New Jersey Harm Reduction Coalition (NJHRC) was formed by people who use drugs, people who used to use drugs, people in recovery, people who have lost loved ones to overdose, people harmed by the drug war, faith leaders, and concerned community members.

We formed in 2019 after the recent closure of the New Jersey affiliate of the Drug Policy Alliance.

We came together because equitable drug policy and dignified care are not only the best tools we have to end the overdose crisis, they are also morally imperative.

We knew we needed a space to unite harm reduction champions who are aligned with intersecting movements for racial, economic, and social justice in New Jersey.

We needed a space to build New Jersey’s infrastructure for a harm reduction response to drug use, and address the gaps in the continuum of care for people who use drugs that we see in our lives and work.

New Jersey Harm Reduction Coalition is that space.

Steve Martorano 
The Behavioral Corner is produced in partnership with Retreat Behavioral Health -- where healing happens.

The Behavioral Corner 
Hi, and welcome. I'm Steve Martorano, and this is the Behavioral Corner; you're invited to hang with us as we've discussed the ways we live today, the choices we make, the things we do, and how they affect our health and well-being. So you're on the corner, the Behavioral Corner. Please hang around a while.

Steve Martorano 
Hi, everybody, welcome. Again, it's me, Steve Martorano hanging on the Behavioral Corner, which we like to think of as being at the intersection of interesting and informative at least, that's our modest hope. The Behavioral Corner is a podcast about everything because everything winds up affecting our behavioral health. It is brought to you through the cooperation of our underwriting partners the Retreat Behavioral Health facilities, about which you will hear later from them. So that's what we do. Check us out wherever podcasts are being podcasted. We're there—the Behavioral Corner. We have an interesting topic again, for you today. We've touched upon the issue of harm control very often here on the program because you apparently you cannot tell people often enough what you're really talking about when you mentioned, harm control. I know that we live in an age where it does not take much to outrage people and drive them into opposing camps. But one is given pause, at least I am that the two words put together harm reduction in association with substance abuse and death should arouse controversy. And yet it does harm reduction is controversial. There's no way around it. To get a better handle on it. We have reached out to people who came to our attention from our neighboring state New Jersey. We're in Pennsylvania here on the corner, the New Jersey Harm Reduction Coalition. And their representative, our guest here on the corner today. Caitlin O'Neill would be with I guess you've been with the coalition from the beginning way back in 2019. Is that right? Katelyn?

Caitlin O'Neill 
Yeah, I'm one of the co-founders. Yeah, okay,

Steve Martorano  
there you go. Again, there it is inheriting their name. They're about harm bringing, you know, reducing the amount of harm in the midst of this devastating substance abuse problem. And now, you know, the tragic deaths, which are unbelievable, at this point are unbelievable. So Caitlin, thanks so much for joining us. I do want to begin at the beginning here for people who might not understand what harm control is. So in the eyes of the New Jersey Coalition, what do you mean when you say harm reduction?

Caitlin O'Neill 
Yeah, so So harm reduction, as a phrase, right? Obviously, those two words have meaning on their own as a phrase and a sentiment and a lifestyle and a movement. Harm reduction is a few things very simply, it's like a set of principles, ideas, and types of service delivery, that support people who use drugs in making it through using drugs, whatever their next step is. And so harm reduction as a service are things like access to treatment on demand when it's wanted, without barriers, access to sterile syringes, access to Naloxone, aka Narcan, the overdose reversal medication, access to therapy, access to housing, access to a bevy of supports that help people survive their drug use. So that's one part of harm reduction. But then harm reduction is also a movement. It's a movement, by and for people who use drugs and people in recovery and allies, health care providers, and mental health providers, it's a movement about the dignity and the rights of people who use drugs,

Steve Martorano 
you really begin to get a firmer grip on this. You're not the first group we've talked to who are dedicated to harm reduction. As you know, it's spreading all over in response to the just massacre that's going on in America with regard to not just substance abuse, but now the mortality from an overdose. It sounds like a You're right. It's a service. You provide services. But it sounds like there's a growing philosophical movement around this. Yeah.

