“I’m really proud of the work that’s being done here in Rhode Island,” Ashley Perry, PWR’s deputy director and OPC co-director, told Filter.

“None of this would have been possible without our strong peer workforce,” she continued, referring to their role in the advocacy coalition behind the OPC legislation—“a lot of people who are running recovery centers, a lot of people who are in recovery, but also a lot of harm reductionists. A lot of people have shifted their very recovery-focused work to look at harm reduction. If it weren’t for these [advocacy] forums, I’m not sure that we would have an overdose prevention center.”

At the site, next to the Rhode Island Hospital, people can use the drugs they bring in, with overdose-prevention resources and trained staff on hand to ensure their safety. PWR also provides harm reduction supplies and education, a drug-checking service and basic needs like food and clothing. VICTA, an opioid treatment provider (OTP), performs some medical, nursing and behavioral health services there, and can make referrals to methadone and Suboxone programs at its separate location in the vicinity. Substance use treatment is available on demand, but not pushed on anyone.

“It’s very low-barrier. Somebody could just come in through the front door. They’d do an intake, and be able to do whatever they have to do.”

“We are the only OTP, I think, in Rhode Island that supports the Modernizing Opioid Treatment Access Act, which would allow any board-certified addiction medicine provider to write a [methadone] prescription to be filled at a pharmacy,” VICTA Chief Operating Officer Lisa Peterson told Filter. “There’s a lot of backlash in the OTP community around that, but I think this is a lifesaving drug … And I think that we help perpetuate the discrimination that’s occurring by continuing to insist that we’re the only ones who should manage this.”

Even so soon after the OPC opened, PWR, VICTA and other advocates are working with lawmakers in hopes of removing a sunset clause in the Rhode Island legislation that authorized the sites—a ticking time bomb that could potentially end operations by March 2026.

“It’s going to take a lot of data and proof that it works,” Katelyn Berthiaume, prevention coordinator at Aids Care Ocean State, told Filter. “That’s one thing that I wish weren’t so strict because to see change takes time.”

Over 35 years of data already show how OPC save lives and bring other health benefits to people who use drugs and their communities; more research will focus on outcomes at the Rhode Island OPC and two sites that were sanctioned by New York City in 2021.

I visited the Rhode Island OPC and interviewed its co-director, Ashley Perry, in early February. You can see part of our interview in the video above. In the rest (which has been edited for length and clarity), we discussed the genesis of the site, its early operations and the needs of the people who use it.  

Marilena Marchetti: How was the opening?

Ashley Perry: It’s been a crazy two-and-a-half weeks, to say the least. It took us a very long time to get here. Already we’ve served close to 70 people. 

MM: What’s the process for people coming to use the OPC?

AP: There’s really not a process—it’s very low-barrier. Somebody could just come in through the front door and tell somebody they want to go up to the OPC [on the second floor]. They’d come up here, do an intake, and be able to do whatever they have to do.

Currently, we have six staffers that are dedicated to the overdose prevention center. Our hours are 9 to 5. We’re able to have up to 16 participants at a time. We have eight booths for any other method of use that’s not inhalation. And then we have two inhalation rooms, each one having four people at a time.

“It’s really a mix of demographics. We see a lot of sex workers here. We see a lot of the LGBTQ population.”

MM: Who does your new OPC serve? 

AP: It’s really a mix of demographics in terms of race, ethnicity and gender identity. Project Weber/RENEW started off as a small sex worker organization. We see a lot of sex workers here. We’re actually home to the only drop-in center specifically for male sex workers. So we see a lot of the LGBTQ population and a lot of trans individuals.

Right now, it’s still too early to tell [how many participants the OPC will ultimately have], but as a whole Project Weber/RENEW serves 6,000 people a year. Here in our Providence office, we serve about 3,000 people a year.  

MM: Your site is soon going to have a drug-checking machine for anyone to use. Is drug checking a priority for your participants? 

