Black representation and harm reduction are key for a nonprofit helping Skid Row drug users

This is the second story in a solutions-reported series that explores the efficacy of new approaches to addiction recovery programs, especially for Black women, from the perspective of local healthcare providers and former clients. (Read the first story here.)

Black women have lost nearly 750,000 years of life to opioids since 2015, according to a recent study. Health care providers and local treatment centers have shifted toward individual-centered treatment tailored to a person’s specific goals and circumstances as opposed to traditional one-size-fits-all substance abuse recovery. This approach helps tackle barriers to treatment like systemic racism in health care and cultural stigmas. 

The Sidewalk Project (TSP) is a nonprofit that helps those struggling with addiction, sex workers and the unhoused on Los Angeles’s Skid Row. Nearly 70,000 people in Los Angeles County and nearly 42,000 people in the city of L.A. — 33% Black — are unhoused, according to the 2022 count. 

Jen Elizabeth, TSP’s certified trauma counselor and director of street engagement and services, said the criminalization of opioids, especially in marginalized communities, is what created much of the secrecy around using that leads to overdose deaths. For this reason, she said, TSP adheres to a harm reduction philosophy.  

Hannah Naefke, an EMT with the Department of Health Services who joined TSP a year ago after assisting with their COVID response team, said, “I think so often, institutions are coming from a place of, ‘OK, you’re coming to me because you need help. So we’re going to help you with our pre-written structure of how we help people.’” Naefke said that part of what drew her to volunteering with TSP is their come-as-you-are mindset. 

According to Naefke, it’s rare for a client to be able to tell a provider, ‘I know I’m an addict. But, I know what I need. Can you work with me to achieve what I need?’ “There’s no organization that does that. I work in an ER [where people think] that folks need to get fixed, to be abstinent, need to quit,” continued Hannah, “Very few work with people while they’re using, with the understanding that healing will naturally come when people are safe, and feel safe to [heal] and feel safe to move to the next step.” She noted that the next step may not be complete sobriety.

Many clients seek out TSP’s open doors advertising “Narcan Here” because of that openness. TSP provides supplies including sterile needles, tourniquets, cotton swabs and Narcan, an emergency treatment for an opioid overdose.

There’s endless care for the clients we serve, regardless of their circumstances, said Naefke.

“You can f–k up and come back and still be cared for…You don’t need a ticket to arrive.”

Being seen—in every sense—by health care providers

Nafaeke said she was not only drawn to the organization because of their view on harm reduction services but also for the opportunity to make a difference for Black women like herself. “I do feel like [giving back, whether money or time] is the essence of Black leadership. And, that is the essence of rebuilding Black communities, to continue to show up…I notice [problems] all the time, but I’m also doing shit about it.”

Isaiah, a Black trans sex worker and TSP participant (who asked that his last name not be used), said seeing himself represented in the people caring for him helps him rise above his circumstances. 

“There needs to be more Black leaders who can be responsible for growth and change in our communities, who can adapt in African American environments and cultures. You have people who need help navigating their way to the system and through the system,” said Isaiah. 

‘How can I be an asset?’

“What do you need today?,” is not only a question but also a mission statement for TSP staff. 

On a cold and windy day in February, clients relaxed on couches draped in colorful fabrics and plush pillows. They used the restrooms, which can be hard to come by on Skid Row, and gathered free food and clothes. One woman sat writing poetry while another woman — clean for two years from an addiction to methamphetamines — sat at a large round table writing a book about her life. It’s something she said she couldn’t think about before she moved into permanent housing several weeks prior. Resident chef for TSP, Tatiana Tical, made pizza and tofu chicken noodle soup in the community kitchen. She served it to anyone who walks in the door, steaming in cardboard to-go cups. TSP is open for people to come as they are and get what they need, which is often more than just shelter from the inclement weather.

“There’s a difference between living and just not dying,” said trauma counselor Elizabeth. “You can’t really have medical care without mental health care. You just can’t because it’s just keeping people barely alive. Survival is not really living, it’s just not dying, right?” 

Local artists come to paint, write, sing and form drum circles with clients, on the street and inside TSP’s center. It’s a way to integrate mental and emotional care as part of a holistic approach.

Crushow Herring, a Skid Row artist who has worked with TSP for 20 years, said TSP “has a real understanding about the condition of the culture that they’re dealing with.” Approaching clients with “open arms” and a “‘How can I be an asset?’ open mind” he said, as opposed to ‘I know what you need to do,’ makes all the difference. For Herring, being an asset means treating each client like a work of art.  

With each mural, Herring said he considers the surface he’s painting on, the day’s wind conditions. He compares his process to working with TSP’s clients: “It’s not a controlled setting. And, it’s not the same situation every time.”  

“[But,] if we are approaching every situation as an art project,” said Herring, “there’s no wrong way that it can come out.”