Welcome to Illuminating InSights, our blog interview series where our team speaks with programs and professionals to learn about their experience in navigating various topic areas related to healthcare training and education. In this post, our team spoke with Aaron Arnold, Executive Director of Prevention Point Pittsburgh, a non-profit organization that provides harm reduction services for people who use drugs and those with substance use disorders. The evidence-based harm reduction services that they provide improve quality of life, prevent deaths, and reduce healthcare expenditures related to infection or illness. Aaron began serving as the Executive Director of Prevention Point Pittsburgh in 2016, and has been with the organization in varying capacities since 2005.
Our interview with Aaron began by learning about his professional background and journey to becoming Executive Director at Prevention Point Pittsburgh (PPP):
Aaron Arnold: My involvement with harm reduction started when I was in high school in the early 2000s in central Pennsylvania. We didn't have a needle exchange program there, but Prevention Point Philadelphia was pretty close to where I grew up. We would load up a bunch of people and go down and try to get as many supplies as we could to bring them back and make sure our friends who were injecting had them. For me, it was always more of an experimental thing. I never really developed an injection drug use habit, but certainly knew many loved ones who did. It made me realize that it's how your brain responds to these chemicals, it's not really necessarily anything to do with any person's motivation or morals or anything like that. When I moved to Pittsburgh, I Googled “syringe exchange Pittsburgh” and found that the program at the time was only operating on Sundays in Oakland, and that’s where I was living. So I was able to walk there and started volunteering. Over time, I took on more and more responsibility, and then was offered a position in 2015 to take over as Executive Director in 2016.
Aaron elaborated on some of the most challenging responsibilities faced by himself and volunteers at PPP:
One of the biggest challenges is finding the funding sources that will allow us to buy the harm reduction supplies that are the core of our services. Federal funding can't be used to buy syringes, and state funding can't be used to do anything related to syringe services in Pennsylvania, which transfers down to county money and city money as well. The ability to get public funds to support a service that is a public benefit or a public good is very difficult.
The other big challenge is that it's a very human-centered service that we offer, and so for better or worse, we know what's going on in people's lives, and we hear a lot about it--about a lot of death and a lot of loss. We see people who are trying their hardest get cycled back into jail and lose all their footing that they had trying to gain some stability and recovery. Supporting the staff and the volunteers and the participants who all experience a lot of direct and vicarious trauma is challenging because for a lot of us, we will do the work no matter how hard it gets, but sometimes we can forget how much it's affecting us.
We can also become a little dismissive of participants because we hear about the same things all the time. But maybe for them, it's a new experience or something that really scared them, or they don't know a lot about it. So trying not to become too cold, or closed off, but also trying not to be so open that you get thrown off and traumatised by the work on a daily basis, is often a challenge related to working in this environment.
"It made me realize that it's how your brain responds to these chemicals, it's not really necessarily anything to do with any person's motivation or morals or anything like that."
In addition to facing these day-to-day challenges, Aaron says he receives a lot of backlash from people who do not understand the goal of PPP. He explains how he deals with the negativity and criticism, and what keeps him motivated to continue his work:
The negativity is pretty much non-stop, so you just get used to it after a while. I've been called every name in the book. I've had threats. I've had people post things online and use pictures from my social media accounts, altering them in unpleasant ways. I just focus on the people that we are helping, not the people who don't understand what we're doing.
Even though I'm the Executive Director and I have to do all the accounting and crunch the numbers and H.R. and all that sort of stuff, I never step back from an opportunity to go to the sites and interact with our participants. If somebody drops into the [administrative] office mistakenly thinking that's our service location, I don't hesitate to jump up and provide them the same level of care they get at a service location. Recently, I just happened to work the two weeks of Christmas and New Year, and being there on those days is really interesting because people are so grateful that we show up on those days. They're like, ‘Oh, it's Christmas and I didn't think you'd be here.’ Not only were we there, but we had individually wrapped Christmas tree Hostess cakes to give people, and gloves and socks, and just tried to make it a nice day. We shoveled out the space where people would have to wait so that they didn't have to get their shoes wet while waiting in line. It's just really great to go out and see participants who probably don't get treated very nicely in the other systems that they're involved in, and then they come to us, and they have a really uplifting experience and an empowering experience. So just to see people leave, knowing that they've got the stuff that's going to keep them and their friends safe and that they were respected by somebody. We do this no matter what day [it is]. We don't just say ‘Oops, we're not going to be there.’ We show up and that helps build a sense of trust.
People will let you know when they're doing better. We often say when people don't need the services that we provide anymore, we don't know what happens to them, so sometimes you assume the worst. But then five years later, you'll see somebody who was a regular in the program for a year at the grocery store, or they'll just stop by the site and say, ‘Hey, you guys got me into treatment, I'm back with my family doing really good in school or working’ or something like that. That's just invaluable. It doesn't even have to be a big change like that. We have people who come back and say, ‘I took your advice and I went to urgent care and I got that thing looked at. It turns out it was infected and if I had waited longer, I probably would have been in the hospital, so thank you.’ Seeing people take the little steps and seeing the results and being happy with it [is rewarding].
"...five years later, you'll see somebody who was a regular in the program for a year at the grocery store, or they'll just stop by the site and say, ‘Hey, you guys got me into treatment, I'm back with my family doing really good in school or working’ or something like that. That's just invaluable."
Aaron shared some information with us on how the COVID-19 pandemic has added new challenges to PPP’s work related to the demand for PPP’s services.
Demand has increased dramatically. We’re seeing easily twice as many people, if not more. The one big change that we had to make that we all don't really like--but was necessary--was that we used to bring people onto the vehicle one at a time so that we could have a private conversation with them. Now we are doing the ‘ice cream truck model’ where we just open the side door, take orders, and hand them out through the doors. It's obviously very necessary in terms of safety, but it changes the dynamic that we have with some participants, especially if they come with somebody else that they don't want to talk about certain things in front of them, or they're concerned about who's behind them in line hearing something. There's a lot less of an ability to make connections and to talk honestly.
The other thing that has changed is there are a lot more overdoses. We have a huge demand increase for naloxone.[If a person has overdosed, naloxone is easily administered to save their life.] Also, people are very obviously experiencing hunger and food insecurity at greater rates than we have ever seen before, and it all started within the first two weeks of the pandemic and the shutdown. We pivoted and started distributing gift cards for food and fundraising specifically for that, and eventually got a partnership set up with the food bank. We're now a food distribution partner with the food bank, and have food boxes with us everywhere that we go. We also recognize that we added a couple of services because we realized in-person services were limited, and we were one of the few organizations willing to still go out there and meet people in person, with the appropriate safety precautions, obviously. We started mailing naloxone to anybody in the state that wants it for free. Mail order naloxone has been going really fantastic. We're averaging between 200 and 300 doses mailed out a month. We just started doing priority setting and geographic targeting so we can roll out more advertising and outreach. [More about mail order naloxone can be found here.]
We also launched a medical services van, which was not supposed to launch until this year, but we got it up and running in October 2020. The van brings a doctor to our service locations where they can provide wound care, pregnancy tests, and buprenorphine prescribing. [Buprenorphine is a medication for treating opioid use disorder and can help a person in recovery.] That's been really great because a lot of people who were getting ready to go into treatment services all of a sudden experienced their treatment slot or location not being available anymore. The drug supply got really shaky and it still is. It got really unpredictable so people were wanting to get away from the illicit supply and onto buprenorphine or methadone [to support their recovery]. We were able to help in that way by bringing the service out of the clinic, sticking it in a van, and literally driving it right up to them where they were already coming [to receive services].