Research has deepened our understanding of addiction, but people living with substance use disorder still face stigma.
Today there are more treatment options and ways to support recovery, such as approaches that reduce harm rather than just stopping substance use completely.
But following a July 24 executive order, federally-supported harm-reduction programs—such as safe consumption and syringe exchange sites—are losing funding.
Outreach workers can still provide naloxone (Narcan), fentanyl test strips, wound care, and other support listed in a July 29 letter from the Substance Abuse and Mental Health Services Administration.
Still, health workers, recovery advocates, and policy analysts say the funding cuts send a broader message that undermines the value of harm reduction.
To learn more, Public Good News spoke with Sarah Laurel, executive director at Savage Sisters, a Philadelphia nonprofit.
She shared how her team got started and the challenges and support they’ve experienced in their harm-reduction work.
Here’s what she said.
[Editor’s note: The contents of this interview have been edited for length and clarity.]
Public Good News: How did Savage Sisters get its start?
Sarah Laurel: The origin story is I’m the founder, and I have a long history of substance use and being unhoused, and in treatment centers and incarcerated.
At the beginning, it was just me and a couple of friends in early recovery starting a recovery house. I think I had 60 days.
I didn’t have any property. I didn’t have a phone or clothes. I only had the dress that I was cut out of when I got to the hospital 60 days prior, and it said ‘savage’ on it.
So, when my friend and I said, ‘Well, we should call it something,’ I said, ‘We’ll call it Savage Sisters.’ That was the first house, and it kind of grew organically.
Now, we have 10 structured houses for both men and women, and two mobile vans to do outreach events. We do 52 per month.
We travel the country and the state, do overdose reversal training, and we talk about drug trends and harm reduction.
PGN: For readers who aren’t familiar, what’s the difference between recovery, abstinence, and harm reduction?
S.L.: I don’t think that there is a difference. I think there are just different ways to describe where you’re at in your recovery journey.
Some, like myself, I’m abstinent. That’s a choice that I made, and I feel good about that choice.
Others may have different medications that help stabilize them and help them on their healing journey. The beginning of their recovery path may be smoking instead of shooting, changing the method of consumption.
It may be switching the substance that they’re consuming from one to another. It may be having safety nets in place and having best practices in place, like using safe supplies consistently or not sharing injection tools and things like that.
Harm reduction and recovery go hand in hand, because recovery is just the process of healing.
It’s whatever makes sense for you and your life that creates safety in your realm.
PGN: Thank you for sharing. When did harm reduction become part of your work?
S.L.: I lived in Kensington, on a pretty well known dope set, which is just a corner where substances are sold.
On that particular corner, there was a lot of sex trafficking and sex workers, things like that. I happened to be on my recovery journey, but I knew most of them from being out there.
I would sit on my stoop, and I would hang out with them and chat with them. And I learned that there were things that they needed: toiletries, sometimes a shower, condoms, and Narcan.
And so, I walked to a local nonprofit and found somebody. His name is Elvis Rosado, and I said, ‘Hey, this is what I need.’
He showed me how to use Narcan in a more thorough way, and I started doing, I guess, outreach.
I have 10 siblings, and so I started collecting clothes and different items from them and just giving them to people that I interacted with on that corner. And I started to notice wounds on my friends, and it was dissimilar to anything I had seen before.
I did a little bit of research and spoke to the Philadelphia Department of Public Health, and they said that there was something called xylazine in the drug supply.
There were no human studies on it, but it was showing up in the supply somewhat.
It was in its very beginning stages. And so, I went down a rabbit hole trying to learn about it and what harm reduction was, and why it was important.
There were some really good mentors. There was a lot of personal research learning what harm reduction was and why it was important.
That’s where the wound care started.
PGN: How did you know you were on the right path?
S.L.: There was a lot of conflicting energy, because I was in a 12-step recovery program, and there was so much stigma about just simply supporting individuals with public health. And the language was contradictory to what I was doing.
I was being told in these spaces that what I was doing was enabling, that I had to let them hit rock bottom. You know, that I was responsible for their death if they died because I gave them a condom or I gave them a [new] syringe.
And then there were these studies, and this evidence, and data, and this proof in the pudding that I was experiencing street-side with individuals who just needed support.
So, I went with what my gut was telling me. It sat right with my soul to sit through these experiences with my friends, to serve them as best as I could, and to learn as much as I could. And the program developed in that way.
PGN: What do you wish other health workers knew about the work that CBOs like yours are doing?
S.L.: That’s a heavy question in this current climate. I don’t want to get emotional, but there seems to be a narrative that we’re just junkies.
Like we don’t deserve to have a wound wrapped or an overdose reversed, and it’s being pushed from the highest levels possible that we are worthless.
The exhausting part of the work isn’t the work itself. It’s having to constantly explain to people that the humans that we serve—that we are—are worth saving.
I did not think it would be an uphill battle of convincing people that we deserve human rights, public health, and a kind word.
I can understand the objections to certain funding and things like that, but we’re not asking for millions of dollars. We’re asking for you to stop putting barriers in our way to serve the people that we love.
The exhausting part of the work isn’t the work itself. It’s having to constantly explain to people that the humans that we serve—that we are—are worth saving.
Sarah laurel
We love them. They’re our community members.
We don’t ask you to serve beside us if you don’t want to. But stop pushing this infectious narrative that people will grab onto and then behave accordingly towards individuals.
When you’re treated like you’re worthless, and [it’s] on the news, they call you worthless. Where’s the incentive to heal?
PGN: How has mentorship helped you navigate the times we’re in?
S.L.: Elvis Rosado worked at a pretty big nonprofit doing harm reduction work when we first connected.
In the past year or two, it’s been Laura Guzman, who has decades-long experience in harm-reduction work. She’s been able to help us navigate this heavy pushback against harm reduction.
Because for probably five years, [the work was] very supported. I mean, it’s always going to be a politicized subject, but it wasn’t being targeted.
It was being supported by federal funding and different initiatives and research grants that were really trying to develop ways to support individuals. And with that evidence and data, you were able to, you know, speak knowledgeably to it and say, ‘Well, actually, this is helpful and harm reduction is a part of recovery.’
They are not conflicting ideas. They go hand in hand.
And then, I would say [that during] the past 18 months, in Philadelphia, specifically, we had huge pushback against harm reduction, public health, supporting people with housing-first initiatives, and things like that.
I’m a baby in this space. You know, it’s been about eight years for me.
So, when I reached out to Laura, and she was able to say, ‘Hey, this is kind of typical. We have to get through these waves. We have to continuously share the message of the work that we’re doing.’
So, sometimes you have to go underground, sometimes you have to get creative and flexible.
That has been the energy that I’ve had to work through.
A correction was made on Sep. 26, 2025: An earlier version of this article excluded Elvis Rosado’s name. It’s been edited to include it.