An episode of “Changing the Conversation” podcast
Georgios Tsangaris and host Ashley Stewart discuss harm reduction strategies that meet people where they are at.
September 25, 2023
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Ashley Stewart, Host (00:05): Hello and welcome to Changing the Conversation. I’m your host, Dr. Ashley Stewart, the Director of Health Equity at C4 Innovations, and our topic today is getting into the real of harm reduction. Our guest is Georgios Tsangaris, who’s joining us from New Orleans. Georgios identifies as someone with lived experience who has done grassroots work for over seven years in New Orleans, and doing this work, especially with folks who are experiencing housing and instability. We’re so excited to have you joining us today, Georgios. Thank you.
Georgios Tsangaris, Guest (00:36): Thank you. It’s really great to be here.
Ashley (00:38): Yes, and I’m really looking forward to our conversation today. I know that this is something that folks are particularly passionate about, learning about, talking about. It’s also something that some folks maybe avoid talking about, so let’s get it to the real of it as we said that we would today. I’m hoping that we might start with you telling the listeners a little bit about yourself?
Georgios (01:01): I’ve lived in New Orleans 12 years, and I got into harm reduction work because I was using drugs, my friends were using drugs. I lost a family member to overdose and friends to overdose, and I wanted to do something about it. And I was unhoused and a lot of my friends were, and my work with that population started from just hanging out and being part of that population and then eventually working in shelters and other services.
Ashley (01:34): Yeah, thank you for sharing that context. And you also mentioned that you’ve done this work in grassroots for seven years. How did that evolve? What did that look like in those seven years? Did you engage with communities differently? What kind of things did you learn over those seven years?
Georgios (01:55): Yeah, there’s a huge difference between working in a grassroots harm reduction organization and working for… Later in my harm reduction career, I also ran the largest syringe access program in the Gulf South. And when we started in the grassroots with Trystereo, syringe access was illegal in Orleans Parish. We were doing hotline meetups that felt a little bit like drug deals. We’d meet on the corner and hand the package, and we had to be really sneaky about it. And through the tireless advocacy and stuff, we were able to change that law, but really, there’s this harm reduction thing about meeting people where they’re at, and we were really doing that with the grassroots. And I think that’s something that’s a lot harder to do if you’re a big organization worried about grant funding or worried about being legal even.
(02:54): I think the majority of the work that is done in harm reduction that really meets people where they’re at and addresses their needs is done by people driving around in their sedan, risking arrest, giving clean, sterile syringes to people.
Ashley (03:13): Yeah, I appreciate that. And I particularly appreciate the language around tireless advocacy because I think a lot of times we also minimize… Folks are doing this and showing up and risking their lives. They’re going out in spaces, doing things that potentially could get them involved in the justice system to support and to help people. And I know one of the things we’re going to talk about later is getting into that stigma component of it and how that prohibits us from being able to really connect with people in authentic ways.
(03:46): One of the things I’m cognizant of is that a lot of folks use different definitions of harm reduction and honestly just have different ideologies about what harm reduction is. Can you share a little bit about what harm reduction means to you and what that looks like?
Georgios (03:59): Yeah. I think a lot about Dan Bigg’s, “Any positive change,” idea, which is that, I’ll paraphrase him, that “Humans are really bad at perfection, but they’re really good at improvement.” So it’s really any change that is reducing the harm and increasing the positive parts of someone’s life with regards to stigmatized activities like drug use and sex work. And I think where people get confused or where they get tripped up about the definition of harm reduction is providers think of themselves as the experts, caseworkers, whatever. They think of themselves as the experts in this person’s life. And they’re like, “I want to tell you, person who uses drugs, how to reduce harm.” But really, people who use drugs know much more about drugs. They know much more about their own lives. They are the experts, and they’re not having their voice prioritized in how to have those harms reduced a lot of the time, and they certainly are by some awesome harm reductionists in the world. But as harm reduction gets more popular and filters out, we lose some of that authenticity and some of that prioritization of the expertise of people who use drugs.
