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Q&A with Emma Roberts, senior director of national capacity building at the National Harm Reduction Coalition

Emma Roberts is senior director of national capacity building at the National Harm Reduction Coalition, a national advocacy and capacity building organization that promotes the well-being and dignity of people and communities affected by drug use. The organization's efforts advance harm reduction policies, practices and programs that address the adverse effects of drug use including overdose, HIV, hepatitis C, substance use and incarceration.

Interact for Health: What is the biggest misconception associated with harm reduction?

Roberts: That we enable drug use and are opposed to abstinence-based treatment. We enable people to be healthier both physically and mentally—by treating them with respect rather than shaming them for their drug use. Abstinence is an important part of our spectrum of strategies, but we also support safer use and managed use options. We also now have evidence that shows people who use drugs that attend a harm reduction or syringe service program are five times more likely to access some form of treatment.

Interact for Health: The National Harm Reduction Coalition has been in existence for more than 25 years. How has the conversation about harm reduction evolved during that time?

Roberts: In the very early days it centered around the dignity and rights of people who use drugs and bodily autonomy given that harm reduction was started by people who use drugs for people who use drugs. As harm reduction became more adopted by mainstream services, I think the larger public health world focused more on HIV, hepatitis C virus and infectious disease prevention sometimes at the cost of losing the original spirit of harm reduction. In my trainings I often share that we can give folks sterile syringes but if we are not careful, we can also give them with a heap of shame, and this is not harm reduction, even if it's a public health intervention. As harm reduction becomes more accepted and widespread, we need to ensure that our principles of uplifting health and dignity, centering participants, respecting autonomy, realism and pragmatism, applying non-judgement and recognizing the socio-economic factors that create systemic inequality for people who use drugs are not lost. We risk diluting the approach and undermining the impact we can have.

Interact for Health: Please describe a harm reduction program that the coalition has implemented that underscores the power of your approach.

Roberts: Our overdose prevention and response work ... has played a huge role in expanding access to naloxone. HRC has been involved in both advocacy work to change legislation at federal, state and local levels to legally distribute naloxone and also establish "Good Samaritan" laws to give protections to folks at the scene of an overdose so that they feel safe to respond. ... We've also been able to advocate that naloxone gets into the hands of the real first responders: People who use drugs, their families and friends. They are most likely to be first on the scene. Our national capacity building programming has been able to follow up on the policy work by supporting programs and communities to get the buy-in they need to expand programming and develop best practices in how they operate.

During COVID the DOPE project in San Francisco was instrumental in supporting the movement of unhoused folks into temporary housing placement while also training staff to understand elevated risks for overdose when folks suddenly find themselves in a situation where they have to use alone and no longer have their usual support networks on the streets around them.

Another example is how both our policy and capacity building programs have been able to push towards the possibility of having syringe service programs in every state and territory.

Interact for Health: How can harm reduction programs demonstrate their value so their continued operation can be sustained?

Roberts: I think their value has been demonstrated over and over again, but we still have to contend with morality-based push back and constantly being asked for new research despite the federally funded research that already exists and testimonies that harm reduction works.

It's about continuing to build connections and relationships so folks can see the benefits of this approach and not stay stuck in all the perceived scary outcomes of not using punitive approaches to treat people who use drugs. A good example of this has been shown during COVID where strict rules relating to methadone prescribing have been lifted. During COVID more folks were provided with take-home doses. Early research has shown that there has not been a significant amount of misuse or diversion. What we've known in our field for years is that trusting people who use drugs to be able to take care of themselves and recognizing them as experts in their own lives in a harm reduction framework works.

Interact for Health: How has COVID-19 affected your work?

Roberts: We've been busier than ever as have harm reduction programs across the U.S. given their role as essential programming during this time. Many harm reduction programs have remained open when other community service provision has shut down or scaled back, and we've needed to continue our ability to respond to their support needs. We recently held two sessions on the topic of COVID vaccine hesitancy. We've also maintained our overall policy and capacity building programs to be able to respond to the needs of folks ... and are now looking at how to develop specific support options as people come out of the pandemic.

Interact for Health: What lessons have you learned through your work?

Roberts: I think the biggest thing I've learned is the constant need for cultural humility. I started out working in communities in the north of England before coming to New York with my son in 2008. I needed to be very aware of how I showed up in any community whether it's the North of England, South Bronx, Bed Stuy, Brooklyn or Coney Island. I am a cis white woman with a different accent and need to be humble about how I reach out to folks and not pretend to be the know-it-all or expert. I bring information and resources and help folks to adapt and tailor these options to make that work for their individual communities. Harm reduction in NYC does not look the same as in rural Indiana or in Southern states. The beauty of harm reduction is our ability to tailor our approaches to fit needs at individual, organization and community levels.

Interact for Health: What makes you hopeful?

Roberts: When I came to the United States in 2008 and asked folks about options for safe consumption spaces, heroin based treatment, decriminalization of substances (like we see in Europe, Australia and Canada) and the possibility of syringe services programs in every state, folks said these things could never happen in the United States. In 2021, all these options are now being seriously considered as possibilities or are beginning to happen in some states. I am hopeful we can continue on this journey to make all these possibilities come to fruition. I am hopeful that in doing so we will finally end the drug war that has harmed so many people.

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