On a Sunday afternoon last July, a group of volunteers met under a freeway bridge in East Oakland and unloaded 30,000 syringes, pipes, cookers, alcohol swabs, and other drug equipment from the back of a pickup truck. They also unloaded food—pasta with tuna, soft pretzels and croissants in sandwich bags—hygiene kits, and Narcan, a life-saving drug used to reverse opioid overdoses.
A volunteer named Luka Zeis, wearing heavy boots and a pin that read “Be Gay. Do Crimes,” explained how to administer Narcan to a woman in a purple summer dress. Alejandra del Pinal, a self-described punk with a buoyant shock of reddish-brown hair, was sorting through the supplies, which would be handed out for free to anyone in need.
The group, Punks with Lunch, is one of a few harm-reduction organizations mainly supporting Oakland’s estimated 1,200 homeless people who use injection drugs like heroin and methamphetamine, a group that is disproportionately Black and Latinx. The group’s harm-reduction philosophy recognizes that harsh legal penalties aren’t the best ways to address addiction.
Many more people, including housed Oaklanders, use injection drugs, but they often have more resources to purchase their own equipment and use drugs in a safer environment. Harsh federal and state laws against drugs like heroin and methamphetamine also push already marginalized people further to the edges of society. This can lead them to acquire and use drugs in ways that are dangerous to their health.
The pandemic has made the lives of injection drug users even more dangerous. When Bay Area county health officers issued stay-at-home orders in March, many people’s jobs disappeared. Panhandling incomes dried up as fewer people were out and about to offer change. At the same time, more dangerous drugs flooded the Bay Area’s street markets and, according to a weekly count by Punks with Lunch, the number of overdoses in Oakland doubled between January and April.
In July, as coronavirus cases kept climbing and the region was starting to feel the economic effects of five months of the shutdown, the HIV Education and Prevention Project of Alameda County (HEPPAC), an older and more resourced harm-reduction organization key to getting supplies to substance users, temporarily shut down after two volunteers tested positive for COVID-19.
For del Pinal, who founded Punks with Lunch in 2015, seeing HEPPAC shut down for two weeks was a warning about the dangers facing all outreach workers and unsheltered people. Punks with Lunch weighed the tradeoffs of potentially exposing its volunteers and the community to COVID-19 against the likelihood of more overdoses and other harms if they stopped handing out equipment.
Ultimately, del Pinal said, her group never seriously considered stopping. “If people need needles, they’re not going to stop using because of a pandemic.”
At the Punks with Lunch event under the freeway, people came from across Oakland, parking their bikes on the pavement or just walking up and waiting in a socially distanced line to receive supplies.
One attendee, 38-year-old Jaramillo, had collected discarded syringes from the road for Punks with Lunch to safely dispose. A methamphetamine user for eight years, he was there to pick up his first meal of the day and 1,000 syringes for himself and three friends who had been reusing the same needles for a week, potentially exposing them to HIV, Hepatitis C, and other dangerous pathogens. “I don’t use it to make it cool. I use it just to make myself normal,” he said.
Jaramillo was unemployed. He’d worked as a line cook before, but no one was hiring and panhandling no longer provided income. “What options are left?” he said. “You’re just stuck at broke.”
Each purchase of meth was a potentially fatal gamble. If fentanyl had been cut into the drug, he could overdose. “It’s fucking horrible. I don’t want no one to go through it,” said Jaramillo about his experience with addiction. “Unfortunately, a lot of us are.”
Del Pinal’s group has stepped up its work over the past eleven months to help people like Jaramillo survive this double crisis of COVID-19 and an increase of more dangerous drugs.
Del Pinal translated highly technical COVID-19 health and safety guidelines into practical protocols for substance users, dealers, and volunteers. She was awarded one of eight Alameda Healthcare for the Homeless Community Heroes Awards for her work in 2020.
“The policies that [Punks with Lunch] created were shared widely and adopted as best practice in the field,” county officials wrote about del Pinal’s award-winning work.
As a state-authorized harm reduction organization, Punks with Lunch relied on an annual $45,000 grant from the California Department of Public Health to purchase safe injection and smoking supplies. Del Pinal typically subsidized the grant with punk-concert fundraisers to buy extra equipment, food, and Narcan. But like everything else, their planned fundraiser concert in March, and their annual summer and fall concerts, had to be canceled.
Del Pinal and her team have found other ways over the past year to raise money, including a new state grant that will allow them to expand their work. She said Punks with Lunch is more dedicated than ever to helping Oakland’s most vulnerable.
“We keep us safe,” she said, “No one else is going to keep us safe.”
Seeing the Bay Area’s disparity and taking action
Del Pinal was inspired to found Punks with Lunch after walking to the West Oakland BART station one day five years ago, past the tattered tents and scattered needles of an encampment around the corner from her apartment. She knew a few of the people living there and let them fill up water bottles at her house’s spigot.
“It’s the same thing that you see every day. People just trying to survive,” she said.
After taking the train to San Francisco, where she worked at the time as a line cook at the restaurant Oro in Mint Plaza, she’d find herself in a different world. As she served $45 grilled lamb heart to Twitter employees, her poverty-stricken neighbors in West Oakland kept coming to mind.
“You can desensitize yourself to it, and many people do, for years,” she said.
In 2016, after a day serving $105 tasting menus, del Pinal returned to Oakland, recruited friends, loaded a cart with ham and cheese at the Dollar Tree, and made 50 sandwiches for her houseless neighbors. The sandwich-making became a weekly event, and a friend coined the name “Punks with Lunch.”
