ESPAÑOLA — Sheilah Galer is the addicts' best friend. They wave her down from the sidewalk, hug her like a sister and trade stories about a hospital visit, an arrest, a burial.

The white Dodge Sprinter she drives around Española and Chimayó is unmarked, yet cops, emergency workers, counselors and addicts recognize that the new syringes and Narcan inside keep people from dying.

A social worker from Iowa, Galer now travels Northern New Mexico four times a week collecting used syringes with needles from heroin addicts and replacing them with new packages of syringes that can be used for the week-ahead high. The effort has curbed the hepatitis C virus, which is spread by infected blood through dirty needles. Someone with the virus, which often leads to liver failure, can continue infecting others for years before they are diagnosed.

On Tuesdays, Jeanne Block, a contract nurse for the state Health Department, travels with Galer down dirt roads, parking at wide spots where she preaches the passion that is Narcan, a narcotic that is pumped into the nose and has reversed some 800 overdoses in New Mexico.

This is the state's Harm Reduction Program in action. The two outreach workers comfort rather than confront addicts — and in doing so teach them how to avoid dying from an overdose or avoid spreading disease by taking simple precautions such as using clean syringes, Narcan or rescue breathing — and, if they are motivated, a treatment program that includes Suboxone.

It's a new way of thinking about addiction — the only way, some argue.

"In Española, addiction is so widespread. They see the guy they used to get high with at Walmart, or their cousin across the arroyo. There are too many temptations," says Dr. Leslie Hayes, a physician at El Centro Family Health Center. "From our perspective, even using heroin twice a week is better than using it twice a day.

"There's so many young people who grew up here with heroin. It's the norm. People would stay clean for five years and then come back up here and start using again in a month," she says.

Keeping addicts from dying, stemming more family suffering and helping them maintain jobs have become teachable moments for Block. "Out here you might have five minutes on the side of the road with a car running, and you can give them some information that saves a life," she says.

The Harm Reduction van leaves most days from the Santa Fe Mountain Center, a nonprofit that was schooled in community outreach from the AIDS epidemic. Its staff and educators have a network for AIDS education that includes clean needles and safe sex, two solutions that helped curb HIV infection here and elsewhere. When the state needed a syringe-exchange program for injection-drug users, the center stepped forward with its staff and expertise. Galer, a Chimayó resident, has been driving the route for four years. At first the state was exchanging 18,000 syringes a month in Santa Fe, Taos and Rio Arriba counties. Today it's closer to 50,000.

She and two other staffers also load up 25 bags of food from the Food Depot — bananas, cereal, cookies, canned vegetables, bottled water, potatoes, Gatorade, pet food and dog treats, as well as first-aid equipment and usually condoms.

Addicts often neglect their diet, and such staples can get their attention, start a conversation and eventually a relationship.

And success in Harm Reduction is all about relationships.

Curb service

Galer drives the Dodge van up through Nambé and parks along N.M. 76 across from the old apple shed in Chimayó. This was the Tuesday after a big weekend drug raid, so Galer is unsure whether her regulars will show, or if some might be in jail.

One woman pulls up and brings a box of used syringes. Galer asks about her son, and they hug.

"He's been clean for five years," the woman says. Block asks about her experience with Narcan, and the woman says she used it four months ago on a friend. It worked, and she needed more.

Two young men pull up in a car — new clients — and get syringes. Block pulls out the Narcan, shows them how to assemble the nasal atomizer onto the syringe and talks drugs — heroin, methadone, pain pills, booze. "Mixing is the most dangerous," Block says. "If someone is doing heroin and drinking, we tell them to do the heroin first."

"That's right, otherwise they can't control the dose," says one of the men.

He told Block about a friend who had passed out, couldn't breathe, and they tried to give him some milk.

For years, addicts have helped each other by shocking the system with cold water, salt water, milk or standing them up and walking. Sometimes it worked, other times they died. Today there is naloxone, trademarked as Narcan. Someone near the overdose victim can assemble the three-piece atomizer and spray the barrel of narcotic into the nose. Absorbed by the membranes, the drug works to block opiates from the brain emitters. Unless the person is dead, it usually works, Block says. She hands the men a plastic bag with two doses of Narcan and an instruction sheet.

The men nod as she talks, and they take the bag. Because Narcan is a prescription drug Block has to record the names of those who receive it in a log that goes to the state Health Department pharmacy.

A few minutes later, two men pull up in a pickup on their way to a contracting job. One said he used Narcan on a friend nine months ago. They were in town but did not call 911. If not for Narcan, "there are 20 people who I know who would have died," he tells Block. Block tells them that if Narcan does not work on victims they need to call 911, and under a new state good Samaritan law, they cannot be arrested for possession of drugs — though there are exceptions for dealers and those on parole or probation.

One car pulls up and asks for condoms, another a food bag. Two young boys on ATVs propel up and ask for Gatorade, but no one underage can exchange needles or receive Narcan.

The van leaves the intersection and moves into town, stopping at a strip mall off N.M. 68, the home of Inside Out, a nonprofit that helps heroin addicts stabilize with Suboxone treatment and peer counseling.

