- [Narrator] This program is made possible through a grant from the Centers for Disease Control through the Indiana Department of Health.

(soft music) - Indiana University did a study that says this has a $4 billion impact to our economy.

Just last year, we lost over 1,000 Hoosiers and we have done that each previous year.

The scale of this is enormous with prescription drugs, the heroin epidemic that's taking place, all set upon the methamphetamine problem that the state's kind of always had.

- A significant amount of our resources are directed towards addressing the drug crisis.

Certainly thefts through vehicles, burglaries, robberies, and other kinds of thefts are mostly generated because of drug use.

So they go and commit crimes to pay for drugs to get those drugs.

- Unfortunately, we do see a racial and ethnic disparity that's associated with illicit drug use.

We have vulnerable populations such as our African-Americans and even our Latino X populations.

Also, we're seeing a much younger white generation from ages 18 through 25 that are emerging becoming indicted that we never saw before.

- It is not a rule or an urban problem, this is someone's father, this is someone's granddaughter, these are our people.

- Harm reduction is a set of strategies that is really aligned with helping people to be as healthy as possible, doing potentially harmful or dangerous things.

So some examples are wearing sunscreen when you're outside on a sunny day, you wearing a seatbelt.

And then of course, with regards to substance use disorder, we have things like non syringe and syringe harm reduction programs.

- We're not trying to get an individual unnecessarily to stop using it, we're trying to reduce the harm that is put in place by them using it.

So, whether that's Syringe Services Programs to ensure that people aren't contracting HIV or Hep C, we know that individuals who engage in these programs are much more likely to enter into treatment and to have meaningful interactions with treatment when they go.

These programs are vital to ensuring people take that first step.

But what we have to do is keep them healthy and keep them alive while they're inactive use.

- The Anderson used to be a factory town, we had two general motors factories here and they closed several years ago.

And so there was some downfall in the community, there's been some bounce back, but it's not like it used to be over the years.

There's just been an increase in substance use.

Our harm reduction program started in August of 2018, so right now we're in a temporary location and we're operating from our van and a tent in the parking lot.

And so when somebody comes up, they they're greeted and then we just kind of talk to them about, what is it that they need as far as their actual harm reduction supplies, but then they move over to the next station, which is where they actually pick up the supplies that they need, which is anything from the syringes to first aid supplies, hygiene items, we've got some winter blankets, gloves, hats, those kinds of things, and sometimes we have food also that we can provide.

The majority of our participants that we serve actually are homeless, there's no place for them to go as they are with them, carrying all of their belongings with them everywhere they go, every time they go, but they can come to us.

You know, when people come in and we have to ask them questions about their drug use and their frequency of use, and a lot of times when they're new, rather than answering the questions, they sometimes say like, this is embarrassing, or this is not where I saw myself and I've never said these words out loud and to see that they can tell us that and still be treated with dignity and respect and not be judged and still be offered help when they're ready, that's huge.

Whether they come once a month or twice a week, they are provided information about HIV, hepatitis C, how to prevent it, really just how to be safe.

And then we also do on-site HIV and hepatitis C antibody testing.

It's a program that I think communities wish we didn't need to have it, the fact of the matter is that people will use drugs, whether this program exists or not.

We're not encouraging substance use, we're not enabling substance use, we are really providing a service to help some of the most marginalized folks in our community, getting them connected with services and preventing the spread of HIV and hepatitis C. - Hepatitis C is a very serious disorder, we have seen here in Marion County, a 200% increase in our cases, it is a very contagious infectious disease.

One of the primary risk factors for hepatitis C is injection drug use, individuals that are sharing their needle between individuals, less than a drop can really infect everyone that shares the same needle.

So it was definitely classified as an epidemic that occurred here with our hepatitis C. So, the number one tool to fight hepatitis C outbreaks hands down is the safe syringe program.

- We go out into neighborhoods where people who are actively injecting drugs need us to go.

So we look at locations based on where people are overdosing, where they're getting arrested for drug related crimes, and going out and providing harm reduction services.

And what that means is we talk to people about their injection drug habits and figure out how many syringes they need in order to be safe.

We just want to make sure that you're able to take care of yourself and have all the tools that are necessary to do that.

That's really what harm reduction is, is about recognizing what a person wants, what steps do they wanna make and how can we get them to that point that they wanna be?

It's so important because most people who are actively injecting drugs do not feel connected with the medical system, and we really help bridge that gap for people.

- As a person of color in this field and in working with people and helping them to see the benefits of these types of resources is definitely going to take time.

It's not a fly by night thing, so SSP is going to have to come into those neighborhoods and connect with those people where they are.

- There still needs to be significant improvement around education, especially for those who don't necessarily get the information on a consistent basis.

- I try to help people to see the benefits of a program such as SSP, but ultimately if they're not there and they're not willing to trust that in that moment, I do my best to start building that trust relationship so that when SSP comes around, again, maybe that time they will at least check it out.

