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In part one of this article – read it here – we introduced the concept of harm reduction in addiction treatment. We provided a brief history of harm reduction, described the three primary goals of the approach, then outlined the four core principles that guide all harm reduction initiatives. We ended part one with the encouraging news about the first significant allocation of federal funding for harm reduction programs: an initiative called HEAL: Helping to End Addiction Long-Term.
The HEAL initiative provided 36 million dollars for harm reduction research. This money funds pilot programs related to eight areas key essential to bringing harm reduction services to people in need:
- Education
- Overdose prevention/reversal
- Medication-assisted treatment (MAT)
- Needle & syringe programs
- Drug consumptions rooms
- Drug checking programs
- Housing support
- Legal services
We’ll discuss each of the program areas below. We’ll describe how they can help meet the objective that drives all harm reduction programs in the U.S. That objective? Reverse the ongoing, upward trend in drug addiction and overdose called the opioid crisis. Since 1999, the crisis has claimed over a million lives and caused significant harm to millions of others.
Harm Reduction Policies and Programs
We describe the fundamental principles and theoretical foundation for harm reduction in addiction treatment part one of this article. Now we’ll share how we – meaning treatment providers alongside local, state, and federal government entities – plan to apply these principles in public policies and programs with the help of funding provided initiative like HEAL.
These eight program areas – while not the sum total of harm reduction efforts nationwide – represent the priorities for effective harm reduction as established by the non-profit advocacy group Harm Reduction International (HRI), endorsed by the Office of National Drug Control Policy (ONDCP) and prioritized in our revised National Drug Control Strategy, developed in 2022.
1. Education and Awareness
Education programs provide people the real information about drugs, drug use, and addiction treatment. In the context of harm reduction in addiction treatment, education classes include specific information on opioid use and opioid use disorder (OUD), including the harms associated with OUD and how to address them. In addition, harm reduction education programs include offering workshops and classes about how to access social services, including vocational programs, housing support, adult education, general health care, and addiction treatment.
Another component of education and awareness around harm reduction is sharing basic information about harm reduction to people with no direct connection to drug use or the opioid crisis. We understand that at first blush, some parts of harm reduction – needle and syringe programs and drug consumption rooms, for instance – may seem unusual, counterproductive, or too progressive. Educating the public about why their tax dollars should go to these programs is important in maintaining support for ongoing funding and commitment to harm reduction.
2. Overdose Prevention and Reversal Programs
Education about drug use and the risks of opioid use and opioid overdose is the best tool we have to prevent overdose, because effective education can prevent the behavior that leads to illicit drug use before it happens.
Harm reduction programs spend significant time and energy on advocating a medication called Narcan, which contains the medication naloxone. When administered correctly and in time, Narcan can reverse an opioid overdose and dramatically reduce the likelihood of death. It’s a lifesaving drug, which, thanks to federal funding and the new national drug control policy, is now readily available nationwide from both pharmacies and public/community health clinics.
Making Narcan easily available to people who use opioids – or their friends or loved ones – means they have access to the same medication emergency medical personnel like paramedics use when they respond to an overdose call. When the Food and Drug Administration (FDA) approved Narcan for over-the-counter sale on March 2023, it was an important step that harm reduction experts have been recommending for years.
Let’s make that clear for anyone reading this who uses opioids or has friends or loved ones who use opioids: you can now get Narcan from a pharmacy without a prescription. Having Narcan on hand can save a life. Therefore, we recommend considering finding Narcan and keeping it close: it saves lives.
3. Medication-Assisted Treatment (MAT) Programs
Medication-assisted treatment (MAT) for opioid use disorder (OUD), also known as opioid agonist therapy, involves the use of three medications for opioid use disorder (MOUD): buprenorphine (Suboxone®), Methadone, and Naltrexone.
While Naltrexone completely blocks the action of opioids in the brain and prevents both the analgesic and euphoric properties of opioids, buprenorphine and methadone act in a slightly different manner. They occupy opioid receptors, which reduces cravings, decreases the severity of withdrawal symptoms, and helps people with opioid use disorder (OUD) reach a physical, emotional, and psychological space where they can engage in treatment and start on the road to recovery.
The Substance Abuse and Mental Health Service Administration (SAMHSA) and the World Health Organization (WHO) consider MAT the gold standard treatment for people with opioid use disorder.
