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Marlie Thompson, 19, remembers when someone on her campus found what they believed to be fentanyl in their cocaine. The person posted this news on the app YikYak with a word of caution — that on college campuses, students should "be careful out there." Thompson is the founder of the University of Alabama’s chapter of Students for Sensible Drug Policy (SSDP), which works to educate students on campus about substance use and how to minimize risk. Her chapter of SSDP has distributed hundreds of fentanyl test strips. Thompson is one of many young people throughout the South and Appalachia involved in harm-reduction work, identifying an urgent need in their communities and showing up to do something about it.
Beau Morgan, the founder of East Tennessee Harm Reduction, noted that young people show a distinct level of passion that matters to the work. “[There’s] a level of commitment and almost militarism that [youth] have about these ideals and the ways that they want their communities to be safe,” they said.
According to the Appalachian Regional Commission, substance abuse disproportionately impacts Appalachia. Rates of overdoses for people ages 25 to 54, as of 2020, were about 61% higher than in the rest of the country. And there were 2,250 overdose deaths in Kentucky in 2021, about a 14.5% increase from the previous year. In the South, the Centers for Disease Control and Prevention found that Tennessee had a death rate of 57 people per 100,000 from drug overdoses in 2021, with Louisiana at 56 per 100,000. In comparison, California had a death rate of 27 per 100,000. Young folks in these regions are watching as their communities are hit with some of the highest overdose rates in the nation.
Both the South and Appalachia face “different structural inequities [that] force people into somewhat unideal circumstances,” Mariah Francis, a harm-reduction resource associate with the National Harm Reduction Coalition, told Teen Vogue. Increasingly, Southern and Appalachian states have begun to adopt harm reduction as a public health strategy. Differing from strategies like criminalization that seek to curtail drug use, harm reduction is a social movement built upon the principles of justice and human rights. Harm reduction recognizes that some people will continue to use drugs and that the most important thing is to minimize the social, health, and legal harm.
Growing up in a small town in rural Kentucky taught me a lot of things: how to climb a tree, how to tend a garden, and how to drive on rain-slicked back roads. But it also taught me the necessity of harm-reduction work before I even knew what it was called. I remember asking my mom about loved ones we never saw and feeling confused by her vague responses. As I got older, I learned that people we knew had used drugs or had substance use disorder. According to the National Center for Drug Abuse Statistics, drug use is highest for people ages 18 to 25 at 39%, and drug use in adolescents rose throughout the pandemic. Young people like myself have a keen sense of what’s going on, so educating about these issues and organizing really matter.
Throughout the South and Appalachia, on campuses and off, students are working in harm reduction. “I think there's a desire for them to be visible,” Francis said. “And to have a stake in the decisions that are being made about them.” They pointed to ideas of youth agency: Young people should have the resources and information they need about drugs in order to make decisions. “Some people use drugs, that’s inevitable,” Francis added, but “people want to be more informed about their choices.”
For Jasmine Benton, a contractor with the Fulton County Health Department, who is working on their newly launched Drug User Health Program, harm reduction is about education, especially for young people. Benton worked with the Georgia Harm Reduction Coalition on an initiative called the Youth Impact Project, aimed at creating spaces for young people to have honest conversations about what drug abuse looks like, how to safely interact with drugs, and how to avoid dangerous situations. “When you say, ‘No, you shouldn't smoke marijuana’ to some children, that's why he's gonna smoke marijuana,” Benton said. “But if you have the approach of, ‘If you're going to smoke marijuana, this is what it looks like,’ then you're informing and educating instead of just saying, No, we shouldn't do this.” The program doesn’t focus on prevention but instead focuses on minimizing potential harm.
Jeremy Sharp, outreach director of SSDP, works with young people across the country to build chapters of the organization on college campuses. The chapters have the agency to focus on issues that face their communities. Some groups focus on preventing drink spiking at college parties, while others work with local health departments to distribute safe-use supplies, like sterile injection equipment and testing items. “[There are] about 50 out of our 100 chapters currently shipping Narcan or doing fentanyl testing-strip distribution,” he told Teen Vogue.
Lauren Miller, a member of GHRC’s youth advisory board, pointed out that young people’s relationship with social media can play a unique role. While social media can promote harm, Miller said, “a lot of harm-reduction work is able to be shared over social media like Tik Tok and Instagram.” It helps reduce the stigma, Miller added, because you see all kinds of people sharing harm-reduction strategies online. It makes the work accessible and approachable for young people.
Young people also take part in harm-reduction work because of the social justice principles connected to it. Darla Bonagura, a member of East Tennessee Harm Reduction, noted that the work is intersectional. “The liberation of our houseless neighbors is the liberation of the working class, which is the liberation of BIPOC and LGBTQ+ folks, and more,” Bonagura shared with Teen Vogue via text. “I know these freedoms matter to young people because they are at the forefront of many of these causes,” she added. The fight for harm reduction is something that youth engage with because it intersects with so many other issues young people care about.
It's important to note that there’s been an increase in harm-reduction strategies, whether through policy or organizing in the South. Through critical conversation and distributing resources, the work young people are doing is ongoing.
A 2022 article published in the journal Substance Abuse Treatment, Prevention, and Policy explains that drug education initiatives for youth often don’t generate student interest because ‘“they weren’t developmentally appropriate” or because the activities “did not relate to their actual lives.” Effective youth-centered harm reduction, on the other hand, is often based on their lived experiences and understanding, so it speaks to them in a way abstract programming doesn’t. Thompson is hopeful that her generation will change things going forward and correct what previous generations got wrong when it comes to youth and drugs. “We are at the beginning of a journey and the people who have made these policies are at the end of theirs,” Thompson said. “So, if we want to make a real change, we have to start now.”
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