- So, we want to make sure that we are engaging all communities that are impacted, particularly those are communities of color and individuals who are Black and African-American so that they can feel comfortable around accessing and civilian services, accessing treatment prevention, support, and feeling comfortable going into community-based organizations and primary care facilities and local health departments to access these services.

And we have to tackle stigma as a number one priority in order to get over the hurdle of getting people connected to care.

- Stigma is huge because it prevents people from, you know, really, truly understand that substance use disorder is in fact, a disease.

It's a disease of the brain, and it's a disease of the body.

It is not a moral failing or moral shortcomings, nothing like that at all.

The stigma again, plays into it when someone doesn't maybe have that confidence or that comfort, or has heard all their lives, that people who use substances are bad people, or they're not moral people, we know that not to be true.

Instead, we know that people generally just need some extra love and support to help them get to that next place to take care of themselves.

- I think one of the health department's greatest achievements and success has been the Safe Syringe Exchange.

It's been extremely successful, and we're very proud of the number of individuals we have gotten into drug treatment.

So it is working, we did see a significant drop in our hepatitis C cases.

- [Erika] When we prevent a new infection via harm reduction, obviously we're taking care of that individual and their loved ones by keeping them as healthy as possible.

But it also helps the community because we are preventing the cost associated with a new case of a disease.

- For every $1 that's spent on a syringe service program, up to $7.58 are saved in HIV treatment costs alone.

That doesn't include hepatitis C prevention, it doesn't include disability from overdose, so, we're cost-effective and we do save lives.

People are five times more likely to get under treatment of these programs.

So rather than ignoring people, we need to really take care of them and welcome them.

- I'm from Anderson, born and raised, I will probably be here forever.

There is no reason to say why I'm on the side of the table that I'm on.

Life circumstances happen, and it's really there before the grace of God go hide.

And I think that's important that we all remember that when we're working with our participants, they're not different, they're us.

- I think the addition of COVID has increased substance use.

It definitely looks like it definitely added to more increase in overdoses, fatal overdoses.

I know there's been more naloxone administered throughout our states.

- We saw such a tremendous increase in our homeless population during this pandemic that we saw a rising increase in the number of drug overdoses taking place as a part of this pandemic and it is continuing.

- You know, recovery connection, they go hand in hand.

And so when you have that disconnect due to the stay at home orders, people are isolated and alone so they can't go out and get services they need, can't get the medications they need.

- We've seen increase in tele-health groups online, but we hear from individuals that it's not the same.

That lack of connectivity leads them to go back the old way of thinking.

And unfortunately, too many people because of COVID have had a setback or have relapsed.

- When the stay at home orders were put in place and all these restrictions, a lot of organizations had to close their doors totally or provide limited support or limited capacity.

So, there's a lot of people who are just left without any connection whatsoever.

- HIV cases had been few and far between in this rural patch of Southern Indiana.

But in January, the number of confirmed cases in the region jumped to 11 and to 40, and now more than 140 people are infected.

It's the largest HIV outbreak in Indiana's history, and the largest seen in rural America in many years.

- Our HIV outbreak in the end of March of 2015 hit national news.

So, a lot of people who were injection drug users, more diagnosed with HIV.

- God I pray tonight, that you will heal Austin, God, that God you'll heal Scott County, in Jesus name.

- Yeah, it was very scary.

In 2015, there was over 200 new cases.

(train hooting) I was born and raised here, at a very young age, I was introduced to IV drug use, at 15.

- A lot of the people in this community have used them entire lives.

It's all they've ever known, is a drug and criminal lifestyle.

I grew up in a family of drug addicts and alcoholics, and I ended up pregnant with my son.

After I had him, I was prescribed some pain meds, I had hurt my back.

So, that just started 10, 15 year long run with opiates.

I got in trouble for the first time when I was 29, and by 31, I was on my way to prison.

- So I got suicidal, I ended up just kind of begging God, please help me.

And then I was introduced to Narcotics Anonymous.

I was able to start working in a program and working on myself.

I've successfully been able to stay clean for almost 30 years now.

Kelly played a huge part in bringing a recovery to Scott County and making it available for all of us.

That's been probably the backbone of my success is having a community, - I don't even think that I could probably put the importance of that into words, it's completely changed the entire county, not just the community, but she molded the recovery community into what it is today.

- For the first two years of my recovery, I lived in Lowville.

Nobody wanted me to come home, my family, my kids, my grand babies here.

And they just kept telling me there was no recovery here, it wasn't safe for me to come back.

So my big idea was if I bring recovery here, if I start helping people, then it will be safe for me to come home.

And then I can, my family won't tell me no after that.

- As far as like the HIV outbreak, there was a lot of my family members that were personally affected.

And I mean, as far as my friends, my close knit friends, or a lot of those were affected too.

