Landscapes of Care Amid Crisis: The Geographies of Rural Opioid Harm Reduction Networks in Vermont

According to the Center for Disease Control, the United States has lost more than 400,000 people from opioid related fatalities since 1999. The federal government has been slow to respond to this crisis which has prompted local communities to assemble to form grassroots harm reduction networks to save the lives of their community members. Harm reduction is a set of strategies and practices that aims to reduce negative consequences associated with drug use and often takes the form of needle exchanges, medication assisted treatment, and safe injection sites. In 2018, the Department of Health reported that there were 110 opioid related fatalities in the state of Vermont. This number of deaths in the sparsely populated, rural landscape of just over 623,500 people has a profound impact on communities across the state. Vermont is unique among other rural states struggling with this epidemic in its proven ability to mobilize, most notably through the state’s Hub and Spoke Model for increased access to medication assisted treatment. This research project explores the social, health, and activist geographies of opioid harm reduction networks through oral history methods to gather narratives from twelve local stakeholders including harm reduction practitioners, doctors, caregivers, families, and advocates to explore the intersection of the opioid epidemic, rurality, and harm reduction in Vermont. The spatial and social dimensions of these networks have emerged as prominent themes and reflect that lived rural geographies deeply influence the production of landscapes of care in Vermont