In 2016, when Donald Trump chose Indiana Governor Mike Pence as his running mate, it unexpectedly brought harm reduction to the forefront of the news. In 2014, the state of Indiana experienced a public health crisis— an HIV outbreak, spurred by intravenous drug use. It was reported that this outbreak was due, in part, to cuts in public health funding and Governor Pence’s opposition to sterile needle exchanges as an anti-drug policy. In the face of this public health crisis, Governor Pence allowed limited needle exchange programs to operate as part of the state’s response (see Indiana is battling the worst HIV outbreak in its history). When Governor Pence was announced as the Vice Presidential nominee, it spurred renewed public debate about needle exchanges and harm reduction as a strategy for reducing the negative effects of drug use.
Needle exchanges continue to be controversial but have slowly gained acceptance across the country. This year three states, Georgia, Idaho, and Florida, have approved bills to approve needle exchange programs (see Needle Exchanges Find New Champions Among Republicans and Key Florida Republicans Now Say Yes To Clean Needles For Drug Users). Unfortunately, many harm reduction strategies continue to be a lightning rod when it comes to addiction treatment. Safe injection sites are now making headlines and pose significant challenges. Earlier this spring the Justice Department sued the non-profit, Safehouse, which has plans to open a safe injection site in Philadelphia. A safe injection site would allow people who use drugs, to do so under the supervision of trained staff, who are prepared with naloxone in the event of overdose, and who can offer support in accessing treatment and social services. Though other countries have successfully used safe injection sites for years and some U.S. cities have explored these sites, Safehouse’s success could be the first official site operational in the U.S. (see Supporters Sue To Open Safe Injection Site In Philadelphia, Citing Religious Freedom).
The controversy around needles exchanges and safe injection sites make it clear, that though we have made progress, many harm reduction strategies are still controversial and face challenges from policymakers, communities, and health care professionals. Harm reductionists advocate for policies, resources, and interventions that meet people where they’re at, support their needs and reduce harms associated with drug use — without judgement, discrimination, or coercion. Grounded in human rights and social justice, programs typically aim to provide health care and social supports for all people — spanning those who use drugs, and those who don’t. Harm reduction may include sterile syringe exchanges, safe environments for drug users, non-abstinence-based housing, psychosocial supports, and education on safe drug use (see Harm Reduction Collation: Principles of Harm Reduction; Harm Reduction In The USA: The Research Perspective And An Archive To David Purchase; and Harm Reduction International: What Is Harm Reduction?).
Treating individuals with substance use disorders is complex and lies on a continuum—with total abstinence at one end, harm reduction strategies at the other, and medication-assisted treatment (MAT) falling somewhere in the middle. In the current environment, spurred by the attention that has been generated by the opioid and overdose death crisis, MAT, and some harm reduction strategies, are becoming more widely accepted.
Last month at The 2019 OPEN MINDS Strategy & Innovation Institute, we learned more about the principles of harm reduction in the session, Addressing The Opioid Crisis: An Opportunity For Innovation In Serving High-Risk Consumers, featuring Devin A. Reaves, Co-Founder & Executive Director for Pennsylvania Harm Reduction Coalition; and Paul Bacharach, President & Chief Executive Officer at Gateway Rehab. Mr. Reaves discussed his work in harm reduction with the Pennsylvania Harm Reduction Coalition, an organization that advocates for policies that improve the quality of life for people who use drugs, people in recovery, and their communities. His key takeaway for provider organization executives in the room was this: If you aren’t looking for ways to help consumers where they are, you are missing an opportunity. He explained:
There is literally 30 years of data that supports this work. Millions of times people have shot up at overdose prevention sites. No one has ever died there. You are a trusted provider in your community. If you don’t have a syringe service program, or a harm reduction service, you are doing a disservice to your community.
Ultimately, how an organization decides to approach harm reduction is dependent on organizational mission, treatment philosophy, and culture. Despite a shift in thinking about addiction treatment and the necessity of these services, the high costs associated with addiction demands that provider organizations get creative with both advocacy (see The Strategic Impact Of Addiction Treatment Legislation) and strategic partnerships so that they can deliver effective services (see Options For Community-Based Services For Behavioral Health). For more resources on either addiction treatment or ways to think about harm reduction, check out these resources in the OPEN MINDS Circle Library:
- The Challenges for Implementing Evidence-Based Practices in Addiction Treatment
- What Is “Housing First”?
- Opioid Clarity?
- Addiction as a Public Health Problem
- Options For Community-Based Services For Behavioral Health
- The Strategic Implications Of HIV & The Addiction Epidemic
- Opioid Addiction By The Numbers
- The Stigma Of Addiction Treatment Medication
- For Addiction Treatment, Medication & Beyond
- Untangling The Access Issues For Addiction Treatment
For more join me on August 14 at The 2019 OPEN MINDS Management Best Practices Institute for the session, “Implementing Provider Rating Scales For Substance Use Disorders: Payer Pilot Results & Impact On Benefit Design,” featuring: Samantha Arsenault, MA, Director, National Treatment Quality Initiatives, Shatterproof; Eric Bailly, LPC, LADC, Business Solutions Director, Anthem, Inc.; and Doug Nemecek, M.D., MBA, Chief Medical Officer – Behavioral Health, Cigna.