Luciano Colonna is the Executive Director of the Intermountain Harm Reduction Project based out of Salt Lake City.

Q: How big is Salt Lake City?

The city is 450,000, Salt Lake County is about 1.2 million.

Q: How involved in this field?

I originally got involved in it because I was living in Thailand and a lot of my friends were sex workers. This was the mid-1980’s and it was apparent that Harm Reduction was really the only sensible strategy to use in the group of individuals whose livelihood depended on sex work. They were supporting themselves and their families. There were few opportunities and sex work really was a viable employment choice.

I got involved in it before we were using the name, passing out condoms, educating my friends and acquaintances about the risks of sharing and the risks of unprotected sex. The risks of being a sex worker and getting too high on drugs and alcohol. When I got back to the United States, I was always a musician, and a lot of my friends were getting sick and dying of AIDS. I was living in Western Massachusetts and writing a book. I saw an ad for an HIV counselor and I figured I could do that part time and still write the Great American Novel. Then, the next thing I knew, we started a syringe exchange program and I’ve been involved in it ever since. That was about ten years ago.

Q: What is going on in Salt Lake City? What is the drug problem like? What is the response?

Well, you know, Salt Lake City is like every other major city in the United States- it has a huge drug problem. Heroin, methamphetamine, and diverted and prescribed prescription drugs, those are really the main drugs of abuse. Then you get a significant amount of cocaine and other drugs of course, marijuana, and the club drugs which are being used a lot.

Of course, when one thinks of SLC, one thinks of Mormons, and that is the dominant culture, but SLC is primarily non-Mormom. It has a Democratic mayor, district attorney, city prosecutor, it has a university and a college here. There is an Air Force base. It is a major interstate, a vibrant migrant community, and tourist meccas for skiing. There are a lot of drugs here, but primarily because SLC is a metropolis. We, like many cities in the west, have a huge methamphetamine problem. Up until a few years ago, death due to illicit drug overdose, primarily mixing heroin and alcohol was the number one cause of death for white males, ages 15-44. That number has come down, we would like to believe because of our Harm Reduction efforts. As that number has gone down, death due to diverted licit drugs, primarily oxycontin, methadone and Loritab, has increased. Like many places around the country, the trends are similar. We here actually, unlike a lot of other communities, have a fairly progressive treatment and public health establishment. There is a lot of networking going on and lot of people willing to collaborate. My organization, the Harm Reduction Project, was actually begun as a discussion group around needle exchange about 13 years ago. The participants at that time were the executive directors of Planned Parenthood, The American Red Cross, Police Department, the homeless clinic, the homeless shelter, the University of Utah, the State Health Department, and the Division of Substance Abuse, and some private citizens. They formed a syringe exchange working group which evolved into the Utah Harm Reduction Coalition, which is now the Harm Reduction Project with a site here and one in Denver.

It is important to know how well supported Harm Reduction is here. We have contracts with the division of substance abuse, Harm Reduction has been recognized as an early intervention. The success we’ve had in Utah doing Harm Reduction and integrating Harm Reduction into public health has enabled us to open our drop in center in Colorado. We consult all around the Inter-mountain and Rocky Mountain West now. Our organization doesn’t just apply Harm Reduction to substance users. We also apply it to commercial sex workers and licit drug users. Here, we do a lot of work with Native Americans who use alcohol and sex workers. We work with a diversion program for women who are arrested for prostitution. Instead of going to jail they can be sent here. The protocol is that they have to be substance users.

We only see women. If a woman isn’t abusing drugs and she’s a prostitute, chances are she needs a lower level of care, not that her issues aren’t very complex. But substance use certainly compounds the problem because you have dependence and addiction and more money problems.

Q: What is Harm Reduction?

I would say Harm Reduction is a set of strategies that seek to reduce the harm associated with marginalized behavior. It’s Plan B. If Plan A is abstinence, Harm Reduction is Plan B. One does not have to have judgment associated with Plan B. Just because there is a Plan A, doesn’t mean Plan A is morally better than Plan B.

With the illegality of drug use and all of the moralizing that goes on everywhere, Plan A is what everyone would prefer. Not all, but a lot- for substance abuse to just go away. Here, our mission is to reduce the harms associated with marginalized behavior. If it is with a homeless alcohol user, it could be keeping him from freezing to death in the evening, to keeping them from falling asleep on train tracks to drinking themselves to death and harming their bodies from the poison of alcohol.

When it comes to youth and substances, illegal substances, it would be talking to them practically about the harms around substances and the realities of legal ramifications of using- being a minor. It’s really talking to people pragmatically about use and abuse.

For us, it’s keeping the needs of our participants premier and working with them to find ways to reduce the harms they might experience as a result of their behavior. Since drug use is very complex, the consequences associated with the behavior- there are many. The same goes with sex and being homeless and being such a marginalized population like Native Americans.

Q: Why is drug use so complex?