But del Pinal said the immense need of Oakland’s homeless community quickly overwhelmed them. “We weren’t even hitting the bare minimum of what people needed,” she said. She sold tamales at her birthday party to raise money and some of her bartender friends donated their tips. Free meals helped, but to empower people to stay safe, del Pinal and her friends realized that what some unsheltered people most needed were sterile syringes, alcohol swabs, and other hygienic equipment to prevent outbreaks of HIV, Hepatitis C, and soft-tissue infections caused by using unclean needles. Alameda County has above average HIV rates compared to the rest of the country, and a disproportionate number of the county’s patients are Black and live in Oakland.
At the end of 2016, Oro went out of business and del Pinal lost her job. After a few months of job-searching, she was hired as a van driver and then a counselor at San Francisco’s Homeless Youth Alliance as her work with Punks with Lunch slowly turned into a full-time job.
Spreading the harm reduction model to empower marginalized people
Del Pinal knows firsthand how addiction can start. After her parents’ rough divorce when she was 12, she dealt with her anger through drinking and the catharsis of punk concert mosh pits. Like many in the punk scene, she used hard drugs and suffered bouts of houselessness.
“When I was in the throes of my youth, there was a lot of self-hatred,” she said, “You end up doing things that you don’t necessarily feel very proud of. It’s survival.”
In 2017, del Pinal’s punk band, Rapid Decline, held a benefit concert in Oakland for the Standing Rock protestors, then drove to North Dakota to give the money and supplies to the protest’s organizers. On the drive, del Pinal saw a sign reading, “Alcohol is a tool of oppression.” She quit drinking after that. In 2018, Punks with Lunch was fiscally sponsored by the Dave Purchase Project, a national harm reduction organization, and the state gave del Pinal’s group a $45,000 grant.
“Needle exchanges and harm-reduction programs are severely, severely underfunded,” del Pinal said.
For many decades, federal and state policies have criminalized drug addiction, rather than treating it as a medical issue. Only in 2017 did Congress lift a 1980s ban on federal funding for syringe exchanges, and the government only took this action after the opioid epidemic killed an estimated 750,000 between 1999 and 2018. The change of heart—and acceptance of less-punitive policies like harm reduction—came about as the opioid epidemic hit middle and lower class white people in suburban and rural parts of the country.
“When you put a white face to substance use,” said del Pinal, “or when you put a white face to homelessness, you get a little bit more sympathy.”
Still, California is one of 44 states without sufficient sterile equipment, making the population “at risk for significant increases in hepatitis infections or an HIV outbreak due to injection drug use,” according to the Center for Disease Control.
By 2018, Punks with Lunch had inspired punks in Sacramento, Chicago, and Las Vegas to start their own chapters under the same name. Many of its volunteers have experienced addiction and homelessness, said del Pinal. But the pandemic’s effect on the harm-reduction community, and the communities they serve, hasn’t received the attention that del Pinal and others believe it should.
“People of color and Black people are kind of slipping through the cracks,” said del Pinal, who is keenly aware that Punks with Lunch is largely a white organization providing services to largely Black participants.
Del Pinal has taken steps to diversify the volunteer base of Punks with Lunch. While some organizations require volunteers to complete an online application and drug equipment training, del Pinal has found ways to ensure that anyone can join Punks with Lunch’s Sunday gathering, get trained, and volunteer on the spot.
The pandemic exacerbated existing inequalities and dangers
The lives of unhoused drug users were incredibly risky before the pandemic, but COVID-19 and the ways governments have responded to the virus have multiplied these existing threats to people’s health.
The price of methamphetamine doubled between January and April as factories in India and China, where much of the U.S. supply comes from, shut down. Smugglers have also faced a more closely monitored U.S.-Mexico border, the main entry point for meth and heroin, according to Drug Enforcement Administration Special Agent Bill Bodner.
“It’s like finding a needle in a haystack,” he said. “Well, the haystack is significantly smaller because there’s less vehicle traffic at the border.”
With limited supply, and seeking higher profits, dealers often cut their drugs with cheaper substances like fentanyl, an opiate ten times more potent than heroin that increases the chance of an overdose. Punks with Lunch began handing out more Narcan in April because of the rising numbers of fentanyl overdoses in Oakland.
Seeing how the pandemic was affecting unhoused communities, del Pinal took steps to ensure harm-reduction groups could continue to operate. She called every Punks with Lunch non-profit across the country, offering advice on safely staying open, though many had already instituted strict safety protocols. She studied the CDC’s COVID-19 safety guidelines regarding sheltering in place and good hygiene. But sheltering-in-place, hand washing, and social distancing are impractical for those without a shelter, access to the internet, sterile equipment, a stable drug supply, money, running water, or a fridge to stock food.
So, del Pinal put official health recommendations into a more accessible instructional pamphlet about basic hygienic practices to reduce exposure to the coronavirus for those living in homeless encampments. It included instructions for making DIY sanitizer, encouragement for substance users to avoid sharing pipes because it’s an easy way to spread COVID-19, and a request to drug dealers to keep their operations to a few streets to reduce travel and exposure.
No similar guidance came from the state. “People just don’t want to address that part. It’s not convenient. It’s not sexy,” she said.
In June, Punks with Lunch’s annual $45,000 grant from the California Department of Public Health was cut to $35,000. The health agency was trying to fund a growing number of new harm-reduction organizations in California. Instead of providing more money to existing organizations, however, CDPH cut their budgets.
Thankfully, in August, Punks with Lunch was one of a small group of harm-reduction organizations that received a new three-year $450,000 grant from The California Harm Reduction Initiative, set up in 2019 by the state and the National Harm Reduction Coalition, a nonprofit advocacy organization. Punks with Lunch used the money to rent office space in West Oakland and store supplies. The group currently has two full-time staff, including del Pinal.
“My big takeaway out of everything,” del Pinal said, “is that this pandemic was just another kind of blip in the overall trauma and crisis that people are experiencing on the street.”