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Let's Talk about harm reduction strategies for substance use

Governor Tom Wolf

Let’s Talk New Mexico 3/10 8am: Fentanyl overdoses took the lives of about 80,000 Americans aged 18-45 in 2020 and 2021. Last month Governor Michelle Lujan Grisham signed a bill that revised an old law to legalize testing strips that tell users whether their drugs contain fentanyl. The tests had been classified as drug paraphernalia. Last year the New Mexico House handily passed a bill to authorize the creation of safe consumption sites for drug users, including intravenous drugs, but it failed to pass the Senate. These are just two examples of Harm Reduction, a public health strategy aimed at making risky behavior safer for the sake of saving lives.

Do you accept that drug use and other high risk behavior is going to happen regardless of local and federal laws, increased border protection, and society’s admonishment? Is it appropriate to make those behaviors safer as a part of a public health and legal response to the problem? Do you worry that Harm Reduction programs give the impression that we condone such behavior?

Share your ideas about ways to address addiction and risky behavior by emailing LetsTalk@kunm.org, tweet #letstalkNM or call in live during the show to (505) 277-5866.



Kaveh Mowahed: This is let's talk New Mexico I'm Kaveh Mowahed. Recently, Governor Michelle Lujan Grisham signed a revision of the Harm Reduction Act to decriminalize the possession of tests that show if a substance contains the drug fentanyl. The hope is that this new tool will help cut into record high overdose rates. In fact, fentanyl overdose has become the nation's top killer of adults aged 18 to 45. The new legislation is part of a larger strategy aimed at making risky behavior safer. Harm reduction has been in New Mexico for a long time, maybe the first thing that comes to mind is needle exchange programs for intravenous drug users. But there's a lot more to it. Think quality control of street drugs or reining in narcotics prescriptions that can lead to addiction. It may sound counterintuitive, but the goal is actually reducing addiction and making communities safer. We'll start the conversation today with policy talk from the Drug Policy Alliance and the New Mexico Department of Health. Then we'll hear from a drug court judge who has gained notoriety for taking a humanistic approach with defendants and will end the hour talking to harm reduction practitioners about their work in communities in northern New Mexico and in Albuquerque. We want to hear from you also, does the idea of making drug use safer make you hopeful or uncomfortable? Email us at LetsTalk@kunm.org or call in live at 505-277-5866. Let's get started. My first guest is Emily Kaltenbach. She's the senior director for criminal legal and policing reform for the Drug Policy Alliance. She also runs the New Mexico office of DPA. Thanks for joining us this morning, Emily.

Emily Kaltenbach: Thank you, Kaveh. Thanks for the invitation. Happy to be here.

Kaveh Mowahed: Yeah, of course. We're happy to have you. Since we're focusing on harm reduction strategies today, let's make sure we know what we're talking about. What is harm reduction?

Emily Kaltenbach: Yeah, we hear this term, often. But we… a lot of people don't really have a good understanding of what harm reduction really means. And broadly defined harm reduction is a set of practical strategies aimed at reducing negative health, social and legal consequences. And some say it's actually a tool for critical thinking. So, if you have a problem, you come up with solutions to solve that problem with the least possible harm. We all engage in harm reduction every day without realizing it. So, you know, one of the examples often used is would you open the oven and pull out a hot pan with a without an oven mitt on? So, wearing mitt.. oven mitts are harm reduction. And, you know, wearing orange when you go hunting is harm reduction or wearing seatbelts or wearing masks during a pandemic is harm reduction. But the bottom line is harm reduction reduces injury and ultimately save lives.

Kaveh Mowahed: Okay, so when it comes to drug use is harm reduction more important than getting people into recovery programs? Why focus energy here?

Emily Kaltenbach: Absolutely. I mean, as I said, harm reduction, when it comes to drug use is about improving quality of life, and ultimately saving lives. But harm reduction from a drug use perspective is really a spectrum, a continuum of behaviors, right. So, on one end of that spectrum, abstinence could be harm reduction. On the other end, if someone is using drugs chaotically, it could be as you discussed in the intro, access to syringes, syringe exchange programs or Naloxone which reverses an overdose. So, harm reduction also can be a bridge into other social supports and treatment. So, when we wrap around harm reduction around someone, they are more likely than to get the services and supports they might need. And what.

Kaveh Mowahed: Okay, what is the national landscape of harm reduction look like? Are we seeing trends?