Caitlin O'Neill 
Yeah. Yeah. And so it's been growing in America since the late 80s. and in Europe, even earlier, and so really, it's the idea that you know, meeting people where they're at that just saying to somebody either do this or don't do this, either you're good or bad, just doesn't really work. And we have proof of that, right? SAMSA you know, the Federal substance use mental health, whatever the other letter stands for. They did a survey a few years ago. That said, only 10% of people diagnosed with substance use disorder are interested in seeking treatment at any given time. And so that means 90% of people with substance use disorder who are not interested at the moment and seeking treatment doesn't mean that they never will be. It might mean that they never will be. But 90% of those people deserve to live to deserve options. And so harm reduction really comes to meet the 90% who are not interested in abstinence-based recovery, and says that you deserve a chance for the next day to see what happens,

Steve Martorano 
correct me if I'm wrong, but my impression of the harm reduction movement is that it is it came out of first of all common sense. It would seem common sense arose to fill the vacuum that hopefully would be created. Once we got past this notion that drugs should be sworn in as an enemy. In a warlike context. We all know that the war on drugs, which is 50 years old, has been an utter and abject failure. We have now moved somewhat beyond that to the notion that this is not a criminal justice problem that cannot be solved solely by a criminal justice method, locking them up, but has to be dealt with as a medical problem. So this group, these groups, harm reduction groups grow up and fill in the void there. Explain to people that when you talk about harm reduction, you're not talking about something purely altruistic. Like, we're good people, we're going to do good stuff for these poor sufferers. Do you believe in harm reduction? Because it's efficacious? Does it actually work?

Caitlin O'Neill 
Well, yeah. So harm reduction is morally neutral. Harm reduction is like, you know, a drug doesn't have a quality of good or bad, it's not a living being it has no good or badness, it doesn't have those qualities. It's not a sentient being. So harm reduction just says drug use exists, and people who use drugs exist and ignore them. And I should say us because I am a former injection drug user, ignoring us and throwing us into a corner doesn't do anything, we're still here, and we're still going to use drugs like you said, 50 years plus of the drug war has shown that you can criminalize the heck out of any substance and there's still a demand for it. If there wasn't a demand, there wouldn't be a supply. And so harm reduction is very morally neutral. It just it's very practical. As you said, there can be a medical model in terms of, you know, what can we prevent, can we prevent infections, can we prevent transmission of certain diseases, and harm reduction actually stemmed from the HIV movement in the 80s. And it was basically people being fed up with seeing their friends, their loved ones, their brothers, you know, their siblings dying from HIV because they didn't have access to sterile syringes. So that's really where the roots of harm reduction come from. In America, at least, you know, that comes out of similar movements, like the Black Panther Party, the Young Lords over in the South Bronx, that comes from movements, like the movement for bodily autonomy and reproductive rights. It really stems from survivor-led movements. It's not that we're just saying, you know, we feel bad for people or whatever. It's us if we are doing the work. And I know that harm reduction works, because I myself use a certain service program during my substance use, you know, I'm here today, it helps me survive, you know, my work is to just make sure other people have access to that same choice.

Steve Martorano 
Yeah. I mean, I'm not here to dwell upon the criticisms or resistance to harm reduction, but they are a huge barrier that I believe needlessly has to you know, it's there in the middle, and you've got to deal with it. It's unfortunate, the programs you mentioned, of which harm reduction is a part, our author thought of, I think in the public mind as a political movement, they think in simple terms. And so I wonder whether or not in spite of the fact that's the truth of the origins of harm reduction, that isn't something that you also have to overcome to tell people? Look, it's not a political movement? It's, it's Harbortouch. Is it a problem?