For more informant about MAT for OUD, please read these articles on our website:
Medication-Assisted Treatment
Methadone Treatment for Opioid Use Disorder
Suboxone® Treatment for Opioid Use Disorder
In addition, there’s an increase in the number of programs that offer MAT to people incarcerated in prisons and jails. To learn more, please read this article by our Medical Director, Dr. Chris Johnston:
The Case for Medication-Assisted (MAT) Treatment in Jails and Prisons
4. Clean Needle/Syringe Programs
These programs can cause significant controversy and often lead to robust resistance from people who haven’t researched how or why they work. Needle and syringe programs provide clean needles/syringes for people who use illicit, intravenous drugs such as heroin. Opponents assert they promote and condone illicit intravenous drug use. However, evidence shows these programs are effective for the following reasons:
- Safe/clean needle/syringe programs prevent the spread of infectious diseases, including hepatitis C and HIV, by offering sterile needles/syringes to people at risk of reusing or sharing share needles/syringes.
- These programs get people who inject drugs off the street and out of unsanitary shooting galleries common to illicit IV drug use. They provide a safe atmosphere where people who use illicit IV drugs can talk about drug use – and the desire to enter treatment – in an atmosphere characterized by openness and understanding.
- Clean needle/syringe sites are most often managed by harm reduction advocates who help connect IV drug users to essential support, such as treatment for OUD, and lifesaving medication like Narcan.
5. Drug Consumption Rooms
This component of harm reduction also receives stiff resistance in the U.S. However, like clean needle/syringe programs, experts on treatment – including the American Society of Addiction Medicine (ASAM) and the American Medical Association (AMA) – fully support their use. A drug consumption room is a safe, clean place where a person can access and utilize safe supplies under direct supervision. Staff in these rooms can help connect IV drug users to treatment programs, offer emergency medical assistance if needed.
Research indicates drug consumption rooms decrease transmission of infectious disease, decrease drug-related criminal activity, crime associated with drug use, and decrease rates of fatal overdose. Data collected at the only two drug consumption sites in the U.S. – both in New York City – report the following data, after two years of operation:
- 4,486 total participants
- 117,559 visits to safe injection rooms
- 1,339 overdose reversals
- Over 2 million units of drug waste (used needles, etc.) collected
6. Fentanyl Testing/Checking Services
Drug testing services are now an integral component of harm reduction services. Over the past several years, the DEA reports an escalating presence of dangerous substances in illicit drugs. These include fentanyl and xylazine, which have been detected in heroin, methamphetamine, cocaine, and others. Drug testing/checking programs individuals to test a substance for the presence of dangerous substances like fentanyl.
7. Housing
Evidence shows that access to safe and stable housing can reduce drug use, drug addiction, and fatal drug overdose. In some cases, housing support for people with substance use disorder (SUD) requires abstinence, but others do not. Research indicates shows that programs like Housing First – a program that has no sobriety or abstinence requirements for access – can help decrease drug consumption and promote overall wellbeing for people in recovery who experience housing instability.
8. Legal Services
In the context of harm reduction, legal services are necessary on at least two levels: the personal and the public. On the individual level, attorneys or legal aid groups support people in the criminal justice system with various needs. They can help them with charges related to drug use, and advocate for access to evidence-based treatment. In the public sphere, attorneys and legal aid groups have work to do. They can help overturn laws, policies, or programs that stigmatize people with substance use disorder. They can also help facilitate the transition from a punitive system to a supportive, reform-based system. A reform-based system is one that provides access to a comprehensive array of harm reduction programs and services.
Reducing Harm: Essential to Our National Drug Control Strategy
The Substance Abuse and Mental Health Services Administration (SAMHSA) is currently in the process of writing a Harm Reduction Framework. The framework will establish a set of best practices to guide harm reduction in addiction treatment around the country. This is a crucial step. It will help implement the harm reduction priorities identified in the National Drug Control Strategy published in 2022 by the Office of National Drug Control Policy.
Harm reduction works. At Pinnacle Treatment Centers, we advocate comprehensive harm reduction services for everyone in need. Keep an eye on our blog for more information, and the next article in our Harm Reduction Series. We’ll discuss the latest harm reduction efforts in California, where we own and operate Aegis Treatment Centers/A Pinnacle Treatment Center Network. Our California locations offer a wide range of SUD treatment services, including medication-assisted treatment (MAT), a core component of the harm reduction approach to opioid addiction.
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