Emily Kaltenbach: So, I mean, in my time in the drug policy, field, we've definitely seen an increase in politicians supporting harm reduction. So actually, as you mentioned before, New Mexico is one of the first states to embrace harm reduction. And we've really led from, as you said, early, you know, government sanctioned needle exchange programs that were often underground. And we were the first state to actually pass a Good Samaritan Law where people could feel safe calling 911 if they witnessed an overdose, and then they wouldn't be charged with drug possession. So, we've come a long way. That's the natural landscape, what's very cool is we're seeing a trend towards support of overdose prevention centers, or they're often called supervised consumption spaces. They are where people can bring their drugs and safely use receive the support to treatment. Rhode Island was the first state in the last year to pass statewide, a statewide law authorizing these types of centers and New York just open two of them; New York City in the last two months.

Kaveh Mowahed: Okay, so they've already been running in New York City. How's it working out?

Emily Kaltenbach: It's amazing. I mean, the data shows that they are well utilized. So, there have been just shy of 10,000 visits in the last couple of months, over 800 participants, and they've been able to reverse about 170 overdoses. So those are 170 people's lives have been saved in a couple months in New York City. They have two sites, one in East Harlem and one in Washington Heights. And it's and, so you know, when you ask about the national landscape, I think we're seeing this country start to embrace unique harm reduction services for this country. But these services have been widely used around the globe and other countries and have good evidence to show that they do save lives.

Kaveh Mowahed: Okay, well, we're talking about safe use sites. There was an effort just a couple of years ago in New Mexico's legislate legislature to allow counties to authorize safe use sites. Its sailed pretty quickly through the house, but then it stalled in the Senate. What happened, Emily?

Emily Kaltenbach: Well, as we know, I think we can say it ran out of time, the Senate side, it stalled in the Senate Judiciary Committee. It was supported with bipartisan support through the house. And unfortunately, it just didn't get put on the priority list to get to the Senate floor. However, I do think there's broad support for this type of service in New Mexico. I think we have to ask, what does that model look like that's appropriate for New Mexico? As I mentioned, in New York City, we have, you know, folks who are using on the streets who are marginally housed these, these services are really important. This could work in Albuquerque; it could work in Santa Fe could work in other urban areas. But we have to ask, is there a way to adopt or adapt that to work in rural communities?

Kaveh Mowahed: Okay, well, now we're starting to get into policy in New Mexico, it's a good time to introduce our next guest Aryan Showers. Aryan is the policy director for the New Mexico Department of Health. Thank you for coming on the show this morning, Aryan.

Aryan Showers: Thanks so much for having me.

Kaveh Mowahed: Sure. We're talking about safe use sites where people can use drugs more safely and under supervision. Do you think there's political will now for the legislature to create safe new sites in New Mexico? Maybe in the next session?

Aryan Showers: I think it's I think it's possible. Now, as Emily discussed already, we saw house bill 123 really, really fly through the House committees. I do think that it ran into some obstacles probably getting scheduled, as well, because it was that first really long virtual session. And I think everyone had trouble figuring out how to adapt to the virtual environment. And it did affect a lot of people who are hoping to get bills through that session. So, I don't see it as any real indication that there's not support for it on the Senate side. I'm feeling hopeful that there would be future support for some kind of initiative that’s similar. I know that the governor is also very supportive of harm reduction generally and seems very open minded about strategies that we can develop that will effectively combat the crisis that we're seeing right now, throughout New Mexico. I think as Emily suggested, it's going to be a challenge to perhaps figure out how to fit this into a New Mexico model. We've seen it in larger cities, and I think it's very easily adaptable to those to those larger cities within New Mexico, but we will have to put some thought into how to sort of universally make that a reality throughout the state. But yeah, I am hopeful I do see it as maybe the next big step in harm reduction strategies that we could contemplate. And I do think that, you know, the state, given how help fever pitch we've, the sensible crisis has become I think that legislators and the public are generally just wanting someone to intervene with some strategies that will work.

Kaveh Mowahed: Okay. Emily, I want to go back to you with a question. Do people want to use sites like these? It seems, I don't know. Kind of awkward, but I don't know. Maybe it's more like going to a bar I'm not sure.

Emily Kaltenbach: No, it's not, I wouldn't have equate it to going into a bar. These sites, these are really treatment and social support sites, right? The… there are people who are using chaotically on the street. And this, without access to harm reduction services. And this is a safe place to use where they're not where they're not going to receive the stigma. They're going to receive support and compassion and access to services. So, we do see people using these in other countries. I mean, just take New York, for example, just shy of 10,000 visits in two months. I mean, I think that's an indication that they're used. And I just want to say that, you know, harm reduction is also about reducing the harm of prohibition and criminalization, and punishment and stigma, right? It's not just access to a clean needle is about changing the way we address drug use and treat it as a health issue and not a criminal issue.

Kaveh Mowahed: Okay, let's switch over to talking about, you know, a major win for harm reduction that did make it through the legislative process this year. Just over a week ago, the governor signed an update to the Harm Reduction Act, it was House Bill 52. That decriminalizes the possession of tests that show if substances contained fentanyl. Those tests had been classified as classified as paraphernalia. And I understand it took a few years for the bill to get enough momentum to get past in both houses. Aryan, why did it take so long?

