minimal contact” devices would let patients who have registered with the syringe service program collect clean syringes and Narcan.

Broadly, though, harm reduction advocates want to eliminate stigma from the start. 

Magliato explained that a core tenet of harm reduction is that people who use drugs are people, and should be treated as such. She added that although this shouldn’t be a radical statement, people with opioid use disorder are often reduced to their addiction. 

“My favorite part of working [at SWAN] is just getting to see people and tell them ‘Have a good day’ or genuinely ask how they’re doing,” Magliato said. “Because most often they will not have that interaction until the next time they see you.” 

SWAN employees Emme Magliato and Brandy Robinson gather supplies before their outreach run. (Sadie Bograd, Contributing Photographer)

Robert Heimer, a Yale professor of epidemiology who has studied harm reduction for over 30 years, said the people who are most at risk of overdose death are those who have just gone through an abstinence-only treatment program — even more so than people who receive no treatment at all. Abstinence-only programs have high relapse rates, but patients tend to feel ashamed about their continued drug use, leading them to use alone. Their tolerance also goes down during treatment, increasing the risk of overdose.

“How do we make [drug use] seem more of a normal activity, instead of making solitary drug use seem like the only solution to keeping your drug use secret and yourself protected from going to jail, from being stigmatized, from being ostracized?” Heimer asked. 

Heimer added that stigma is perpetuated in many ways. People in abstinence-based treatment are often called “clean” — implying that people who use drugs are “dirty.” Opioid use disorder is treated as something shameful, instead of a medical condition that changes the brain, making it impossible to abstain from drug use without experiencing severe withdrawal symptoms. 

Heimer said that stigma can even prevent people from accessing effective treatments for opioid use disorder. Methadone and buprenorphine are long-acting opioids that block opioid withdrawal while inhibiting the effect of heroin and fentanyl, preventing people from getting high. 

“Methadone and buprenorphine produce a stable level that allows people to feel normal: not too high, not too sedated, not too close to losing consciousness and not going into withdrawal. And it allows them to pursue a more normal life,” Heimer said.

According to Heimer, medications like methadone are the most effective treatment available — much more so than abstinence-based treatments, which have a high relapse rate. However, instead of being treated like any other medicine, they are stigmatized as “trading one drug for the other.” 

Safe spaces for safer use

Apart from stigma, people who use drugs don’t always have a safe place to go. Especially among the unhoused community, drug use often occurs outside or in public spaces.

Evan Serio, program manager at the Downtown Evening Soup Kitchen, said that public restrooms are a common site for drug use. In recognition of that fact, DESK has implemented a three-minute knock system: every three minutes, a staff member knocks on the bathroom door to get a verbal confirmation that the guest is still conscious and has not overdosed. 

With this, many community members have sought to establish dedicated spaces where people who use drugs can safely congregate. In Fair Haven, a team of community leaders — including representatives of the Connecticut Harm Reduction Alliance, the Fair Haven Community Health Center, Junta for Progressive Action, SWAN, the Board of Alders and the New Haven Police Department — are trying to establish an engagement center on Grand Avenue.

Mark Jenkins, executive director of the Connecticut Harm Reduction Alliance, described the center as “a haven to get many of those folk who publicly loiter in that area, to give them a space off of the beaten path where they can congregate without persecution or prosecution.” 

The benefits, Fair Haven alder Sarah Miller explained, would be twofold. The center would provide a welcoming space where guests could access medical care, syringes and other services. It would also alleviate residents’ concerns about public drug use and drinking, especially in the neighborhood’s main commercial corridor. 

Miller added that the potential location, at 229 Grand Ave., is key to the proposal’s success. 

“We want those services to be available, but we don’t want them right in the middle of our commercial district,” Miller said. “[The proposed site] is close enough to where the activities happen in the center of the neighborhood that we think it’s realistic people would go there, but it’s not as visible as it is right now. It’s not as disruptive to the healthy economic development of our neighborhood.” 

Jenkins and Miller both indicated that the city withdrew its initial commitment to fund the center last year, instead prioritizing funding for a syringe and litter collection team.

Benjamin Oldfield, chief medical officer of Fair Haven Community Health Care, said the team hopes to open the engagement center later this year, adding that they have “two promising funding opportunities.” 

SWAN volunteers assemble safer drug use and safer sex kits. (Sadie Bograd, Contributing Photographer)

Separately, a group of harm reductionists and government officials are pushing for Connecticut to pass a senate bill that would establish three pilot “harm reduction centers.” Unlike the planned Fair Haven engagement center, these centers would be explicitly intended for drug use: places where people could openly consume drugs in the presence of trained health care providers, who would provide treatment in the case of an overdose. 