So that kind of gave me the incentive to do what I do today.

- There's three of us that work here, then we're all peer recovery coaches.

Most of my client can relate to me pretty easily and I can then, we've all seen the same things, known the same people, had the same friends that have died.

- A lot of people that we see are people that we might have used with and when we ran active addiction.

So to see them come in and see us on the other side of it, wow, how'd you do that?

How did you get here?

If you can do it, then I can do it.

- A lot of times, new people will come in and you can sense that they're uncomfortable.

And usually when I can sense that, I am really quick to let them know that, you know, I used to use a needle and that I understand and that I know, and that just basically squashes that uncomfortableness.

- Here at the health department, I just make sure they're safe, whatever that means for them.

I meet them where they're at, and if they're not ready to quit using, just make sure they're safe while doing so.

Make sure they have clean syringes, make sure they know how to mix their drugs properly, make sure they know harm reduction.

Like, just make sure that they're safe because nobody taught me that when I was out there using.

- They're the highest at risk of people to become HIV positive.

So when these people come in, it's a no judgment zone.

We always offer treatment, we offer Narcan, in the winter we try to keep warm jackets and blankets 'cause a lot of these people are even homeless too.

- We suggest everybody get tested every three months, as long as they're still using.

So, we try to keep up with most people, it's been about three months since you've been tested, it's time to get tested again.

If it's our positive population, we know a lot of them is HIV and Hep C testing, we usually keep up with them really well.

But there's still some people out there in the community that thinks that us here at the Syringe Exchange are enabling people to continue to keep using.

They don't understand what we do here, so, it's just slowly trying to educate everybody else.

- We've basically stopped the spread of HIV through the Syringe Exchange, and we have the IU docs that come here, prep medication, or saving lives with Narcan.

- As we here and as our numbers of new positives drops each year since the outbreak, I think people are starting to come around to the idea that what we do here is not enabling, it's helping.

- But the outbreak, so many generations of families, we're here just sharing the same syringe over and over.

You know, grandparents, kids, even, you know, grandkids, all sharing the same syringe.

And I think bringing this Syringe Exchange here was the best thing that could happen to this community.

- Still misunderstanding around the concept of giving permission that if I'm giving you a clean needle, if I'm giving you Naloxone, I'm enabling you to have unsafe behavior.

I'm giving you permission.

- No one is saying that IV drug use is safe or something that anyone should be doing, rather than saying, if people are going to engage in IV drug use, then we should try to make that as safe as possible.

- So, helping individuals who don't understand, get the concept that no actually this changes the conversation and eventually the individual on the other side of the exchange says, I'm maybe interested in seeking recovery, and we know that happens all the time.

- My name is Mark Gerardot and I am currently employed with the Fort Wayne Police Department.

I'm going on my 22nd year, I'm pretty close to that.

We basically have a community in our county of around 300 to 400,000 people.

And we are literally looking at three to four overdoses a day in our community, it's devastating.

In a lot of times at the end of the day, I'm exhausted, which is pertinent because I was on my way home.

I was already on overtime, I saw it on my MDT in my computer, there's an overdose and I'm like another one, like you know, we see them all day.

And I like, I'm too tired, I'm going home, and something inside of me said, go to this one.

- My name is Nate Mollering and I am 27 years old.

I've been in Fort Wayne the majority of my life.

I was born here and I grew up here, I played football at Concordia High School and then I went to the University of St. Francis here in Fort Wayne and played football there on a football scholarship.

The way that I got started on opiates was I had several injuries, I blew out my shoulder actually three years in a row.

I remember the first time I took a Percocet, It was like, I had found God.

When I took it, I felt like this is how I'm supposed to feel every day of my life for the rest of my life and I distinctly remember that moment.

I was still using heroin, I tried to play football again, but I was strung out.

So what I ended up doing was checking myself in the St. Joe Behavioral here in town.

I did a heroin detox in there, and then I went to Indianapolis to a treatment program down there.

I think it was there maybe a month or two, and then I left.

And at that time, my family didn't really want me back in the house.

I had stolen jewelry from my mom, I had taken out credit cards in their name, drain their bank accounts, I felt so much shame.

I really just felt like I was a pretty worthless human being at that point.

February, 2017, I went back to my ex-girlfriend's house, was able to go in with a bag of dope, and I told her I was going to take a shower and I overdosed in the bathroom.

And that's when the, I remember waking up to the firefighters standing over me, they had revived me, brought me back.

They put me in the ambulance, took me to the hospital, I left against medical advice.

Less than I think, six hours later, I went and got another bag of the same dope, went back to her house, shut myself in the bedroom and then shut myself in the bathroom, in the bedroom and overdosed again.

And emergency services had to be called out yet again, twice in 24 hours.

I wasn't actively trying to kill myself, but I didn't care.

They had said to me, Nate, I don't think you're going to live a third time.