Aryan Showers: Thanks for that question. So, I do think that the last time we proposed it, it was again during that that virtual session, and things were just difficult, too. And it took a while I think for the state and the legislature to really fully accept what was happening with fentanyl. I think that things have really shifted into a new phase with the opioid pandemic, or pandemic… epidemic that we've been seeing in the country for quite a long time. And fentanyl has really sort of changed the urgency. So, I do think that by the time we proposed this last time, we had just a lot of broad support for it. We had a lot of people involved with the bill itself, who really advocated for it, we had communities, harm reduction providers that were very vocal, very, very active and helping us sort of shepherd that through the session as well. So, I mean, the advocacy network is incredible around harm reduction, and we had just so much participation. So, I do think that, you know, just the urgency of the issue, along with the broad support that we got from so many different groups within the state really may, you know, got it across this time.

Kaveh Mowahed: Right. You were actually in some of those legislative committee hearings this year. Can you tell us a little bit about what sort of testimony you heard from you know, those interest groups and so forth?

Aryan Showers: Well, yeah, so we had, you know, first of all, we had a lot of support just from, you know, public health group. So, you know, the New Mexico Public Health Association came out in support, we had different sort of medical organizations supporting the initiative, you know, obviously, the Drug Policy Alliance was involved. And then we had, you know, we had several teenagers who actually testified to their own experience getting hooked on fentanyl, who were at the time of their testimony, actually in recovery at a at a place called Serenity Mesa in Albuquerque. So, I think that that was all very powerful testimony, very impactful. And these two teenagers who testified, were basically talking about their experience getting unwittingly addicted to fentanyl thinking that they were actually using a different substance. We're seeing more and more of that; I actually spoke to the director of that facility the other day, and he had told me that one of his kids had had relapsed on meth and actually overdosed and died on fentanyl, not knowing that it was, you know, adulterating that, that substance. So, we're seeing that more and more often. And we heard a lot of testimony, I think during the session that was very, very powerful to the legislature.

Kaveh Mowahed: Okay. This is Let's Talk New Mexico on 89.9 KUNM, I'm Kaveh Mowahed. We're taking your calls about policies that make drug use less deadly. Tell us what you would or would not support…. why you would or would not support these strategies by calling in at 505-277-5866. We'll be right back.


Kaveh Mowahed: Welcome back to Let's Talk New Mexico. I'm Kaveh Mowahed, we're talking to Emily Kaltenbach from the Drug Policy Alliance and Aryan Showers, the policy director for the New Mexico Department of Health. Do programs to make drug use and other risky behavior safer, make you feel hopeful? Or do you worry that implies that we condone that kind of behavior? Call 505-277-5866 or tweet to us with the #LetsTalkNM. Aryan, I want to know more about the implementation of the of the HB 52 revisions. When are we going to start seeing those fentanyl tests? And how available are they going to be to users?

Aryan Showers: Well, we want them to be really widely available. The fentanyl test strips are just really another tool that we're adding to our overdose prevention sort of toolkit. So right now, that includes Naloxone and Naloxone and overdose education. We're going to simply add fentanyl test strips to that grouping of tools that are used to prevent overdose. So, what we what we are hoping for is to see some federal funding become available probably in May. Our Harm Reduction Program Manager Josh Swatek, along with some other folks within that program, have sought out federal funding in several areas to help us purchase a ton of these strips so that we can distribute them. So, we do see that the legislation itself will take effect in mid-May, we will also have SAMSA funding, and I think some CDC funding available around the same time but the bill also does another thing. So, it's not only making possession of fentanyl test strips legal. It also allows the department to promulgate rules around what it can include as supplies that we can distribute through our harm, harm reduction provider network. So, you know, 25 years ago, when this act was passed, the Harm Reduction Act, it was really contemplating a problem that involved black tar heroin.


Kaveh Mowahed: Aryan, I think we may have lost you. Okay, we'll come back to you in just a moment. How about I pitch a question to Emily Kaltenbach. From the Drug Policy Alliance, I invited callers to kind of express objections they might have to harm reduction policies. I wonder if you can chime in on how you address people who have moral or other objections to harm reduction strategies.

Emily Kaltenbach: Again, I think we have to go back to the definition of harm reduction. Do people you know, drive faster because they're wearing a seatbelt? You know, I think that we all engage in harm reduction every day. And again, it's about saving lives. So, if harm reduction can actually be a bridge to treatment, and maybe even ultimately, abstinence, if that's what that person wants and is engaged in, then why wouldn't we support harm reduction. Harm reduction also reduces costs in our community. You know, think of the cost of transporting someone to the hospital, every time there's an overdose, or the cost of treating someone in a ICU because of an abscess, because of drug use. I mean, there are so many reasons that harm reduction is really important for our entire community. It saves lives. It keeps families together. And it is a bridge to other social support.