Caitlin O'Neill 
It's getting turned into one, people are politicizing it, but it isn't one, you know, I always say, you know, overdose doesn't see what party support overdose and substance use affects all of us. And if we turn it political, but it doesn't have to be, then it becomes a weapon, then people don't get access to care, then our loved ones don't survive. And so it isn't political. Right now, we are in a place where people are attempting to do so and make it political. But it really says that you know, there is not a single I don't know a single human being who's not affected by overdose in some way. Whether it's, you know, two degrees of separation three degrees, like somebody knows someone who has been impacted by opioid overdose if you live in America at this point, and so I see it as a bipartisan issue. It really surpasses all political things, and if we can keep it as a public health issue, although we are living in a time when public health is being politicized, so that's kind of what we see with harm

Steve Martorano 
reduction. Yeah, it's not the golden Age of thoughtfulness Is It Anyway, let's leave the notion of, of controversy and resistance with this one last question. So that people understand bringing lowering the harm. Providing harm reduction in this context is not an attempt to make it easier for people to use drugs, but to make it harder for them to kill themselves, or die. Keeping them is the goal so that they can get clean.

Caitlin O'Neill  
Hopefully, hopefully, well, well, we don't put judgments on what happens when what decisions people make regarding harm reduction do have a place in recovery, right? Obviously, people can't make it to recovery if they die while they're using. But that's not where harm reduction and harm reduction is about bodily autonomy and choice. We know that in America, of all of the people who use an illicit drug stronger than marijuana, a very small percentage of those people even identify as having substance use disorder or addiction. And so we talk about harm reduction as really about choice and about the people who are experiencing substance use disorder and experiencing all the harms that come with that making sure you stay alive. And yeah, in a lot of cases, it leads to recovery. Because what happens is people are treated with dignity, people are given a choice. And I know for me, if you give me a choice, I'm more likely to want to like work with you than if you're like, do this now. Right? So that's just how we work as human beings.

Steve Martorano 
Yeah, again, it's hard for people to get their heads around this, I think I understand completely, that this is a value. I mean, in terms of what people decide to do when you help them in this regard. That's their decision if they continue using drugs, but it's with clean needles and, and safe injection sites, and they have Narcan around the house, well, then that's their choice, and they go ahead and do it. But for me, the benefit is, they're alive. And if they want to stop doing this, they can't if they've overdosed and died, so the door is always open. If you can avail yourself of the services of people like Caitlin O'Neill and her group, she co-founded the New Jersey Harm Reduction Coalition.

Caitlin O'Neill 
And actually, my pronouns are they them? Thank you.

Steve Martorano 
I'm sorry. Yeah, that's okay. We talked a lot about the philosophy behind this. The resistance is lessening, I think, in some cases. So in terms of what you guys are advocating, the things, you support with regard to harm reduction. Tell us about a few of them.

Caitlin O'Neill 
Yeah, so in New Jersey, when we formed in 2019, we were formed, it was really a working group, you know, few of us stayed on to actually work for the organization. But some of it was just people who were frustrated. Many of us have lost loved ones to overdose. You know, I found harm reduction. Obviously, I was utilizing the services when I was injecting drugs, but I didn't know it was called harm reduction. I just do it was these people who helped me survive, right. So later on the way, I found it was my partner who died from an overdose in 2014. And I was in abstinence-based recovery and not really finding the answers. He was somebody for that that didn't really work for him. Right. I started to think what does work right? What can work? And because it's, we want the people that it works for? Yeah, there are plenty of people that abstinence is amazing, and it helps us thrive and move forward. But some people aren't interested, right? And so how can we meet them where they're at? And so I met some other like-minded folks who were frustrated about harms of the drug war that they've seen happen, overdose, incarceration, you know, HIV, things like that. And so we formed and one of our first priorities was Naloxone access. At the time in New Jersey, you could kinda sorta get it from certain agencies, but it wasn't really widespread. And so we saw the state was doing free Naloxone day, once a year or two days a year. And we said we can do that every day, free Naloxone day, every day. That's how we keep people alive naloxone in every home where there's a chance of an overdose happening, right? And so we really started with that. And what was amazing was legislators listened to us. And you know, in 2022, we got a Naloxone standing order pass that says anyone in New Jersey can legally carry, distribute and use Naloxone without a prescription. And now, the state has gone even further to make everyday free Naloxone day that pharmacies can now in New Jersey, you can walk into a pharmacy and receive Naloxone for free from the pharmacy counter without any identifying information. You can say I need Naloxone, and they can give it to you. And that's, that's huge.

