A Whole New Song and Dance for Drug Outreach

Concerts, not unlike this undated 76th Street gig, are now popular venues for promoting harm reduction.
Concerts, not unlike this undated 76th Street gig, are now popular venues for promoting harm reduction. Beau Horyza / Solo Visuals
In 2019, few individuals, regardless of their political affiliations or relationship with medical science, can deny the ongoing opioid crisis.

This specific moment in time seems especially perilous: According to recent data from the Centers for Disease Control and Prevention, there were 68,000 opioid deaths in 2018 alone. While that represents a 5 percent decrease, Vox describes it as a kind of leveling off, fostering false hope that's ultimately detrimental.

Given this ongoing dynamic, researchers, advocates, and citizens alike have taken up the cause. The growing despair has fueled new forms of outreach, and one of the more novel approaches to enter the mainstream is harm reduction. This umbrella term describes a wide array of approaches to stem the negative connotations of drug use, including syringe exchange programs and co-pay assistance for the overdose-reversal drug Narcan.

"To me, harm reduction is basically minimizing harm for the groups with maximum risk," says David Riutta, a volunteer with the local Shot in the Dark coalition. "It’s about helping out extremely marginalized groups in using as safely as possible. It’s basic lifesaving."

Monique Tula, executive director of the Harm Reduction Coalition, says that the approach has actually been around for 30 years, having grown out of ACT UP, which supported individuals with HIV through advocacy.

"Despite the age of our movement and organization, I’m never surprised to hear people are unaware of harm reduction," she says. "There’s still this stigma attached. People think because someone uses drugs they don’t deserve rights or to be treated [like a] human. That view or perspective is what’s caused harm reduction to have trouble taking root."

Even Riutta was unaware of harm reduction until becoming sober himself. That speaks to the larger issues with traditional treatment, and the nuance that harm reduction promises.

"Recovery looks different for everyone," he says. "It’s kind of like taking an organic approach, and taking people’s needs into consideration." Riutta notes that people will always use drugs regardless, and that "any change is good in my book."

Harm reduction advocates emphasize Riutta’s notion of meeting people where they are — and that includes concert halls nationwide. In May, Billboard published an excellent piece about musicians combating the crisis in a variety of ways, including bringing Narcan to shows. Around the same time, Sadie Dupuis, of the band Speedy Ortiz, shared her own experiences and promoted an ongoing collaboration with HRC.

"I think rock 'n’ roll goes hand-in-hand (with drugs)," Riutta says. "It’s all about escape." Tula says that the connection between musicians and harm reduction is more apparent than some people might've imagined.

"In the Bay Area, if you pulled together a group of harm reductionists, a good percentage would look like crust punks," she says. "A lot of people come from punk or punk-adjacent; these people see their communities in the crosshairs. There’s threads of that everywhere, certainly in Arizona."

The Valley seems like fertile ground for this music-centric, all-hands outreach. But as with other groups, awareness is an issue. Stephen Chilton of Psyko Steve Presents says while "bands bring nonprofits into shows to table all the time, I can't say I have noticed this one come up."

Several people we spoke with, including artists and stakeholders, expressed unfamiliarity with either harm reduction or Narcan. For some local bands, like pop-punk outfit No Refills, the issue is the prevalence of harder substances.

"We haven’t seen much of any [hard drug use], save for maybe people drinking a couple too many beers," says guitarist/vocalist Tyler Drosendahl. "It’s far cleaner than I thought it would be 10 years ago."

That said, Drosendahl thinks that if bands are serious about championing harm reduction, they need to understand what that all entails.

"It’s still kind of a touchy subject," he says. "But I suppose it all depends on the time and the venue. We as a band do have a certain responsibility — if a show were getting out of hand, for instance, we’d always tell people to cool it. So it’s maybe better us than some other person."

At the same time, Drosendahl recognizes that there are limitations to their outreach. For one, he says, not every concertgoer is as fully engaged, and outreach might be ineffective. The aim, then, is to reach those people "who want to be there, who are more willing to get educated." It’s also a matter that Phoenix may be unprepared compared to clubs elsewhere.

"We just did a tour from Phoenix to Seattle in March," Drosendahl says. "And the first show in Tucson, someone offered us a drug overdose kit. And we were like, ‘Jesus Christ, we’ll take that.'"

To some degree, the impact of the message depends on the size of the band, and basic metrics go a long way in determining the impact of outreach efforts.

"There’s a local band who has 100,000 streams on Spotify," Drosendahl says. "And their lead singer has had some drug abuse in his past. Sometimes the crowd will listen, but it depends on how invested the fan is."

While Drosendahl says that there’s a real concern of bands "preaching to the choir," Riutta believes that it’s not about "going around and asking people if they’ve heard the good news about harm reduction." Instead, it’s about simply showing up.

"When we table at an event, you’ll always have curious people," he says. "Those people are always more inclined to come and check it out. Getting people comfortable is the biggest thing. We’re just giving them the resources to have conversations with their friends."

Riutta says most of the knowledge folks need is more common sense, like "who they’re getting (drugs) from and things like never share a straw because that’s how you get hepatitis C."

It's this lack of education that likely contributes to Arizona's ongoing opioid problems. Sarah Fynmore, a policy coordinator with Sonoran Prevention Works, points to harrowing data from the Arizona Department of Health Services that shows 3,471 overdose death statewide since June 2017. Via email, she notes that Arizona experienced the single greatest spike of deaths from illicit drug fentanyl between 2016 and 2017, with the CDC going so far as targeting Mohave County as experiencing, or at risk of, an outbreak of HIV or Hepatitis C due to injection drug use.

This issue's especially persistent among younger groups. Per data from the American Journal of Managed Care (courtesy of Fynmore), death rates are significantly higher among people ages 15 to 34. Meanwhile, rates of deaths involving fentanyl doubled from 2011 to 2016 among people ages 25 to 34. A 2017 survey from Dignity Health and the Barrow Neurological Institute reflected just that: 25 percent of surveyed teens used opioids recreationally.

click to enlarge Arizona's overdose deaths by category. - CDC
Arizona's overdose deaths by category.
Fortunately, there’s ample evidence of harm reduction’s effectiveness. Tula says that in the last decade or so, there were "marked decreases" in the rates of IV drug users contracting HIV, which is partially thanks to more syringe exchange programs. However, as federal agencies cracked down on so-called "pill mills" circa 2010, she says people moved to injecting heroin, leading to higher incidences of HIV.

There's also a 2018 study published in the Harm Reduction Journal, which found that "a majority of festival attendees aged 18-30" favored free drug checking at music festivals, indicating that the practice would "influence their drug use behavior."

Drosendahl supports the idea of outreach, for harm reduction and other causes, but he makes one especially valid point. All the speeches and tabling in the world are great, but ultimately it’s the art that has just as much of an impact.

"One of our songs is about heartbreak, but it’s also about drug abuse," he says. "The great part about being in a band is you can write songs that resonate. You can make people feel not so alone, and it’s often the same step as just talking to them."

Editor's note: A previous version of this article stated that the CDC targeted Mohave County as a site for a potential opioid 'outbreak.' It has been changed to "HIV or Hepatitis C due to injection drug users."
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Chris Coplan has been a professional writer since the 2010s, having started his professional career at Consequence of Sound. Since then, he's also been published with TIME, Complex, and other outlets. He lives in Central Phoenix with his fiancee, a dumb but lovable dog, and two bossy cats.
Contact: Chris Coplan