Kaveh Mowahed: Okay, I'd like to go ahead and jump ahead just a bit and introduce another guest. We have Josh Swatek, the Harm Reduction Program Manager for the New Mexico Department of Health with us. Before going to work for the state, Josh did similar work with the City of Albuquerque. Thanks for being here, Josh.

Josh Swatek: Oh, thank you Kaveh. How are you doing this morning?

Kaveh Mowahed: I'm doing pretty well. We had a technical difficulty and lost Aryan. We're going to try to get her back. But I have another DOH kind of policy question. I think maybe you might be able to jump in. There was an ask for funding for a funding increase for harm reduction and other DOH work. We got news yesterday that the Jr. funding bill was vetoed by the governor. And I wonder if that's gonna affect DOH as harm reduction plans? What kinds of things would that money have gone towards?

Josh Swatek: For us, that's not going to impact our direct programming at all. We actually got an increase in our base budget through HB 2 this year, really to purchase more Naloxone, and we're going to use it for purchasing of fentanyl test strips as well. So really, we currently have the resources to implement these sorts of programs. As soon as the delivery goes into effect.

Kaveh Mowahed: Okay, great, thank you. And I just got the word in my earphone that we do have Aryan back on the phone. Thanks for coming back to us Aryan. I want to go ahead and actually introduce another get…. another guest. I want to shift the discussion a little bit from policy to the criminal justice system. Our next guest is Judge Jason Lidyard from the first Judicial District in northern New Mexico. Judge Lidyard runs a drug court and kind of a novel way, including meeting people in public places where they're more comfortable, like a local baseball field. Thanks for joining us this morning Judge Lidyard.

Judge Jason Lidyard: Of course, glad to be here. Thank you so much for having me.

Kaveh Mowahed: Yeah, sure. We're happy to hear from you. I always like to start the conversation with defining the terms. So, we're all on the same page, can you tell our listeners about drug court and how it's different from a criminal or a civil court?

Judge Jason Lidyard: Sure. So, drug court is an alternative to incarceration. It's also an alternative to probation. It's a court run program that lasts in duration for anywhere between one year and two years. It's a program post adjudication, which means after a person's convicted, they get referred to the program. And instead of reporting to a probation officer or being incarcerated, that person reports to the court. And they report to the court every two weeks to meet with me, to talk about how they're performing in the program. And between those meetings with me, during those two weeks, they are required to meet certain obligations, such as counseling requirements, your analysis requirements, programming and treatment requirements. And then when they meet with me, we talk about their compliance, and I see how they're doing. And they do that for a certain number of phases. And if they're able to accomplish all the requirements, then they can graduate. And after their graduation, then generally they're relieved of any further obligation with the criminal case that they refer to the program with. And I've been doing that for about four years. And I've been working with the Mountain Center in Espanola, as they're my treatment provider to provide services to our clients.

Kaveh Mowahed: Okay. And we do have a guest with us from the mountain center, who I'll introduce in just a few minutes. I don't want to jump too far ahead, though. So, do offenders, Judge Lidyard come straight to you or are, they, it sounds like they have made their way through a criminal court first and then are referred to you.

Judge Jason Lidyard: So, I would be the presiding judge over the criminal case. So along with my responsibilities with the drug court program, I handle all felony level cases of a criminal in nature in Rio Arriba County and Los Alamos County. So, individuals come to me with a criminal case, and I handle the underlying case. And as part of the resolution of that case, they may be referred to the drug court program. So, I'm involved in the case before it even comes to the drug court program.

Kaveh Mowahed: So, you're with these defendants all the way through the process. It sounds like you have the opportunity to really build relationships with them.

Judge Jason Lidyard: Yeah, I interact with him at the very beginning of the case when the charges are filed against them, and they come before me at arraignment. And I inform them of the charges that they are facing the possible penalties and I set conditions of released for them that they must comply with during the pendency of the case. And then they appear in front of me periodically as it proceeds to either trial or resolution through a plea agreement. And through resolution of the plea agreement or through resolution after trial. I could refer them to the drug war program to meet with me and begin programming.

Kaveh Mowahed: Okay, we have an email from a listener. Lisa, who says she's all for harm reduction. She wants to live in a community where safety is a priority. She goes on to say, now, I'm going to quote her. “My question concerns the broader community impact of long term substance use. Given that Albuquerque has a very high rate of home break-in stuffs and other property crimes, and that many of these crimes are committed by people with substance addictions, who steal in order to fund their substance purchases, I'm wondering what can be done to reduce the harm being experienced by the victims of the crimes?” So, Judge Lidyard, I'm wondering, are these kind of separate issues like Lisa maybe presents them or does harm reduction also affect crime or vice versa?

