Each Thursday morning, the Strength in Peers van parks outside of the New Season Treatment Center on the south end of Harrisonburg. The center provides opioid addiction treatment. Deborah Mason and Frank Pilkerton set up signs; one that advertises "free Narcan" and another that says, "Need help? We are listening."
"We're just meeting the community where they're at," Pilkerton said. "We just gave a COVID test away."
Both Pilkerton and Mason are peer recovery specialists — they help others healing from substance abuse, trauma or mental-health issues by drawing on their own lived experience.
"I am just gung-ho for recovery, because I know it works in my life. So, I'm just hopeful that it would work in someone else's," he said.
They're also the boots-on-the-ground team for the organization's harm reduction program, one of six official programs in Virginia. For people who aren't yet able to stop using drugs, such as opiates or meth, these groups provide free supplies that help prevent overdoses and the spread of bloodborne diseases.
Strength in Peers also assists people with naloxone, a medication that can reverse the effects of an opioid overdose. The Strength in Peers team gives out the medication for free and teaches people how to use it.
"We encourage people to do their dosing together, so that they're not separated and they're not doing it by themselves," Pilkerton said.
The group also gives out test strips that detect whether fentanyl — an opioid that sometimes is added into other drugs without the knowledge of the person buying it. Its potency has connected the drug to overdoses across the country and in the commonwealth.
"A lot of times, if they're coming out of jail situations or incarceration situations, they may not be able to handle the doses that somebody out in the community, that has been doing it regularly, can handle," Pilkerton said.
While the Narcan and fentanyl test strips are openly available, there is one part of the program that the state requires to be carefully regulated: the needle exchange.
People who sign up and agree to follow the rules of the program — like not bringing drugs onto treatment centers' property — can receive free, sterile needles from the organization and dispose of used ones. Between January and June, 89 people participated in the needle exchange.
Nicky Fadley, executive director of Strength In Peers, explained that this can help prevent the spread of bloodborne pathogens.
"We have, in particular, an epidemic of hepatitis C," she said. "It's so easily spread."
In 2019, the Virginia Department of Health received more than 11,000 reports of "confirmed or probable cases of acute, chronic, and perinatal hepatitis C," according to a report from the department. It does note, however, that the actual number is probably higher, given that only about 20% of acute cases are symptomatic.
Harm reduction goes beyond public health, though.
"For those of us who come from a recovery perspective, our heart is knowing that, again, all people have value," Fadley said. "[A]nd although things sound dire and feel really challenging and hopeless, that anybody still can recover."
Strength in Peers started its comprehensive harm program in May 2021, after being authorized by the state health commissioner. Before 2020, there were four similar pilot programs in the state, but changes to Virginia law that went into effect that year have made it a bit easier for other organizations to start their own.
Even though they're an authorized program, Fadley still encounters misconceptions about what they're doing.
"The main one we hear is that we are enabling people or making it easier for them to use," she said. "[T]he reality is people are using and they're going to use, whether they have sterile needles or not. … And what happens when people don't have sterile supplies is we have transmission of infection … wounds that get very infected."
Besides saving lives and preventing disease, there's another reason to do this work: When people come to trust Strength in Peers through its harm reduction services, they're more likely to reach out if they want to pursue recovery.
Last week, Pilkerton and Mason started leading a new recovery group for those working to overcome drug or alcohol addiction.
"It was a wonderful experience," Pilkerton said. "It's all about meeting them where they're at. So, we are not telling them, or suggesting that they do anything. But what we do is have them recognize their behaviors. … If they think they can do something else that would enhance their life, we can direct them toward that position."