I don't think we'll make it here in time for time number three.

I remember I said, that's fine, I said, don't come.

And they said, I want you to talk to somebody, he said he's a narcotics detective.

He doesn't want to talk to you about your source or anything like that, he's supposed to talk to you.

I said, okay.

- I sit down on the couch next to Nate, and then I'm like, this guy's not going to make it, 'cause I've seen it before, he gave up on life.

Again, you're broke spiritually, you're broke mentally and physically.

And this drug had a way of just debilitating people in such an awful way that they just don't care anymore.

If Nate was a picture with wording on it, that's what it said, it said I'm done.

He goes the drugs that I've overdosed on, came from the same dealer that my best friend overdosed and died from.

It's the same drugs that I overdosed on the day before, less than 24 hours ago.

I don't care what it happens to me.

- I think at one point I said, I think I said, my life's over.

I think he kind of laughed at me, he said 24 years old, your life's not over, but I believe that.

But in that moment, you know, having a narcotics detective who was a veteran on the force say that they believed in me, it was a big deal honestly, and that was the moment where I was ready for change.

Mark, he took action to make that happen, and I think that was very important.

The window of willingness to go to treatment is very small and it closes extremely quickly.

He made a phone call and, I was on a plane the next day going to treatment.

- For me, Nate's the poster child for don't give up.

Don't give up as an addict, don't give up as a first responder when you're going to these people.

There is a state statute for possession of a syringe, for a police officer, that's a level six felony arrest.

For me, all of this is what is the bigger picture, what's the big picture in all of this?

Is it arresting somebody for a needle or is it about helping somebody get away from this.

Harm Reduction is very much outside of the box, that we've created in this country, but how do we deal with drugs and the drug habit.

Drug dealing is a different story, it's still incarcerated as far as I'm concerned, but the addict is get them help, and jail is not always help.

Because once I helped at solving theft from Walmart, it's solving stealing from your family, it's hurting your family, it's hurting your friends.

All those problems start to disappear when the drug addiction is gone.

So the bigger picture is if I have to walk past a needle and go, yeah, I see it, I can arrest you for it, I'm not going to because putting you in jail is not going to help you, and I have that discretion as a law enforcement officer.

We talked a couple of times when he's down a treatment and, then he gets back and he's working a job here, we kept in contact.

And then he's like, hey, I'm going to go work for Fort Wayne Recovery, I'm going to be there.

And I'm like, oh, a great end to the story, or a great beginning of the story.

A guy who was really ready to be dead is now helping people get through what he's been through.

- Giving back to people and working with others that are in early recovery, or even in active addiction, it was very rewarding.

I've been given a gift and I really, I want it for everybody who struggles with substance use disorder.

I feel like Mark Gerardot was there for a reason to connect me with the people that I worked for now.

And through those experiences, I'm able to help the next person, you know, and I want to help them not have to go through the things that I went through.

I just want to save their families a lot of grief.

I can't bring back my friends who are gone, but I can be there for the next person.

- So one reason that peers are so important when somebody has been revived from Naloxone is that Naloxone immediately throw someone into withdrawal.

And so it's so important at that moment when somebody is feeling their worst and all they want to do is go and get their next hit so they won't feel bad.

It's really important that we have those peers to engage that.

And hopefully, you know, that can be an intervention point for people.

- Indiana, I think it's at the forefront as far as creating and building a peer worker force infrastructure.

- Peer recovery coaches are the diamond in the rough if you will, in the recovery sector, it's definitely something that people are wanting and supporting these days.

And with my personal experience of being in recovery, I am helping other people, specifically people from my own community.

So, individuals, families, and communities of color, help to recover from addiction, mental illness, and trauma.

Some people get offended when you say things to the effect of, you can't help me unless you've been through it.

And honestly, a good bulk of that is true.

It was really hard for me to connect with therapist who had no addiction training, let alone personal or familial experience with it.

It was really hard for me to connect with them.

- When I was 17 years old, I was arrested, and I turned 18 in jail.

So I spent 26 years in prison.

And so I come to this as an individual with lived experience, not just from the perspective of having lived with addiction myself, but also that I have empathy for those individuals who are still in the madness.

And I share with them my experience to trials and tribulations and that it wasn't a straight line for me either.

Then it helps to give them something to hold onto, something to believe in.

- I have been living with HIV for almost 13 years.

I went through those emotional moments, I went through the periods of feeling like I was nothing, like I was trash, like I was nasty.

The thing that I did not have was someone who looked like me, and who spoke as I did and come from the same background to tell me, hey, it's going to be okay, smile.

Someone who could tell me, what do I do tomorrow when I opened my eyes, how am I going to get through tomorrow?

And that's the part that I didn't have, that I tried to help and provide today, someone who knows.

- I can go into a room of other people that are in recovery and feel just the same as them.

Then, you know, we've all had the same struggle, we've all been there.