Ashley (05:25): It reminds me of a conversation I was just having the other day, particularly like you’re saying, people who maybe are intending to do good work because they work in the area, but have ideas about what it means for what someone should be desiring or should be wanting for their own lives, creating and perpetuating that stigma, that assumed expertise because working in the space as opposed to leaning on that lived expertise of individuals.
(05:49): Yeah, I really appreciate you bringing that up. And I think a lot of times people will, in the attempt to be an advocate, sometimes minimize what harm reduction can look like. For example, having a conversation about folks who are unhoused and whether folks should be in shelters or whether providing tents and pillows is sufficient. And the conversation that we were having circled to the only way to advocate is to look at other alternative housing solutions, which this person’s intention was absolutely to advocate. And also, other folks in the room were promoting that harm reduction looks like what that person might need in the moment. And I’m wondering if you could speak to it because I think this is a conversation that happens a lot where the impact or the intention of harm reduction really gets convoluted?
Georgios (06:38): I think it goes back to who is an expert on what they need? And if you’re saying everyone needs to be in a house and housing first is a great model, and I love it, but some people aren’t… It doesn’t work for them to be in a house. Being indoors can be really difficult when you have trauma. There’s a million reasons why someone might not want to be in an apartment. And if we’re really meeting people where they’re at, that’s going to mean that some people are going to live in a tent for their whole lives because that’s their choice, and we have to honor their autonomy, and we can have this whole narrative about how being in a house would be so much better for them, and it might address some of their needs that we perceive, but if it’s not addressing the needs that they have according to their perception of their own life, then we have to honor that.
Ashley (07:29): And there might be an opportunity to begin to assess and say, “What do you need? What do folks need?” And provide that platform for folks to say, “You know what? If I were leaning into, or if I had resources or support around this, then maybe I could have more opportunities to process my housing, or if I had the mental health support maybe, or if I had spaces or opportunities to connect with community more,” whatever. These are assumptions that I’m making right now, but at the end of the day, by providing that opportunity for folks to tell us, as opposed to coming with solutions, solutions, solution, but creating open space for dialogue, for discussion, for exploration. Maybe someone doesn’t even know what they’re needing in a particular moment, but is there that patience, that grace, and most importantly, the space for those conversations to happen, I think might be something there too.
Georgios (08:21): Yeah, definitely. I want people who are interacting with these populations to come at their interaction with curiosity and humility, and ask people what they need and try to explore that with them. I want it to be collaborative, and so often it feels top down, “This is what you need, this is what I’m going to do for you.” And when I talk to people with lived experience, so often they’re just saying, “I’m not being listened to. No one’s listening to me,” and that’s a powerful thing.
Ashley (08:57): It is a powerful thing. It is a powerful thing. We’ve been teetering around this conversation of the role that stigma plays and bias, and I think stigma and bias really does underpin a lot of people’s assumptions about what folks want or need or should want or should need. And I think that stigma is multi-layered, it’s multi-buried, it happens both in close relationships in folks’ lives, as well as organizational, structural, and societally. So I’m hoping we could talk a little bit about stigma and bias and the impact that has, or you’ve seen that have, as it relates to harm reduction?
Georgios (09:36): Yeah, it’s the water that we’re swimming in in American society in so many ways. I’m a certified peer support specialist, and even in that community where everyone has lived experience, it’s for people in recovery. So the internalized stigma that we can come with as peer support specialists or people with lived experience can mean that we don’t treat the people with the same experiences as us the way that they should be because we don’t like that version of ourselves that was using or something. So when we see someone else engaged in that activity, all that judgment and stigma can come up, and it plays out in so many ways. So part of that stigma is, like we’ve talked about, people who use drugs not being considered the experts on their own lives. And part of that is this assumption that drug use is not utilitarian, is that it’s an irrational action.
(10:40): And drug use, substance use is addressing some need in everyone’s life who is using. And in recovery, people want to say, “Well, you just stop. You just cease use, cessation of use, sobriety. That’s the gold standard.” But actually, if you’re telling me that to just cease use, but you’re not addressing in some other way, some alternative way that need that that’s meeting, then you’re harming me because suddenly my coping mechanism is taken away, and I don’t have anything to replace it. And that’s stigma in action because we’re not trusting the person, and we’re not looking compassionately with curiosity saying, “Okay, what is this doing for you and how can I either make it safer or help you if you want, find a different way to meet that?”
