Notes from the Field: Iowa Harm Reduction Coalition is Familiar with How to Support Community Through Crises like COVID-19

The first case of COVID-19 to hit Iowa was recorded on March 8, 2020. We did not see the first death in our state until a few weeks later, on March 24.

But since then, everything has changed.

The transmission of the virus accelerated, and the pandemic moved quickly across our state (like many others). Like other national crises before, COVID-19 has illuminated many existing health and social inequities in our communities.

Not only has the pandemic shone a light on the cracks within our social systems, it has actively accelerated the growth of inequities and seemed to expand social stratification along existing lines.

Since 2016, I’ve led the Iowa Harm Reduction Coalition — an Iowa nonprofit that advocates for the health, rights, and dignity of people who use drugs — as well as those whose lives are impacted by substance use and drug policy.

As an organization engaged in policy, training and direct service, we logged nearly 48,000 clients served throughout the state in 2019. Although we are a young organization, we have been through a lot. Last year we lost one of our staff members, Andy, to an overdose. Andy was a foundational part of the Iowa Harm Reduction Coalition, a brilliant and disruptive thinker with the sort of “mad scientist” approach to public health that is somewhat of an archetype in the harm reduction community.

Between the overdose deaths of our clients, the funding anxieties, the growing pains of a young organization and long hours, we were already tired when the pandemic started.

As the case numbers began to swell, I listened to the voices around me saying that this was the time to fight — to step up, band together and look out for one another. I couldn’t help but think that it felt like being kicked when you’re down. Something else? Another crisis?

It turns out that harm reductionists know something about crisis.

As our communities entered a state of disruption and fear, part of me wanted to offer a greeting to each and every person suddenly launched into the chaos: Welcome. Nice of you to join us here. I heard this sentiment echoed by many of the coalition’s clients and participants.

Vanessa, a longtime outreach volunteer, told me, “Honestly, I know people are dying, but I just can’t care so much about this whole COVID thing … I’ve got enough stress and problems as it is, c’mon!”

She is right. Many of the individuals who frequent our drop-in center in Cedar Rapids are without a place to sleep and are in the middle of a somewhat chaotic relationship with heroin and/or meth. Over 75% have been incarcerated in the past year, and only 35% have an income above $1,000 per month. Some are in poor health, and all are well acquainted with death and loss.

But a familiarity with stress is sometimes accompanied by a knowledge of how to survive.

As an organization that engages with both social systems and individual people, we envisioned an organizational response to COVID-19 that could operate at multiple levels. Mirroring the structure of our existing programming, we sought to help keep Iowans who use drugs safe and healthy; provide other service providers and organizations with information and knowledge regarding the impacts of COVID-19 on their clients who use drugs; and envision the regulatory and legal changes necessary to address any harms or injustice experienced by people who use drugs in the moment.

As the crisis has unfolded and our response has progressed, we have documented our responses at multiple scales in a tool kit that we recently debuted on our website. We’ve presented our response in the form of a timeline, tracking the progressive ways the pandemic has impacted people who use drugs in Iowa. The timeline kicks off with resources for primary prevention of COVID and information for people who use drugs regarding their unique vulnerabilities for exposure to the coronavirus.

As the timeline moves closer toward the present, we document global shifts in drug markets that have led to disruptions in the drug trade at the local and regional levels. Meth, normally Iowa’s most popular illicit substance (following marijuana), has become nearly impossible to locate in most parts of the state, with costs having increased significantly. When meth is located, its composition is altered such that longtime users report unusual and unpleasant experiences, and people whisper that it could even be “krokodile.” Cocaine and crack, uncommonly used in Iowa due to their high cost and sparser availability, have instead supplanted meth’s place in part of the state, offering stimulant users a cheaper alternative, but one that can come with new risks to health.

The timeline also documents our current policy work, compiling resources from virtual events and original research.

In reflecting on the past weeks, we can say with some confidence that many Americans would not have lost their lives — or experienced immense suffering as a result of the pandemic’s downstream consequences — in a world that had been designed in a much different way.

Many of the damages of the pandemic and its secondary effects result from the choices made in linking health care access to employment status and overcrowding our prisons and jails, thus turning them into literal petri dishes.

In this moment, we are working to facilitate conversations examining the necessity of both jails and the laws that fill them, which are reflected in a series of resources that stem from a webinar hosted by the Iowa Harm Reduction Coalition with jail administrators, sheriffs and prosecutors from around the state.

Forthcoming highlights include an investigation of the variation in COVID prevention strategy across Iowa’s 99 county jails. Separately, an upcoming feature focuses on the changes in telehealth access for medications used in the treatment of opioid use disorder and explores the steps that federal and state agencies must take in order to ensure the continuation of telehealth MAT access.

The pandemic has altered the basic mechanics of the way we do our work and the services we offer that support our community. Yet, it has also demonstrated the grit and resilience of harm reductionists and people who use drugs: we continue to offer services on a daily basis — not closing for a single day — while our participants survive in spite of social and economic upheaval.

You can access the collection of resources presented in the Iowa Harm Reduction Coalition’s COVID-19 tool kit at