Opioids
History of Harm Reduction in Minnesota

Minnesota has needle exchanges, and we have Sue Purchase to thank for laying the foundation for this work.

Sue was introduced to injection drug use when she was 19 years old. She had already been experimenting with drugs since the age of 12 while growing up in Cloquet, Minnesota. She lived in the mountains of Colorado with her two children and a husband who dealt cocaine. She left her husband and returned to Minneapolis. It was her family's belief that the only way to "sober up" was to go to chemical dependency treatment. However, to Sue it seemed that the Minnesota model had a narrow definition for recovery and placed an emphasis on religion, along with taking stock of one's own moral inventory. This was not a treatment style for which she was prepared, and she believed she could handle her drug dependency issues on her own.

Sue would go on to eliminate her cocaine use on her own volition and return to school to work towards her degree in Human Services. It was here that she was exposed to HIV prevention education and the risk factors associated with injection drug use. In her experience with injecting, it was common practice to share syringes and the rinse--not wanting to waste scarce resources.

This new knowledge led Sue to the harm reduction efforts that she began in Minneapolis with the groundbreaking needle exchange program, “Women With a Point”, along with Tony St. Pierre. Tony and Sue found they had similar histories related to drug use. And although, Sue's focus was harm reduction and Tony's was abstinence, they found common ground in the importance of syringe exchange and good public health.

 “We had a point to make and a point to give,” Sue explained. “The reasons that women come to drug use are unique and varied; therefore, they have to be acknowledged with unique and varied service-delivery methods.”

The two started with a home delivery service, operating out of the trunk of their cars and meeting with people in prearranged destinations, most often a parking lot at a shopping mall or coffee shop. The shelters on Curry Avenue became a regular stop on Tuesday nights, where they brought socks and granola bars, along with condoms and syringes. As word and reputation spread, they were invited into people’s homes. It was this personalized intervention that allowed them to meet women who were pregnant and parenting while using in isolation. Sue’s view of harm reduction is that it respects all positive change: it meets people where they are at, and it makes a safe space to “show up, be real, talk about difficult things, and have an open dialogue.” They had conversations with women about what it was like to meet their drug needs while simultaneously being a successful parent, making it through the day, and supporting their family financially. Sue understood that substances were these women’s first line of defense and had become their best friend from sexual assault, domestic violence, mental illness, and other forms of trauma. They worked in a way that was respectful of the relationship that women had formed with the substance. “It was serving them in some way, and we had to understand that before we could ever start talking about a different way of making it through life,” Sue said.

Approximately eighty-five percent of women in drug treatment facilities have survived a primary trauma (i.e., sexual assault, physical assault). Many women have multiple traumas. Sue explained harm reduction as “impromptu, on the spot conversations, responding without judgement, and showing compassion and understanding. Women are raised to be everything to everyone, what if you lose the ability to do that? There is so much shame.” Harm reduction acknowledges that active users are valuable right now. “You don’t have to reach the bottom before you can get better, and you don’t have to be sober or even want to get sober to be treated with respect,”Sue said.

In the first year, Sue and Toni passed out 10,000 syringes, and within four years they had passed out 200,000 syringes - all during a time when anything other than an abstinence-based program was considered blasphemy to even talk about. Sue and Toni were true innovators. “It was controversial, revolutionary, and it saved lives,” Sue explained.

Harm reduction is in no way a green light to use, nor does it minimize the risks of using. “Often, people think that by using harm reduction methods, you’re encouraging people to use. Quite the opposite. If you’re going to use drugs, then learn how to use them in a safer manner. I educated people not to share cookers, cotton, water, or needles. And, we’d talk about what else they could do while actively using to take care of themselves, like do you have medical care, prenatal care, healthy food?” Sue said.

Sue went on to explain that over the years, “Minnesota Department of Health funded us for almost every single dollar we asked for, which was f*cking phenomenal!” Sue started a group called “How to Manage a Habit on a Budget”, and it was funded through the Minnesota Women’s Foundation. Sue encouraged, “Trust your crazy ideas. You know where we need to go, and the getting there will happen.”

Sue Purchase presented at the 6th Annual Harm Reduction Summit at White Earth.

Currently Minnesota has Syringe Access and Disposal via pharmacies and Syringe Services Programs (SSP). SSPs have a wider array of services that usually include HIV, Hepatitis C, and Syphilis testing, as well as support and assistance in accessing treatment and recovery services.

Please visit the Opioid Dashboard for more information on opioid overdose death, nonfatal overdose, use, misuse, substance use disorder, prescribing practices, supply, diversion, harm reduction, co-occurring conditions, and social determinants of health.