Ashley (11:40): Yeah, I think what would it look like if we addressed or started the conversation there? What need is it meeting for you? What needs are not being met? What experience are you having? I had the privilege and the opportunity to honor someone’s experience just the other day where it’s like I’m navigating through all these systems and getting rejection after rejection, and then on top of that, I’m being treated as if I’m less than by all of these different folks. And that’s exacerbating all of the things that led me to the coping mechanism that showed up for me when I started use.
(12:15): And so we are, like you said, maybe pushing people away or creating more barriers for folks by not starting with the simple question, “What do you need? What is this serving you? How is this supporting you? How is this helping you cope? What are you coping with?” All of those things could be initial parts of conversation that are not about judgment, that are not about what people should or shouldn’t do, but really getting at how can we support at the root?
(12:46): And then another aspect of it that really comes to mind is this idea of being in community with people or surround yourself around people who will help you be better. And I think that that’s something that comes up a lot too. What are your thoughts on that?
Georgios (13:03): Yeah, I think in 12-Step and other mainstream recovery models, there’s an idea that you have to separate yourself from people who were using, from the people in your life that are still using in order to protect your sobriety. But also, we know that the opposite of addiction is connection, and we know that being in community is so important, and if someone’s trying out sobriety and they’re like, “Okay, I can’t hang out with any of my old friends from the encampment or wherever because they’re all using,” then they’re isolated, they’re alone. The people who understand them and have been in the trenches with them aren’t there, that’s not serving them, actually. Being isolated is going to make them more at risk of overdose if they start using again, and it’s not going to make them connected and recover.
(14:05): And I think there’s a crisis of disconnection and loneliness and trauma in our society, and that’s a societal issue that we see as this personal moral failing in people who decide to do drugs about it, when really, I think we have to look at ourselves and the society we live in and say, “Why is the world that we’ve created so full of pain that we have people who need to completely leave the world through substances on a regular basis?”
Ashley (14:40): Yeah, that’s powerful. And one of the things that I was thinking, I’m so glad you bring up that point about people having to potentially leave or dissociate with their community in order to receive support or to navigate through a lot of different recovery supports. I also think about what we often assume to be safe or trusted people. And a lot of times we’re encouraging folks to go into communities or back into communities or maybe be around folks who are maybe removed from their youth, but maybe activators or reminders or places that have not felt safe to people. And again, is that part of the conversation we’re having to say, “Where do you feel safe? Who are your safe people? And how do we help to support or create a community that’s going to feel nurturing?” As opposed to saying, “Here’s this bus pass to go back to your hometown,” where that might not actually be a place that feels safe or evokes a lot of deeper emotions and feelings and experiences. Even might be safe folks, but maybe just not in the moment. And so helping people reconcile a process through that.
Georgios (15:52): Yeah. I think about doctors that I know who are actually harm reduction informed, and they’re working against years of horrible interactions in a medical setting, where their patient, if their patient is stigmatized or marginalized in some way, is assuming that they’re going to be a horrible jerk to them, that their doctor’s going to treat them like garbage, because that’s how it normally is if you look like a drug user or homeless or whatever the judgmental eye is saying. And it’s so vulnerable to be in a medical setting, and that’s when people are re-traumatized by their providers not being harm reduction informed, and even if a doctor is, then they’re working against those years of trauma that the person’s experienced. So it’s difficult. We’re just trying to rebuild trust constantly and also having other people break it.
Ashley (17:00): Yep. I had a lot of conversations. I’ve been asking folks, “What are the barriers or what are folks experiencing as creating divisiveness, perpetuating stigma, and really creating and driving disconnection?” And something that continuously comes up is that there’s no one way. There’s going to be different needs for different folks. Some folks are going to need some really specific rigid rules and requirements that help them develop different patterns that will be helpful to them. Then there’s other folks who could really use support in examining where they are, processing through how they’re feeling, what they need and what that’s going to look like at a pace and in a space that works for them.