More than 120 such overdose prevention centers exist around the world, including the recently-opened OnPoint facility in New York City. To date, Heimer said, not a single person has died at one.

State Senator Saud Anwar, a co-sponsor of the legislation, said the pilot centers would be located in the greater Hartford, New Haven and Bridgeport areas. New Haven Community Services Administrator Mehul Dalal expressed support for the legislation at a public hearing on March 22.

“One option is to say that we accept that people are going to continue to die, and probably the number is going to increase … If we refuse to accept that, then we say, ‘What works and what doesn’t work?’” Anwar said. “Frankly, it’s not rocket science. We are basically doing what has been proven to be effective, and not in one place, but multiple places.”

Anwar explained that many people fear that overdose prevention sites will enable increased drug use or encourage people to start using drugs. The data, he said, shows the opposite — overdose prevention sites simply provide a safer place for people to consume controlled substances that they were already going to use. 

Community Health Care Van director Altice said he thinks it’s “only a matter of time” until Connecticut establishes overdose prevention sites. For him, the real question is whether they will have sufficient and sustainable funding in the long term.

Conflicting laws and roles for law enforcement

Harm reduction operates in an often-hostile legal environment. For example, in addition to criminalizing the possession of drugs, Connecticut criminalizes the possession of drug paraphernalia. Serio, of DESK, explained that this puts people who carry harm reduction supplies like safer-use crack pipes at risk of arrest and incarceration. He called for the law to “not criminalize individuals for what essentially breaks down to a medical intervention.” 

At the federal level, the “crack house statute” in the Controlled Substances Act criminalizes anyone who knowingly manages a site where controlled substances are used. This places overdose prevention centers on uncertain legal territory. But according to David Oliveros SPH ’23, who has collaborated with harm reduction initiatives through the Global Health Justice Practicum, this has not prevented other overdose prevention centers from operating in recent years.

Harm reductionists unite in their opposition to these overlapping forms of criminalization. Drug use, they say, is not a problem we can arrest our way out of. Incarceration is itself one of the many harms that harm reduction seeks to prevent. 

But advocates remain divided on the proper role of law enforcement in harm reduction work. 

Jenkins, of the Connecticut Harm Reduction Alliance, expressed skepticism of actors who claim to practice harm reduction while relying on law enforcement to conduct outreach.

“When you have organizations that are using law enforcement to engage people right now in harm reduction, and they’re still a harm-producing entity, it’s a contradiction,” Jenkins said. “When you have a small percentage of that group that may have buy-in, but by and large, the larger group is still causing harm, I don’t agree with it.”

At the same time, Jenkins and others acknowledged that the situation is unique in New Haven, where the police have been more supportive of harm reduction initiatives. Jenkins and Lucibello, both of SWAN, referenced the work of Lieutenant Michael Fumiatti, Fair Haven District Manager for the NHPD. 

Fumiatti helped convene the Fair Haven team which is working on the engagement center, and he has collaborated with SWAN on efforts to create dialogue between street-based sex workers — many of whom have experienced drug-related arrests — and police officers. 

Over the course of his career, Fumiatti told the News, he came to see how “pointless” it was to arrest people over and over again for the same low-level drug-related crimes.

“What’s the point of me arresting someone seven times, ten times on low-level drug offenses, specifically paraphernalia?” Fumiatti said. “Trying to get people into services and get them help and get them to make their own decisions to hopefully go into a rehab or engage in safer practices, that’s a public safety thing just as much as arresting people — I would say even more so, because what we’re looking at is root problems, rather than band-aids.” 

Fumiatti explained that officers have broad discretion over how they respond to offenses, and are not obligated to make arrests except in cases of domestic violence. Rather than arresting people on paraphernalia or possession charges, he now tries to direct them to available services.

He mentioned a local business owner who regularly calls the police because of a man who stands outside his store, harassing customers. The traditional law enforcement response would be to write the man a ticket for trespassing and move on. Fumiatti’s new strategy would be to buy the man something to eat, have a conversation with him and encourage him to change his behavior. 

The goal, he said, is for police officers to “mediate an issue [rather] than to just be a robot.” He tries to make arrests only when someone is at risk of causing harm to themselves or others, and he encourages other officers to take a similar approach. He added that by focusing less on low-level drug offenses, officers have more time to focus on major crimes. 

Groups like COMPASS carry ROVERs filled with harm reduction supplies. (Courtesy of Andressa Granado)

The establishment of COMPASS, New Haven’s nonviolent first responder team, might further reduce punitive responses to drug use. 

