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
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
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