Interview with Annajane Yolken

Interviewer: Liza Begum, Global Operations and U.S. Policy Intern

Annajane Yolken is a public health advocate, working to translate data and research into evidence-based drug policy. She is a co-founder and co-chair of the Substance Use Policy, Education, and Recovery (SUPER) PAC. She is also Director of Programs at Project Weber/RENEW, a peer-based harm reduction service organization in Rhode Island. 

1. When did the campaign for harm reduction centers [safe injection facilities, safe consumption spaces, SIFs] start in Rhode Island and why was it pushed for?

We have been working on this issue – at least I’ve been working on this issue for maybe about four years at this point. But I think other people have been working on it for longer than me. That’s just when I started. So that’s sort of all I can speak about. And of course, people have been working on issues around needle exchange in so many other related harm reduction issues for decades. So this is all built on that work, specifically the campaign for safe injection facilities, what we’re calling harm reduction centers. You might hear different terms. I want to raise that so it’s not confusing. 

We started about four years ago. The first convening that I was part of was convened by the Rhode Island Medical Society. So they got a group of people together who were interested in working on this. They were coming, obviously, from the medical perspective, but other people brought different perspectives and we kicked it off with a public educational event at Brown Medical School and then worked on different pieces, media pieces, but a lot of legislative work as well to try to get this law passed. So this law was introduced three years ago and then was introduced last year and then it was introduced this year, and it finally passed this year.

2. How did this campaign achieve success as the first state to allow for harm reduction centers?

I think that it was able to achieve success because a lot of people had been personally impacted. A lot of lawmakers had lost loved ones. And so when a bunch of different people got together, including researchers, people in recovery, people who do street-based harm reduction outreach came and said this is an evidence-based way to save lives. No one has ever died in such a facility across the world. I think after hearing a lot of that sort of evidence and people’s personal connections is how I was finally able to get past it. And there were a lot of great champions within the law, within the legislature, including people who had personal experience with this topic or had a family member who was impacted, who really pushed for it. 

And I realized that I didn’t answer the first part. The second part of your first question around why this was pushed for. I think Rhode Island, like many places, has been really impacted by a high rate of overdoses. And there are people every day doing a ton of hard work to do street outreach, get things like Narcan out into the world where people kept on saying that that wasn’t enough and there were still a lot of people dying. And so this was presented. And people viewed this as an evidence-based way [to save lives] because no one has ever died in such a facility. And that’s really why people coalesced around it.

3. Why do you think there are no operating SIFs in the U.S. when there are in Switzerland, Germany, the Netherlands, Norway, Luxembourg, Spain, Denmark, Australia and Canada?

Yeah, so I think there’s a few different reasons for this. One is federal law, right? So there is a federal law called the Crack House Statute, clearly based on the name, you can tell what type of orientation it has and what era it came from and what sort of background is, including a very racist background. And so that has stopped a lot of people from exploring this. And even in Rhode Island when we were working on it, there were definitely people who worked for the state government who were like, “Oh, there’s nothing we can do because of the federal law”. The way I see it is people also legalize marijuana despite federal law. So that is a real barrier, and people [were/are] very concerned, especially under the Trump administration, that they would be prosecuted. And that was a real challenge, I think, beyond that specific law. 

I think there’s just a more general air of not caring about people who use drugs, about a legacy of a racist war on drugs that really attacked people who use drugs and criminalize people who use drugs. And this is such a different paradigm shift of, “OK, we’re going to support people, we’re going to give safety to people, not we’re going to take safety away from people”. And I think there’s a paradigm shift around what is considered, quote-unquote, ‘enabling’. And I think that there’s sort of a definitely a lot of people who see these facilities as being enabling rather than this is a public health intervention or this is a medical support system.

4. You mention a lot of good things about SIFS, but are there any cons?  

I mean, I think that there aren’t. I’m clearly biased, but I don’t see any specific negativities. I can think of other things that people might think of as being negative. So there might be people who are concerned about how this will change the neighborhood if we have a safe injecting facility. However, research has shown that it actually reduces crime and doesn’t reduce things like needle debris. It really can be helpful. And I think, you know, I don’t see how this is different than, say, a bar or something. I think so. I think that’s a thing. 

There are definitely people who are really concerned about what type of funding would be used for such a facility. You know, there’s a limited amount of funding, you know, for the Rhode Island program. No state or taxpayer dollars will be used for it. But I definitely know there are some concerns. People like, oh, I don’t want my taxpayer dollars to go toward this, but people’s taxpayer dollars aren’t. So that was something that we’re also working through.  

5. Do you think SIFs are just as effective as existing prevention, harm reduction and treatment interventions or are they more effective/less effective?

