Sue Purchase: Guerrilla Public Health Provider

Sue Purchase started smoking cigarettes at age 12. Before the end of seventh grade, she was smoking marijuana. She tried LSD in eighth grade. By 16, she was snorting cocaine.

Mind-altering substances offered an escape for Purchase, who grew up in the 1960s and 70s in a Cloquet household that was filled with domestic violence. “To say it was traumatic is to put it mildly,” she says. “My story gets at many people’s stories. It is a traumatic childhood that leads to drug use.”

Purchase married young. Her husband introduced her to intravenous drug use in the mid-1980s. The domestic violence and drug use continued in her marriage.

Eventually she left, determined her children would have a better future. She stopped injecting drugs. But she was never comfortable with the abstinence-only model of drug treatment, with its religious base and all-or-nothing framework.

She went back to college, where she learned about the relationship between trauma and drug use and discovered harm reduction as an alternative. It was a “lifesaving” revelation.

In 1996, Purchase founded a Minneapolis needle exchange program called Women With A Point — the first program of its kind in Minnesota. Since then, she has dedicated herself to harm reduction, working tirelessly on various projects over the years in multiple states.

Compassion and a Sterile Syringe

Harm reduction is a practical approach to providing health care services to people who are actively using drugs, according to Purchase. “It is the idea that public health matters first and foremost before somebody’s drug use,” she explains. “Rather than requiring abstinence mandates for services, harm reduction accepts people exactly where they are.

“Recovery is any positive change — as people choose to define it for themselves.”

Purchase points out that drug users, and mothers in particular, are harshly penalized for their behavior, which makes it difficult to access the services they need. “If you reach out for help, and especially if you are not white, you might lose your children,” she says.

A harm reduction approach starts with compassion, the absence of judgement, and a sterile syringe. “The point is literally the point,” Purchase often says. “It is about building a bridge to services and care. It is a lifeline for people who do not have one.”

The statistics on harm reduction are compelling. People who access syringe services programs are five times more likely to enter a treatment facility.

Harm Reduction in the Northland

Three years ago, Purchase returned to the Duluth area. After learning about the gap in services for people using drugs in Northern Minnesota, she started Harm Reduction Sisters. The nonprofit provides mobile syringe supplies and HIV testing, as well as opioid overdose education and naloxone — a fast-acting drug used to treat opioid overdoses.

Because the U.S. government has a syringe exchange ban, no federal dollars can be used for the basic supplies Harm Reduction Sisters needs to do this work. But Purchase is resourceful and was able to secure foundation grants of $20,000 to start up in January 2020. That funding was completely spent within three months. “To say [the situation in Northern Minnesota] is dire is an understatement,” she says.

The Covid-19 pandemic exacerbated this public health crisis. People were disconnected from support systems and turned away from in-person crisis services. Overdose deaths in the U.S. rose to over 93,000 in 2020 — up from 70,630 in 2019 — which was the largest amount ever recorded in a 12-month period.

Even as drug use was on the rise, syringe services in Duluth and Superior closed down due to the pandemic. “When there are not enough clean syringes to go around, there is a ripple effect,” Purchase says, noting that that region is facing multiple outbreaks of HIV, syphilis, hepatitis C, and hepatitis A.

While other programs were shuttered, Purchase was constantly distributing syringes — 80,000 a month in Duluth and the surrounding rural areas. She did much of this on her own, delivering supplies in her car north to International Falls, south to Pine City, and just about everywhere in between.

Along with supplies, Purchase provides education about the importance of sterile syringes for disease prevention. Service recipients have the chance to talk about their situation, but she does not pressure them to quit using. The goal is to build rapport so the person has supportive services in place if they decide to change their behavior.

Purchase views Harm Reduction Sisters as a feminist response to the opioid crisis. Services are nonexclusive, but Purchase tries to cater to women and people of color because they often have additional barriers and traumas. According to the Minnesota Department of Health, American Indians are seven times as likely to die from an overdose as whites in Minnesota. African Americans are twice as likely to die from an overdose as whites.

She adds that home delivery is particularly helpful to connect with women who have children, or pregnant women who face severe consequences for drug use. She is currently working to secure funding to expand intervention work, case management, and HIV testing.

“If one person did not stigmatize somebody else, that would go a long way,” says Purchase. “People are dying. There are women I work with who have lost multiple children. And it is preventable. Pull your head out of the sand. Pay attention. Watch your judgement. There is so much people can do.”

Action = Change

• Learn more about harm reduction, harmreductionsisters.org
• Know how to spot an overdose, tinyurl.com/RecognizeOverdose
• Make a tax-deductible donation to help pay for syringes, harmreductionsisters.org/donate-1
• Contact your representatives. Tell them to allocate funding for harm reduction services to address the opioid epidemic.