Harm reduction is a framework that has shaped public-health interventions and policies since the onset of the AIDS epidemic. It encompasses multiple practices and strategies in diverse clinical settings, guided by the principle of “meeting people where they are.” In the summer of 2019, as a group of students interested in the harm-reduction approach to patient-centered care, several of us collaborated with faculty mentors to form the Harm Reduction and Addiction Medicine (HRAM) student interest group, with the aim of organizing hands-on experience in harm-reduction work and promoting harm-reduction education for the Einstein student body.
Staying Committed during a Pandemic
Just as HRAM got going, the COVID-19 pandemic derailed our spring and summer plans. We had begun recruiting student members, hosting events on campus, and networking with students at other New York City medical schools. Over the course of a few days in March 2020, this momentum came to a screeching halt. Medical students were released from clinical rotations, and on-campus student activities and meetings were cancelled. Faculty mentors were redeployed as frontline workers to keep pace with medical care needed for the COVID-19 outbreak, and community collaborators had to shut down many services. We had hoped to connect student volunteers with addiction-treatment and harm-reduction groups, link interested students with faculty members they could shadow over the summer, and host harm-reduction workshops on campus; all these plans were put on hold.
We made a quick pivot and found inspiration in other classmates who were organizing initiatives to help meet the demands of COVID-19 surge capacity, including personal protective equipment (PPE) fabrication and grocery deliveries for patients and frontline workers.
Inspired by these efforts, we reached out to the newly formed Einstein Student COVID Response executive team to publicize our group as a virtual volunteer resource for addiction-treatment and harm-reduction programs. Because the executive team was in contact with medical student organization efforts across New York City, it learned of similar student groups at the New York University, Columbia, and Mount Sinai medical schools that were looking to collaborate. We soon formed an alliance of more than 25 students from five medical schools across New York City who were committed to supporting people who use drugs.
One silver lining to mandatory social distancing has been the use of virtual spaces to help medical students bridge physical distances and organize cohesively. Representatives from each medical school met virtually to share ideas. As more students and more schools joined, we instituted weekly video conference calls to brainstorm projects and develop plans. For example, students from one medical school were helping with a virtual buprenorphine clinic within their health system, so we worked together to publicize this new service to addiction-treatment and harm-reduction programs across the city. We also launched a social media presence (@harmreduction.nyc), with the goal of increasing public awareness of important issues affecting people who use drugs, and providing helpful resources.
Quarantine interfered with our desire to gain experience in working with people who use drugs; for example, we could not go to syringe-service programs to assist clients in person. To bridge this gap, we asked the programs for informal needs assessments. Several of them reported the challenge of keeping their services open because of a shortage of PPE. As a result, we collaborated with a newly formed citywide medical student group (PPE2NYC) and Einstein’s PPE-distribution student group to donate over 5,000 pieces of PPE—including masks, face shields, gowns, and gloves—to workers, volunteers, and clients at syringe-service programs. While we couldn’t physically “meet people where they were,” we were able to support community-based programs promoting harm reduction.
Likewise, our plans to go to clinics to help patients in person were scrapped. Instead, we reached out to addiction-treatment providers. Many providers acknowledged the large number of resources available but expressed concern about the difficulty patients might experience when navigating those resources. Simply making patients aware of available resources was not enough; ensuring that resources can be accessed equitably was our goal. We pulled together two resource guides: one for patients and one for providers. The patients’ guide is designed to fit on a single page, written in both English and Spanish, and easily printed or shared electronically with a QR code. The patients’ guide also lists resources for those with access to the Internet and those without. The providers’ guide is a comprehensive, multipage document listing resources that we confirmed to be operating during the pandemic, including syringe-service programs, food pantries, and legal services. As we learned of new resources, we could update the document and share it with providers via the cloud.
Our efforts culminated in a student partnership with the Substance Abuse Treatment Program (SATP) to establish a virtual help line to address patients’ concrete needs. Student volunteers signed up for shifts that corresponded to the clinic’s operating hours, and placed or answered calls. Some patients needed help obtaining cell phones, so we arranged with SATP providers to have patients call us when they arrived at the clinic to pick up their methadone so we could help them complete online applications for free phones through Lifeline, a cell-phone assistance program. As the summer heat increased, we also helped patients apply for cooling assistance through the state. For patients needing food, we located the closest food pantries or arranged for grocery delivery through city programs. In each of these cases, we worked with patients through the virtual help line to address their unique and very specific needs.
As we look to integrate principles of harm reduction into our medical education, HRAM students have experienced the importance of engaging patients beyond the walls of the medical system. “Meeting people where they are” during a pandemic has pushed us to use virtual platforms to organize our grassroots response and help people who use drugs. We have learned to engage stakeholders as we establish our initiatives and iteratively seek their feedback. Ultimately, we have to sustain the momentum of this student network dedicated to promoting harm reduction and addiction medicine. To be better advocates in the midst of colliding overdose and COVID epidemics, we have to tailor our efforts to reflect the real-life experiences of our patients. These lessons will shape our ability to improve the lives of people throughout the city who use drugs, and help guide us for the rest of our medical careers.
Frank A. DiRenno, M.Sc., Albert Einstein College of Medicine class of 2021, co-founder, Harm Reduction and Addiction Medicine Interest Group
Nupur Shridhar, Albert Einstein College of Medicine class of 2023, member, Harm Reduction and Addiction Medicine Interest Group board.
Kelly Yang, Albert Einstein College of Medicine Class of 2022, co-founder, Harm Reduction and Addiction Medicine Interest Group
Michelle Toker, Albert Einstein College of Medicine Class of 2023, member, Harm Reduction and Addiction Medicine Interest Group Board
Tiffany Lu, M.D., assistant professor, medicine at Albert Einstein College of Medicine and medical director, Montefiore Buprenorphine Treatment Network