COMPASS’s teams include a social worker and a “peer recovery specialist,” or someone who has lived experience with homelessness, addiction or mental illness. The teams can provide crisis counseling, harm reduction supplies and help with accessing social services. In addition to conducting their own outreach, COMPASS teams can respond to 911 emergency dispatches, and Fumiatti said that NHPD officers regularly call on COMPASS’s crisis teams to respond to incidents related to substance abuse.

Lucibello said that NHPD is unique in its approach to drug use, but that “traditional policing is at odds with harm reduction.” She said that police officers in Waterbury had told her that “we know we’re not going to arrest away the drug problem, we know that the War on Drugs is bullshit, but we still have to enforce the laws.”

She added that harm reduction efforts ought to be led by people who have personal experience with drug use.

“It’s just like anything else,” Lucibello said. “The people that are closest to the problem, are closest to the solution… The people that have been there and understand and truly can show empathy are those that are most effective in building connections and helping people.” 

Nationwide, federal policy might also be shifting away from incarceration and towards a strategy of harm reduction, according to John Hamilton, president and CEO of Liberation Programs, a Connecticut drug treatment and prevention organization that incorporates harm reduction practices. He pointed to a recent grant announced by the Bureau of Justice Assistance that provides funding for “comprehensive programs in response to the overdose crisis.” 

A more trustworthy medical system 

Even more than law enforcement, people who use drugs express distrust of one institution in particular: the medical system.

Jess said she hadn’t had much involvement with the police. But when it came to hospitals, her response was instant.

“Their bedside manner is terrible,” Jess said. “Everyone that I know that has been to the hospital all last year has had something to say, like how they’ve been rude and treated badly if they had addiction in the past or if they’re an active addict.” 

Heimer said that most people with opioid use disorder consume opioids not to get high, but for “maintenance” — that is, to avoid withdrawal, the symptoms of which include potentially life-threatening vomiting, diarrhea, nausea and muscle pain. Costello, of Cornell Scott, explained that many emergency rooms refuse to treat withdrawal symptoms, which patients start to experience while waiting for treatment. 

Imagine, Costello said, that you go to the doctor’s office for a problem. While you’re there, you develop terrible tooth pain. The doctor refuses to treat your tooth pain, and keeps focusing on your original concern.

“You’re gonna get aggravated, you’re gonna get mad. You’re probably going to leave to try to get to a dentist to fix the tooth pain, right?” Costello said. “Well, it’s the same thing with the dopesickness, the withdrawal symptoms.” 

Costello added that this problem has been especially acute since the prescription opiate crisis. He said that the medical community has started “under-treating” withdrawal symptoms, out of a fear that patients are trying to get opioids for illicit resale. The reality, he said, is that substances like fentanyl are so cheaply available that there’s no black market anymore for prescription painkillers. 

According to Costello, when treating patients with opioid use disorder, medical providers should give patients opioids, putting them into “a window of cognitive sobriety” where they can stop worrying about withdrawal and focus on whatever problem brought them to the doctor in the first place.

As it is, people who use drugs often avoid going to the hospital and leave against medical advice once they’re there, Costello said. To fill this gap in accessible and respectful care, multiple providers run mobile clinics designed to meet drug users’ needs. 

Cornell Scott’s Street Medicine program conducts outreach to New Haven residents experiencing homelessness, many of whom also have opioid use disorder. In addition to following their own outreach routes, they often partner with groups like SWAN and offer services in soup kitchens and homeless shelters. The program’s three teams try to cover the whole city, including Hamden, Milford and West Haven.

The Community Health Care Van offers mobile health care services including HIV testing, primary care and syringe access. (Courtesy of Angel Ojeda)

Similarly, the Community Health Care Van offers healthcare services out of its 40-foot mobile clinic in the Hill, Fair Haven, Newhallville and other neighborhoods. Altice said the CHCV was the nation’s first mobile healthcare van when it was created 30 years ago, during the AIDS epidemic. 

“The trust issue is really important,” Altice said. He noted that offering mobile services is central to the harm reduction approach — the van is quite literally meeting patients where they are. 

Trust, Costello added, comes from consistency: showing up in the same areas every week, reaching out to people directly and following through on commitments.

Costello said that healthcare outreach programs also need to think from the perspective of people living on the street. For example, because homeless people’s belongings are regularly stolen or confiscated, Costello might distribute a smaller number of pills with more refills. 