(17:48): Then you also have other variables that play into folks’ experience including identity, like race, ethnicity, gender identity, and age is something that comes up a lot. Do you see any of that and the identity center stuff show up in your work in harm reduction?
Georgios (18:05): Yeah. New Orleans has its own culture and African-Americans in New Orleans have their own culture, and you have to meet people there and have some cultural understanding.
Ashley (18:19): I have appreciation for the history. I’m talking general, now that you’re mentioning it, New Orleans has a really rich history that I think would play a pretty critical role in that conversation.
Georgios (18:32): Yeah, and I think it’s hard to have people who maybe are just jumping in and don’t appreciate the complexities and nuances and haven’t spent a decade or more thinking about Katrina and aren’t involved in that or just jump in or, “I want to help,” and that’s awesome, and we need more helping hands, but you have to do it with this understanding of where you are and how that shapes everything.
Ashley (19:04): When you think about particular organizations that you’ve seen implement different approaches and strategies, anything come to mind?
Georgios (19:11): Yeah. So when I ran the syringe access program that was grant funded, we could afford to give away a lot more supplies to our participants. We saw 400 participants in a single drop-in, for example, but everyone had to come to us, and so that was the New Orleans Syringe Access Program, and they’re great, but people had to come to us. They had to come during certain hours. So those were barriers for people. They weren’t going to get on the bus in time. Their car broke down. They’re at work when we’re having drop-ins. So we were able to give a larger volume of supplies, which really met a crucial need, but had those issues.
(19:56): And then with Trystereo, which is the grassroots organization that I’ve worked with, we have a hotline so people can text us, and we will meet them. We’re not as well funded, so we can’t give them as many supplies. But for participants with physical disabilities, we were the people bringing them supplies because they couldn’t get to New Orleans Syringe Access Program. And Trystereo, with its more grassroots approach, when I first started with Trystereo, I was able to say, “I think we should do drop-ins too.” And I know from my own experience where people are using drugs and where they need it, and I’m going to go talk to my old dealers and be like, “Hey, can we set up around the corner?” And they’re like, “Yeah, that’s great.” So we were able to use that lived experience to better meet our community’s needs.
Ashley (20:50): Yeah. Thank you so much for sharing that. I think this might be new or different or maybe even challenging for some folks to process, folks who are working through their own biases, folks who are struggling to understand the lived experiences of others. And so as we think about folks watching this who might be connecting to it personally, they themselves or a loved one is looking for recovery, or we’re thinking about folks who are serving communities, who are hoping to implement some harm reduction ideology into their practice with the desire to help and support as many people as possible, what is one key or critical takeaway that you think folks should consider or have at the front of their mind in doing this work?
Georgios (21:40): Yeah, I think it comes back to humility and compassion. So many people who are social workers and all these things that I’ve interacted with know next to nothing about drugs and what they’ve been taught about drugs and drug use is usually wrong. When I do trainings, de-stigmatization trainings, I’m always like, “If the police have told you anything about a drug, that is probably false, especially if it’s fentanyl. So you don’t know what you’re talking about and let me teach you.” So I want people to come in as knowing that they’re a baby in this world if they don’t have that lived experience and listen to the people who know.
Ashley (22:23): Curiosity to learn, an open mind, and most importantly, seeking out lived expertise and lived experience. I think that those are really important takeaways for all of us. I think we really can lean into that, and those are things that folks can start to do immediately as listeners and as people who are hoping to continue to create spaces and communities that are supporting all folks. So Georgios, we’ve had such a robust conversation. Really grateful and thankful for your time, your knowledge, and your expertise with us today.
Georgios (22:57): Yeah, thank you so much, Ashley. I really appreciate having this conversation.
Ashley (23:00): Thank you. And to our listeners, join us next time on Changing the Conversation.
Erika Simon, Producer (23:05): Visit c4innovates.com and follow us on Twitter, Facebook, LinkedIn, and YouTube for more resources to grow your impact. Thank you for joining us. This episode was produced by Erika Simon and Christina Murphy. Our theme song was written and performed by Peter Hanlon. Join us next time on Changing the Conversation.
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