The Issue:

 

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.