A lot of times when people are using, they don't have anybody that they can trust.

You know, when you're out there, I didn't trust anybody when I was out there.

Somebody always wanted something from me or somebody always was out to get me or out to hurt me.

So, really what we are here is just, we'll meet them where they're at and whatever that looks like.

- A peer recovery coach is different from like a social worker at a hospital because we are nonclinical, So I can't diagnose anybody with substance use disorder.

I just operate that they have substance use concerns and they need assistance to recovery pathways.

Oftentimes in being a social worker, a licensed mental health counselor, they encourage you not to self-disclose and a peer recovery coach it's almost encouraged to self-disclose that you're in recovery you know, that's a value add for you interfacing with your patients or your client.

- I don't go to anyone suggesting that I have the answers and that I think that they should do what I did, my position is that I'm going to walk with you, and if you tell me that you're interested in reuniting with your children and also trying to maximize the benefit of your skill set in terms of being productive, then I'm going to just ask you, well, where does using or drinking fit into that program?

And when you tell me that it doesn't then, okay, let's look at what we can do, okay.

- I firmly believe the opposite of addiction is human connectivity.

I can only speak on my experience, and I know that for me, I always felt disconnected from the world for some reason.

Most people with substance use disorder have some kind of co-occurring disorder, mentally, emotionally.

I think it's a huge, huge help to have harm reduction services available.

And I'm a big supporter of it, I think it's very important.

You know, the longer we can keep people alive, the longer we have a chance to attract them to a better way of life and get them into recovery and the stories of success, you know, I really try to hold onto those.

A lot of people don't make it, you know, and that's very hard, that's the hard side of the job, right?

It's when people go back out, they pass away, but there are people that do make it and that makes it worthwhile absolutely.

- There's a need for, in the African-American community, community of color, Hispanic community, and I'm bilingual.

I speak very right Spanish clearly, and English sometimes.

But it's important to be able to get into areas where people perhaps for cultural reasons, but for the language barrier, I just don't want to go to other areas to seek that kind of help.

some of these types of programs aren't available specifically in the Hispanic community.

- I think part of it is, there aren't many people of color represented in the recovery field as a whole.

So, the points of connection aren't really there, how, again, can you help me if you're not really familiar with my experience.

So, okay, well, you know what it is to be addicted to something, but you don't know what it is to be a black person.

So, how can I truly connect with you?

How can I trust that your resources will reach me as a person of color?

So when we talked about the syringe programs, for some people of color, it feels like a setup because you know, it's illegal to have a syringe on your person with intent to use.

So, you are giving me the syringe, that's now safe to use, but am I even going to get to use it?

Am I going to get stopped after leaving this space and arrested?

So, as a person of color in this field and working with people and helping them to see the benefits of these types of resources is definitely going to take time.

While they're helping to serve from someone else, they are growing and getting well themselves in their own healing journey by doing this type of work.

So again, I believe that peer recovery coaches are absolutely imperative to anyone's recovery journey.

- What we've been doing for years and years now is just arresting people and putting them in prison.

We know that doesn't work, we cannot arrest our way out of this problem.

We've got to start doing something different and we're starting to see agencies do different things, trying to connect people with treatment, using peer recovery coaches, and I think that is really the evolution of this drug crisis.

- And so it's so important that intervention points along the continuum that we place these peers to interact with individuals.

And so whether that be in our county jails, we're training peers and the department of correction.

- Let me tell you a little bit about myself, my best laid plans, my best thinking, I couldn't think the best I could possibly think because I was under the influence most of the time.

- INPEP ECHO is the Indiana Peer Education Program.

People from INPEP came and taught a 40 hour training to selected offenders, which they now teach the same program that they were taught, which is all about how you can track diseases.

They wanted to target these facilities to try because all of these offenders will be returning to the community.

A safe prison makes a safe community, and that's why they start here.

- Well, we have a variety of issues that we speak about.

I'm actually kind of passionate about addiction, so I speak a lot of addiction, but we do hepatitis C, we do HIV and sexually transmitted infections.

- We live in a very enclosed environment and we need to understand how easy it is to make each other sick, but just as easily, how easy it is for us to protect each other so that we're not getting sick all the time.

IV drug use, sharing needles and equipment (indistinct).

- This work as the peer educator is very important to me.

When you come from a situation that I come from, where you really feel as if you owe a debt, I owe some people a debt.

a lot of times we find it easier to speak to one another than having to speak to an individual who has the lack of a better term power or authority over us.

It's easier to taking my medicine from someone I think I have somewhat in trust.

- It's 10 Hours total workshop that the peer educators put on for other people incarcerated here in this facility.

The Indiana Peer Education Project is the replication of the New Mexico Peer Education Project.

So about 10 years ago, staff at the University of New Mexico identified that The New Mexico Department of Corrections had a very high rate of Hep C infection.

