Survival Story: Responding to the Opioid Epidemic in Rural New England
by Alastair Huntley
The Upper Valley Region is a testament to life’s striking contrasts. This picturesque area, bisected by the Connecticut River, extends across New Hampshire and Vermont, encompassing several towns. Among these is the affluent enclave of Hanover, New Hampshire, known for being the home of Dartmouth College. Yet venture a few miles from the Ivy League town, and you’re transported into the heart of isolated rural landscapes. Here, much like in other rural corners of America, the shadow of substance use and the opioid crisis has been cast over some inhabitants. In response to a surge in overdose fatalities, harm reduction has become an indispensable resource in the region.
The Upper Valley’s approach to harm reduction is multifaceted, serving as a vital public health initiative. It extends its reach through essential services such as HIV/hepatitis C testing and treatment and facilitates access to syringe service programs (SSPs) for individuals who inject drugs. SSPs provide critical resources and act as a gateway to support. Individuals who engage with SSPs are five times more likely to seek drug treatment and nearly three times more likely to cease drug use compared to those who do not utilize these programs, according to the Centers for Disease Control and Prevention. Furthermore, harm reduction seeks to reduce stigma while advocating for the rights of people who use drugs.
Survival Story: An Artistic Approach to Harm Reduction was inspired by my hands-on experience in harm reduction across both states. A pivotal moment occurred as I sat in a mobile phlebotomy van, under the dim glow of a headlamp, preparing to do a blood draw on a participant in the HIV/hepatitis C treatment program with which I work. Her reluctance to seek treatment at local hospitals due to fear of judgment and trauma underscored a common narrative of stigma experienced by people who use drugs.
After being overprescribed pain medication following surgery, I developed opioid use disorder (OUD) and saw firsthand how stigma and a lack of empathy created negative outcomes. It’s a story I am resolved to change.
Through “Survival Story,” we harness the transformative power of visual storytelling to educate the public about harm reduction and provide training on the administration of Narcan. Our approach to stigma reduction and empathy-building blends a fictional narrative with education, aiming to alter perceptions and behaviors surrounding drug use. Drawing from my struggles through recovery, I wrote “Half Shell,” a short story that explores the challenges and resilience of a pregnant teen navigating the complexities of OUD. In collaboration with the TLC Family Resource Center and the HIV/HCV Resource Center, we embarked on a journey to bring this story to life. Illustrated by artist Samuel Rafa Garcia, the visual component of “Survival Story” offers a glimpse into a dramatic, fictional world, serving as the narrative backbone of the exhibits.
The inaugural exhibit took place on March 28, 2024, and was a moment of connection. It brought together individuals in recovery, healthcare professionals, and community members, united by art and a shared interest in harm reduction.
. . . the main character, Danielle—I know that girl. Can’t count the number of times you hear someone wanting to get clean, then their boyfriend, how they’re living, just makes it impossible.—Alexis, in recovery
. . . the art was a great way of engaging with harm reduction through an abstract lens. It was an effective setup for when the exhibit transitioned to training. I felt like I could relate to substance abuse more. —Laura, community member, Sunapee, New Hampshire
Following the showcase of artwork, the exhibit transitioned to an informative session on harm reduction techniques, highlighting their public health benefits and encouraging personal reflection. Individuals in attendance and those involved in harm reduction in the Upper Valley were asked, “What does harm reduction mean to you?”
Harm reduction attempts to create space for individual choice and autonomy. Rather than insisting on a system-defined intervention, care is tailored to the needs and preferences of an individual. —David de Gijsel, MD, MSc, MPH, Infectious Disease Physician, Dartmouth Health
Harm reduction and recovery-based services go hand in hand. Often when people are trying to determine what recovery could mean for them, harm reduction strategies become an essential tool to mitigate some of the negative impacts that substance use can cause. Another vital component of harm reduction within the realm of peer recovery is the strategies that create an opportunity for relationships between peer recovery support and those still exploring their options. —Dan Wargo, Director, TLC Family Resource Center
Harm reduction is getting the resources you need to get on your feet again. Could be a place to live, treatment, finally seeing a doctor because there’s a nightmare waiting list around here. —Mike, in recovery
The exhibits culminated in Narcan training, empowering attendees with the knowledge to save lives. Attendees received instructions on how to identify the signs of an overdose and how to administer Narcan. Everyone in attendance then left the event with two free doses.
One attendee, who is in recovery, was asked what he thought of the lack of Narcan availability in the Upper Valley:
People with diabetes get medication, insulin, even when they don’t make lifestyle changes that could help. But when it comes to drug use, so many people have a moral issue with making Narcan more available. What’s the difference between giving someone insulin and giving someone Narcan to save their life? —Justin, Grantham, New Hampshire
The “Survival Story” exhibits demonstrated success in bridging the gap between harm reduction education and community engagement. Four were held in total, hosted at the TLC Family Resource Center in Lebanon, New Hampshire, and Dartmouth College Health Service in Hanover. In total, 110 participants received Narcan training, and 177 Narcan kits were distributed. These outcomes underscored the tangible impact of the project, equipping attendees with tools and knowledge to address opioid overdoses within their communities.
Building on the success of these exhibits, I founded SocialTheory, a social enterprise that integrates human-centered storytelling with innovative technology. Together with the DALI Lab at Dartmouth College, we are transforming “Survival Story” into an interactive web-based experience. This digital platform will combine powerful visuals, narrative storytelling, and evidence-based harm reduction strategies to create accessible resources for medical professionals, first responders, and community members. By scaling the reach of “Survival Story,” we aim to foster greater empathy and reduce the stigma surrounding OUD. With the generous support of the Magnuson Center for Entrepreneurship at Dartmouth College, we are driving a shift in how society understands, supports, and uplifts people who use drugs.
- Alastair Huntley is the founder of SocialTheory, a social enterprise blending innovative technology and human-centered storytelling to assist in addressing public health issues. His flagship initiative, Survival Story, is an interactive, web-based experience that uses visual storytelling and evidence-based harm reduction education. With a background in harm reduction outreach and community initiatives rooted in visual storytelling, Huntley focuses on reducing stigma and improving outcomes for individuals affected by substance use disorder.
- Email: alastair.huntley88@gmail.com
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