Judge Jason Lidyard: I think they go hand in hand. With the drill core program, we're trying to address the underlying reason why people engage in substance use. And if we're able to address their substance use and help them recover from that, then we can also prevent crimes that are related to drug use from occurring. The cost of supplying someone's addiction on a daily basis is extremely exorbitant; the price to obtain heroin on the street, for an average user could be anywhere between $50 to $150 a day. And that is extremely expensive to fund. And as a result, individuals commit theft crimes and fraud crimes to support their addiction. So, if we can address their underlying drug use, and help them recover from that use, then we can prevent criminal activity related to that drug use from happening. So, we can help those victims of crime not experiencing the harms that they are enduring as well.

Kaveh Mowahed: Okay. I see we have a caller. Mandy in Albuquerque, you're on the line. Go ahead, Mandy.

Caller Mandy: Yeah, hi. So, I'm an advanced practice nurse specialist in substance use disorder. So, I treat patients with addiction. I just wanted to voice my support for all of these harm reduction approaches and measures. There's so much data to support these harm reduction approaches, and that they in that they save lives, and they facilitate recovery. But to the point that you've been talking about what the judge, you know, there's this wider both public health and public safety benefit as well. So, if we're providing support services, harm reduction supplies and a safe place for people to go, it reduces crime, and it reduces improperly discarded syringes, and things like that. So, it makes our whole community safer and healthier. And although you know, substance use disorder is really a health condition. But it's too often viewed as, as, as something to be punished or like a criminal justice issue only. And I've seen my own patients go through this countless times. And it really leads to these extreme health inequities and barriers to care for patients. So, I really think, you know, moving away from this, like stigma and punishment approach to these harm reduction measures, and a public health approach is, is more compassionate, but it's also a lot more effective. So, I really appreciate the conversation today.

Kaveh Mowahed: Thank you for calling Mandy. And I'll tell you, Emily is nodding along Emily Kaltenbach. From the Drug Policy Alliance, would you like to respond or something?

Emily Kaltenbach: Yeah, absolutely. I just want to support it voice my support for what the caller's point. One of another policy that embraces harm reduction is decriminalizing drug use, possession, right, or drugs possession in youth. And we saw that happen in Oregon. And so that is a really important step, if we're going to treat it as a public health issue, we need to stop criminalizing the possession of small amounts of drugs, and instead, move that into the public health system. And I also just want to share about the syringes that in New York, the overdose prevention center, I heard, they just shared with us that syringes that have been discarded on the streets have dropped significantly. They got a call from their parks departments saying what's going on, we're not picking up as many syringes. And I think we can directly link that to the opening of those overdose prevention sites.

Kaveh Mowahed: Okay, I want to encourage people to call in and share how can we get away from thinking of drug users first as criminals and then as people with substance use problems? Tell us your ideas, call us 505-277-5866 or email, LetsTalk@kunm.org. You can also reach us on Twitter with the #LetsTalkNM. I'd like to go back to judge Lidyard. I'm not going to ask you about decriminalizing drugs. I think policy is maybe not your jam. But it sounds like you do have some discretion when it comes to how you interact with and address your client's needs. That's different from probation or parole, right I'm still trying to kind of get at the benefits of the drug court.

Judge Jason Lidyard: Yeah, so as a judge, given my position and the authority that comes along with it, I have the ability to when someone's not complying with the drug court program to address that situation by not saying, I'm going to arrest you and incarcerate you. But to say I'm going to try a different approach. And what I generally like to do is try to understand the person's circumstances and have an honest conversation with them about the issues that they're facing and trying to comply with the program and trying to give some realistic remedies to that situation to help them be more compliant, and to connect with the resources that were able to provide. And if someone is when I'm learning about their circumstances in active use, and I learned that, then I apply a harm reduction approach. And I refer them to the Mountain Center and talk to them about the importance of safe use, and to get connected with sterile syringes to prevent the transmission of disease, to get provided with Naloxone to prevent fatal overdose, and also to discuss with a counselor, and a therapist, the idea of medical assisted treatment, such as methadone or Suboxone, which also prevents harm in preventing or not requiring that person to go into the illicit markets, which is a dangerous environment for people to go into, for their safety, as well as to use the substances that they obtain in those markets. In the illicit market, there's no knowing what the substances that you're purchasing, you don't know what's in that substance, you don't know the potency of that substance. And that can be a very dangerous thing for someone. So, providing them an alternative through medical assisted treatment is another harm reduction approach that I apply. And with the passage of House Bill 52, now I can refer them to the Mountain Center, and they can get fentanyl test strips and they can also get other sterile use equipment to assist in making sure that when they do use that they're doing so safely.

