belts, designated drivers … if you go out on a boat, you wear a life preserver. Hopefully you’re not in an accident, hopefully the boat doesn’t capsize, but if it does, you have that life preserver, that seat belt to offset the risk. That’s all harm reduction,” Raville said. “Life is inherently risky. What I like about harm reduction is it’s a true action item you can do today.” According to Raville, syringe access programs allow people to properly dispose of used syringes and obtain sterile ones, reducing transmission of HIV and hepatitis C. HRAC also hands out safer use kits that help reduce some of the most serious dangers associated with drug use by providing sterile supplies, overdose reversal medication, and basic health items that can prevent infection, disease transmission, and death. BEYOND INDIVIDUAL HEALTH In 2012, HRAC began safe needle distribution and disposal. At the time, the Colorado Department of Public Health and Environment reported that Denver County counted 533 active hepatitis C cases in state surveillance data. By 2022, the county recorded 281 new chronic hepatitis C diagnoses. The categories changed over time, so the comparison is not exact. Still, the overall picture is clear. Denver’s hepatitis C burden is lower now than it was when HRAC’s syringe access work began. The organization also works to put naloxone in the hands of those most likely to witness an overdose. Narcan, the brand name for naloxone, is a medication that temporarily reverses an opioid overdose. “People who use drugs are the true first responders in this overdose crisis; they need access to naloxone first and foremost,” Raville said. Raville argued that harm reduction’s importance extends beyond individual health. She said it also improves public safety and responds to a crisis that punishment has failed to solve. “We get more referrals to our program from the Denver Police Department than we do from all of the hospitals combined. Police participation shows harm reduction increases public safety right here in our community,” Raville said. Kanatser said that the relatively low cost of harm reduction saves Denver millions in public health costs. According to Kanatser, the need has only become more urgent as overdose deaths continue to hit Denver’s unhoused community. Elected officials have, in her view, swung the pendulum back toward criminalization and incarceration. “Nobody will talk to anybody about drugs, what works, what keeps people alive. They will never tell the truth about it. Politicians like to focus on ‘Just say no.’ They like to blame the individual. Arrests look like action. But arrests make substance use more dangerous and more difficult to overcome,” Kanatser said. She said that if a person is afraid of an arrest, they are less likely to call for help or ask for help. It drives substance use underground. Raville said the Harm Reduction Action Center is often criticized for not pushing people into treatment, but she argues that criticism ignores both the limits of the treatment system and the realities people face while living outside. She said HRAC does not oppose recovery, but rejects the idea that treatment should be forced or treated as the only valid response to drug use. “If you’re such a big treatment fan, nobody’s stopping you from trying to get people into treatment. But not everybody is ready for treatment or can afford treatment,” Ravile said. “We’re doing something positive, healthier, and safer today.” Raville said treatment is often difficult to access and very expensive. Many programs also fail to help individuals seeking help because they do not use an evidence-based approach. “If you believe the end goal is drug treatment, you have to start with harm reduction. We keep people alive. You can’t seek treatment if you’re dead,” Raville said. FACING LAYERED THREATS According to Raville, pushing people into treatment without housing or support afterward can set them up for relapse and greater danger. Many people face a heightened risk of overdose after treatment because their tolerance has dropped and their bodies are no longer accustomed to the substances they previously used. Dr. Sarah Axelrath, a primary care and addiction medicine physician with the Colorado Coalition for the Homeless, said the realities often push individuals to rely on substance use to cope with trauma. Treating addiction without addressing housing and other basic needs sets individuals up for failure. Through Stout Street Health Center’s clinics and street medicine teams, Axelrath cares for people living outdoors across Denver. She said the threats they face are layered, physical, medical, and social, and that those pressures often compound one another. Trauma can deepen the instability of homelessness, she said, while fear and exhaustion can also shape the way people use drugs. “Substance