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PORTLAND, Maine - The opioid crisis was getting worse and Jesse Harvey was sick of people dying, so he began asking a pointed question: What would Jesus do?
For Harvey, a young activist who had struggled with addiction, the answer was increasingly clear.
He decided to start a church. Its core belief, Harvey said, was that people who use drugs do not deserve to die.
The group was called the Church of Safe Injection. It distributed clean syringes, fentanyl test strips and doses of naloxone, an opioid overdose antidote, mostly from the back of Harvey's red Honda hatchback.
Such efforts were partly illegal in Maine, but for Harvey they were a moral imperative. "Some people say that what I'm doing is too radical," he told an interviewer in 2019. "And I think my answer to that would be, isn't it time for radical solutions?"
Harvey was a fervent believer in reducing harm to drug users, a once-controversial approach that has gained support from policymakers, including in the Biden administration, as overdose deaths have increased.
In the shadow of the pandemic, the opioid crisis reached a grim record. Last year, drug overdoses killed more than 100,000 people in the United States, a 50% increase since 2019. At least 80,000 of those deaths involved opioids.
The increasing lethality is driven by the nationwide spread of fentanyl, a potent synthetic opioid that is also found mixed with other illicit drugs. "This is, right now, the most dangerous time to be a person taking drugs," said Nora Volkow, director of the National Institute on Drug Abuse.
The story of Harvey and the group he founded shows the depths of the challenges facing those on the front lines of an emergency that is both unrelenting and under-resourced, one where the most difficult work is sometimes done by recovering drug users themselves.
For Harvey and his closest colleague, Kari Morissette, preventing overdose deaths was intensely personal work. Both felt that harm reduction efforts had saved their own lives, and helping others was a source of hope at a time that too often could feel despairing.
As the pandemic took hold, the duo continued to hand out sterile supplies to drug users in Maine. But Harvey's own recovery began to unravel. Morissette grew deeply worried about the person she considered her mentor and one of her best friends.
In mid-2020, Harvey wrote to a friend that the work gave him a "sense of purpose and direction, rather than shame and despondency."
Harvey arrived in Portland in 2015 after finishing college. Newly sober and full of energy, he became a vocal advocate in the recovery community, always carrying a tiny notebook in his pocket to record ideas.
He began working for Greater Portland Health doing outreach to marginalized groups and developed a special closeness with the city's homeless population. Friends said it was a question of temperament: He never judged and always made people laugh.
Harvey was born in Massachusetts but spent much of his childhood in Africa and South Asia, where his parents worked in international development.
After the family returned to the United States, Harvey started middle school and his parents divorced. When his new classmates asked him where he was from, "he would have to say Kathmandu," recalled Catherine Nash, Harvey's mother. "The kids were like, 'Where's that?'"
Harvey combined a sharp intelligence - "smarter than a lot of his teachers," recalled Mollie Kravitz, a friend who met him in seventh grade - with a goofy sense of humor. In high school, he was prescribed an anti-anxiety medication, which his mother believes started his path to addiction.
One day in 11th grade during a psychology class, Kravitz saw Harvey crush a pill and snort it off his desk. Alarmed, she told a teacher, and Harvey was summoned to see the principal.
Harvey's struggle with substance abuse - including alcohol, meth and, at times, opioids - deepened during college, his mother said. He ultimately graduated summa cum laude from King's College in Pennsylvania, but those years were punctuated by trips to the emergency room, treatment programs and several court-ordered commitments, she said.
After he stopped using drugs and moved to Maine, Harvey threw himself into activism. He started Journey House, a group of recovery residences. He also founded the Portland Overdose Prevention Society, whose goal was to push the city to establish a supervised injection site.
But none of this felt like enough to Harvey, his friends said.
Ryan Hampton, a well-known recovery advocate and author of two books on the opioid epidemic, crossed paths with Harvey in 2017, and the two became close. They were both young and a couple of years into their sobriety; they loved to think up revolutionary solutions to big problems.
Hampton remembers being at a conference where he and Harvey were "spitballing ideas left and right" as the "older, more, quote-unquote, experienced people" sitting at the table tried to tamp down their exuberance.
Unlike some experts, the pair believed that abstinence was not the only path toward recovery. Harvey once said that his route out of addiction was not evidence-based but instead "evidence-hostile."
Both Hampton and Harvey believed that people in recovery needed a greater say in policy decisions, instead of being told what to do by doctors and scientists. Both were inspired by the work of gay activists in the fight against HIV and AIDS.
They embraced harm reduction, a strategy whose tenets include widespread distribution of naloxone, a drug that can immediately reverse opioid overdoses and goes by the brand name Narcan; providing drug users with clean needles; and opening supervised consumption sites where drug users can be monitored.
(There are only two authorized supervised injection sites in the country, both in New York. The Biden administration has not endorsed the concept.)