And that that hepatitis C infection was also flowing into the community.

Not only was it just sort of incidental that people in the correctional facilities had hepatitis C, but it appeared that they were getting affected while incarcerated.

Our model is really all about harm reduction.

We understand that there are a lot of pressures present in correctional facilities that people were meeting people at a point in their path that they may not be ready to, completely abstain from the behaviors that put them at risk.

So, we really teach our peer health educators to talk about how do we reduce the harm.

So, is that not sharing hygiene equipment, is that not sharing needles to minimize risk in whatever form.

And that begins by getting people to understand what risk is.

- The term harm reduction, it's about getting them to do the right thing, even sometimes the wrong thing the right way.

So if a guy is addicted to needle use and he can't stop, maybe let's get him not to share his needle or maybe let's get him not to shoot after anyone else or something to that nature.

- People are more careful about what they're doing and they tell you about it as they do it.

I mean, as they go along their day, one may tell you about the preventive measures that they took during the day, just from what they've, what we taught them during our presentation.

So yeah, they tell us about this all the time.

- I'm not naive enough to think that I changed anybody's life in one 15 or 20 minute period, but I'm hopeful that they took enough information that will allow them to make some decisions to change their own life.

And that's all you can really offer anybody as an opportunity to change their own life, 'cause they're in need to make all the choices - For every facility in the States, I mean, because like I said, majority of the prison population are, will be returning to the community, so they should have the opportunity to, be privy to the same information that we have or go through these classes.

- And then monthly telehealth ECHO's sessions, and ECHO is Extension for Community Healthcare Outcomes.

It's a model that's used in a variety of medical settings to train providers remotely using video conferencing technology.

And we've adopted that to work with our peers, so we treat them just like the doctors or nurses or pharmacists that are other health ECHOs.

- School is very important, something I discovered a long time ago is that I thrive on purpose.

I've been locked up 38 years and way that I continue being locked up in surviving is thriving on purpose.

Everyday when I get out of bed now I have a sense of purpose and that's making sure that I'm ready for the day, making sure I'm ready for the classes that we're going to lead keeping current on the information.

- It's hard, you know, in corrections to see results sometimes.

I think this program has given me to where I see results of offenders, where the light bulbs are going on, who knows where it can go, we can do more programs, more peer education, it's just beginning.

- And you got to know it makes you feel good, it makes me feel good, it puts a smile on my face, knowing that somewhere along the line, I've had an impact on somebody else that wasn't all bad.

When you think about what a legacy is and being able to say, this is something that I did that no one can take from me and no one can downgrade or degrade, that I actually done something good and I'm worthy, man, that feels good.

- One of the things that often gets lost in the discussion is the connection that these programs create to healthcare.

So, people who are participating in syringe programs are connecting with drug treatment, they're connecting with other healthcare resources, they're connecting with housing, nutrition, all kinds of other needs.

- My name is Melanie Vehslage and I'm the Harm Reduction Health Educator at the Monroe County Health Department.

So, I do outreach three days a week with the mobile outreach unit out in the community that most they're, it's kind of exciting, I love driving big vans(indistinct).

- Well, Syringe Service Program is many things, what it is not is simply a needle exchange or a trade-off.

what a Syringe Service Program does is meet people where they are and provide an array of services.

So, part of that service is getting a person that clean needle if they need it, but it can also be getting them a referral to housing or to food or to other services, medical care, getting them signed up for insurance, mental health services, and we could go on.

We're talking about saving lives and it that's what it really is about, it's a public health response, and this is one of the best practices for reducing the spread and transmission of infections like hepatitis C or HIV.

Treatment for hepatitis C could easily be at least $80,000 or more, so, that's for one individual, and we can operate a Syringe Service Program, a very small scale one for that amount of money and save a lot more lives.

- A person who has experience with injection drug use is not always treated the best in a doctor's office.

And so that can be, you know, a huge barrier for a person who says, well, maybe I don't feel so bad today.

It's probably not going to affect me for a little while, I'll just hold off or something.

So, that can be tricky.

And I just think it's really important for those people to understand that somebody cares about them.

- The state legislature wrote a law to allow counties to request a Syringe Service Program.

We were among the first to have a Syringe Service Program and we are on a two year cycle now, and we request that renewal from our county commissioners.

We have one of the strongest Syringe Service Programs, we serve, I think the largest number of participants, but I attribute that as much as anything to our relationship with the Indiana Recovery Alliance.

So, instead of us doing it in-house and trying to add staff, and we have contracted with a not-for-profit agency, that's already doing harm reduction and education in the community.

- The Indiana Recovery Alliance is a nonprofit organization that we call ourselves a harm reduction organization.

We work on various services that further the goal of harm reduction and getting an education about harm reduction on top of direct services in the community.

So, the biggest difference that we see in terms of segments of community is people who have the ability to get transportation to our brick and mortar office and come in and see us versus the people that we go out and see in our mobile outreach.