use as a cause of homelessness is not even in the top three,” she said. “The top causes are housing instability, unaffordability, and unemployment.” Once people become homeless, Axelrath said, substance use can become a response to the conditions of survival outside. “Many people who are homeless did not use meth before they became homeless,” Axelrath said. “They end up using meth during homelessness because they are trying to stay awake at night so they can be safe and not feel so vulnerable.” That kind of survival strategy, she said, can become a punishing cycle. “There’s nowhere safe for them to sleep during the day,” she said. “So sometimes they use opiates to come down and try to get a little sleep. If they can’t, they use more meth to stay awake, and they get trapped in this cycle of profound sleep deprivation and escalating substance use.” THE UNSUNG HERO Axelrath said she admires the dedication Kanatser has shown to the unhoused community and those who use substances. “It takes a special person to do what Ruth has done for so many people, for such a long time,” Axelrath said. Raville said the center’s work is especially critical for people living outside, where lack of sleep, constant displacement, and daily crises can intensify drug use and overdose risk. In that environment, she said, the organization offers more than supplies. It offers consistency. “Harm reduction’s here, we’ve always been here, we’ll always be here, we’ve ebbed and flowed for years on people loving us and hating us, but the only constant has been we’ve been here, and we’re a home for thousands, keeping people alive.” Inside that work, Ravile said, Kanatser has become inseparable from the organization itself. “Ruth is the harm reduction action center. We all work for Ruth, Babe,” Raville said. Raville said Kanatser’s ability to connect and care for individuals is what makes her uniquely successful. “Ruth definitely understands drug use, she understands health education, she understands the systems in which we work. She is able to engage with the methadone clinics, the jails, the legal system, so she’s been such a great advocate for people for so many years. Ruth is the unsung hero. She doesn’t do much outside of here because she’s so busy inside of here.” Liz, who has experienced homelessness in Denver on and off for 20 years, considers Knatser a steady and nurturing presence in a system that often feels chaotic and impersonal. “Ruth, she’s like our mom, or like Wendy from Peter Pan,” Liz said. “She is always there with the Lost Boys, making sure they’re safe no matter the challenge.” Liz described Kanatser as someone who takes care of people while still meeting them as equals. But more importantly, Kanatser is consistent in her care for those who need help. Liz said Kanatser did more than offer kindness. She said that Kanatser helped her find safer ways to survive when she was using. Kanatser was also instrumental in persuading Liz to seek treatment for hepatitis C. “There were lots of reasons I avoided treatment, but maybe more than any, I didn’t feel like I deserved help,” Liz said. “Ruth called bullshit on that.” After Liz missed doses during treatment, Kanatser pushed Liz to continue and get healthy. “It was all her, man,” Liz said. “She pep-talked me back up, and like, she’s like, ‘We’re gonna keep moving forward, it’s going to work, it’s going to work.’ And it worked. I am still free from hep C.” Even when Kanatser challenged her, Liz said she never doubted her care. “She always tells me how it is,” Liz said. “But never has she ever made me feel like I’m not loved.” $436: ENOUGH TO BRIDGE THE GAP Kanatser knows how thin the line can be between survival and catastrophe because she once lived there herself. She has described heroin as “a tool for survival” during a difficult period of her life. She remembers sleeping in cars, grinding through day labor, and spending years trapped in motels because she and her husband could never quite save enough to get into an apartment. What changed her life, she said, was not some sudden moral awakening, drug treatment, or bootstraps transformation. It was the gift of $436, enough to finally bridge the gap and get her housed. That memory has never left her. Too many of the people she sees at HRAC, she said, are still waiting on their own version of that chance, still living in the space where one emergency, one arrest, one missed work shift, or one bad batch can end everything. “I feel like what I do is invaluable,” Kanatser said. “And I feel like as long as I can, as long as they’ll let me, that it’s important to protect those who are even more vulnerable, right? Who have even less opportunity than I did.” Voluneers assemble safe use kits for distribution to HRAC’s clients. DENVER VOICE APRIL 2026 9
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