Chicago Recovery Alliance

A harm reduction program model offering a variety of services largely aimed at educating and aiding those who inject drugs

The Chicago Recovery Alliance (CRA) started harm reduction outreach in January of 1992 and, through collaboration with people who inject drugs, has grown to become one of the larger harm reduction programs in the world to date. CRA provides a wide array of services to people who want to reduce drug-related harm in their lives and in their communities.

Services include:

  • The provision of sterile injecting equipment
  • Naloxone training and distribution
  • Overdose and safer drug use training
  • Harm reduction counseling
  • Referral to treatment
  • Real-time drug checking using spectrometer machines and fentanyl test strips

These services are provided seven days a week, nearly every day of the year, at many different “brick and mortar” drop-in locations and by mobile outreach vans. CRA is staffed by a small team and is supported by volunteers.

One of CRA’s unconventional approaches has been meeting regularly with participants in what is called a Community Advisory Groups (CAG). These groups are composed of a diverse group of people injecting drugs in a geographically limited area. CRA pays participants for their expertise. CRA believes that CAGs have informed the initiation of their work, as well as providing valuable ongoing feedback. CRA offers overdose prevention and naloxone program training to individuals, educators, and agencies; they prioritize trainings that involve people who use drugs as well as staff.

Teaching injection drug users how to use naloxone is an effective risk reduction strategy.

Continuum of Care
Harm Reduction
Type of Evidence
Response Approach
Overdose prevention
Syringe service program / Needle exchange
Peer-reviewed Article

Evidence of Program Effectiveness

A small peer-reviewed qualitative study found that overdose prevention efforts build on the knowledge possessed by injections drug users. Specifically, teaching injection drug users how to use naloxone is an effective risk reduction strategy:

“Participants were 81% were male, their median age was 38. They reported having injected a median of 10 years and having witnessed a median of six overdoses in their lifetime. All described overdoses were recognized and responded to quickly. None of the overdoses resulted in a fatality and naloxone was successfully administered in 58% of the last witnessed overdoses. Administering naloxone for the first time was characterized by trepidation, but this feeling dissipated as the naloxone quickly took effect. Emergency medical personnel were called in 10 of the 31 described overdoses, including four in which participants administered naloxone. The overwhelming majority of experiences with police and paramedics were positive.” (Sherman et al., 2008)