AP: With drug checking, a lot of harm reductionists feel like we missed the mark on that. We should have started drug checking for people when we started seeing fentanyl and xylazine coming on. Now people already have tolerance to these drugs, people are already addicted to them.

So for some people, no. For some people, yes. Some people will come in who are recreational users, who really want to test whatever they’re going to take to a party or take to a rave. Rhode Island has a big college scene, and we know that we have tons of college kids who come out for things like fentanyl test strips. And a lot of people are seeking out things like psilocybin test strips.

The population looking for drug checking is different from those we normally serve. The drug checking will be on the first floor to make it low-barrier for people. People going up to the OPC won’t be required to use it.

We’re partnering with COBRE; they’re going to provide us with a machine, and they’ve been training our staff on how to run it, so it’s very exciting and beneficial to us.

“What’s always in the highest demand is just safe spaces. A lot of our people are really struggling out on the streets. Homelessness in our state has nearly tripled.”

 

MM: Which service is in the highest demand, or has growing demand?

AP: What’s always in the highest demand is just safe spaces for people. Somewhere where people can come in and get something warm to eat. A lot of our people are really struggling out on the streets. Homelessness in our state has nearly tripled in the past few years. We have more shelter than ever, but it’s still not enough. And many times, the people that we serve, people who use drugs, are really left out of that.

When you go downstairs after this, you’ll probably see a bunch of people sleeping on our couches and cots, because they haven’t slept all night. We really see a war on homelessness in our city as a whole. People are going deeper and deeper into the woods so they won’t be kicked out of places. We see all the time: People get kicked out of encampments and then they die.

Even though we have this overdose prevention center it’s still about getting Narcan to the people who need it most, getting education to the people that need it most. Over the past few years it has gotten extremely challenging to be able to do that. In some of our neighboring cities, they just passed ordinances to be able to arrest people who are homeless on state or city property. And then here in Providence they’re allowing us to have an OPC. But our work in Pawtucket is constantly being attacked by law enforcement out there. Everywhere we go it’s something different.

MM: How is your relationship with the police here? 

AP: Our police chief here actually used to be on our board at one time. I will not say that the police here are perfect, because they’re not. But for the most part, they don’t want to arrest people for petty crimes of having a crack pipe in their pocket.

Our police in Providence have listened to us on these matters. Maybe not on some other matters. Yesterday, the police chief and the mayor were both here giving mayors from all across New England a tour. Some of the other police chiefs were asking our one how police feel about this. Our chief was like, “These people have a great reputation in the community … I’m proud that we’re able to support this work.” So I’m hoping that our relationship will continue to build in that way of them referring people to us, versus them bringing people to prison for things that we know people shouldn’t go to prison for.

I can’t believe that me as a person is saying this—I’ve been arrested by Providence police a number of times. But they’re trying to do things differently, and I appreciate them trying to have an open mind. As we know, what we’ve been doing for decades hasn’t been working.

“I would never anticipate opening an OPC and getting city council approval in almost any other city in Rhode Island right now.”

MM: Why is Rhode Island the first state to sanction OPC, and Providence the first Rhode Island city to open one?

AP: First of all, we have a mayor who is in recovery. We have a mayor who understands this work. Here we have city councilors who believe in the work that we do. They believe that we’re out here saving people’s lives. They see it when they’re visiting encampments.

We [PWR] have been here now for 13 years. Whether we were wearing backpacks [with harm reduction supplies] or had drop-In centers. So I think that here in Providence, we’ve really built a reputation for ourselves. We have good leadership here who believe in research and believe in real things. That’s critical for us.

We don’t have that same leadership in other places. I would never anticipate opening an overdose prevention center and getting city council approval in almost any other city in Rhode Island right now.

When the bill for this OPC passed, the mayor of Woonsocket floated a resolution to ban OPCs from ever opening in the city. Today they’re the number one overdose hotspot in Rhode Island. Bad leadership does not believe in science, does not believe in facts.

MM: Your site is part of a medical campus with Rhode Island Hospital and Brown University Health. What factors went into choosing this location?

