‘They Should Have to Answer to the People They Harm’

For Arlene Mahoney, harm reduction starts with a simple premise: People are going to use drugs, and public health efforts should focus on keeping them alive.

Mahoney leads the Southwest Recovery Alliance (SWRA), a peer-led organization that distributes harm reduction supplies to people who use drugs in Phoenix. She is also the co-chair of the research board that guides the University of Arizona’s Harm Reduction Research Lab.

Her work puts her at the center of a broader debate over how cities respond to homelessness, substance use, and public safety. Supporters of harm reduction argue that services such as naloxone distribution, sterile supplies, and health education prevent deaths and connect people to resources. Critics argue some of those same programs enable drug use and contribute to public disorder.

That debate has increasingly played out in city parks and public spaces, where outreach organizations and unsheltered residents often interact. For Mahoney, those relationships are not separate from public health — they are the foundation of it.

Mahoney has also participated in research examining access to harm reduction tools. In 2023, secret shoppers visited pharmacies across Maricopa and Pima counties to examine how often people seeking syringes were denied access despite not needing a prescription under Arizona law.

We spoke with Mahoney about the impact of drug policies, why she believes harm reduction is necessary even when people continue using drugs, and what she says everyday residents can do to support their unhoused neighbors.

LOOKOUT: Who do you know that's been personally affected by the kinds of things that you're fighting against?

AM: I know a lot of folks, personally, that exist outside of what SWRA does, that have been directly impacted by violent policies like the war on drugs, the park ordinance, the systems that hold the ethic of punisher rather than the ethic of care. We have a lot of the same folks that we see every week for multiple years, and we get to know them on a first name basis and then, one day, they just don't show up anymore. And you hope the reason they're showing up isn't because they overdosed, and then sometimes you find out it is.

The city council is going to be complicit in the deaths that are happening and it's social murder ultimately. They know what's going to happen… they should have to answer to the people they are going to harm and ultimately kill. … Phoenix City Council is explicitly banning distribution of intramuscular naloxone and FDA approved overdose reversal medication at a time when Arizona is number one and trending upward for overdose deaths.

LOOKOUT: What happens if Phoenix does the same ordinance that Tempe just did?

AM: People are going to die. Preventable deaths, suffer.

LOOKOUT: Why harm reduction and not getting people to just not use drugs?

AM: Well, people have used drugs since the beginning of time and no one's ever been able to stop anybody from using drugs. So why not just give people the supplies they need to do it safer?

Harm reduction saves lives and isn't exclusively for substance use. A seatbelt is harm reduction. … We don't tell people, you can't drive in a car, we just give them a seatbelt. Same thing with a helmet. Riding a bike could be dangerous, but we give people a helmet, which reduces harm if they get in an accident. It’s the same thing with drug use. Yes, there's risk to doing drugs, but there are tools so you can do it a little bit safer because people are going to do it.

LOOKOUT: If there's a success story you want to tell, I'm happy to hear it.

AM: Just seeing people feeling empowered to make informed decisions about their health. Often we'll tell people, “Hey, did you know hepatitis C can live outside your body on the surface for four weeks, or in water for two months?” and people are just like, “whoa, I had no idea.”

I tell them that's why you should use a cooker or use a tie, and then they come back and they say to me, “Hey, I told my friend about how hepatitis lives in water and we didn't share a water and instead we used sterile water.” Those feel like much bigger wins than publishing a manuscript.

LOOKOUT: What orgs are out there that are making a positive difference?

AM: Oh my God, there's so many. So different harm reduction orgs, you know, like riot does great work, shot in the dark … We know Circle the City is doing great work. SPW [Sonoran Prevention Works], AZ Hugs, and Aries Foundation. I know there's a lot of smaller groups too.

LOOKOUT: What can people do to help?

AM: So if somebody wants a call to action right now: They can freeze water bottles. When you see folks on the side of the street, give them water. If somebody has a sign and they're asking for money, give them some money. It doesn't matter what they do with the money once you give it to them.

Be generous if you can. I know times are hard. Provide water, advocate, educate your neighbors. If you hear a conversation where people are talking about our un-housed neighbors or talking about people who use drugs, and they're getting it wrong, call them in and tell them, “Hey, these are our neighbors,” and don't let the stigma win out, or misinformation.

LOOKOUT: If people were to volunteer for your org or one of the orgs you mentioned, what might they end up doing?

AM: Each org is structured differently, so it depends. You can pack [harm reduction] kits, that's a great way to volunteer. We have a community night we host bimonthly, and we always have a volunteer opportunity where we ask people to help us pack safer kits for our SSP.

It might look like doing testing. It might look like delivering SSP services. It might look like doing a donation drive. It just depends.

LOOKOUT: What's one thing you wish people knew?

AM: That people who use drugs are just people … Everyone deserves access to overdose and disease prevention. Using [drugs] doesn't mean that you should die from a fatal overdose, especially if there's medication that can prevent or reverse that overdose, and our unhoused neighbors are our neighbors, they just don't have houses.

Read More Stories From This Series