Block eyes a couple of Narcan recruits. She explains that having Narcan is not illegal, and that she gives it to friends and family who are not users. "It just takes 20 seconds to put this together," she says holding the vial and its two parts.

How do you know when someone is overdosing? Block asks. "Real slow breathing, purple or blue lips. ... Lack of oxygen is why they're overdosing ..." Block says. Because Narcan does not remove the opiate from the bloodstream, she tells them, friends need to stay with overdose victims at least an hour after Narcan to make sure they don't relapse. "Make sure they can get up and breathe on their own," Block says.

Connecting with the community

The two stop for lunch at an Española restaurant, and Galer visits with a new grandmother. Galer pulls out a photo of the baby that the woman gave her months ago. Then Galer says hello to a man who burglarized her home and whom she last saw when he went before the judge. They chat.

After lunch, Galer answers phone calls and stops at homes. "Hello, this is Sheilah," she tells a caller. "Do you guys need to meet up with me today? Do you need Narcan?"

Streaming down U.S. 285, a woman gives the van a high five, another holding groceries waves her finger.

Galer turns into the house of Michelle Silva, a mother of three grown children who don't use drugs. Still, Silva believes that Narcan has saved the lives of friends and family.

The last time she used it was a few weeks earlier when a friend injected heroin, didn't get high, then shot more — a total of 50 units.

"Her lips turned blue, she was breathing, but she was faint," said Silva, who used two vials of Narcan on the woman. It took 10 minutes for her to awake. "I made her stay here for a couple of hours. I gave her something to eat," Silva says.

Silva didn't take her friend to the hospital and she didn't call 911. "Since I had the Narcan, I was confident I knew what to do."

Six months ago, someone brought a young girl to her house who had overdosed on alcohol and heroin. In that case, the victim didn't wake up after the Narcan, so Silva did call paramedics, and the girl lived. "People know they can come here. They know I have Narcan," Silva says. She said neighbors also come for clean syringes and she will give those out, "but I won't give them my Narcan."

The van spins into a trailer park in front of a house with four flags — one honoring POWs.

Galer honks the horn but no one comes out, and she moves down the gravel to another home.

"Honk, Honk." One man says he'll be right out. Another says, "I don't need it this week."

Up a driveway in Chimayó and into a family compound, a woman and her niece come out with syringes. The woman says she's used Narcan on eight people in the last two years, Block says.

The last time was just two weeks earlier on two different family members. Each needed two doses of Narcan to breathe on their own. "They didn't know what had happened. We told them, "Thank God they got their lives back,' " the woman tells Block.

Galer hands them food baskets, two other men come and they accept cookies. Galer apologizes for missing the grandfather's rosary. They exchange stories about someone in jail.

The van pulls into another driveway and a woman comes out saying she's been off heroin 90 days.

"Wow, congratulations," Block says.

They talk about a friend in the hospital, and Block gives her bottled water and a bag of dog biscuits. A man wanders over from next door and asks for biscuits as well.

It's the last stop of the day. The van turns into a compound and parks in front of a trailer. A man with a bandaged hand comes out. Block looks at the wound and gives him clean bandages. Another man comes and asks for syringes.

The man who lives here carries a box of syringes used by himself, a girlfriend and a few neighbors — 900 in all over the past month. They get dumped in a hazardous waste bin, and he gets replacements.

Back to the man with the bandages, "I don't have antibacterial." Block tells him, "If you start getting a red streak up your arm, you need to go to the hospital."

Keeping communities safe

This is the crux of Harm Reduction, giving addicts the tools they need to live safely — even if they never get into recovery. The Harm Reduction Program used to include alcohol swabs, sterile water and tourniquets, but has been cut to the basics. Before needle exchange, Dr. Hayes said almost all the addicts she saw over age 30 had some form of hepatitis C, and the cost to the state was hundreds of thousands of dollars for each treatment. Now, she seldom sees the infection in younger users as long as they use clean needles.

"Harm Reduction prevents blood-borne pathogens from being spread among people who use illicit drugs," said Dominick V. Zurlo of the state Health Department. "It teaches people how to lead healthier, safer lives, and everyone benefits from that."

For Block, it's the conversations with addicts — about child vaccinations, schools, condoms, HIV, jobs and treatment — that are the intangibles of the program.

"I'm a public-health nurse. You can't say they're an addict and their life is not valuable. They're still good parents, good children, good brothers and sisters. Just because you're an addict, it doesn't mean you're a bad person. It means you have an addiction."

The van turns up the highway back to the Mountain Center. All 25 food bags are gone as well as 30 doses of Narcan and thousands of syringes — a good day for Harm Reduction.

By the numbers:

New Mexico heroin deaths (2007): 39
All other opiates/opioids: 242

Total enrolled Narcan patients since 2001: 6,894 people
Narcan used: 2,385 doses

Total syringe-needles dispensed in 2009: 1.4 million
Harm Reduction Program budget: $1.3 million
Harm Reduction employees: Two full-time positions