Shilo Murphy, a former homeless person who heads the Seattle-based People’s Harm Reduction Alliance (PHRA), was one of the more than 1,000 people at the Harm Reduction Coalition meeting in Baltimore last week. We talked to him about his work with needle exchanges.

A longtime resident of the Seattle University District, Murphy has worked at the University District needle exchange program for the past 18 years. Co-founder and executive director of the PHRA, he is also national president of the San Francisco–based Urban Survivors Union, which also runs harm reduction programs. He is a self-acclaimed “proud drug user.”

The PHRA was founded by Bob Quinn, who worked in hospice care for HIV patients. He died two years ago, and Murphy, who considers himself Quinn’s son, is now in charge.

One of the largest organizations of its kind in the country, the PHRA gives away almost 4 million syringes a year throughout four counties in Washington state. Murphy, the only paid employee of the PHRA, said the organization uses peer distribution models. “Our real success is keeping it dirt cheap, having no overhead and getting the supplies to people when they need them,” he said.

Drug users are on the board and the staff of the PHRA, said Murphy. “We can’t afford not to include drug users,” he said. “We give everyone 300 syringes” to pass out, he said. In addition, crack pipes are given out, because when people share crack pipes, they can transmit HIV as well. In addition, people burn their lips on crack pipes, making transmission via kissing or sharing pipes increasingly likely.

“You can’t focus on one single behavior” when trying to prevent HIV transmission, said Murphy. “If you only focus on sex, that won’t be helpful,” he said. “You need to deal with the full gamut” of risks, he said..

The PHRA also gives out naloxone to reverse overdoses. “So many people were dying,” said Murphy. The group uses the injectable intramuscular naloxone, as drug users know how to use needles.

No problems with Seattle police

The group has no problems with the police in Seattle, said Murphy. “The most progressive organization in Seattle is the police department,” he said. “We have had only minor conflicts in Olympia.” Murphy describes the group’s relationship with law enforcement this way: “The police want to have drug users be as disease-free as possible, because they may have to put their hands on them,” he said. “They want people to be clean.” The police suggest that drug users take their used needles and syringes to the needle exchange, he said. “The police get it,” he said.

But in some counties in the state, if someone overdoses, witnesses are charged with manslaughter, said Murphy. “Let’s be clear: people still go to jail,” he said. “We are still working toward a better tomorrow.”

While the PHRA peers and volunteers do refer drug users to opioid treatment programs, the group “doesn’t have an agenda,” said Murphy. “Our message has always been, ‘If you’re going to be a drug user, be the best drug user you can be.’”

The treatment field isn’t seen as welcoming by many drug users, Murphy pointed out. “Let’s be honest: the term ‘clean and sober’ applies to someone who has been dirty,” he said. “They still use those terms in the treatment field on a daily basis.” As a result of this stigma, there are people “who have been too ashamed to tell their lover or their parent that they’re drug users, and they have died alone of an overdose,” he said. “Every day I talk to drug users who tell me how worthless they are — it’s because everyone around them tells them they are worthless.”

We asked Murphy what he thinks the chances are that the federal government — Congress and the administration — will make it easier for drug users to engage in harm reduction programs such as needle exchanges. His response was bitter and hopeful at the same time. “Do I think the federal government is going to care about a minority population that is dying in the street? No,” he said. “Do I think they will care about folks who need help? No. I’m trying to be realistic. I hope that they care.” At the Harm Reduction Coalition conference, Murphy planned to “go to panels, speak on panels, talk to old friends, talk to people I meet, and create a larger community,” he said. “With that, we can defeat anything.”