A group of Houston-based activists is enlisting bartenders in the fight against the overdose crisis with a new educational program intended to teach service industry professionals how to spot — and help — someone who is experiencing an overdose.
The informal collective of activists, who go by the name Harm Redux HTX on Instagram, makes use of a practice known as harm reduction, which seeks to mitigate the adverse consequences of drug use. “It’s the principal belief that all life is precious,” says Flores, an organizer with the group. (Editor’s note: Both organizers interviewed for this story asked that their full names not be published, due to laws in Texas that can sometimes be used against people who engage in harm reduction practices.)
“It’s a desire to reduce the stigma around drug use as well,” says Flores, who adds that people who use drugs are often viewed in the context of their value to capitalism, which causes people to be denied social support like housing, insurance, counseling, and more.
“[The view is] if this person is going to be unreliable, or a liability to my ability to profit off of them, then they’re not worthy of services from the state. And so that’s why you see so many people slipping through the cracks,” Flores continues. “When a moral standard is implemented or exercised on folks who use [drugs], then it gives the state grounds to deny caring for them. Like, now it’s okay to dehumanize them, it is alright for them be houseless and be underserved by the community.”
The group’s work is a response to the country’s decade-long overdose crisis initiated by both widespread prescription of synthetic opioid pain relievers like fentanyl, and aggressive marketing of the drugs as “nonaddictive” by manufacturers like Purdue Pharma. The COVID-19 pandemic only made things worse. Multiple studies indicate that a wide range of intersecting factors, like increased economic insecurity and social isolation, exacerbated opioid use. Opioid use can also affect respiratory and pulmonary health, which may make those with opioid use disorders more susceptible to COVID-19, according to the U.S. Department of Health and Human Services.
Texas is among the states hit hardest by these overlapping crises. According to the Commonwealth Fund, a private foundation that supports independent research on health care issues, overdose deaths in the state increased by more than 35 percent during the first eight months of 2020.
Prior to the pandemic, volunteers with Harm Redux HTX were popping into bars across the city, sharing flyers and information on how to spot an overdose with bar employees and patrons. They shared knowledge on the use of Narcan, a drug that helps to reverse the effects of an overdose. But with the overdose crisis worsening in Texas, the volunteers decided to develop a more formal program to bring that training to bartenders and other service industry workers.
The group believes that this information is essential knowledge for bartenders, like knowing how many ounces are in a double pour and when to cut off a drinker who’s consumed too much alcohol. Harm Redux HTX sees the work they’re doing as a complement to the education that bartenders undertake when they receive a Texas Alcoholic Beverage Commission license from the state.
“This is really just an extension of that,” Flores says. “When you’re drinking, you are typically more inclined to use other substances. And so with that concentration of issues that occur at bars and venues, it just makes sense that bartenders are already used to having to learn that knowledge through TABC.”
Rosey, another organizer with the group, notes that bars and clubs are hotspots for other substance use, and that bartenders have a unique relationship with their customers that can make spotting an overdose or unusual behavior easier. “Who’s sober at the bar?” Rosey says. “Who is seeing these customers come up and get drinks?”
Part of Harm Redux HTX’s outreach program includes providing bar staff with training on how to acquire and administer Narcan, or naloxone, a prescription drug that can be used to reverse the effects of an overdose. The drug can be administered through an injection or inhaled, and is nonaddictive. However, the concept of harm reduction is an equally important aspect of the program.
“It’s not just give the person Narcan and they’ll be fine,” Flores says. “There are steps that one should follow if you aren’t a medical practitioner.” Those steps including making sure the person has taken the full dose, staying with them to provide support while the Narcan kicks in, and deescalating the situation safely without having to call the police.
“Other harm reduction trainings have different practices, like calling 911 immediately,” Rosey says. “But we understand the police violence that often occurs after calling 911.” As such, the group encourages bartenders to make sure that any drug paraphernalia is removed from view before calling for emergency help.
It isn’t a perfect system, Rosey admits. “There’s no set way, or exact set of rules, to make sure that no harm happens,” they say. “It’s kind of a sticky situation, so we have to figure out how to navigate it safely. We’re trying to remove all possible harm that we can, which involves the law, unfortunately. We have to make sure that everybody involved is safe.”
The group is just getting started, but Harm Redux HTX has already had a few bars and employees express interest in the training, including Austin music venues Empire Control Room and the Parish. But they also face roadblocks to spreading the word about the program to other Texas cities, including what they believe is an Instagram shadowban that has prevented the collective from sharing its resources with some of the workers who might need it most.
In addition, Texas has laws that can be used against people who practice harm reduction. Those laws include things like Houston’s homeless feeding ban, and laws that target clean needle exchanges. (Rosey notes that, in Texas, someone caught with a stash of clean needles intended for a needle exchange could be charged with one felony per individual needle under the state’s drug paraphernalia laws.)
Still, the group believes the benefits of this training outweigh the risks for bar staff, especially since, in Texas and many other states, bartenders can be held legally liable for the behaviors of intoxicated patrons.
Despite these challenges, Harm Redux HTX is moving forward. The group is currently connecting with bartenders and bar owners all over the state, especially in Houston, trying to get its harm reduction strategies in front of as many eyeballs as possible.
Bar owners and service industry workers who are interested in participating in Harm Redux HTX’s training program can email the group at firstname.lastname@example.org.