What brought you to this moment? Your answer, whatever it may be, is built by a collection of memories. The study of our past, individual and societal, and the intersection of history and medicine informs Alex Halberstam’s academic and volunteer work. “I think about [care] from a memory perspective: where we come from, why care looks the way it looks, what treatments are available for whom,” she said.

Once a month Halberstam (HMS MS2) volunteers at Access, Harm Reduction, Overdose Prevention and Education (AHOPE). AHOPE provides a range of services to people who use injection drugs, including integrated HIV, hepatitis, and STI testing. It offers free legal and anonymous needle exchange. Volunteers help the center pack safe consumption kits. This allows the staff to focus more of their time on providing care and holding space for longer, deeper conversations with clients during open hours.

When harm reduction care is provided at the highest level, the provider meets the person where they are—without expectations. It’s a practice of accepting the patient as a person seeking care in the present. “Harm reduction is not a tool,” Halberstam said. “It’s meant to be an end in itself, a space where people can flourish.”

The National Harm Reduction Coalition explains that harm reduction is a compassionate approach to care that affirms individuals are the primary agents in reducing the harms in their lives. Simultaneously, Harm Reduction acknowledges that factors such as poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities render people vulnerable to, and affect their capacity to deal with, drug-related harm.

Valuing lived experience

According to a Massachusetts Department of Health report, opioid-related overdose deaths increased by 12% in Boston from 2022-2023 even though there was a 10% decrease statewide. The report highlighted racial inequities in overdose deaths. 

The Substance Abuse and Mental Health Services Administration outlines six pillars of harm reduction, the first being that the work is led by people who use drugs and have lived experience of drug use. The SAMHSA Framework states, “Put simply, the effectiveness of harm reduction programs is based on the buy-in and leadership of the people they seek to serve.” 

SAMHSA also reports that formally acknowledging a community’s shared traumatic history is a fundamental step in preparing for and planning community engagement efforts that address health inequities. The students of Harvard Medical School, Harvard School of Dental Medicine, and Harvard T.H. Chan School of Public Health often come to these schools looking to make the world a better place. There is a constant tension with that desire and the history of these campuses, which were built on land claimed from surrounding communities via practices of redlining and forced relocation. The history of the school itself abounds with stories of discriminatory care, research, and admissions practices, and has contributed to, if not caused, traumatic legacies for the community. It’s something students must come to terms with and acknowledge to fully show up for communities in need.

“I try to be conscious of where my positionality enables me to cross boundaries, and where I need to step aside for someone with a lived experience I don’t have,” Halberstam said. “Whenever possible, I prefer to support community work that’s already being done.”

Halberstam’s work is not just for the community; it also has helped her grow in her medical training. “All of this informs the questions I ask and where I’m skeptical,” she said. “It prompts me to think, what other options do we have for people?” 

Harm reduction under threat

While the U.S. Department of Health and Human Services’ Overdose Prevention Strategy lists harm reduction as “critical to keeping people who use drugs alive and as healthy as possible,” this form of care is consistently under threat. “Even more important than the history [of harm reduction practices] is the current need for advocacy for harm reduction programs that are under attack,” said Sarah Mackin, Director of AHOPE. For this reason, AHOPE volunteer nights have a second goal: to build understanding of Harm Reduction among current and future healthcare providers. In this way, the volunteer nights are as much about teaching as about kit packing, and volunteers leave with a better understanding of how to advocate for Harm Reduction practices.

You can support AHOPE’s work by attending a volunteer night. To receive updates about the next date, contact Audrey Lambert.