What does harm reduction look like in Linn County?

In 2023, Iowa received over $2.5 million in federal funding for overdose prevention activities. The Overdose Data to Action in States (OD2A-S) is a five-year grant selected Iowa counties are using to track drug overdose data and put effective programs in place to curb overdose rates.

Part of these efforts include harm reduction activities. According to the National Harm Reduction Coalition, harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.

Linn County Public Health onboarded a harm reduction coordinator in October 2024. While the department does not offer any treatment or recovery services, it runs educational programming for community providers and funds a full-time peer recovery coach at CRUSH of Iowa Recovery Center. Other collaborators include the Substance Misuse Committee of Linn County and local emergency responders.

The Gazette sat down with Heather Meador, clinical services supervisor at Linn County Public Health, to talk about how the organization is implementing harm reduction programs, what makes them effective and what results look like so far.

This interview has been edited for brevity and clarity.

Q: Why is Linn County implementing harm reduction efforts?

A: We look at HIV, hepatitis, syphilis, and we’re seeing increases in a lot of these infections. And why do we see those increases? A lot of it comes back to substance misuse, especially if we’re injecting substances into our body because of sharing needles, sharing supplies. And so that’s kind of how we got into the harm reduction realm, because we were seeing these increases in these infections.

Q: Harm reduction is a broad term that can mean a lot of different things. What exactly is Linn County calling “harm reduction”?

A: Harm reduction is just trying to reduce the harms that one may be doing on to themselves … When we're looking at sexual health, using condoms to help prevent the spread of HIV, gonorrhea, chlamydia, is a harm reduction technique. You're using something to help protect yourself.

In the substance misuse world … harm reduction means not sharing needles with other individuals, not using old needles if you're injecting, because that can lead to wound infections, that can lead to the spread of infection. So if we can use clean supplies that are new supplies that reduces harm to yourself. Having Naloxone or Narcan nearby, so that if there is an overdose event that occurs and someone can administer that, you don't die. That's reducing harm.

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So it's any of those strategies that helps to reduce your likelihood of harming yourself or even harming somebody else, because if you have these infections, you could spread some of these infections to others. And so we want to decrease harm to yourself and to the community.

Q: I’m hearing you use the phrase “substance misuse.” Can you explain what that means?

A: You can have substance use disorder, substance misuse, it’s the inappropriate use of medications … We want to be careful with the terminology that we use that we’re not offending individuals. Because for some people, this wasn’t the plan. They became addicted to something without realizing that they were on that road towards addiction. So they hear the word “abuse” or “you’re a substance user,” and that brings on shame. That makes that road to recovery harder.

Q: How does harm reduction differ from other approaches to substance misuse?

A: Back when I was in high school, what was very popular was a commercial that was on television that had a family holding a frying pan and the egg, and this is drugs. This is brain. This is your brain on drugs. Don't do drugs. It was more of a scare tactic. And what we have learned over time, and the data continues to show, that doesn't work long term.

What the studies and what the data is continuing to show if we can create a supportive atmosphere where the individual does not feel ashamed of themselves … Those are the individuals that not only get to recovery, but then have a better outcome with recovery. They stay in recovery longer because they feel supported, they feel cared about.

Q: You brought on a harm reduction coordinator last October. Can you describe the work she does?

A: Our harm reduction coordinator is going out to different medical providers in the community and working to provide education on substance misuse, how to talk to your patients about substance misuse, what this looks like. Because unfortunately, a lot of people think substance misuse might be that unhoused person on the street, and a lot of times it might be that grandma that lives next door to us that had surgery and hasn't been able to get off a pain medication, so substance misuse is a wide range.

The other thing that she does is called public health safety teams, PHAST for short. And so with that, we're working with different EMS systems, fire departments, police departments. And what are we doing as a public safety sector when it comes to substance misuse, and how can we better help those individuals to decrease the times that they're needing emergency medical services, hoping that at some point we can get them to recovery.

CRUSH (Community Resources United to Spread Hope) is a community resource center. They have peer recovery coaches, so we help to support a full-time position there for that peer recovery coaches … Part of this working with substance misuse coalition is helping providers to know that there is a peer recovery coach, someone that has lived experience, that understands what that individual is going through, that can walk with them, side by side on that journey. It's not the health department, but we do work with CRUSH closely so that they can get those peer recovery coaches to be on that journey.

Substance misuse, it's a journey. And people may do well, and then they fall off and they come back on. And so it's a journey to get from where you are to the point of recovery, and we want to be there throughout the whole journey. And if someone's not ready for recovery, what can we do to keep them as healthy as possible so that when it does come time that they may be ready for recovery, that they have a better chance of recovering?

Q: Some people may wonder why the county is encouraging safe practices for substance misuse. How do you respond to people who say you’re just enabling people to keep misusing substances?

A: I totally understand where they're coming from. I understand that logic. It's the logic that has been given to us for many, many years. Unfortunately, we know that doesn't work. We’ve seen it over and over again. If it did work, we wouldn’t be where we are today, and we wouldn’t be having this conversation.

I think it's important to remember that this person that is misusing substances, this is someone's brother, son, father, mother, sister, aunt, grandmother. This person is loved and valued and probably never wanted to be in this position.

Q: Have you seen any success so far with the harm reduction programs you’ve implemented?

A: What we have heard from some of our emergency service providers is that they’re not having to administer Naloxone as much on the street because of our vending machines, and that people know where the vending machines are … since we started the vending machines, which would have been June of 2024, that I know, we’ve given close to 4000 doses of naloxone into the community and surrounding communities, because we know people from other counties have come in to get those products too.

I take that as a huge win. Even one life saved, that’s a win.

Q: What’s next for harm reduction in Linn County?

A: Big next steps is just to continue on this work, to keep looking at the data that comes in to help us to thoughtfully plan out our next steps.

Part of it too, is trying to normalize this conversation. I think one good thing that came out of COVID is that we normalized the mental health conversation. I think it's much easier to have conversations now regarding mental health than it was in the past. I'm hoping we can get there with harm reduction too.

Comments: fern.alling@thegazette.com