Steve Martorano 
Yeah, that's a remarkable sea change in attitude for people who I can't imagine. Don't know what naloxone is. The generic name is Narcan. And this is a drug administered to someone who has overdosed, and it reverses the effects of that it saves a lot of eyes in other words, you know, Caitlyn, I thought for the longest time now that in your in our homes, we've all grown up with a little mom, we'll have a little dad, we'll have a little first aid kit. And you know what's in there? We're not. I'm old enough to remember MercuroChrome They were band-aids, right? Maybe some gauze and cotton, right? Yes. I'm telling I tell people all the time, if you have young children, teenagers should have that should be in the kit.

Caitlin O'Neill 
Absolutely, or else. Exactly. And you hope you never have to use it. But it's the type of thing that if you have to use it, you want it there. You know, it's the same as an epi-pen. If you have a child that has an allergy, you're gonna keep an epi pen in the house if your child has a peanut allergy, right? And so if you have someone in the house, who's especially like you said, young people who are likely to experiment and be naive about what they're experimenting with, um, you know, I know me, my, my substance use started around 14 or 15. So which sounds really young, and that's a little extreme. I understand, right? Not everyone's gonna do that. But back then I was fortunate that we didn't have the type of drug supply that we have right now. And somehow, you know, I survived that experimental period in those teenage years. And, you know, we want to make sure that everybody has that opportunity. And so the amazing thing about New Jersey is it's anyone above the age of 14, who can walk into a pharmacy and get that naloxone. And again, you're not ideal. So it's like up to the discretion of the pharmacist to think that you look 14 or over. But I'm really glad that they made it accessible to teenagers as well. Because just like condoms should be accessible, even though you're maybe hoping your teenager might not have sex, they might be right. It's very human to experiment with those things. We think the same thing with Naloxone or Narcan, just having it. You might never have to use it. It might expire right in your cabinet, but just habit.

Steve Martorano 
It's like the life jacket when you get on a boat. I mean, you don't expect the boat. But you better have the jacket on in case it does. And not with regard to Narcan. Fentanyl has changed the paradigm dramatically. Because it has been introduced in all sorts of things that a young person might not be aware of. You know, as I said, Narcan should be in everybody's home first aid kit. You know, the margin of error is non-existent. Let me ask you about a couple of other things. What about needle exchanges? Are just the coalition in favor of that?

Caitlin O'Neill 
We have a service branch and a Policy Branch and our Policy Branch also was active in getting the syringe access expansion bill passed last year, as well as the decriminalization of syringes. So, you know, we know that when syringes are criminalized, people are less likely to dispose of them properly. They're less likely to carry new ones. And they're more susceptible to police confiscating if they have new ones, so then they're more likely to reuse or share a syringe. So yeah, we fully support syringe access. In New Jersey, we currently have seven syringe service programs, which we call Harm Reduction Centers because there's so much more than syringe services that have been there. So we absolutely support them. And we are in the works of expanding that as well. And we believe there should be at least one in every county for New Jersey to get on board, Kentucky by example. So we have seven, Kentucky, which has about half of our population, has 67 or more at this point. So for a little bit of, you know, comparison, we are a little behind. And we're catching up, which is really great.