Kaveh Mowahed: Okay. NPR ran a story yesterday out of Colorado, where a mother lost her son to an accidental fentanyl overdose, and feels that if you're carrying small doses, you are a distributor because it's so potent. Emily, I wonder if you feel that challenges the idea of decriminalizing small amounts of drug?

Emily Kaltenbach: Well, I think we have to recognize that drug prohibition has only resulted in the drug supply becoming far more adulterated and more dangerous. And so, if we decriminalize people are going to be more likely to seek out services and support, I think that they'll be more likely to use drug checking services. And so, we may be able to then, I mean, hopefully, we can avoid these tragic deaths of our young people. We need to make sure they are getting the support and services. So, if we can be able to address the illicit supply and the dangerous supply in an unregulated market, I think we're going to actually see better health outcomes.

Kaveh Mowahed: Okay, I'd like to come back to Aryan; when we talked in the past about the rollout of the fentanyl tests, you mentioned there would be new training for law enforcement. I'm wondering do you just mean, letting them know that tests are illegal to have? Or is there more to it than that? What about if they find a test in someone's pocket? Is that, you know, reason to search cars or something like that.

Aryan Showers: Right. So, so we've had a long standing relationship with law enforcement, and we work very closely with law enforcement and in developing trainings around the Harm Reduction Act. So, the Harm Reduction Act requires training. I mean, this is the first really significant update in quite a long time. So, we suspect that, yes, the trainings will be updated. Law enforcement will be fully educated about, you know, what this allows for and what it does not. But generally speaking, you know, we've had the needle and syringe program for a while, and this will sort of just be an expansion of that program that already exists. And so, if someone has a needle or a syringe on them, and they're a participant in the in a harm reduction program, they have they generally will have a card on them that indicates that they program participant. So, officers are aware of that, and they look out for it. And they know that that really signals to them. That this is someone that's engaged in the program. And sometimes, you know, someone might not have a cord on them, they usually go through a process, they might, you know, we're pretty familiar with that kind of circumstance arising and we, it's almost like having, you know, insurance but not having proof on you. So, we will generally just reach out and provide a letter so that that person is, is given the documentation that they need.

Kaveh Mowahed: Okay. You are listening to Let's Talk New Mexico on 89.9 KUNM, I’m Kaveh Mowahed, stay right there. We'll be back in just a minute.


Kaveh Mowahed: Welcome back to Let's Talk New Mexico on KUNM. We're talking about interventions to make risky behavior and especially drug use safer. Call 505-277-5866 to share your thoughts. I'm going to go ahead and bring in another guest. We have Kelly Mytinger. from the that's the Harm Reduction Program Manager from the mountain center. That's already been mentioned a couple times. You're here to talk about what it's like on the ground doing intervention work and often working with the same clients that Judge Lidyard sees. Thanks for joining us this morning, Kelly.

Kelly Mytinger: Thank you so much for having me, Kaveh.

Kaveh Mowahed: The Mountain Center is in Espanola. But you do work all around that region, right? Tell us about how y'all do harm reduction. What are the services?

Kelly Mytinger: Absolutely. So, we have a mobile unit that goes all over Rio Arriba and Taos County and a little bit of Santa Fe County. We cover 6000 square miles in our outreach week. And some of our routes include going up to Taos, we go all the way up to Chama. We go up through Dixon and Peñasco, pretty rural places. So, we do that every day of the workweek. And then we also have a fixed site location and office in Espanola, where people can come in to receive all of the services that they would be receiving on our mobile units. And that would include safer drug use supplies, you know, syringes, paper smoking supplies, we also provide condoms, other safer sex supplies, Narcan, we provide food, very low level wound care, supplies, pet food, menstrual products, we provide COVID Safety supplies, really, whatever our community's needs, that we can reasonably financially find a way to provide to them, we find a way to do that.

Kaveh Mowahed: You just mentioned a lot of services. Harm reduction goes way beyond you know, fentanyl test strips and clean needles then I'm hoping we can dig into that a little bit more. Maybe when we come back to Josh Swatek in just a few minutes. But Kelly, I want to know, who are your clients, adults, kids, mothers, fathers, all shapes and sizes? Who are you saying?

Kelly Mytinger: Absolutely. I will start with our clients are adults. Part of the harm reduction legislation in New Mexico is that anyone who's a client of a syringe service program must be 18 years or older. So, there's that. Our prescription drug overdose prevention program, which provides Narcan specifically to larger groups of people will sometimes interact with youth, but it's largely adults. And really, everybody, substance use doesn't really have a specific way that it looks in terms of who comes to our office and who ends up needing our services. It's pretty tied to poverty and lack of resources. People of all income brackets use drugs but people who can afford to do those things privately and get their supplies, with their own money don't typically need to access harm reduction programs. So, we tend to see people who need our services for financial reasons and also need all of the other supplies we provide for financial reasons.

