As the opioid crisis in Arizona has gotten worse, the conversation around how to address it has changed. It used to be that lawmakers would push for stricter punishments for drug users, for their paraphernalia and, in many ways, their very existence.
Now, there’s still talk of punishment, but it’s more focused on dealers and traffickers. There’s a lot more talk about protecting the lives of drug users from overdoses — with needle exchanges, fentanyl tests strips and more.
A lot of that change has to do with the work done by Haley Coles. Coles has been the executive director of Sonoran Prevention Works for 14 years, working in harm reduction for drug users in Arizona. She has lobbied at the legislature, grown networks of advocates statewide, and she has done it all while recognizing that drug users are human beings.
Because she was one.
She’s stepping down this summer and sat down with The Show recently to talk more about why — and her own story that led her there.
Full conversation
HALEY COLES: I was a teenager, and I found myself really struggling with depression and my mental health, and heroin was a really good balm for that. I really think that heroin actually saved my life. It made the pain of living tolerable enough. I do think that, for me personally, the pain of living was too much, and so that’s what I turned to — one of the things that I turned to — and I became dependent on heroin pretty quickly. I tried to stop a lot of times, and I wasn’t able to stop.
This was a different time. Fentanyl was not in the drug supply. The heroin was relatively consistent and predictable, and I found myself sharing syringes. And I knew very well that it was dangerous to share syringes. I knew young people — people my age — who had Hepatitis C, who had HIV, and I did everything in my power to not share syringes, but it was incredibly difficult to obtain sterile syringes.
LAUREN GILGER: So, 20 years ago when you were a teenager, right? But take us back to a little bit of what that was like in your mind. You said it saved your life in some ways, but it’s also so dangerous in others. What was it like when you tried to stop?
COLES: It was demoralizing. In my head, I wanted to stop, and another part of my head didn’t want to stop.
And that was so much of the challenge for me was I had this physical dependency that was very difficult to get through, and I would go through detox and withdrawals — I did that probably a dozen times — I would get through it, and then I’d say, OK, I’m only going to use every three days, so I won’t become dependent. And by the end of the first day, I had already used four or five times, and I just couldn’t stop. So yeah, it was hard to have my mind kind of at war with what I wanted.
The things that were really important to me became less important, and I found myself in some really dangerous relationships and dangerous situations. And I was really fixated on one thing, which was getting high and feeling better. I felt normal when I was high, and I felt not OK when I wasn’t high.
GILGER: What did it do to your life? School, family, etc.?
COLES: I dropped out of school. I did go get my GED, and I started at ASU — early. But the great thing about that is I could go to class and then I could sleep in the library for four hours, and then I’d go to another class, and I’d meet with my dealer, and then I’d go to another class.
So that worked for me, for a little while, and then I started dropping my classes in college. I had these dreams about going to New York University, and I wanted to be an actress, and I stopped doing theater. I didn’t even bother applying to out-of-state colleges. I had a job — I was just the worst employee ever.
So I don’t have the same kind of story as a lot of other people do, because I was so young and I didn’t have that much to lose. But a lot of the things that I hoped for just weren’t important to me anymore.
GILGER: Yeah. How did you get out of it?
COLES: Through medical and therapeutic intervention. My parents didn’t know, and I told them, and I ended up in detox the next day. And in my head, I was going to go to detox. I was going to get it out of my system and then maybe go to meetings, maybe get on medication, and I’d be fine.
But since I was underage, once I was institutionalized, my parents wanted to keep me institutionalized. And so I was in treatment for almost a year. I didn’t want to be there, but I didn’t really have much of a say, and I was on medications for opioid use disorder. I do believe that those also saved my life.
I was in therapy. I did 12-step. I did a lot of things. And I know that I also had an incredible amount of privilege where I didn’t have kids that I was taking care of. I didn’t have a career that was at stake. I didn’t have housing that I had to figure out how to pay for. I didn’t have legal troubles.
So I do think that so much of that positioning and that privilege really helped me with being able to do what I wanted to do, which was to stop using at the time. But yeah, it took a lot of things, it took a lot of support from a lot of people.
GILGER: And a long time, it sounds like.
COLES: And a long time. I tried stopping a dozen times. I went through detox over and over and over again, got it out of my system, and I wasn’t able to stop.
GILGER: Wow. OK, so you do stop eventually. You spend a long time working at that and making it happen it sounds like. You get out, and eventually you start working with people in the same situation. Which would be, I’m imagining, rewarding in some ways but also probably really difficult in others. Talk about the process of founding Sonoran Prevention Works and wanting to do this kind of work.
COLES: As cliche as it sounds, it really has always been a labor of love. As challenging as it’s been, it’s never felt hard because it was so important to me. In 2010, myself and two friends who had all kind of been in the same situation — we’d all shared needles, we’d all seen people overdose, some of my colleagues had overdosed themselves — we wondered why on Earth there wasn’t a needle exchange in Phoenix, which is one of the largest cities in the country, where there are needle exchanges all over the country, in every other major city.
