How Can Churches Serve People Who Use Drugs?

“WE ARE IN the midst of an overdose crisis,” said Hill Brown, southern director of Faith in Harm Reduction. “We say overdose crisis and not opioid crisis because right now overdose is the crisis. We’ve had opioids forever.”

In 2020 and 2021, during the height of deaths and extreme social isolation from COVID-19, deaths from overdoses surged in the United States before reaching a new baseline. The CDC estimates nearly 110,000 overdose deaths in the 12 months ending November 2023. That’s up from 71,350 deaths in the 12 months ending November 2019. Nearly 70 percent of these deaths were related to fentanyl and other synthetic opioids. For people 35 to 64 years old, the overdose death rate was highest among Black men and American Indian/Native Alaskan men at around 60 per 100,000 persons. Overdoses have become the third largest cause of death among teens 14 to 18 years of age, behind firearm deaths and vehicle collisions, rising to an average of 22 per week in 2022, largely driven by fentanyl in counterfeit prescription pills.

While churches have long hosted recovery groups focused on abstinence from drugs, some faith leaders are exploring how churches and other religious institutions can serve people who use drugs (PWUDs). By offering safer drug use resources such as sterile syringes and smoking supplies, fentanyl test strips, safe consumption sites, naloxone (an overdose reversal drug) training, and counseling, they are also working to extend this welcome and compassion without moralizing about drug use or judging PWUDs.

Collectively known as harm reduction, these practices were originally envisioned as strategies to curtail the spread of HIV. In this context, harm reduction aims to reduce the negative consequences associated with drug use. Its values include viewing PWUDs as sacred and beloved, believing love is greater than the law, allowing PWUDs to exercise choice, and centering a person-first approach that embodies compassion, dignity, and justice.

Some wonder if harm reduction enables drug use more than it keeps people safe. But for leaders engaging in harm reduction work, the approach is much like encouraging the use of seatbelts: saving one life at a time. “People are the best experts on their own life, and we really need to listen to people that are affected by these things,” said Rev. Luke Sumner, advocacy manager at Aurora Commons in north Seattle.

Established by Awake Church in 2011 as a space for unhoused persons to gather in a homey setting, Aurora Commons has expanded to include a health clinic, social workers, training, and outreach. Though now independent of the church, building deep relationships with people has shaped Aurora Commons into a place where harm reduction practices reach people who do sex work and PWUDs where they are most needed. “Our mission didn’t start with harm reduction,” Sumner said. “The central part of our mission is deep listening to our neighbors, creating this neighborhood living room.”

Sumner grew up in a cultural and religious context where drug use was seen as a moral failing leading to inevitable personal ruin. His ideas about drug use were challenged during seminary when he volunteered with and was later employed by HOMEpdx, a church-based street outreach in Portland, Ore. Relearning how to view addiction has been part of his faith journey.

“People use drugs for a variety of reasons,” Sumner said, “I had this idea that drug use drove homelessness, but I encounter a bunch of people who only started using drugs when homelessness got so bad they had no hope for anything else.”

Partnering with other service providers and King County Emergency Medical Services, Aurora Commons provides sterile drug use supplies, fentanyl test strips, and naloxone along with training for its neighbors, all with the goal of saving lives. Even with these measures, a recent memorial ceremony at Aurora Commons honored four neighbors who had died; three of the deaths were drug related.

“If they’re using drugs, to do it safely the supplies are important, we need those.” Sumner insisted, “But we also need to have a culture where people are willing to be honest with us and talk to us and help us, as a community, keep everyone safe.”

Removing Stigma

DEE-DEE STOUT, a clinician and professor focused on harm reduction in the San Francisco area, has worked in the addiction field since 1988, “essentially, when I entered treatment,” she said, noting that her drug-using history factors deeply into her work. Stout, the author of Coming to Harm Reduction Kicking and Screaming, initially sought to study relapse prevention as she worked with people in a drug and alcohol treatment center. But the work of G. Alan Marlatt, a key thinker in harm reduction for substance use, changed the course of her efforts.

Rather than perceiving substance use as moral weakness, Stout began to see that the chemical reactions produced by drugs — even those as innocuous as caffeine or moderate alcohol use — put a cushion between the user and their reality.