Kaveh Mowahed: Judge Lidyard, I'm wondering, you said you worked with the Mountain Center regularly and they just kind of maybe drew a thread or drew a line from poverty to drug use, and probably also crime. Is that something that you experience and see regularly? Is poverty, the uniting theme, unfortunately.

Judge Jason Lidyard: Unfortunately, it is. Correct. We live in a world of haves and have nots, and many of the people that come in front of me are the have nots, they are dealing with a lot of circumstances in their life that were just outline poverty, lack of resources, employment issues, education, things of that nature. And that's what I see generally in the population that comes before me.

Kaveh Mowahed: Okay. I guess I want to go back to Josh Swatek right now. We introduced him earlier in the hour, but I'll just remind you that Josh is the Harm Reduction Program Manager for the New Mexico Department of Health. And he worked in Albuquerque before going to the state. Josh, I'm wondering, we heard a description about the, you know, the plethora of services offered by the Mountain Center. Is that sort of thing available in Albuquerque, too?

Josh Swatek: Yeah, absolutely. We, we have services for a number of providers in Albuquerque. There's several that offer food, housing assistance, job assistance, assistance for identification, a vast array of services that are tied to a harm reduction programming.

Kaveh Mowahed: Okay, Kelly, I'm wondering, how have you been doing this work long enough that you've been able to kind of see any shifts in harm reduction practices to adapt to the rise of synthetic opioids? How new is that problem?

Kelly Mytinger: Yeah, absolutely. I have been volunteering and then working with the Mountain Center on and off since 2013. And really recently, it has looked pretty different. In general, we have provided a lot of syringes over the course of our program’s history. It provided smoking supplies, here and there. But they weren't hugely popular. I'd say around last summer, we started seeing a real decrease in people coming to us looking for syringes, and people coming looking for smoking supplies. Mostly because largely, the jump that is available are blue fentanyl pills, that people have been smoking. Some people are looking for them. Some people are pretty upset that they have trouble accessing the substances that they're used to. But I'd say like in the last month, we go through days where it looks like we only saw maybe 10 people at our office, because that's how many syringes exchange encounters, we had. But in reality, we probably saw 20 or 30 people, just 10 to 20 of those people were not interested in or needing syringes anymore.

Kaveh Mowahed: Okay, and Josh, did you have something to add to that? I'm sorry, we can't hear you. Oh, there you are.

Josh Swatek: There we go. So, this is a nationwide trend that we're seeing as individuals switching from objecting to smoking. And another great thing that House Bill 52 does is it allows the harm reduction program the flexibility to respond to how people consume substances. So, house bill 52 has allowed us the regulatory authority of the Department of Health to offer additional items to the harm reduction programs to really cater to what people are using right now so that we can get fentanyl test strips and overdose prevention messaging in the lock zone out to the wider community.

Kaveh Mowahed: Okay, and Josh, I'm going to check back with you later and see if we can get a maybe some names of some of those service providers in Albuquerque and get them up on our website. I do already know of Casa de Salud and dope services. I'm sure there are a lot more in the metro region. But just for listeners if you need that reference, we'll get it up there today. Aryan actually, Josh just brought up something interesting, the shift from injecting drugs to smoking drugs, and that reminded me of a conversation we had recently, where you said that actually, that is a harm reduction measure that smoking drugs is actually safer or less dangerous than injection. Tell us about that.

Aryan Showers: Right. Yeah. So, I mean, harm reduction is generally regarded as a positive approach to managing really high risk behaviors. And, you know, as we discussed previously, this isn't just limited to drug use, we can apply this to many different situations and types of behavior. So, in the, you know, we've been really managing the opioid epidemic, and it's been focused on needles and syringes. For the last 25 years, we have been promoting alternatives to drug users as a safer method of ingesting their substances. You know, needles and syringes are regarded as the most high risk method for ingesting subject substances, you have soft tissue injury, infection that goes along with that. And it can really create a whole host of other problems, including the transmission of disease. So smoking devices, you know, everyone would prefer that people are ready today to get into recovery. That's not always the case. And we can't really impose our timing on people's recovery. But what we can do is suggest that they switch to modes of ingestion that are safer.

Kaveh Mowahed: Okay, Kelly, I'm wondering if the Mountain Center has a policy about whether you steer people toward recovery programs while you're out in the field doing harm reduction work.

Kelly Mytinger: Absolutely, we tend not to steer people just because we really want to be very value neutral with our clients. We understand that relapse is part of recovery, and likely clients who engage with recovery programs, will end up needing our services again, at some point in the future. And we really want to make sure that people do not feel ashamed or judged to come back to us after we have referred them to treatment. But we always make sure to have resources available for people, when they express interest in going to treatment, whether that be to our suboxone program at our office or methadone programs in the community, or other forms of treatment that people are interested in. We have those things ready and available for when people express on their end that they're interested in that service.