Steve Martorano  
With regard to those initiatives, harm reduction, why's that? Meet enormous resistance? I think a safe injection site might be number one on that list, it sets off alarm bells, political fights, and NIMBY response immediately. What's the situation in New Jersey? Regarding safe injection sites?

Caitlin O'Neill 
Yeah, so we're not there yet. In New Jersey, you know, like I said, we don't even have enough, sir access to sterile syringes, to even to even think about safe consumption sites yet. We see New York on point, New York with two locations they've saved, you know, they're like close to 1000 lives have been saved since they've been open. And so you know, whether it's controversial or not, I think one thing most people can get on board with is that people don't deserve to die using and if people can't get on board with it, those aren't the people we're talking to right. But in the general sense that we can all come together that people deserve to live, I think is a good starting point. And while it can seem kind of radical, safe consumption sites keep people alive. And what also exists at a safe consumption site is access to treatment many across the world. They're much more common in Europe and Canada. They're connected to treatment centers, right? And so they're connected to counseling. So you're not just going in and being left to your own devices you're connecting with The nurse, a counselor, someone who's checking in on your day-to-day health.

Steve Martorano 
Yep. When folks hear this, hear stuff like this, and they hear you say people deserve to live and not die. Some people say, Yeah, well, then they shouldn't be doing that. And if they do it, they, you know, society couldn't walk away from it. They didn't have anything to do with this. Do you think that the spread, ironically and tragically, that the spread of opioid use in this country, out of the inner cities, out of the poor neighborhoods, out of the communities of color, and into the middle-class, suburban world, is one of the things that's driving people towards a more humane approach to this? Once? Is it not a problem for those people? But a problem for all of us? It's funny how people get aboard. Do you see that happen?

Caitlin O'Neill 
Yeah, well, yeah. And so the thing is, is that substitutes have always existed in the suburbs in white communities. You know, in New Jersey, actually, there was a report that one of my colleagues put out a few years ago, that says that actually, white people use and sell illicit drugs at higher rates than black and Latin X people, or Hispanic people. We even know there's evidence that the drug war was targeted to target black communities and to target communities of color. There are files from the Nixon staffers that talked about the reasons they were doing these things. So first of all, yeah, the narrative that it was, quote, unquote, like those communities, we're here to say that narrative was we were lied to, right? But what happened was white communities, and middle-class communities had more access to care, and right, had more likelihood of having access to treatment, and things like that. And so while yes, now that people are kind of seeing more people, unfortunately, with the toxicity of our unregulated drug supply, you know, it's not about doing too much right. One bag, you

Steve Martorano 
can't kid yourself any more about the size of this problem and who it's affecting.

Caitlin O'Neill 
And so, Oh, I was just gonna say so, in New Jersey, what we see like, even though our statewide overdose fatalities have dropped in the past year, greatly due to things like naloxone distribution and harm reduction, we see that they're rising in black and Hispanic or Latin X communities. And so that is a disparity that needs to be addressed. And that really can tie directly into criminalization. And you know, the difference in how white people who use drugs are treated with compassion, and people of color who use drugs are treated as criminals.

Steve Martorano  
Yeah, to sum up, a couple of points here, recently, members of the coalition, I guess, testified in Trenton, in opposition to harsher criminal efforts against the use, and possession of fentanyl. Why did the organization take that position?