The approach remains politically contentious, with critics saying it enables drug use and fails to tackle the problem of addiction on a wider scale.
But research has consistently shown that naloxone and needle exchanges save lives and reduce the transmission of HIV and hepatitis. The studies of overdose prevention sites also point to lifesaving impacts.
"Dead people can't recover," said Chelsea Shover, an epidemiologist at UCLA. "You have to meet people where they're at."
Harvey said his own life demonstrated the importance of this approach. Once, during a relapse, he injected drugs at an underground safe consumption site and experienced a fentanyl overdose. He was revived with four doses of naloxone, he told a friend in an email. If he hadn't been supervised, he said, "I'd be dead right now."
One night in 2018, Harvey called Hampton to share his latest big idea: a church that would combat overdose deaths.
Instead of talking about distributing sterile syringes and naloxone, Harvey decided to do it himself under the auspices of an interfaith church that he registered as a nonprofit organization. Hampton remembers thinking it was a brilliant idea but didn't believe Harvey would make it happen.
Harvey was raised in the Christian tradition but wasn't particularly religious. He became ordained on the internet and made business cards for the Church of Safe Injection, complete with a quote from the Book of Matthew ("Blessed are those who are persecuted because of righteousness . . .").
Together with a group of roving volunteers, Harvey distributed clean syringes, doses of naloxone, condoms and other sterile supplies on the streets of communities such as Portland, Lewiston and Auburn.
At the time, it was illegal in Maine for an individual to possess more than 10 hypodermic syringes, which meant a key part of the church's activities was a crime. Harvey believed his work could be legally protected as an exercise of religious freedom, but the argument was never tested.
The concept caught fire. Chapters of the Church of Safe Injection sprang up in West Virginia, Connecticut, Arizona, Montana and Tennessee, as well as in other parts of Maine. For Harvey, it meant a growing amount of media attention and police scrutiny.
On a cold afternoon in April 2019, Harvey set up a small table in the parking lot of a Unitarian Universalist church in Auburn, a city in southern Maine. Arrayed on a brightly colored tablecloth were alcohol wipes, condoms, snacks, fentanyl test strips, doses of naloxone and a plastic container for used syringes.
The Auburn police chief told Harvey that if he gave drug users clean needles in exchange for dirty ones, he would face criminal charges under state law.
In a video of the exchange, Harvey, then 27, nodded, his face serious. "But under, you know, notions of righteousness and justice and health equity," he said, "there's no way we can't do this."
Harvey worked constantly, friends said, and could be found writing grants at 2 a.m. Along with running the Church of Safe Injection, he was studying full time for a master's degree at the University of Southern Maine while juggling other projects.
It was "hard for him to find balance," said Eric Skillings, a friend who helped start Journey House. "Which is like most people with substance use disorder - that's how we are, all or nothing."
By mid-2019, Harvey had begun using drugs again. In August, he was involved in a minor car accident and charged with driving under the influence. He was also charged with assault and drug trafficking after a nurse at a hospital found him in a bathroom and alleged that he squirted her with a syringe of meth.
Harvey later wrote that what happened that day was a "horrific accident" and expressed "extreme regret" for the incident. "There are so many things I would go back and change, if I could, to lessen the hurt I caused others."
His public relapse was devastating, said his close friend Morissette, a Maine native who joined the Church of Safe Injection in early 2020. "He had spent so long being this person held up on a pedestal," Morissette said, and "ended up getting vilified."
People he had worked with closely distanced themselves. He resigned from Journey House, the organization he founded.
Harvey felt the media coverage of his relapse and arrest had turned him into someone unrecognizable: a violent criminal. The result was a kind of "stigmatization and ostracization more damaging than any I had previously known," he later wrote in a piece he shared with a friend.
At the start of 2020, Harvey was placed in a court-ordered treatment program in Massachusetts that was housed in a prison. While a prior stay in a similar setting had helped him get sober, this one was disastrous. Harvey said the authorities kept him longer than necessary, jeopardizing his graduate studies. He went on a hunger strike.
When he was released after five weeks, Harvey said he planned to write a book about the failures of the treatment system. He was consumed with the criminal charges pending against him. His lawyer attempted to reach a plea bargain with prosecutors that would avert time in prison.
At a recovery meeting in Portland in February, Harvey met Morissette for the first time. Vivacious and outspoken, Morissette had recently returned to Maine from Florida. For a decade, she had used drugs and done sex work while living on the streets of Miami, sometimes feeling so desolate that she believed death would come as a relief.
She knew how life-changing harm reduction could be. A year or two before she stopped using drugs, a group of volunteers began coming around her neighborhood offering access to treatment services and handing out clean needles.
"I can't tell you the relief that it brings somebody," she told a podcast in 2021, to hear someone say, "'If you're ready, I am here, but while you're not ready, let me help you to be safe.'"
When Morissette met Harvey, she was working at Dunkin' and feeling profoundly adrift. She told him she was looking for a sense of purpose. He offered to show her one.