AP: One of the biggest things is that we need actual City Council approval for any location that we have. We came across other locations that just maybe weren’t the best locations for the neighbors. We definitely wanted to make sure that we weren’t going to open up a space that people were going to be objecting to on day one.

The hospital is actually making a lot of referrals to us, so people are just coming straight from there, sometimes if they went to the emergency room for an overdose. Some referrals are for frequent fliers who go to the ER just to sleep.

The hospital will make a referral to us and discharge people in the morning when we open. It’s not necessarily just for the OPC, but also the wraparound services that we provide like basic case management, HIV testing, support groups and connections to care and housing. Most of the time when people who use drugs or even people who are just experiencing homelessness are sitting in emergency rooms, it’s just because they need somewhere safe to be.

Our original drop-in center that was just for male sex workers was just up the street before. So a lot of people think that there’s not a lot of foot traffic here, but that’s not the truth. A block away from here is actually where a lot of nightlife happens. It’s where a lot of our strip clubs are. It’s where the male strip is. So that’s where a lot of our male sex workers are working.

And then a block over, on the opposite side, is where we see a lot of female sex workers working. So we really are in the center of everything. But if you’re not familiar, you may not know that. I think people anticipate to see a lot of panhandling and things like that in the streets. Here in Rhode Island, I think it’s kind of discreet. We have a lot of hustlers who are actually engaging in sex work or other things and if you don’t know, you don’t know.

“I’m hoping down the line to have basic primary care, whatever that may look like. A lot of times our people are not connected to primary care.”  

MM: Your clinical partner, VICTA, is an opioid treatment provider that runs methadone clinics. What’s that partnership like?

AP: We don’t have a methadone clinic here, but VICTA does have an office space downstairs. There’s a behavioral clinician there who figures out a person’s overall health condition. There’s a full-time nurse there. We’re partnering with them to provide the medical services that we as a  team cannot provide including basic wound care and antibiotics. They’re an amazing OTP,  really doing a lot of cutting-edge work at their home methadone clinic on Elmwood Avenue. I’m extremely proud to be able to work with them.

We already know that there’s so many issues with methadone as it is, but we’re really trying to fill in those gaps. So if somebody comes in today and wants to get put on methadone, we can drive them to VICTA’s Elmwood location and they can be put on methadone the same day. They are being very flexible with us, and that is what health care and harm reduction needs to look like.

We’re not at a stage where we have to bill for services yet. We have this amazing grant through opioid settlement funds where we’re able to pay for our providers’ time, for at least this year, without having to bill. They can take the time to really build relationships with people in this community. I’m extremely proud of that because that’s what we need to do right now.

VICTA does hep C treatment here. It’s very new, so we haven’t enrolled anyone in the program yet. I’m hoping down the line to have basic primary care for people, whatever that may look like, whatever people need. A lot of times our people are not connected to primary care.  

MM: VICTA seems like an outlier among opioid treatment providers, with respect for harm reduction and the agency of people who use drugs.  

AP: There’s a long history of VICTA wanting to come in and do things differently. Their COO [Lisa Peterson] was actually one of the people to really push [the OPC] bill forward and really is a harm reductionist. She wants to see that harm reduction work is happening. They really focus on holistic care, not punishment. They’re not just trying to keep people on methadone their whole life.

We have a bunch of methadone clinics here, but two of them are overdose hotspots. What’s happening is that people are still using drugs and using methadone because we’re not giving people a high enough dose so they can stay off fentanyl. And the clinics are so uptight about split dosing.

Methadone is supposed to be the gold standard for harm reduction treatment, but the reality is it’s not patient-centered around what the person actually needs. I’ve seen it over and over again: People will come in and say, “Oh, I take the methadone, but by 2 in the afternoon I’m really all over the place.”