“It always cracks me up when people say, ‘But it changes your brain,’” she said. “Why the hell do you think we use it? Why do you have a glass of wine at the end of a tough day? Because it relaxes you — it changes your brain.”

Helping her clients answer the questions “Why am I using this drug?” and “What benefit am I getting from its use?” leads to solutions for harm reduction such as moderating the amount or frequency of use and ensuring the safety of the substances used.

“Substance use is actually the solution for the drug user,” she said. “It’s not a problem when they start, it’s a buffer.”

Harm reduction is not “encouraging drug use or telling people that everything is fabulous,” said Maia Szalavitz, author of Undoing Drugs: How Harm Reduction is Changing the Future of Drugs and Addiction. Szalavitz’s experiences with intravenous drug use in the late 1980s, like learning to disinfect her needles to prevent HIV transmission, gave her perspective on what people experiencing addiction need and don’t need.

“A lot of people in addiction ... feel socially rejected, have difficulty connecting, and have a lot of self-hatred,” she said. “When somebody tells you ‘I believe in you exactly as you are,’ it opens the door for people to change.”

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Bringing Churches on Board

TO EXPAND ACCESS to life-saving services in faith-based spaces, the National Harm Reduction Coalition, in cooperation with Judson Memorial Church in New York City, established the Faith in Harm Reduction initiative. It seeks to involve PWUDs, people who do sex work, and faith communities in creating harm reduction-based resources for spiritual care, including prayers, blessings, and music.

“As communities and individuals of faith, we need to do the faithful work of wrestling with all the ways we put up barriers to people’s access to healing and community,” said Rev. Erica Poellot, executive director of Faith in Harm Reduction and minister of Harm Reduction and Overdose Prevention Ministries for the United Church of Christ.

“My understanding of the gospel is that’s where healing happens,” she said. “It happens in the context of community. We work a lot with communities of faith to expand compassionate care and hospitality and be advocates and stand in solidarity with folks.”

Hill Brown began working with the Steady Collective in Asheville, N.C., in 2016 and quickly received an education on what harm reduction looks like in Appalachia.

“We mostly served folks who were injecting drugs — heroin and meth,” Brown said. “We understood from the very beginning that the fixation on opioids doesn’t work in Appalachia. There’s lots of generational meth use, and so we were serving folks who needed sterile supplies.”

Brown joined Faith in Harm Reduction in 2022, relocating to Green Mountain, N.C., where outreach with rural churches begins when people are ready to have a conversation about drug use and overdoses in their community. While a syringe exchange may be too controversial for many churches, providing naloxone and training to administer it and other overdose reversal measures is a first, life-affirming, step.

Since 2017, Faith in Harm Reduction has equipped people for overdose prevention and response, including distributing naloxone, at 225 harm reduction summits with faith communities in 33 states.

“When we start there, you can build,” Brown said. “The next step for a lot of rural congregations, if they still have health ministries or a nurse on site, is to say you have folks in your community who need wound care and they can’t get to the hospital. Would you be willing to provide that?

“Being in relationship with people who need that kind of care and those folks trusting you is another great window into harm reduction.”

Respect Is Key

UNDERSTANDING AND PREVENTING overdose deaths is an important aspect of harm reduction. A recently published Yale University study of opioid use disorder patients in Connecticut found that compared with no treatment at all, methadone and buprenorphine, common medications for opioid use disorders (MOUDs), reduced the risk of death by 38 percent and 34 percent, respectively. On the other end of the spectrum, non-medication-based treatments, including abstinence-only programs, increased the risk of death by 77 percent.

“A lot of the people that we work with have been managing the use of multiple different types of substances in order to achieve a particular effect that helps them deal with trauma,” said Philomena Kebec, economic development coordinator for the Bad River Band of Lake Superior Chippewa and co-founder of Gwayakobimaadiziwin Bad River Harm Reduction in northern Wisconsin.

“If they have that MOUD [in their system], that’s a strategy that’s going to help protect them against fatal drug poisoning events.”