The two became inseparable. They spent hours together packing hundreds of kits to hand out to drug users, whether for administering naloxone or caring for needle wounds. Morissette quickly joined the board of the Church of Safe Injection.
"I get to help people in situations that I literally just got out of a few months ago," Morissette told Molly Whyte, her best friend.
Harvey and Morissette continued their work after the pandemic started, knowing that the vulnerable people they served would have even fewer options to get clean supplies or access treatment.
One person who helped them: Zoe Brokos, who was the head of Portland's certified needle exchange program and had known Harvey for years. Brokos said that in the early part of the pandemic, the pair would sometimes arrive to exchange garbage bags full of used needles for clean ones.
But by summer 2020, Harvey's life was beginning to fall apart. Friends described him as ashamed and often depressed. He was "just a shell of a person compared to when he was sober," Skillings said. Morissette checked in on Harvey constantly, but he began to withdraw from nearly everyone.
The last time Brokos saw Harvey was in August 2020. He had been sleeping outdoors, she said, and just feeling "so awful." She told him she loved him and was glad to see him.
On Sept. 7, Harvey died of an accidental overdose at age 28. Alcohol, fentanyl and heroin were found in his system.
There was a flood of grief. Hundreds of people gathered for a memorial held on a grassy slope at Portland's Eastern Promenade, a large park overlooking the deep blue waters of Casco Bay. Tributes flowed in from friends, colleagues, even elected officials. Some said Harvey had saved their lives. One friend contrasted the compassion Harvey extended to everyone he met with the lack of it in his final days, quoting a poem by Rumi:
Since you will come
And throw kisses
At my tombstone later
Why not give them to me now
This is me
That same person
After Harvey died, Morissette was crushed. She never fully forgave herself for not being there to help him. She had his name and the date of his death tattooed on her forearm and resolved to continue his work.
She proved a formidable organizer in her own right. Last year, under Morissette's leadership, the Church of Safe Injection successfully applied to become a certified needle exchange in Maine, a status that came with $50,000 in state funding.
Meanwhile, state legislators have passed legislation that support the group's mission. Officials repealed the law that made it illegal to possess more than 10 hypodermic syringes, the statute that police had cited to threaten Harvey with arrest. They also expanded Maine's "good Samaritan" law, which shields people seeking help with overdoses from arrest or prosecution.
Each time there was a small policy victory, Morissette said, she wished Harvey had been there to see it.
Earlier this year, the Church of Safe Injection, known as CoSI, reached a milestone. It opened its first brick-and-mortar location on the main street of Lewiston, a city of 36,000 people about 40 miles from Portland.
The choice of Lewiston was a tribute to Harvey, Morissette said. He had distributed sterile syringes in the city while under surveillance by police at a time when drug users there had no authorized source of clean supplies.
CoSI opened six days a week thanks to a rotation of devoted staffers, most of them volunteers. Morissette spoke with passion about making the premises a welcoming place free of stigma. There are comfortable couches, vases of fresh flowers and, against one wall, a discreet array of storage bins holding everything from naloxone to syringes to wound kits to toothpaste.
Drug users can come inside, exchange used needles and receive supplies, some of which are already packed into small brown paper bags.
Since CoSI opened its doors, Morissette said, it had served more than 650 people. It had exchanged 97,000 used syringes and provided connections to treatment services to any drug users who wanted them.
Morissette would often drive the streets of Lewiston after midnight, trying to track down drug users she was worried about, said Whyte, her friend, who also works at CoSI.
In an interview earlier this year, Morissette was excited to talk about Harvey's legacy and CoSI's plans. The state had recently increased its funding to the group, which would allow it to expand to four other locations.
Behind the enthusiasm, however, she was struggling. In May, she revealed on Facebook that she was "mentally deteriorating" and had repeatedly attempted to take her own life. A friend had revived her using naloxone.
"I thought that if I was open about my struggles that it would make me 'less qualified' to be a person people can call, that people can count on," Morissette wrote. "I am sorry for anyone that I disappointed."
A week later, Morissette died of an accidental overdose. She was 33.
On a sunny Sunday afternoon at the end of May, Morissette's friends and family gathered at the Eastern Promenade in Portland, the same spot where Harvey's memorial was held in 2020. Friends dressed in bright colors to honor Morissette's unapologetically bold fashion sense. They read poems and blew giant bubbles and threw flower petals into the cold waters of the Atlantic Ocean.
Nash, Harvey's mother, was there, as was Kravitz, Harvey's childhood friend.
This is "a hard day in an endless string of hard days," said Jodi Cohen Hayashida, a pastor who was close to both Harvey and Morissette. She spoke of the "wider grief of having to say goodbye over and over."
In Lewiston, CoSI closed for the month of June to mourn. At the start of July, it reopened its doors with a fresh influx of volunteers.