Give them a freaking split dose, you know! Give them two doses! People are still using right outside and dying outside of methadone clinics. That’s not just here, that’s nationwide. It’s time to say, why? Why is this happening? But it’s often not a thing that we talk about, because methadone clinics are the moneymaker for a lot of states.

“The thing I keep telling everybody is that harm reduction has always been hard. This fight was never easy, it’s not made for the week.”

MM: What’s next for Rhode Island? Could the state decriminalize drugs, like Oregon did? 

AP: Total drug decriminalization is what I and many other people on my team want. Maybe not in the next couple of years, but maybe down the line. I think that this is going to be an experiment for a lot of people, to see if it’s going to work—which we know it will. It’s really reassuring our lawmakers that this can happen here. And then it’s saying, “Okay, this is what we need to do not just for Providence, but for all of Rhode Island.”

So we’re making a lot of progress. It’s just about the timing, I believe, of when we’re trying to make that progress.

The thing I keep telling everybody is that harm reduction has always been hard. This fight was never easy, it’s not made for the week. And we gotta get through some way, somehow. This time we just need to hold each other up. We’re going to keep on keeping on.

The post Inside Rhode Island’s Pioneering Overdose Prevention Center appeared first on Filter.

906 Vapor is a short documentary I made about a vape shop owned by Slis in Houghton, Michigan. The population of this quirky, remote Upper Peninsula community is just shy of 8,000. Its heyday as the world’s largest supplier of copper has long passed, but its residents remain proud of their heritage and identity. 

A geophysicist by training, Slis smoked for 44 years. He quit the first time he used a vape. He believes vaping saved his life, and has been giving back ever since. So far, he’s helped over 1,400 other people quit smoking. 

A fearless advocate for people’s right to access effective harm reduction alternatives, Slis sued the Michigan governor to stop a vape flavor ban, and won in 2019.

906 Vapor, which you can watch above, bears witness to how independent vape shops function as nonjudgemental, educational drop-in centers for people from all walks of life who want to quit smoking. 

For some months, I followed Slis and his devoted regulars as he fought to keep his shop open amidst a political anti-vaping backlash.

At Slis’s shop, a pit bull named Bernie sits in the window. A sign above her spot reads, “You can’t pet dogs when you are dead, quit smoking! I can help.” The canine recruiter brings countless new customers into the store.

For some months, I followed Slis and his devoted regulars as he fought to keep his shop open amidst a political anti-vaping backlash. His struggle is emblematic of the wholesale demise of the independent vape industry, encompassing shops like 906 Vapor and artisanal e-liquid producers. 

As the ending reveals, the film is something of a time capsule. It’s also a celebration of the communities built by individuals who ushered in a new era of smoking cessation, permanently transforming people’s chances of health and longevity.

Importantly, 906 Vapor preserves the origin story of tobacco harm reduction (THR)—how it sprung from creative people desperate for better smoking-cessation options than those offered by public health providers and doctors. It’s a story that refutes the lazy and widespread conflation of vaping with Big Tobacco. 

Slis has the ability to frame tobacco harm reduction in a way that speaks directly to those who remain skeptical, on the basis of how tobacco companies later pivoted to meet demand. People like him line the rapid trajectory from the 2003 invention of the e-cigarette by Chinese pharmacist Hon Lik to the explosion of DIY communities that brought more and more people into the “ex-smoker” fold. 

Slis directly contends with the aftermath of that initial rise in vapes’ popularity. He confronts the anti-vaping agenda spread by billionaires like Michael Bloomberg. His story challenges the politicians, regulators and corporations carving up a restricted THR market while offering grassroots vape providers as sacrificial lambs. 

The narrative put forward in 906 Vapor, about where tobacco harm reduction came from and where it may be going, is both a warning and a call to action.

The production of 906 Vapor was supported by a scholarship from Knowledge-Action-Change. The Influence Foundation, which operates Filter, has received restricted grants and donations from KAC. Filter‘s Editorial Independence Policy applies.

The post “906 Vapor” Tracks Assault on Grassroots Tobacco Harm Reduction appeared first on Filter.