Many brick-and-mortar health clinics and addiction treatment programs, although more limited in their capacities, are also attempting to incorporate harm reduction frameworks into their care.

Oldfield explained that as a federally-qualified health center — a comprehensive healthcare provider that serves an underserved population and qualifies for enhanced federal funding — the Fair Haven Community Health Center operates in a fee-for-service model. It receives reimbursements for traditional clinic and telemedicine visits, but not necessarily for patient outreach or harm reduction efforts. 

“Harm reduction and patient engagement does not fit neatly into that rubric,” Oldfield said. “We need to be out on the streets, working in partnership with these agencies, talking to neighbors, discussing options for care and harm reduction. That doesn’t always get remunerated in a way that we need to to maintain our bottom line.”

Federal law also constrains federally-qualified health centers’ ability to operate syringe service programs and overdose prevention centers. 

Oldfield said FHCHC collaborates with community partners who face fewer legal and financial limitations. In addition to their main clinic on Grand Avenue, in the heart of Fair Haven, they provide services at an outpatient addiction treatment program and hope to offer telemedicine at the forthcoming engagement center. 

At the APT Foundation, a substance use treatment provider, physical accessibility is linked to temporal accessibility. CEO Lynn Madden said that APT offers walk-in evaluations and same-day treatment, recognizing that many of its patients would struggle to keep appointments. 

Oldfield also noted that FHCHC’s clinicians regularly prescribe or recommend Narcan. Furthermore, when treating people with substance use disorders, they understand that “for a lot of people who use substances, their goal may not be abstinence.”

In addition to clean syringes, SWAN distributes safer injection kits. (Courtesy of Emme Magliato)

Hamilton said that Liberation Programs’ outreach had evolved from “recovery coaches” to “overdose response specialists.” When engaging with people after an overdose, the coaches used to ask, “What does your recovery look like to you?” and “How can I help you in your recovery?” Now, they ask, “How can we help you today?”

“It could be a clean needle, it could be a fentanyl strip… It could be a meal, it could be gloves, it could be a sleeping bag,” Hamilton said. “We really don’t want to come in with an agenda. And I think that’s the major shift.”

Liz Evans, the senior director of harm reduction at Liberation Programs and a longtime harm reduction advocate who helped establish OnPoint NYC, explained that harm reduction strategies are not meant as a replacement for more intensive treatments for substance use disorders, but rather as a complement. Harm reduction recognizes that many people currently do not want or cannot receive treatment, and it aims to provide acceptable and accessible care without judgment.

In doing so, it actually increases the likelihood that people will enroll in further treatment. 

“The underlying key is just to create relationships with folks that often are mistrustful of services and don’t feel like people have their back if they ‘fail.’ So for us, there is no failure,” Evans said. “The objective really is to build trust and to build relationships so that there’s always an open door, if somebody wants that, and in the meantime, to work really hard to try and keep people alive… Most of the research outcomes show that harm reduction is, in fact, a pathway into those supports and services, as well as its own pathway, legitimately on its own.”

Responding to community concerns

Practitioners emphasized that harm reduction is an evidence-based set of practices that reduces overdose deaths and the spread of disease while improving health outcomes — as well as a more humane response to a devastating epidemic.

“People who have a drug use disorder, they are considered less than,” Madden said. “It becomes an identity. You become your illness… People aren’t illnesses, they’re people.” 

Yet harm reduction initiatives often run into community backlash. 

In 2020, NHPD started to distribute harm reduction kits to people upon release from police custody, recognizing that people are more vulnerable to overdose immediately after incarceration. The department received “a lot of negative pushback,” according to Fumiatti.

“People who aren’t as educated about harm reduction… are more likely to have a negative view of the police, as in, ‘Well, you guys just don’t want to do your jobs,’” Fumiatti said. 

Fumiatti said that any harm reduction initiatives should be combined with public education campaigns to explain the benefits of harm reduction and encourage community participation.

Evans highlighted the importance of reframing conversations around stigma and drug use. 

“I think one of the greatest challenges for folks… is the misdirected fear that by acknowledging somebody who is still active in their drug use, and trying to help them to stay less at risk of overdose and less at risk of other kinds of harms, that is also somehow making the situation worse, or ‘enabling’ is the language that gets used a lot in the US,” Evans said. “I like to redefine enabling and say, ‘What we’re actually trying to do is enable people to have hope for a future so that they can stay alive and so that they can have some quality in their life.’” 

Senator Anwar said he is hopeful that community members will be open to harm reduction solutions once they see the data. The opioid epidemic is so widespread, he added, that “opioids have touched every family in our state.” 