And so we identified two spots and go there three different times in a week to be able to reach those people who are kind of living in a more precarious situation than the people who have cars and can drive and come to see us at the office.

I am a person with lived experience with substance use disorder myself.

And so when people show up and they know that, because we publicize that that is the case, that we are people who understand.

People show up and they feel safe, and people have told us, this is the one place that I've gone to take care of my health where I don't feel judged, I don't feel stigma, I feel understood.

Harm reduction, I attribute to saving my life, personally.

Looking back, I see that I made small positive changes in my life that took me from absolute chaotic drug use to someone who now lives in recovery.

And it's important for me to be there for other people to make sure that honestly, that I'm assisting others and not having to feel the way that I have been made to feel in the past.

I believe that language completely shapes our perceptions of reality, honestly, and language can be very stigmatizing.

And historically, certain words that have become just ingrained into our common parlance, have been stigmatizing words, and so, language is super important.

When people have told me that they are trying to get clean, I say you were never dirty.

I've had people's eyes light up whenever I say that, I've had people start to cry, whenever I say that.

It's just such an emotional impact to hear that from somebody, to hear, you aren't dirty, you were never dirty.

I find addict to be a stigmatizing word because, it categorizes someone as a label, it turns them into that label.

I say, people who use drugs, because that is what they are.

It's a person who uses drugs.

When you call 911, just say, what's happening, say, my friend isn't breathing.

We're all about celebrating even the smallest of wins.

And for me, a small win is just a moment of meaningful connection, and that's what I'm striving for.

I want to create moments of meaningful connection.

It's phenomenally important because they are telling us that they are not getting that anywhere else in their lives.

And so, I mean, it's worth saying, I think that the CDC released data that basically stated that people are five times more likely to enter treatment when they are a participant of a Syringe Services Program.

- Our goal is to prevent transmission and infections, and we want to keep people healthy and alive and able to enjoy their life.

- Just because somebody uses drugs, they're not immune from the rights to, access public health services.

It's not that they are separate from the rest of the community.

We're all part of this community together, and we all deserve to have access to public health services.

- It affects the community at large.

I mean, when you help the people that are most marginalized, you're benefiting everyone and I think that's really important.

- I am in awe of the work that they do, and I think that every time that we have a volunteer or we have a participant who says, thank you, or comes up later, like, in a meeting or something and expresses their gratitude, people who have written letters in support of all of those things, give us gratitude for that, yes.

- It's a stigmatized disease, it just is and I understand other diseases have been that way.

People have said cancer was that way, diabetes is that way, I think we're afraid of what we don't know.

- The science teaches us that drugs hijack your brain chemistry, they alter the way that you think.

If anyone has ever spent any amount of time with someone who is addicted to heroin, you'll see that it is all about where is their next dose coming from and how do they continually chase that?

They're not concerned about food, they're not concerned about their safety or their welfare, they'll do unimaginable things to chase that next high.

- We're making progress.

When I first learned about harm reduction in a completely different way, in 2011, I was so taken aback.

I've been in recovery since 1989, abstinence-based recovery.

Somebody told me harm reduction, that I'm going to actually continue to work with someone, to use their substance of choice and walk them towards abstinence was appalling to me.

But then fast forward to understanding more about opioids and understanding more about intravenous drug use and the potential for the spread of communicable disease, it makes perfect sense.

- There's always a treatment provider available and there'd be connecting people or being connected to services on a regular basis.

There's a lot of misinformation out there.

Sometimes we hear that Syringe Service Programs are heroin starter projects, and if we try to alleviate that thought, lots of law enforcement is very black and white that, hey, somebody's committing a crime, they should go to jail.

Well, this is the big conflict and the big rub between law enforcement and public health is, public health has the ability to determine a crisis and emergency and be able to create a Syringe Service Program in their community.

Yet, possession of a syringe with intent to use a controlled substance is a level six felony.

What would really be helpful is if legislatures would create some kind of law that minimizes that.

- The discussion about harm reduction really started in response to, the 2015 HIV outbreak in Scott County.

The 2015 legislation that created syringe exchange in Indiana is the toughest political battle I fought in the state house, and it's an ongoing battle.

We now have nine counties with syringe programs.

We have to view harm reduction, including syringe exchange as a public health response, it's a critical tool.

So, communities need to have access to this tool.

I wish we had Syringe Service Programs available statewide.

- They may be charged for syringe possession, they may be charged for illicit drug use, but at the same time, if they have hepatitis C and HIV, and they shared that syringe with somebody else, they may be now charged with some of these HIV criminalization, hepatitis laws, and face even more harm to themselves.

- [Clere] So we're saying gather all your syringes and go to the Syringe Service Program with a paraphernalia, and maybe you get pulled over or stopped along the way, and you can be charged for each of those syringes.

So, it's a conflict.