And we started looking into the laws, and we saw that distributing syringes is a class six felony. It was a class six felony. We saw that Sheriff Arpaio had said that if he caught anybody distributing syringes, he would personally arrest them.
So this was information that we didn’t have before and we had and we said, “OK, well, we better be careful.” And we got this teeny tiny grant from out of state, for $1,200, and we used that to buy a whole bunch of syringes and cotton and cookers and alcohol wipes and all the things that people need for safer injection.
And we started riding our bikes around downtown Phoenix, and we were afraid that Sheriff Arpaio was going to personally arrest us. So we would put the syringes in, like McDonald’s cups and bags, and walk around parks and interact with people and tell them what we had.
And they were freaked out, too, because to be a person who uses drugs and to be in public, you’re at constant risk.
And so, it took some time to build relationships and to build trust. But eventually we started delivering syringes all over the Valley. We started doing outreach at certain locations that would allow us to do that.
And that was really the first step, was getting the supplies out there. But we knew, at the same time, we had to change culture and we had to change laws because it shouldn’t be three ragtag, former IV drug users breaking the law to distribute syringes on bicycles. This is a proven, decades-long public health intervention.
And so it was kind of us doing both of those things at the same time — doing the underground while doing the aboveground culture-changing work.
GILGER: So you started lobbying essentially, right? You get involved in lawmaking, in the Legislature — a place where you’ve spent a lot of time now, I’m guessing. Did you ever imagine yourself there? What was that like?
COLES: Oh, no. Never. But, I’ve kind of always done the things that nobody else wants to do. So, I was happy to put myself in that position. It was fine for me.
When I was younger, I wanted to be an actress. And when I was in college, I studied creative writing. And honestly, I felt like I was kind of able to meld those things along with my personal experience when talking to legislators, finding creative ways of speaking to their values while still being honest about my values and honest about what was needed.
Yeah, I definitely had to have some really hard conversations where policymakers basically told me that people like me shouldn’t be alive — that people like me deserve to die for our decisions, when what I know is that it’s not the choices you make, it’s the choices you have.
But my work at the Legislature, I feel so proud of it because year after year, going down there, eventually it made a difference. And we were able to legalize needle exchange programs as well as fentanyl test strips.
GILGER: Let’s talk about the approach that Sonoran Prevention Works has taken, because, as you’re saying there, it’s pretty radical — especially in a conservative state, at a conservative Legislature, dealing with lawmakers who probably think about drug use very differently. Your slogan is “building a healthy Arizona with people who use drugs,” right? So you’re asking people to take a different approach to think about people who use drugs differently and think about what that means a little differently.
Talk a little bit about first just what that is and the sort of mind shift you’re trying to explain to folks.
COLES: So we use a theory called harm reduction, and it’s similar to wearing a seatbelt when you’re driving. Driving a car is very dangerous. We don’t say don’t drive a car. We say wear a seatbelt, get a Volvo, put in airbags. And so it’s that same approach with drug use, where we’re not saying don’t use drugs. We’re saying that’s the choice that you’re choosing to make, there are things that can be done so that you can be safer despite making that choice.
I think that so many organizations who work in the substance use field really view people who use drugs as helpless and hopeless and sick, and the reality is that all of us use drugs. Some of them are legal. Some of them used to be legal. Some of them used to be illegal.
I think it’s helpful to humanize drug use and people who use drugs. Everybody has a different reason for why they’re using. And so first and foremost, we have to humanize people. We have to understand that we are all part of families and communities that are devastated when we become sick and when we die of preventable deaths.
And so our approach is acknowledging that drug use happens, that it’s real, that human beings have used drugs since the beginning of time, that we will never live in a drug-free world and that we can work with people to make positive change — whatever that positive change may be.
Some people want to stop, and they need help getting child care. They need help being able to pay for their apartment while they’re in treatment.
There are other people who don’t want to stop using and don’t see any reason to stop using. But maybe they want to change the way they use. Maybe they don’t want to use needles anymore. There are ways that we can support that.
Maybe they want to use less frequently. Maybe they don’t want to use when their kids are around. There’s just this wide array of options that our society doesn’t typically consider.
It’s either you’re using drugs and you’re going to get sick and die alone, or you’re not using drugs, and there’s really no in between. But in reality, there is. And that’s what our organization tries to do is to meet people exactly where they are and build people up, give people choices so they actually have choices and actually have options for being safer and happier.
GILGER: Right. I mean, bring us into some of those conversations you’ve had with lawmakers who probably saw this very differently, because the law comes into play here for them, right? Like you’re going to hear a lot of people say, “Well, this is illegal. We cannot support this. We cannot support people who do this or help them do it in any way.” How do you approach those conversations?