Caitlin O'Neill 
Yeah, so we take that position because from our lived experience and from the people we work with every day, we know that criminalization actually makes people less likely to call 911 for help when someone overdoses. I've heard that out of people's mouths. It's one of the reasons we make sure people have Naloxone, in case they won't call 911. You should call 911. Right when someone's overdosing, but we've heard people are afraid. In New Jersey, every overdose death is investigated as a drug-induced homicide, and knowing that I'm going to be really scared to call 911, Right? And even though we have the Good Samaritan Law, the overdose prevention act in New Jersey, I still, just as a person in that lifestyle, you know, I'm going to be really scared. And so if the penalties increase, and the penalties that are being proposed in New Jersey, are such a low threshold, that the way fentanyl use works, you know, it's a little different from heroin fentanyl doesn't have legs the way heroin did, it doesn't have as long of a half-life. So I'm going to be using more bags of fentanyl if I was, you know, then I would be using of heroin. The amount that is in these new penalties basically means that every single person is that uses any kind of opioid because we know that all opioids right now on the street have fentanyl in them. They're susceptible to not just criminalization but felonies and mandatory minimums. And that is the exact opposite of what our lawmakers said, right? Our lawmakers expanded access to Naloxone and treatment, you know, treatment on demand. We have the amazing reach NJ program in New Jersey and things like that they expanded access because they believe that people who use drugs deserve compassion and deserve a chance to thrive and utilize evidence-based programs. So we also point out that while these bills seem like a good idea because we know that legislators want to do something they want to save their constituents. They don't want to see people dying, right? We know that they're well-intentioned, but they're just missing the mark.

Steve Martorano 
Yeah, well, it's a knee-jerk reaction. I mean, here, on the one hand, New Jersey seems very progressive With the notion of harm reduction and open to that idea, and moving forward there, and then on the other hand, fentanyl scares the bejesus out of them, and they revert back to what they know well, and that's a heavy hand of the criminal justice system. So it's good that coalition exists for people who walk in and then say, Wait, timeout, make sure you know what the results of this would be. Caitlin O'Neill. Finally, with regard to the issue of decriminalization of drugs across the board, does the New Jersey Harm Reduction Coalition take a position on decriminalization?

Caitlin O'Neill 
Yeah, we support the decriminalization of drugs and the people who use them. And I know that that can sound like a radical concept, right? Again, because we see all these stories, we're experiencing people around us dying. And what I know is that criminalization will not bring my former partner back. Criminalization will not bring my best friend Danny back, right? criminalization will not bring back the people we've lost. And I say their names because you know, I do this work in honor of them. And while sometimes when we lose someone, we're scrambling, we want someone to pay, right? We want someone to be responsible. We have, as you stated earlier, 50 plus years to show us that that doesn't work. Drugs are still here. Drugs are here, as you mentioned, more prevalent than ever. And so if that criminalization worked, they would have worked by now, and they do not work. And so we're in support of full decriminalization because we know that there is a possibility for change. We know that illegally regulated drug supply works. Look at our alcohol supply in the 1920s. We didn't have that right.

Steve Martorano 
I was just about to say if people think that's an unbelievably radical notion, consider that two of the most dangerous drugs out there have been legal and regulated forever, and that's tobacco and alcohol. So there's a model. It works if people want to

Caitlin O'Neill 
look at alcohol prohibition, during alcohol prohibition, people were dying left and right, because the doses were unregulated. A bottle this size that I might think has wine in it could have enough alcohol to kill me. Right? And,

Steve Martorano 
and history shows us that the consumption of alcohol spread exponentially during Prohibition. The minute they said you can't do it, people wanted to do it.

Caitlin O'Neill 
Yeah, it's really a mirror. Yeah,

Steve Martorano 
we have models. It's not an utterly crazy notion to decriminalize drugs. If we do it. We have done it routinely for decades and decades. Caitlin O'Neil, New Jersey Harm Reduction Coalition. Thank you for your time. You guys are supported by donations, I suppose. And you're always looking for volunteers.

Caitlin O'Neill 
always and always looking for volunteers and advocates? Yeah.

Steve Martorano 
Okay. We'll have a link on our behavioral corner website for the coalition. And We will thank you for your time and your work in New Jersey. And we'd love to have you back at your earliest opportunity.

Caitlin O'Neill 
Awesome. Love to come back. Thanks so much for having me.

Steve Martorano 
Have a great day. Thank you, guys, for your time. Check us out wherever you check out podcasts. And don't forget, you know, like us, follow us. Push the buttons and check out the harm reduction efforts going on in your community.

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