Kebec’s organization made 2,000 deliveries of naloxone in the four-county area they service in 2023 and twice as many to all of Wisconsin through a partnership. It partnered with a local church to provide warm socks and other needs for people living outside. Education and job opportunities are also part of the complete harm-reduction strategy.

The most effective approach, Kebec believes, is treating substance use disorder as a disability and offering an array of treatment options, including therapy and medications, to reduce the effects and consequences of nontreatment and sudden reintroduction to drug use.

“If we give people support for dealing with their trauma, they’re going to be less likely to engage in substance use,” Kebec said. “If we give young Native and Black folks opportunities to work, earn a living, and engage in activities for money that are prosocial then we’re going to have less drug use in our communities,” she continued.

The organization Bronx Móvil began as a bilingual outreach program in 2018 when a group of friends with histories in harm reduction and activism sought to fill the gap left by nonprofit organizations that closed on weekends. Initially pooling their money together to rent a vehicle, they established routes through the Bronx to engage with intravenous drug users and others living outside and offer harm-reduction supplies.

Tamara Oyola-Santiago, a co-founder of Bronx Móvil, emphasized the importance of going to people. “Whether it’s in an encampment underneath the bridge, if it’s on the platform of the subway, if it’s on the intersection of a street,” or meeting people “working the bodega sweeping in front of it” she said, her team has been there.

The term “any positive change” is an often-heard mantra among harm reduction practitioners. It is an important aspect of building relationships and understanding people as they are and what, if any, changes they would like to make.

“Any positive change might be the fact that I get a hug,” said Oyola-Santiago. “Next time, there’s consent to enter the person’s home that might be in the encampment where I’m doing outreach. That means that there has been a shift in the trustworthiness and the trusting process of the human relationship, necessarily, for hearing, for healing.

“Any positive change could also be drug related. From injecting to smoking, or from smoking to something else, or decreasing the amount that’s being utilized. ... There’s a ripple effect ... something that validates and humanizes.”

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A Window to Salvation

THE MOVE FROM recovery groups to harm reduction practices can present challenges for some churches. Szalavitz noted it may be difficult for groups like Alcoholics Anonymous and Narcotics Anonymous to share facilities with organizations that also offer sterile injection supplies, MOUD distribution, and other safer use services. At the same time, it can be a powerful witness for faith communities.

“It’s so important for people of faith to understand that this is not something that is their enemy or that they should be scared of,” said Szalavitz. “People with addiction are people. They are our people. If we’re going to say that we love humanity or that we’re trying to save all people — these are people.”

For some, the theological and ethical imperatives found in the teachings of Jesus — to be with those society doesn’t value, to seek and save the lost, to remember that what goes into a person doesn’t make them unclean — guide their practices to understand what positive change means for each person in the context of a culture that seeks to ostracize and criminalize PWUDs.

“Substance use issues are revelatory about how disordered our society is,” said Brett McCarty, Duke Divinity School faculty member and principal investigator at Churches Promoting Recovery.

“You can look at how messed up the criminal justice system is and the health care system and our economic sector — the messed-upness of the world is on full display,” McCarty said. “If churches and faith communities were to find and follow Jesus on the margins among people struggling with substance use issues and allow that work of following Jesus there to transform their lives, then that’s what salvation might look like, especially for mainline white American churches today.”

McCarty was drawn to harm reduction work after a family member survived an overdose and believes the biases regarding PWUDs are echoed in churches. He and others acknowledge the difficulty of overcoming these presumptions while noting the urgent need to offer compassion and life-affirming care for PWUDs.

“People often accuse me of being an enabler,” said Rev. Michelle Mathis, co-founder and executive director of Olive Branch Ministry in Hickory, N.C. “We enable — as harm reductionists and as people of faith — people to build that trusting relationship. ... Harm reductionists meet people who use drugs and people who engage in sex work where they are. We also must meet congregations and bodies of faith where they are.”

For her organization’s host church, this meant overcoming fears about finding drug-use materials on church grounds. The results of these difficult conversations, Mathis believes, are worth pursuing, noting that people who use harm reduction services are five times more likely to begin recovery and three times more likely to quit injecting drugs. “If the church does not engage people who use drugs where they are, we’re going to lose those lives one way or another,” she said. “Whether it’s a physical loss or a spiritual loss.”