Five mornings a week, two white vans pull up to the curb outside the soup kitchen in downtown York.
Their trunks are full of donated clothes, toiletries, and paper bags of clean syringes and tourniquets. For the rest of the day, the women of the York Harm Reduction Project will wait for people to walk cautiously up and ask for "works," the street term for a clean syringe.
Sometimes clients will spend days walking past the vans before finally admitting they need a syringe. The women in the vans are patient. Their lives all have been touched by heroin addiction. They know that their job is as much about withholding judgment as it is preventing disease with clean needles.
It's an attitude that officials and advocates in York County have embraced as overdoses rise in this rural county on the Maryland border. Even as its District Attorney's Office has gone after drug dealers with an unusual charge known as "drug delivery resulting in death," the county has also instituted harm-reduction measures more common to larger, more progressive communities.
Needle exchanges, where people can turn in used syringes to get new ones for free, are technically illegal in Pennsylvania, but they operate at brick-and-mortar locations in Philadelphia and Pittsburgh with the permission of city officials. Controversial even in liberal bastions like Philadelphia, they're a harder sell in more conservative environs like York. But officials in York, cognizant of their role in preventing blood-borne illnesses, have allowed the mobile exchange to operate quietly for more than a year.
Coroner Pam Gay, a former emergency-room nurse, was suspicious of the idea when advocates from Lancaster reached out to her in 2014. A conversation with Philadelphia's medical examiner, Sam Gulino, changed her mind, she said. "He told me to research it for myself," she said. "And everything I was reading was showing positives. He opened my eyes." When the exchange launched in 2017, she wrote a newspaper column praising it and spent days responding to angry comments on Facebook.
"I was able to change some minds," she said. "And it was just the right thing to do. I didn't care if I didn't get reelected."
District Attorney David Sunday launched a heroin task force with Gay when he was a chief prosecutor in 2014, and worked to persuade the 23 local police departments in York to start carrying the overdose-reversing spray naloxone. They held community meetings around the county that were swamped with people whose loved ones were struggling with addiction or who had died from it, and others for whom the crisis had not hit home.
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"When this first started, there was this mind-set of 'These are addicts, let them die,' " Sunday said. "But our goal was to destigmatize this issue."
York's harm reductionists say that stigma is lifting — somewhat. On a warm day last month, Renee Zimmerman, in a bright orange shirt that read "York Harm Reduction Project," drove her white van through the streets on the city's west end. She had a needle delivery to make to a woman named Beth, who had been hiding her addiction from her boyfriend for months, and feared going to the vans openly.
Zimmerman's son spent years homeless and addicted to heroin in Baltimore, and she knows what can happen without clean needles: Her son lost part of a bicep to an infected abscess. He has been off heroin for two months now. Her experience with his addiction inspired her.
"People in addiction, deep in addiction, need someone to guide them through," she said. "And I just felt in my heart that I could do that. I'll never do anything else."