COLES: First off, laws change all the time. What was illegal 15 years ago might be legal today, and what was legal 15 years ago might be illegal today. So, I think also understanding that we are creating criminality. People who use drugs aren’t inherently bad people. They aren’t inherently criminals. But when you create laws that say that drug use is a criminal offense, then you are creating a criminal out of a person.
But, unfortunately, lawmakers didn’t start listening until we were in the middle of the worst overdose crisis that we’ve seen by the numbers. And with some of the policies that we were pushing for for a very long time, there were a lot of other policies that were introduced that just didn’t work.
The Arizona Opioid Epidemic Act of 2018, we had been pushing for legalized syringe service programs for years before that, and they kept saying no, and they kept saying, “We’re going to do this instead.”
And by the time we were able to get the syringe service program law passed in 2021, we said, “You guys already tried. You’ve tried a lot of different things. They weren’t evidence-based to begin with. You didn’t consult people who use drugs in their families,” and we’ve seen now over a few years that it really didn’t work and that things have gotten even worse.
So really, it’s those personal stories that have made the biggest impact. And so, whether it was my personal story, whether it was bringing in constituents who had personal connections or parents who had lost their kids, that was what really spoke to people — being able to understand that it’s whole entire families and communities who are affected by preventable death.
So, while we weren’t able to get lawmakers to get on board with decriminalizing drug use, we were able to get quite a bit of support in understanding these are the decisions people make, whether you like it or not, and there are tangible, inexpensive, easy solutions to keep people alive and to keep people healthy.

GILGER: How did naloxone change this conversation? I’m imagining it sort of dropped a maybe good bomb into the middle of it, right?
COLES: Oh, huge. Yeah. So, naloxone had been around since, I think, the ’60s or the ’70s for a very long time, and it was only used by emergency medical personnel. In the ’90s in Chicago, there was a needle exchange program called Chicago Recovery Alliance that got their hands on naloxone and started distributing it to their participants, to people who use drugs.
And dozens and then hundreds and then thousands of people were using naloxone to save people’s lives without calling 911, without going to the hospital. And we know that because there are criminal penalties, a lot of people who are using are really afraid to call 911 and for good reason.
So in 2012, when we were distributing our syringes in McDonald’s cups, we had some friends from out of state who sent us naloxone. And it was illegal in Arizona at the time to be doing it without prescription, to be distributing it without a medical professional there without prescription, that was not legal.
And we did it anyways because people’s lives depended on it and because it was safe and it was the right thing to do. And we started hearing those reports of overdose reversals and lives saved.
And so, in 2015, on a larger scale, when the health department and policymakers started talking about naloxone in Arizona, we said, “Hi, we’ve already been doing this. We’ve been doing it for years, and that’s been working.”
It did unfortunately take two years at the legislature to get naloxone access expanded to all laypeople. But it happened, and it’s been incredible.
We’ve distributed over a million doses of naloxone. We’ve had nearly 30,000 lives saved as a result. And that was all because of community organizing and people who use drugs themselves saying, “This is what we need and we’re going to go and get it.”
And I think we’re pretty past the concerns that people used to have of, “Oh, if there’s naloxone around, then people will feel safer pushing it to the edge and using and potentially overdosing.” Study after study has shown that that’s not true, and if you just use common sense — if a person overdoses and then they are hit with naloxone, they’re not high anymore, they’re very sick. They’ve basically wasted whatever money they used to get high.
It’s a horrible experience to wake up from an overdose after receiving naloxone. So, that’s really not an actual concern, that’s not a reality.
But there has been so much emphasis on opioid overdose and not enough on stimulant overdose. And we’re seeing — and we’ve been saying this for a long time, and the data is showing it — that people are overdosing more and more and dying from stimulants. And there is unfortunately not a naloxone for stimulants.
GILGER: Stimulants like what?
COLES: Like meth and like cocaine.
GILGER: So let’s talk then about what comes next here, because we’re talking to you now about the work that you’ve done here for a long time and the important work you’ve done. But you’re leaving, right? This is the last couple of weeks of this job for you. And you’re not leaving Phoenix, I understand, but talk a little bit about why and what’s next for you.
COLES: Yeah, I’ve known for a long time that I wasn’t going to do this forever and how important it is to have leadership from other people, from a lot of different people. I never wanted this movement or this work to be dependent on one person.
And so for years, I’ve been working to bring more and more people in. Our organization has trained thousands and thousands of people on harm reduction, how to implement it. We’ve got 40 incredible staff who deeply believe in and understand harm reduction.
And not many people get to say that they accomplished their dreams. And I have. It was my dream to legalize syringe service programs. And I did that and it happened. And that doesn’t mean that there’s not more work to do. There’s still so much more work to do, and it doesn’t have to be me.
GILGER: Good luck in what is next for you. That is outgoing executive director of Sonoran Prevention Works, Haley Coles. Haley, thank you so much.
COLES: Thanks for having me.