ADVANCING HARM REDUCTION POLICY & PRACTICE
The United States is in the midst of a drug overdose and addiction crisis. Nearly 200 Americans are dying from opioid-involved overdoses every day. Nationwide, healthcare, societal, and criminal justice costs associated with addiction and its consequences are mounting. As injection drug use increases, so does the risk of transmission of infectious diseases including hepatitis C and HIV, each carrying their own human and economic costs.
To addressing opioid use disorder, overdose and the transmission of HCV and HIV, we can draw on interventions that are well-studied and cost-effective. Proven harm reduction tools include syringe service programs, naloxone distribution, 911 Good Samaritan laws, supervised consumption facilities, and low-threshold opioid agonist therapy. However, despite their demonstrated effectiveness, the level of coverage of harm reduction interventions is abysmally low in the United States and many countries around the globe.
At present, there are numerous structural barriers to implementing and scaling harm reduction programs. These include a lack of political support, chronic under-investment; overt hostility among policy-makers; legal and zoning barriers; direct and indirect interference by law enforcement; and a lack of technical support and data-driven tools to maximize their reach and efficiency.
Although organizations that support harm reduction policies and programs do exist, there are no national, regional, or local entities that provide comprehensive resources for breaking down these structural barriers. The advancement of harm reduction policies and programs has thus been slow and inconsistent, while progress in hard-won battles has too often been rolled back. On the federal level, one illustration of this glacial and fragmented progress is the continued ban on the use of federal funds on syringe supplies. On the state level, only 20 states and Washington, D.C. authorize syringe exchange programs by statute. Locally, the shuttering of existing syringe service programs in high-need jurisdictions of California, Indiana, and West Virginia present recent examples of aborted advances.
With the overdose fatalities continuing to surge and new outbreaks of HCV and HIV underway in Ohio, Massachusetts, West Virginia, and Indiana, a coordinated national harm reduction strategy has never been more urgent. The tools we need to address these overlapping crises are already available, but their effective deployment is stymied by stigma and misguided policy. It is time for the nation to mobilize these resources effectively and bring them to scale.
Massachusetts Syringe Exchange Programs (1994-2018)
Supervised Consumption Site
Opposition Response Paper & Advocacy Tool
Stigmatization of individuals experiencing substance use disorder (SUD) is pervasive in news media, medicine, and society. Supervised Consumption Sites (SCSs) are difficult to implement due to this stigmatization, despite considerable evidence showing that they prevent overdoses from turning fatal, increase safe injection hygiene, and improve access to SUD treatment. There are currently more than 100 sites in 11 countries achieving these outcomes. Multiple US cities are considering SCSs, however, none operate yet. This project assessed the landscape of SCS stigma in Boston to provide public health advocates the data necessary to respond to stigmatizations. First, we conducted a news and social media review in excess of 100 stories published by Boston news outlets between 2017-2020 about SCSs. We compiled negative public comments to identify SCS misconceptions in Boston. We found that Bostonians were concerned about increased crime, public spending, and condoning “illegal” activity. Second, these misconceptions were the basis for a comprehensive literature review on SCSs to aggregate considerable evidence responding to these misconceptions with evidence-based research. Ultimately, this culminated in an advocacy tool that is presently used in Boston’s harm reduction community.
This tool is designed for harm reduction advocates to counter misconceptions, community stigmas, and fears about supervised consumption sites with evidence-based research. This guide breaks down these myths and assumptions in an organized and aesthetic format that can be disseminated to educate the public.
Additionally, we produced a detailed research paper expanding on this analysis and the growing body of evidence in support of supervised consumption sites.