“People recognize that there’s a problem, and they’re willing to listen,” Anwar said. “In a neighborhood, if you see people in dark alleys using drugs and substances, as opposed to going to a facility which has protections and a well-lit, safe environment… you are likely to select the latter.” 

Without sufficient community engagement, though, the backlash can be overwhelming. This was evident in the recent resistance to a proposed methadone clinic in Newhallville.

The APT Foundation runs four methadone clinics in the greater New Haven area. One of those clinics, on Congress Avenue, has been subject to repeated complaints about violence, littered syringes and public drug dealing and use. Howard Boyd, chair of the Hill North Community Management Team, said that local schools have had to construct fences and better lighting because of problems in the area. 

Madden blamed the issues with the Congress Avenue site on its location. Unlike APT’s other clinics, she said, the Congress site is in a busy neighborhood, where people tend to loiter just outside the property. APT plans to move its Congress Avenue operations to a new facility on Long Wharf Drive. 

Boyd agreed that the Congress clinic is in a busy, central part of the neighborhood. But he said that APT has failed to sufficiently engage with the community.

“If this is on our property, we’re gonna take care of it, but… once it’s crossed the street off of their property, it’s whatever,” Boyd said. “That’s the kind of attitude I was getting from them.” 

In early 2022, APT purchased a building on Dixwell Avenue in Newhallville, intending to open a new clinic in the neighborhood. Community members gathered in opposition, citing not only the problems at the Congress clinic, but also APT’s failure to engage with community members before purchasing the site. 

Hamden council member Justin Farmer, whose district abutted the proposed Dixwell location, said he was not contacted at all before APT made its purchase.  

“If you haven’t talked to the community, you shouldn’t be doing this,” Farmer said. “If there isn’t community buy-in, you’re going to have tension, and in the case of the methadone clinic, that’s the last thing people need.” 

Newhallville residents protest the proposed APT clinic on Dixwell Avenue. (Sylvan Lebrun, Contributing Photographer)

Farmer connected the lack of communication to broader tensions with race and class. He explained that the proposed clinic exacerbated community concerns about gentrification, underinvestment and overpolicing. There was a widespread perception that people would come from other neighborhoods to access APT’s services — while local residents continued to suffer from economic disinvestment.  

“If it was East Rock or any other affluent neighborhood, you wouldn’t be able to put in something like this without engaging in dialogue,” he said. “You cannot add something like a methadone clinic to Newhall without providing wraparound supports.”

Farmer said he felt the proposal “pigeonhole[d]” the community: either they supported the clinic, or they didn’t care about people with addiction. In reality, he said, the lack of available treatment is a problem — but so is the disproportionate siting of treatment centers in low-income Black and Brown communities.

Although APT has since ceased development of the Dixwell site, Farmer added that the lack of communication had set back the entire conversation about harm reduction, saying, “I can’t go to my community now to convince them we need a safe user site because now they’re pissed off about a methadone clinic.” 

Madden, however, attributed the choice of the Dixwell location to systemic factors outside APT’s control. The foundation needed a facility that was at least 40,000 square feet, zoned for outpatient medical use and within their price range — “there are not a lot of those kinds of properties that exist,” Madden said. She added that APT had worked with three city administrations to locate a suitable property.

The problem is exacerbated by the strict regulations around methadone, for both patients and providers. Methadone cannot be dispensed at standard pharmacies or doctor’s offices because it must be stored in a safe, behind a locked door with two alarms, according to Madden. This means that the number of places where patients can obtain methadone is extremely limited, although recent federal regulations allow for the creation of mobile methadone clinics. 

New Haven’s methadone clinics are mostly located in majority-minority or industrial neighborhoods on the southeast side of the city. The Newhallville clinic would have expanded access, but residents were concerned about problems with APT’s management and community engagement. (Courtesy of Sadie Bograd)

Patients also must go to a licensed methadone clinic every day to receive their dose, increasing congestion at clinics. 

During the COVID-19 pandemic, however, the federal government started allowing take-home methadone treatment. This exemption improved patient satisfaction and engagement, and may soon be made permanent. 

Boyd, of the Hill North Community Management Team, emphasized that community opposition is not inevitable. He expressed that, with better management, methadone clinics and other harm reduction services could be deeply beneficial. 

“We’re not against the treatment at all. We know people need treatment,” he said. “It was just really a communication problem. Talk to us. Be part of the community.”

For connections to local harm reduction resources, visit the New Haven Harm Reduction Taskforce, Connecticut Harm Reduction Alliance or ConneCT Without Stigma.

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