GREENSBORO, NC – The skinny young man quietly walked into the room while waiting for the free supplies to help keep him from dying: sterile water and a stove to dissolve illegal drugs; clean syringes; Alcohol swabs to prevent infection; and naloxone, a drug that can reverse overdoses. A sign on the wall – “We stand to love drug users for who they are” – felt like a hug.

It was the first day on which the contact point in a residential area here opened its doors since it was closed due to the coronavirus in spring 2020. “I am very happy that you have all opened again,” the man, whose first name is Jordan, said a volunteer who handed him a full paper bag while heavy metal music played over a loudspeaker in the background. He asked for extra naloxone for friends in his rural county, an hour away, where it was in short supply during the pandemic.

The death toll from overdose rose nearly 30 percent to more than 90,000 in the twelve months that ended in November, according to preliminary federal data released earlier this month – suggesting 2020 beat recent records for such deaths Has. The astounding surge during the pandemic is due to many factors including widespread job losses and displacement; decreased access to addiction treatment and medical care; and an illicit drug supply that became even more dangerous after the country was closed.

But the forced isolation for people struggling with addiction and other mental health issues is possibly one of the greatest. Now, with the nation reopening, the Biden government supports the controversial approach the center is taking here known as harm reduction. Rather than giving drug users abstinence, the main goal is to reduce their risk of dying or developing infectious diseases like HIV by providing them with sterile equipment, tools to check their drugs for fentanyl and other deadly substances, or even a safe place to nap Will be provided .

Such programs have long been under attack to facilitate drug use, but President Biden has made expanding harm reduction efforts one of his drug policy priorities – the first president to do so. The American Rescue Act earmarked $ 30 million specifically for evidence-based harm reduction services, the first time Congress has raised funds specifically for that purpose. Funding, while modest, is a victory for the programs, both symbolically and practically, as they often run on tight budgets.

“It’s a tremendous signal to recognize that not everyone who uses drugs is ready for treatment,” said Daliah Heller, director of drug-use initiatives at Vital Strategies, a global health organization. “Harm reduction programs say, ‘Okay, you do drugs. How can we help you stay safe and healthy and alive in the first place? ‘”

Although some programs like this one, run by the North Carolina Survivors Union, managed to keep holding some supplies – handing them through windows, offering roadside collection, or even mailing them – practically all of them stopped during the pandemic To invite drug users. Many customers, like Jordan, stopped coming and lost a trustworthy safety net.

Some former Greensboro Center regulars have died or disappeared. Many lost their homes or jobs. At the same time, the center was flooded with new customers and is now having problems keeping enough supplies on hand.

“The struggle that people are having right now, unrecognized and unanswered, is really difficult,” said Louise Vincent, Executive Director of the Survivors Union.

Yet many elected officials and communities continue to refuse to provide people with medication for drug use, including recently introduced test strips to screen drugs for the presence of illegally manufactured fentanyl, which appears in most overdose deaths. Some also say that syringes from harm reduction programs litter the neighborhoods or that the programs lead to an increase in crime. Researchers deny both claims.

West Virginia has just passed law making syringe service programs very difficult to operate, despite an increase in HIV cases from intravenous drug use. The North Carolina Legislature pondered a similar proposal this spring, and elected officials in Scott County, Indiana, whose syringe exchanges helped contain a major HIV outbreak six years ago, voted this month to end it. Mike Jones, a local commissioner who voted to end the program, said at the time that he feared the syringes being distributed could contribute to overdose deaths.

“I know people who are alcoholics and I don’t buy them a bottle of whiskey,” he said. “And I know people who want to kill themselves and I won’t buy them a bullet for their gun.”

Many harm reduction programs are carried out by people who have previously or are still using drugs, and their own struggles with addiction, mental illness, or other health problems have also flared up during the pandemic. In Baltimore, Boston, New York, Washington, and elsewhere, beloved movement leaders themselves have died of overdoses, chronic health problems, and other causes in the past year.

