Johns Hopkins students offer harm reduction in East Baltimore

Every Monday through Friday, from 10 a.m. to 4 p.m., Johns Hopkins undergraduates can be found in East Baltimore standing in front of "the Lighthouse" with a metal cart. If you walk up and say hi, they'll gladly show you their stock—syringes, smoking kits, Narcan, instant ramen—and if you ask, they'll hand any of it over, free of charge.

These volunteers are part of a student organization called HopOn Harm Reduction. During the 2023-2024 academic year, they reached 573 East Baltimore residents, handing out more than 700 boxes of Narcan, 19,000 syringes, 317 smoke kits, and 140 sniff kits, as well as wound care supplies, hygiene products, condoms, fentanyl test strips, and food.

"We very, very rarely let inclement weather stop us," says senior and HopOn co-director Shirley Xie. "A lot of our participants do not have stable shelter, so if they are out here needing supplies, then we will be out here providing them."

Adds co-director Garrett Gregory, also a senior: "Most of the interactions are very positive. People just come and they take their stuff, they'll chat for a little bit, and they'll be on their way."

According to the Maryland Department of Health, Baltimore experienced 1,043 drug and alcohol-related deaths in 2023. Harm reduction programs such as HopOn distribute materials meant to reduce overdoses, infections, and other serious risks that come with substance abuse. They also direct interested participants toward relevant housing, medical, and rehabilitation resources.

The cause and effect is simple: Handing out new syringes discourages people from reusing old ones, limiting the spread of blood-borne diseases like HIV and hepatitis. Distributing Narcan and fentanyl test strips reduces the frequency of fatal overdoses. Providing necessities like food and hygiene products improves participants' quality of life.

"Harm reduction is an evidence-based strategy," Xie explains. "It's well-documented that this is something that genuinely, truly works in ways that abstinence or putting people in prison for substance use does not."

HopOn's goal is not to eliminate drug use in Baltimore. Instead, they aim to reduce the dangers and stigmas surrounding addiction, decreasing participants' suffering and enabling them to seek help on their own terms.

"You make both less change than you might expect and much more," Gregory says. "We have handed out a very substantial amount of Narcan and syringes in the past year, but you do have to be kind of reasonable with your expectations. Harm reduction isn't as simple as, 'If we give Narcan to everyone, they'll stop using drugs.' It's really all about empowering people to reduce their own harm."

HopOn was founded by Max Sahhar, A&S '23, during his time as a Johns Hopkins undergraduate.

"In the early days, it was a lot of standing around with, quite literally, two bags, one filled with syringes and one filled with naloxone, on the street corner in East Baltimore," he says. "People really didn't know why I was out there, and there was a bit of distrust, but over time, the community grew to know me."

Now a medical student at Brown University, Sahhar worked with classmates Patrick Winguth, A&S '24, and Brian Min, A&S '24, to expand the club to its current form. The program now averages 15 to 20 members each year.

"After a certain point, it couldn't just be me," Sahhar explains. "These days, even if [the community members] don't know the person who's out there, they are so friendly and so ready to talk because they know that every single person that we put out there is going to be great people."

Before being given a shift, HopOn volunteers receive training to understand the physical and emotional needs of the program's participants. The majority of people who use their service are experiencing issues like poverty, homelessness, severe medical conditions, and/or mental illness, all of which make it harder to attempt sobriety. But by establishing a rapport with regular participants, HopOn volunteers can start to build trust.

"Our main priority is both the safety of our participants and of our volunteers," Xie says. "We're really cautious and very careful about making sure that everyone in this situation is comfortable before we put anyone out there."

HopOn is far from the only harm reduction program in Baltimore. Similar services are offered by community centers and nonprofits across the city, including Charm City Care Connection (CCCC), of which HopOn is a subsidiary. HopOn receives much of its supplies from CCCC, including syringes and smoking kits. Narcan and drug testing strips are supplied by the state, with additional supplies coming from grants and other sources of funding, including the Bloomberg School of Public Health. HopOn's faculty sponsor Karin Tobin, BSPH '00 (MHS), '04 (PhD), helps the club obtain materials and maintain best practices. She also serves as the associate director of Lighthouse Studies at Peer Point, a designated Maryland Overdose Response Program.

It's a lot of supplies for a group that started as one student on a street corner. Looking back, Sahhar says he feels immense pride in HopOn's growth.

"I knew starting it that many of the volunteers that I brought in would someday be leading public health departments, they'd be in advocacy, or, most often, they would be physicians," Sahhar says. "Regardless of the environment, it's great that they're building this understanding and sympathy toward people who use drugs, and it's great that they're building a connection with their community.

"We had a regular way back in the very earliest days of the program when it was really just me," he recalls. "One week he came in on a wheelchair instead of his normal prosthetic leg and crutch. He had just had the worst day of his life because someone had broken his prosthetic leg and he had to go find a wheelchair. And yet he had gotten himself all the way over to the program because despite all that happened, he still needed that support: syringes and Narcan. I had not really talked to him that much before, but on that day he told me exactly what the program meant to him. He said that on top of it being about the actual supplies of syringes and Narcan, it's about this place that he can go and be accepted immediately without question. That's something that I hear a lot about, the experience of people who use drugs, that it can be isolating. On that day in particular, he really appreciated that there was at least one person that he could count on who would be there."