Hundreds of feet from New Orleans City Hall, a six-foot long, collapsible table stands on the grass, alongside a paramedic tent and an impromptu meal station. On Tuesdays around 3 p.m., a rough line starts to form at the table as people begin to trickle into Duncan Plaza.

“Can I get some 28s and some 30 shorts, please?”

As the first participant approaches, a volunteer records their demographics, listing the supplies requested on a half-sheet of paper. A second volunteer gathers them in a plastic bag. 

Available supplies include, but are not limited to, syringes, tourniquets, cookers and other paraphernalia, provided to cut down on sharing within the community. Naloxone and test strips for fentanyl and xylazine — the latest adulterant, a powerful sedative — are also available for overdose prevention. Water, toothbrushes, masks and socks are provided by donors.

An all-volunteer harm reduction collective, Trystereo’s mission is to “affirm the dignity of people who use drugs and to address limited harm reduction resources in our community.” The collective offers overdose prevention and wound care throughout New Orleans. 

Harm reduction involves a public health effort to prevent the spread of HIV, hepatitis C and various other skin and blood borne infections. 

Colin Hines is a collective member who works in overdose prevention, response training and volunteer onboarding. He became involved in 2018 after his close friend, Yasha, passed due to an overdose. “I asked how I could help,” he said. 

Hines said the best way for him to move on was to do something for the community. Having experienced many overdose losses, he said learning to debunk misinformation and handle future situations changed his relationship with grief in a positive way. 

“I remember responding to an overdose in Minneapolis where somebody had dragged their partner into the Mississippi River to have the cold water shock them awake,” Hines said. “I found this person underwater, not breathing, floating down the river. The only thing I knew how to do at the time was CPR, so it was very scary.”

After that, Hines learned how to respond to overdoses the correct way. 

‘What and Who is Acceptable and Why?’

This is the question Ayanna Reyes-Dawson wants to explore in her work as a harm reductionist and documentary photographer, formerly based in New York City.

Sharing her everyday experiences on Instagram, she often receives a mixture of disturbed and intrigued responses. 

“Being in contact with a freshly used crack pipe, handing needles to someone you gave Narcan to a couple of hours ago or dealing with someone’s sores that look really crazy,” said Reyes-Dawson. 

Highlighting commonality, she seeks to bring the stories of her subjects to a greater audience and address stigma. 

“Once it hits you on a personal level –- it may not be a friend, but it can be your favorite rapper you listen to — once that’s kind of shoved in your face, it forces you to rethink [and] reconsider past feelings of drug use,” said Reyes-Dawson. 

In a Day’s Work

Underneath the floodlights of St. Roch Park, a group of volunteers sit on a plastic tarp, in the rough outline of a circle. They meet on the first Wednesday night of each month, coming together in a ritual Trystereo has been performing for over a decade. 

The volunteers complete their delegated tasks, transferring supplies from bulk-sized boxes to separate safe injection kits. The air is filled with conversation as volunteers, new and old, bond over stories of compassion and understanding. 

The monthly kit-packing meetings are a designated space for education and involvement in a community that can often be hard to reach. Luka Bair is a harm reduction consultant and researcher, who spent five years working with Trystereo before taking a national role with the National Harm Reduction Coalition. 

“Harm reduction can feel a bit prickly at times or not as welcoming to folks trying to gain that core understanding,” said Bair. “We’re so focused on making every moment work, so it’s a consistent struggle to remain as open as we can.” 

Bair said they consider the harm reduction community to be the warmest and most loving people they know. 

“Not creating stigma can just be words we use, but to actually see their effects, where this person feels comfortable coming to us when they’re really good and still comfortable enough that we’ll embrace them the same way coming back, those things do feel really beautiful,” Hines said. 

Rising to the Challenge

When Trystereo was founded, the majority of their services were illegal and the collective was largely underground. 

Former Louisiana Chief Medical Officer Joseph Kanter’s first-in-the-state standing prescription for naloxone allowed Trystereo to begin providing open services. Over time, state and national support for harm reduction has largely increased. 

Trystereo maintains a good relationship with City Hall while pushing for more government intervention. According to Hines, the city did not approve a program that proposed to mount and dispose of syringe containers. Therefore, Hines said needle litter is “on the city.” 

To Bair, almost every opioid death is a policy failure.

Trystereo has come a long way since its 2011 beginnings as a 24-hour bicycle delivery service, yet Hines said he half-hopes it can one day transition to a staffed collective. 

“I want it to be better and easier for everybody who does this work and not just have to be picking up the government’s slack for free, on our time,” Hines said. 

Reyes-Dawson said she finds that the amount of volunteer-based harm reduction initiatives in New Orleans greatly exceeds those in New York City, where paid positions are more prevalent. The difference attests to the political climates of the two cities; the NYC government is more willing to fund efforts, according to Reyes-Dawson. 

Simultaneously, Hines said he understands that paid roles may not be ideal, referencing what Reyes-Dawson called “compassion fatigue.” 

“You don’t know if you’ll see someone in your caseload or someone you’ve seen every day ever again,” she said.

Professionalization may be a risk, especially when those who make decisions lack lived experience or personal investment, according to Bair. 

“I do my work because if it doesn’t get done, then more of my friends die,” Bair said. 

Changing Drug Landscape

“We are in the midst of an unexpected disruption,” Bair said. “Prescription amphetamines are heavily interrupted, which has had this cascading effect. There is xylazine mixed in … I’m seeing the worst wounds ever seen in my entire life. To treat them, I have had to go into battlefield medicine and look at injuries caused by IEDs and explosives.” 

Bair compares the current state of drug use to alcohol prohibition, which resulted in an increase of alcohol-related deaths and creation of more dangerous substances. 

“The ‘drug war’ is not based in reality, this idea that they’ll stop drug use by prohibiting drugs. They’ve been trying for 40 years. Drugs are more powerful, more available, cheaper and more dangerous than they were 40 years ago, and that rises every year,” Bair said. 

Bair’s expertise in spatial trends leads them to suggest that xylazine will only be a temporary, yet detrimental, addition to the drug supply. According to Bair, keeping a close monitor on trends within the drug market can maximize harm reduction services.

“I’m just excited to be able to continue to meet everybody’s needs,” said Hines. “It’s the most basic goal but can feel really like a struggle sometimes.”