Founded by lifelong Tennessean Daniel Garrett in 2019, Tennessee Harm Reduction is a peer-based harm reduction organization that reduces opioid overdose fatalities, limits the spread of blood-borne disease (e.g., HIV, hepatitis C) via needle-sharing, and improves the societal and legal treatment of people who use drugs. Garrett, Director of Tennessee Harm Reduction, (currently) single-handedly achieves these goals by volunteering his time to provide several services

Tennessee Harm Reduction achieves these goals by providing several volunteer-based services, carried out almost entirely by Garrett himself, that are listed and described below:

1. Distribute Harm Reduction Supplies and Education to At-Risk Populations in Rural West Tennessee

Daniel Garrett, an active injection drug user, a former online sex worker, and openly bisexual man, is currently the only person in non-Memphis West Tennessee* to actively distribute a full slate of harm reduction supplies at no cost to participants, including:

• Insulin syringes for injection drug use
• Two types of naloxone: Intramuscular naloxone kits and NARCAN® nasal spray
• Rapid fentanyl test strips
• Reusable metal cookers
• Isopropyl alcohol swabs
• Medical-grade tourniquets

*Question: Why do we use the verbiage “non-Memphis West Tennessee? Also, where does West Tennessee stand in terms of harm reduction infrastructure?

Answer: West Tennessee is the most rural Grand Division of Tennessee — the other two are Middle Tennessee and East Tennessee. West Tennessee is unique in that it’s the only Grand Division with just one city that has at least 100,000 local residents Memphis, at a population of 633,104.

Of the Volunteer State’s three Grand Divisions, East Tennessee is the most advanced in terms of harm reduction; for example, it’s got two organizations that run a total of four syringe exchanges (Knoxville, Chattanooga, Johnson City, and Newport). Middle Tennessee comes next — via Nashville, it’s had a syringe exchange for something like two decades, operating underground for much of its lifetime. West Tennessee has two syringe exchanges, although they’re both based in Memphis, and Memphis is in the far southwestern corner of the region. As if having one city wasn’t bad enough, that city isn’t even accessible by most West Tennesseans. Memphis’s largely-exclusionary location and its ultra-low population density are, in my opinion, responsible for its profound lack of HR infrastructure. Out of the three Grand Divisions, West Tennessee finishes dead last in terms of forward-thinking social services support for people who use drugs. Although I wish I had more conclusive data or evidence to back up my claim, trust me when I say it’s true — after all, I am the master of my domain! ;^)

Let’s face it — social services programs have long been drawn to big cities with dense populations. Put simply, it’s just way easier to help more people that way. Such programs aren’t drawn to somewhere like the resident-sparse Grand Division of West Tennessee.

This is

Calculating the Rural Population Density of Each Grand Division
East Tennessee2,470,105Middle Tennessee2,883,086West Tennessee1,557,649
Modified pop.1,944,631Mod. pop.1,874,148Mod. pop.924,545
Area (mi2)13,558Area (mi2)17,009Area (mi2)10,650
Rural pop. density143.43/mi2Rural pop. density110.19/mi2Rural pop. density86.81/mi2
Cities exceeding 100,000 residents in each of the three Grand Divisions
*Note: The Tri-Cities area is composed of Johnson City (71,046), Kingsport (55,442), and Bristol (27,147)

Note: You can see why we mention “non-Memphis West TN” just by looking at a map; also, considering Memphis is the only true city — a.k.a. the largest with nearly a million inhabitants — in all of West TN and that dense urban centers almost always have more harm reduction infrastructure than rural areas,

The History of Our Safe Drug Use Supply Distribution

Daniel has lived in West Tennessee since 2014, when he moved to Martin (north-central Northwest Tennessee) to attend college — and pick up a fun opioid habit just months after arriving. He began using heroin in 2016, sourcing it exclusively from Jackson (dead center of West Tennessee; Jackson is the region’s second-most-populated city with 68,205 residents). Near-daily trips to Jackson, a regional center of homelessness, drug use, and sex work, gave Daniel a chance to freely distribute harm reduction supplies, an opportunity that wasn’t present anywhere else in rural West Tennessee.

Note: Rural West Tennessee has five Regional Overdose Prevention Specialists, who have full-time jobs (a minority of the state’s 22 ROPS are employed part-time) educating Tennesseans about opioid overdose, preventing them in the first place, and responding to them with naloxone — and distributing NARCAN®, of course.

Unfortunately, they have two major shortcomings: they’re only allowed to give out NARCAN®, nothing more, and they generally require participants to undergo in-person, town-hall-style trainings that last upwards of 90 minutes (or, at least this was the norm for a long while); more recently, I’ve heard of some ROPS only asking participants to undergo 20-minute-long phone-based trainings.

As much as I’m glad people get paid by the state to do this stuff, these public health-social service professionals only pick the lowest-hanging fruit off the proverbial harm reduction tree.

2. Make Valuable Intangible Resources Available to

3. Report Rural Tennessee’s Area-Specific Challenges to the Harm Reduction Community at Large

Question: Where is harm reduction infrastructure most established in the U.S. and Canada?

Answer: Dense urban centers — a.k.a. cities.

4. Promote Pro-Drug User and Pro-Sex Worker

Since the age of 10, I’ve spent the majority of my free time on the internet. Right around the time opioids became my drug of choice in 2014, I began browsing Reddit’s r/Opiates forum. Naturally, I eventually explored its sidebar, wiki, and FAQ, which collectively introduced me to the concept of harm reduction. 2016 marked the first time I received harm reduction supplies via mail — I took up a (lady) “Bropiate” on her offer to send forum members syringes, naloxone, and other harm reduction supplies.

I started injecting opioids in 2017. Although rural West Tennessee didn’t have a lick of harm reduction infrastructure, I was already familiar with the concept of mail-based harm reduction supply, giving me access to supplies that my local counterparts weren’t at all privy to (thank you, NEXT Distro!) I referred them to NEXT, but seemingly no-one took my referral seriously — since they’d long been marginalized as “dirty, untrustworthy dopeheads” and lived somewhere with no HR infrastructure, they sensed the prospect of dozens of brand-new insulin syringes — valued locally between $3 and $5/unit — magically appearing on their doorsteps as too good to be true.

Immediately after realizing the juxtaposition of my region’s widespread need for safe drug use supplies with a paradoxical lack of interest in free supples from my drug-using counterparts — despite having “the plug” on syringes, cookers, cottons, naloxone, alcohol swabs, tourniquets, you name it they got it

After receiving some free naloxone, syringes, bacteriostatic water ampules, and other harm reduction supplies from a good-hearted poster on Reddit’s r/Opiates forum, I started giving out harm reduction supplies in 2017. In late October 2019, I received a call from a harm reductionist on the other end of the state — East Tennessee, for the uninitiated —

For Drug Users, By Drug Users

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