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HARM REDUCTION: ACTION OVER IDEOLOGY Story and Photos by Giles Clasen Ruth Kanatser is called the unsung hero of the Harm Reduction Action Center community. RUTH KANATSER’S MORNING ROUTINE began well before dawn. Kanatser and her husband climbed out of their car at 3:30 most mornings, racing to the methadone clinic, then to the day labor dispatch before the best jobs were gone. Some days included 14 hours of hard labor before they searched for a safe place to park, get a few hours of sleep, then start all over. That was Denver for those experiencing homelessness in the early 2000s. Most days, Kanatser and her husband made just enough money to survive, never enough to get ahead. Complicating their efforts was a nagging need for heroin. During those years, Kanatser depended on methadone to overcome withdrawal symptoms from heroin. Both the drug and the solution felt like a trap. TRYING TO STAY OUT OF WITHDRAWAL “When you’re using, you’re very quickly no longer getting high,” Kanatser said. “You start using just to avoid getting sick from withdrawal. The street-level heroin user, the person really struggling on a day-to-day basis, is just trying to stay out of withdrawal, to stay out of the hospital. Methadone can help, but it brings its own problems.” Kanatser said that relying on methadone to overcome addiction was expensive and came with so many restrictions that working and earning her way out of homelessness was difficult. “It’s not that it doesn’t help, it does, but the system under which it is administered is so overly parental, and just very gross,” Kanatser said. “When you take methadone, the clinic is in your life, you have no privacy, and they set the rules on when you come, when you go. It can be restrictive in a way that makes regular day-to-day life, like work and family, nearly impossible.” On a good day, Kanatser and her husband would walk away from their temporary jobs with $80 between them. Keeping the methadone prescription current also cost money, a lot of money. And it had to be paid before anything else, because it was the only thing that guaranteed they could work the next day. They also set aside $35 each day for a dirty hotel on Colfax. If they had any money remaining, they bought food. Frequently, they went without. “It was stressful all the time,” Kanatser said. “You never felt safe. Ever. Never ever.” For nearly four years, they turned to hotel rooms when they could scrape together enough. They slept in their car when they couldn’t. A proper apartment would have cost significantly less than hotels each month, but getting into one required a payment up front for first and last month’s rent plus a security deposit. It was a threshold that kept moving just out of reach. “We would always save up, get close to having a deposit, then something would go wrong, an emergency, and we were back to square one,” Kanatser said. “It was ridiculous, no matter how hard we worked or how hard we tried, we couldn’t move forward for years.” Having a car helped. It meant they could drive other day laborers to work sites for a few extra dollars, and get to the casino jobs up in the mountains, which paid better than anything in the city. But living in an old car without money to maintain it is like counting on a time bomb that could undo all of their hard work. When the cable connecting the gas pedal to the engine snapped one night, stranding them miles from a safe place to sleep, they walked to buy the part and fixed it themselves in the dark with flashlights. “My poor husband was on the ground underneath, and I’m in the car upside down in the dark with flashlights trying to thread this thing through,” she said. “I think we were there for I don’t know how many hours. Just desperate. But we didn’t have any other option. We didn’t have the money to get the car repaired, and it was our home. We had no choice. That was desperation.” NOT A LOT OF MONEY, BUT EVERYTHING What finally broke the cycle wasn’t discipline or determination alone. Her husband’s parents gave them the cash to secure an apartment. “It was $436. I remember that to this day,” she said. “It’s not a lot of money. But it was everything.” Most people, she said, never find their $436 and never overcome homelessness or addiction, often dying on the street. Today, Kanatser is the assistant director of the Harm Reduction Action Center (HRAC), a Denver-based organization that provides clean syringes, naloxone, fentanyl test strips, safer use supplies, and a range of support services to people who use drugs. Most importantly, HRAC offers the services without judgment. Kanatser said getting her first job with what would become the Harm Reduction Action Center was a matter of timing, exposure, and luck. Before she ever applied, she had encountered early harm reduction work through Urban Links and Denver Health’s REACH program. Those programs were the first places, she said, where anyone in healthcare saw past her substance use and treated her as if her life mattered. “It was also the first place where anybody treated me like a human being,” she said. “Anybody said anything I had to say was valuable whatsoever, and that was mind-blowing.” When a part-time outreach position opened at HRAC years ago, Kanatser nearly did not apply. She was unemployed, depressed, and convinced that more qualified people would get the job. “I almost didn’t even interview for it,” she said. Kanatser’s mother pushed her to go to practice interviewing, if nothing else. She got the job, starting with 20 hours a week doing street outreach, and has been a fixture in Denver ever since. PROVIDING SERVICE WITHOUT JUDGEMENT The Harm Reduction Action Center emphasizes substance use awareness, focusing on fact-based education, safety, and dignity. HRAC does not require individuals to pursue sobriety. Instead, the organization focuses on safety, and if a person wants to find treatment, the organization helps. Since 2002, the Denver nonprofit has provided syringe access, naloxone, health education, and a consistent point of contact for people navigating drug use, homelessness, and an increasingly toxic drug supply. For nearly 25 years, Kanatser has been sharing the organization’s philosophy, rooted in reducing the negative consequences of drug use rather than insisting that a person stop using before they deserve care, support, or safety. Lisa Raville, the center’s executive director, said harm reduction is both practical and familiar, even if the term remains politically charged. “We use harm reduction in everything we do every day. Seat 8 COMMUNITY FEATURE

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