People use drugs for lots of different reasons. There are lots of repercussions for using substances. You might have someone who is using drugs purely for recreational reasons, it doesn’t mean that one might not still get addicted using it recreationally. But someone could also use recreationally and just stop because they mature out of it or they walk through that door so many times they just get bored. Or they continue to use and nothing happens. Or you could have a woman or man who discover that methamphetamine is a great way to deal with their issues around food. If you have an eating disorder, then you have a very complex issue. We know some people like to self medicate. Some people smoke pot and spend the next twenty years in their parents’ basement watching reruns of Gilligan’s Island and sucking on a bong. Why that happens to some people and not others is part of the complexity of substance abuse.

Some people can drink alcohol and have a perfectly good time, they can drink on occasion. We know some people will end up in jail or domestic abuse situations, they’ll be really sick from the harms associated with alcohol abuse.

It’s semantics here- eating disorder or just concerns about the way you look. We live in a culture where women are preoccupied with the way they look. Then they discover a drug that keeps them from wanting to eat- is it an eating disorder or what?

In Utah, when you go to jail, they take a photo of you and put an armband on your hand with your photo on it. A lot of women have this image of themselves, usually pretty thin when they were arrested using heavily. In jail, there’s not much to do but eat fatty foods. Well, by the time these women get out, they are released in the clothes they were arrested in, and they have this image of themselves… We live in a society where fat- where looking normal is not okay.

I was watching TV with my daughter yesterday and she said, how come all the women on television are really thin and beautiful?

Q: What determines whether someone winds up in jail or the basement or nothing?

If you look at who’s in jail, I think your skin color might have something to do with it. There are socio economic and racial factors- racial profiling- poverty has a lot to do with it. Then, I don’t know why. Some people are able to quit.

There was a study on free base smokers in California. Free base is crack before it was called crack. It was abused a lot by middle class and upper class white people. You remove the base yourself and then you have a very smokeable, believed to be addictive drug. What happened to all those people? They didn’t all wind up in prison. They’re the older non-user today. Why did they just move on? I bet you their skin color and money and the courage that comes along often with having preferential treatment helped them do it.

Q: What is the incarceration rate here?

In Utah, it’s not like many states where there are a disproportionate number in jail for drugs. There is a bill we are trying to get through the legislature now- The Drug Offenders Reform Act- similar to Prop 36 where we will provide more treatment slots for individuals that do have drug use issues. People aren’t just getting locked up indiscriminately for drug use here. Usually it’s along with another crime.

Q: It’s not 80 or 90%?

It absolutely is not.

Q: Is treatment accessible?

If they have money, pretty good- like anywhere. You can go to a private rehabilitation program if you have $20,000-$30,000. It depends on the kind of treatment you need. There are waiting lists here. One unique thing Utah has though is intern groups for people waiting to get into treatment. They can go everyday of the week to a meeting and it’s not a 12-step meeting. They can get some support that way. We run groups for active users here. But Utah has a nice extra group.

We have methadone, buprenorphine is becoming more and more available. There are out patient treatment programs, in-patient, ranging from cognitive approaches to medication based to a few old dinosaurs with therapeutic communities.

Q: How have things changed over last 10 years?

There is more treatment available for women, women and children. Almost all of the organizations in town are fairly familiar with Harm Reduction now. Many treatment centers have utilized Harm Reduction in the past because relapse is such a big part of recovery. I think you’ll find in Salt Lake more and more providers cognizant of what Harm Reduction really means. There’s overdose prevention and education in the jails and therapeutic communities. If people aren’t responding to treatment, they get referred to us. When walking out of treatment they get referred to syringe exchange. The fact that our org is funded by the division of substance abuse says something about the treatment communities perspective on Harm Reduction.

I would never advise anyone to move to Salt Lake City for their treatment needs, but there is a continuum of care. People are open to improving upon the treatment here and enhancing it. We try to work closely with our fellow providers because a lot of the people that walk through the door of either our organization or the needle exchange are going to try to access treatment. I have seen a lot of collaboration and support. We had our fundraiser last week, the mayor and Ethan Nadelmann were the speakers. This was in Salt Lake and about 100 people showed up to give us support. The director of the division of substance abuse was there, representatives from the health department and detox facilities were there. I think that says a hell of a lot!

Q: What do people need to know about what’s going on?

I think they need to know that entire communities of African Americans and Hispanics are being destroyed because of the War on Drugs. Just look at who’s being incarcerated and the color of their skin and how they identify their cultural heritage and you’ll see that. Young Americans are losing access to student loans and in many cases, having their lives and futures derailed because of youthful indiscretions and because of experimentation, and/or because they might have a drug problem. It seems outrageous to ruin someone’s life because they have a drug problem. A ridiculous amount of money is being spent on the so-called Drug War and not on treatment. When it comes to incarceration, re-entry help for people who have been incarcerated because of what amounts to drug problems isn’t there. I think a ridiculous amount is being spent on drugs that are less harmful as opposed to drugs that are more harmful. We say we want to keep kids from using drugs- which is not happening- and don’t put the money where it could be more effective, like alcohol and tobacco.

The War on Drugs has facilitated the growth of a multi-billion dollar black market for substances that are unregulated, untaxed, and forcing our young people to go underground, pushing them away really. The War on Drugs has done more to destroy families in this country than any other government intervention that I can think of.