Pranav Padmanabhan
BA Student
My name is Pranav Padmanabhan, and I am a fifth-year undergraduate in Geography and Disease Modeling. While in Columbus, I volunteered at Safe Point, a syringe exchange run by Equitas Health, where I was introduced to the world of harm reduction.
Harm reduction as it applies to preventing drug overdoses and the spread of diseases like HIV has many definitions. As a public health philosophy, it’s the “acceptance that a continuing level of drug use in society is inevitable and defines objectives as reducing adverse consequences,” in opposition to formerly hegemonic strategies of abstinence and criminalization. It typically includes distributing the overdose-reversal medication naloxone, sharing information and supplies like syringes to facilitate safer use of drugs, and more recently, drug checking through fentanyl test strips and spectroscopy machines. SAMHSA’s definition explicitly mentions easier access to “substance use disorder treatments.” However, decades before its embrace by government public health, harm reduction consisted of underground, grassroots mutual aid networks of activists illegally handing out syringes on the street and getting arrested for it. To many of these activists, harm reduction isn’t just a targeted strategy focused on individual behavioral changes, but a broader movement to secure the bodily autonomy of all people who use drugs. This view challenges the medicalization of addiction and drug use, instead viewing it as a cultural phenomenon shaped by one’s environment. It’s also the recognition that the cause of the overdose crisis is not individual choices or even the so-called “disease of addiction,” but prohibition and the only way out is a safe, accessible supply of all drugs.
My honors research thesis explores the dichotomy within the “harm reduction” umbrella, using Columbus as a case study to compare two paradigms of harm reduction in practice and situate them within a larger sociopolitical context of the neoliberal takeover of social justice movements in the United States. As a geographer, I am particularly interested in how biopolitical harm reduction manifests specific “sites of health” that reinforce the surveillance of people who use drugs, as opposed to outreach that brings resources to where people are and whose goal is building community networks that resemble “right to the city” movements. Throughout the summer and fall, I am interviewing harm reduction outreach workers representing a wide range of organizations to learn more about how, where, and why harm reduction is practiced, as well as their outcomes.
The purpose of this research is to center on the person-first, no-questions-asked practice of harm reduction that stands in opposition to the “data-driven” model prevalent in public health research and practice, which often alienates groups of people who use drugs who have been historically monitored and criminalized by the state. While I am using a framework of two intersecting but distinct philosophies of harm reduction to better illustrate the landscape of harm reduction in Columbus, these boundaries are muddied in practice; for example, Safe Point itself is a government-funded, nonprofit-run, specific point of care, but is also a community site where grassroots organizations freely mobilize, and many of its employees are also volunteer activists. The institutionalization of harm reduction is not ubiquitous, and partnerships between progressive organizations like Safe Point and radical activists have resulted in spaces that lie in a gray area between a site of biopower and liberation.
Changes in the law and mindset by state actors are crucial, as harm reduction policies are necessary to save lives, but relying solely on government funding and support is flawed because it leans heavily on the whims of those in power, who are the furthest removed from the material realities of the overdose crisis. By highlighting the work of activists who have gone unnoticed by academics and policymakers, we can gain a fuller picture of what works and how various players in the harm reduction space coexist and can complement one another, as well as how the forces of commodification and depoliticization of healthcare services have impacted people who use drugs and those who service them.
This project is being advised by Dr. Kendra McSweeney, whose expertise in both qualitative community-based research and the global drug trade has been invaluable. I have also been inspired by multiple classes in the Geography department, including Dr. Mat Coleman’s Political Geography class, where I first learned about theories of biopolitics, Dr. Madhumita Dutta’s Urban Spaces class which focused on organizing and hidden labor within cities, and Dr. Elisabeth Root’s Spatial Data Analysis course which provided me with the GIS skills to create the project’s output.