I think that it depends on the different programs you’re looking at. I think giving people as many options to find support [and to] find resources is really helpful. I think that there are people who might find a harm reduction [sic] that is an appropriate entity. Some people might prefer not to go to a location. They use drugs, but might prefer to use drugs at home, especially if they have a home. And other services like getting Narcan into people’s hands are effective. 

I mean, the evidence around the fact that no person ever died in a facility, I feel like puts it in such a different tier than other interventions. Where we do we can do street-based outreach and give people lots of Narcan, but people are still dying because there might not be someone to use that Narcan or whatever the case may be. So I do think ultimately we need to build options for people and good options for people. And so this is one option for people. This isn’t the only option for people.  

6. What motivated you to campaign or push for SIFs? Did you share a personal connection with the topic?

Yeah, I got involved in this work through personal connections, I think, around the topic of safe injection facilities, It’s like we have this proven thing that is very clearly very effective and we have a lot of people who are dying. And so, like, why not? Like, a lot of times it’s like, “Oh, the solution isn’t there.” But here is a solution, maybe not the only solution. A solution is very clear here. And so to me, it was around trying to make that connection.  

7. Do you think many people are in favor of SIFs or do you think a majority of people are against the idea?

Yeah, I think it depends. The people I mostly speak to who are outside of the harm reduction world where people in harm reduction are for it are lawmakers. And I see lawmakers’ positions all very heavily on it, even in the past few years. So people with whom I had a conversation with three or four years ago were like, “Oh, my God, that’s ridiculous. You’re giving this shooting gallery, blah, blah, blah.” It’s initially kind of counterintuitive, I think, for folks who aren’t involved in social work. But then when explaining it, you know, explaining the evidence, explain that people now just have unsafe places to use drugs rather than safe places to use drugs. That explains when some people, like my kid or my partner’s life, would have been saved with such a facility. I think that’s when people’s opinions sort of change. And so we’ve definitely seen that happening…we didn’t pull every person in the state[, but] I do think that it’s a marker of some of the shifts that are happening.  

8. Do you think there should be requirements in these safe zones, like guidelines for people who want to do drugs safely or do you think it should just be free, meaning everyone should do what they want?  

Yeah, I think that there need to be boundaries. I mean, I think there need to be guidelines that people have a shared expectation of what is in the space and that everyone in the space can feel safe. So making sure that women feel safe, for example. And I think that just like any organization, there need to be clear guidelines. I think there needs to be certain if there’s behavior that makes people feel unsafe or makes people be unsafe, that can’t be tolerated…So I think it’s around lovingly setting firm boundaries so that the space can be utilized. 

..I think that in terms of the way it’s going to roll out in Rhode Island, it’s going to be regulated by the Department of Health, so it’s going to be a more medical model. There will be guidelines just based on..terms of maintaining regulations and whatnot. It won’t just be [a] free-for-all in that way. We’ll also need to show impact, right? So we’ll need to collect data, we’ll need to do certain things, especially if this does open, just being towards the being among the first. I think that there’s a lot we want to make sure that we can prove impact.  

9. Why do you think Rhode Island was the first site to pass the law regarding SIFS and not any other area in America?  

I think it was a lot of different things. I think Rhode Island has the benefit of being very small. And we have a million people compared to New York City, which has eight million people or nine million people or whatever. So with that, there’s a tight-knit community and everyone really knows each other well. People know their lawmakers super well because each lawmaker represents a few people. And there’s a pretty strong collaborative effort between researchers and policymakers and advocates, service providers, and whatnot. And so I think that that was really helpful for Rhode Island. 

And Rhode Island also has been very hard hit by the overdose crisis. And that got worse in 2020 in many places in the country. We also have a pretty forward-thinking Department of Health, which is really cool. So they’ve been very supportive of this whole process. And I think that’s really helped the process move along. It [helped that there were] formal recommendations from the Governors’ Overdose Task Force for Harm Reduction Center. It’s given [a] sort of structural legitimacy, so to speak, into the process. And, you know, so there have been champions both within those agencies and outside those agencies that have really pushed this through. And because it’s Rhode Island and it’s small, it doesn’t take that many people to get something passed for better or for worse sometimes. But in this case, for better.

10. Do you think the pandemic had any role in the new law being passed?

Yeah, I think so. I think that the pandemic definitely impacted the rate of overdoses. Unfortunately, some more people died. So it became a more public health crisis. I think also COVID sort of threw the idea of normalcy out the window…we all changed so many things about our lives to really address public health. And I think that that mindset definitely carried through to other things, including this. I think it also gave the Department of Health sort of more people to listen to the Department of Health more because they were so prominent in the COVID response. So I also think that was helpful.