- What can we do to improve the law so that it causes less harm, so that people can then use more of these effective public health measures that involve harm reduction approaches.

- So for the majority of my career, I was doing public health grassroots advocacy around preventable injury and death.

In 2013, my 20 year old son, Aaron overdosed on heroin and lost his life.

I was sort of unexpectedly introduced to a pilot project that Indianapolis Metropolitan Police Department was participating in to create better access for the first responders to the overdose reversal drug Naloxone.

So, I learned all this stuff that I didn't know, as a fairly well-educated person, I didn't know there was such a drug that could have saved Aaron's life.

Initially, the task was raising money to help first responders with access to Naloxone.

But then we also learned that you as a family member or a caregiver or a loved one, or an individual who wanted access to Naloxone to be able to save someone's life needed a prescription, and the prescription had to be for you, which is a barrier.

And no one's going to go to their doctor and say, I misuse opioids.

That was sort of our next task was to work with advocates and legislative officials to create access to the overdose reversal drug through a non-prescription.

So, we passed Aaron's law in 2015, Aaron's law allows for basically over the counter access to Naloxone without a prescription.

Even though I said we're doing better because we are, we still have such a long way to go.

Though I had a conversation with the senator just this week from Northern Indiana who communicated to me that her first responders are dissatisfied with access to Naloxone, because they have told her that people will use heroin and call 911 because the Naloxone is going to make their high better.

Okay, that's the complete opposite of what Naloxone will do, and she believes that, and the individuals who are still on the fringe of the circle, who for whatever reason, haven't fully educated themselves, don't feel that it's a topic they need to understand because it doesn't affect them.

- We have health commissioners, Imma say best health commissioners in some of our cities, in some are counties, who won't even talk about harm reduction.

That's not our problem, the numbers are not big, it's not enough for us to even talk about, and we know goodwill, that's not true.

They align this project is a not-for-profit agency that the original mission was to assist people who are HIV positive or living with AIDS.

This agency is heading on 30 years of service that we have provided to Northwest Indiana.

In the prevention area, we have HIV testing and Hep C testing, we have substance abuse counseling, we have meals on wheels, food pantries, sort of the whole continuum of services, our region continues to grow.

And so the need continues to grow with all of the substance abuse treatment centers that we have throughout like in Porter and LaPorte County, I am surprised at no one's trying to do anything on harm reduction.

- Harm reduction works, it prevents disease, and it saves lives.

Since the syringe exchange legislation in 2015, it saved countless lives.

- So, we got lot of work ahead of us.

It's not going to be an easy task because you have people who don't want to deal with it.

Why are you bothering with harm reduction?

You know, if people get high, want to get high, let them get high, if they die, they die.

But that's not, how you supposed to treat human beings.

Because while you talking like that, that could be your son, that could be your daughter, it could be your grandmother.

Honestly, it could, it could be anybody.

- The fact that health is so politicized, that's a problem.

The politicians could sit and decide and not the medical community can make decisions about health is a problem.

If it was about public health, then all those things that would make a community healthy would be the priority.

Yes, So, if distributed condoms, lubricants, cookers, cleaners, syringes, whatever will make my community healthy, then that is what would be legal, that would be the priority, yes.

- If we look at what happened in our Southern part of the state, we are actually in Northwest Indiana.

We're one step away from that happening to us because of the denial in our communities and in the administration.

And all you need is one spark, and all of a sudden you got a epidemic on your hands.

We don't have to have that through it, this here is preventable.

- We do know that it works, we know the research knows that harm reduction works, but the legal structure is really important.

We can't do effective harm reduction if that harm reduction is criminalized, maybe that's a good one way to put it.

- And when we break down stigma in communities, we break down the stigma in the representatives at the state house.

And so ensuring that we have data that these programs work, ensuring that people are able to visit these programs and meet participants, and truly understand people who are suffering from substance use disorder are people.

It begins to go a long way to personalize the issue and really get people from all walks of life to understand that they want nothing more than what they want for their own children.

- We have 40 years now of research globally that supports the idea that harm reduction, not only prevents transmission of bloodborne pathogens, but that it also supports the overall health of an individual.

And so it's looking at the data and looking at that collective message, but then also using that piece that we understand about reducing stigma and saying, you know what?

I have a neighbor, I have a friend.

I have someone that I love who is dealing with the disease, and I need to be the best neighbor that I can be, my friend or loved one.

And the way to do that is to educate myself and to look at what I can do, because the nature of us as Midwesterners, the nature of us as Hoosiers, you know, we do wanna take care of the people around us.

And so I really do think that we are kind of uniquely positioned to already love thy neighbor.

And so, you know, having then the information and the resources to be able to make good choices about how we take care of each other, I think it just, it makes us a pretty powerful force to be reckoned with.

- [Narrator] This program is made possible through a grant from the Centers for Disease Control, through the Indiana Department of Health.