Kaveh Mowahed: And Josh, I'm wondering if that goes for the state too, is there a policy about trying to get people into recovery if the ultimate goal is to get people to stop using substances?

Josh Swatek: Definitely, our goal is to help people when they're ready, that like Kelly said, we will maintain that value neutral approach. So that way, if relapse does happen, people aren't afraid to come back to us because they don't want to feel like they failed their service providers. So, when individuals are ready for recovery, we're able to refer them because we're a really trusted resource. Really, the goal about harm reduction is building those relationships. So, we can navigate people into what services they need, when they are ready for them. So, recovery might not be on someone's mind when they might be experiencing homelessness. So those are some of the things that we focus on is really focusing on the needs of the client and on the individual level across the entire state. And it's really been proven successful. If you look at the data, individuals are engaged in harm reduction programming, they're five times more likely to enter treatment, and three times more likely to succeed. And that's really because its client based individualized, policies that really are linking people in the care.

Kaveh Mowahed: Okay, Josh, I'm wondering now does DOH’s harm reduction work extend beyond substance use? In particular, I'm thinking about dangers associated with being unhoused, like you just mentioned, or maybe even sex work?

Josh Swatek: Sure, so while, my program doesn't directly work with that all the time, we're working with other organizations. And we also have, we also find navigation in the Medicaid assisted treatment, and hepatitis C curative therapy. And our programs take a very broad view of that. So, we look at funding, helping people obtain housing, identification, insurance so they can get treatment. So, we take a very broad view of harm reduction. We also work with organizations such as street safe, New Mexico and Albuquerque, that are that work with individuals who are doing sex work. So, we want to spread harm reduction messaging to them. So, it's really a close collaboration with lots of organizations that work in different fields. And some of our funders, like Albuquerque Healthcare for the Homeless in Albuquerque, obviously, are working with individuals who are experiencing homelessness to. So, it's really a collaborative effort across the entire state.

Kaveh Mowahed: Okay, I'd like to go back to Emily Kaltenbach. With the Drug Policy Alliance, I have kind of a maybe a macro question for you. Given our long history of harm reduction here, we still have a pretty bad track record when it comes to addiction in New Mexico. What needs to happen along with harm reduction, what other strategies should we be employing? Emily, we can't hear you.

Emily Kaltenbach: I apologize. Can you hear me now?

Kaveh Mowahed: Yes.

Emily Kaltenbach: Okay, great. I think one of many of those strategies have been mentioned on this morning, addressing economic disparities, behavioral health issues, folks being unhoused. All of those things need to be addressed along with harm reduction. New Mexico is a very poor state. And there's a lot of economic insecurity and until we address some of those underlying root causes of why people may be using drugs chaotically and problematically, we're not going to see the full benefits of, of substance use treatment unless we're also addressing underlying issues.

Kaveh Mowahed: Okay, we are getting near the end of the show. I just want to come back to Kelly to ask, what's the biggest need right now for the Mountain Center? What are your biggest challenges?

Kelly Mytinger: Yeah. Right now, our biggest challenges and needs for our participants are wound care. We see a lot of people with wounds either related to injection or other modes of substance use. And unfortunately, people experience a lot of stigma trying to access medical care. People who use drugs are really not treated very well, unfortunately, by medical providers. So, we see a lot of people with wounds that they are unwilling or unable to seek treatment for that ended up getting a lot worse than they need to be. So wound care and stigma free medical care are huge needs. Services for unhoused. Individuals and housing are also incredibly needed. We have a lot of clients who are technically housed, but who would still need federal definitions of being unhoused because of basically the state of their housing, lack of utilities, things like that.

Kaveh Mowahed: Alright, I'm gonna have to jump in there. The theme music is coming up. We've reached the end of the hour. I wish we had more time. Thanks to everyone who called in or emailed and a big thank you to our guests Emily Kaltenbach, Aryan Showers. Judge Jason Lidyard, Kelly Mytinger and Josh Swatek. KUNM will keep following and reporting on addiction drug use and especially fentanyl. Please keep sharing your thoughts with us on Twitter #LetsTalkNM, on Facebook search for KUNM radio or email us LetsTalk@kunm.org. If you miss part of the show, we'll have audio up on our website soon. You can also subscribe to the Let's Talk New Mexico podcast on Apple podcasts and Spotify. Our engineer is Marino Spencer, Taylor Velazquez handled the phones today. Bryce Dix live tweeted for us and Megan Kamerick produced the show. I'm Kaveh Mowahed for Let's Talk New Mexico on 89.9 KUNM.



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Kaveh Mowahed is a reporter with KUNM who follows government, public health and housing. Send story ideas to kaveh@kunm.org.
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