Ms. Vincent, whose own opioid addiction stemmed from a long battle with bipolar disorder, made a brief return to illicit drug use this spring. She was keen to prevent withdrawal, she said after trying unsuccessfully to switch from methadone to another anti-craving drug, buprenorphine. She later learned that the small amount of fentanyl she was using was mixed with xylazine – an animal sedative that can cause weeping ulcers on the skin. She ended up in the hospital with her hemoglobin level so low that she needed a blood transfusion.

At the start of the pandemic, Ms. Vincent said street drug prices soared. Then drugs that were sold as heroin, methamphetamine, or cocaine were trimmed with unknown additives. Fentanyl was ubiquitous – including increasingly in counterfeit pills sold as prescription pain relievers or anti-anxiety drugs. But also substances like xylazine, which appears in illegal drugs from Philadelphia to Saskatchewan.

“It’s just poison,” said Ms. Vincent, who is being treated with methadone again. “The drug supply is like nothing we’ve seen before.”

On the afternoon of the center’s reopening, a young woman asked for a refresher on how to inject naloxone and if Ms. Vincent could explain what a meth overdose looks like. An older man asked if there was anything to eat besides clean syringes; a volunteer put a pastry in the microwave for him.

In addition to running the program here, Ms. Vincent is the director of the National Urban Survivors Union, a larger nonprofit, promoting harm reduction services across the country. In 2016, her 19-year-old daughter died of a heroin overdose while she was in an inpatient treatment center where naloxone was not available, she said.

Naloxone is more common now, but Ms. Vincent wants another life-saving tool to be disseminated: drug control programs that would allow people to find out exactly what substances are in illicit drugs before using them. Such programs exist legally in other countries including Canada, the Netherlands and New Zealand. Another type of harm reduction program used in other countries – where people use illicit drugs under medical supervision if they overdose – remains illegal here after a group trying to start one in Philadelphia so far lost in court.

“We cWe could have a real-time monitoring system instead of waiting for death reports from the coroner, ”Ms. Vincent said. “It would change the game, wouldn’t it?”

She found the xylazine in the drugs she recently took with a device called a Fourier Transform Infrared Spectrometer that a donor gave to her group this year. It can determine which substances contain samples of street drugs in minutes.

Jordan, who is 23 years old, had traveled from Stokes County, near the Virginia border, where the pre-pandemic overdose rate was nearly double the national average. His cousin, he said, was hospitalized weeks earlier after overdosing on a “really bad batch” of fentanyl that were found to contain traces of heavy metals in tests.

“At least 50 people in my area were rescued from here by Narcan,” he said, picking up several boxes of 10 vials of the injectable form of the antidote. “Even my grandmother knows how to manage it.”

Many harm reduction programs, including this one, help or sometimes even offer people to put people on drug treatment. But Jordan is one of the many drug users who are not interested in this path, at least for the moment. The next programs are in Greensboro or Winston-Salem, each a healthy drive from home. And treating food cravings like buprenorphine or methadone, which have been shown to save lives, “doesn’t really work for me,” he said.

The county that includes Greensboro, North Carolina’s third largest city, had 140 fatal overdoses last year, up from 111 the year before. The numbers don’t include the people who died from infections caused by injecting drugs, including the fiancée of a woman who walked into the center at dusk on the day of the reopening and called out to Ms. Vincent, “Where’s Louise?”

She met Ms. Vincent when they were both patients in a methadone clinic six years ago and regularly came to the center for injections and naloxone. She and her fiancé had tried to stop drug use during the pandemic, unnerved by the strange new adulterants that were showing up in the stash. But her fiancé started developing a high fever last December and was admitted to a hospital intensive care unit, seriously ill with endocarditis, a heart valve infection that can result from injecting medication. He died just before Christmas.

“Do you all have a meeting tonight?” Asked Ms. Vincent, referring to the self-help groups the center held several times a week before the pandemic.

“You’ll start again soon,” Mrs. Vincent assured her. “Being connected is much more important than any of us thought.”