Research Recognizes Reality

Dear HEAL Community,

HEAL communities are looking for every possible tool to address the alarming crisis of drug overdose deaths, including new ways to address the full set of needs of people who use drugs. Beyond treatment for their addiction, many people who use drugs need help staying safe and healthy, and alive.

Harm reduction approaches are those that connect people with the services and resources they want and need, including protection against overdoses and infectious diseases like HIV, hepatitis C, and associated health problems. It is a major focus toward saving lives in the evolving opioid crisis.

Harm reduction strategies include syringe services programs, which provide access to and disposal of sterile syringes and injection equipment; vaccines; testing; and connections to medications for infectious diseases and substance use disorders. Other examples of harm reduction tools are naloxone for opioid overdose reversal and rapid-acting fentanyl test strips, which can be used by individuals or community clinics to check local drug supplies for the presence of fentanyl, which is widely available and driving all-time high numbers of deadly overdoses.

Harm reduction approaches and programs aim to be very practical. For example, a January 8, 2022, New York Times headline read “New York Plans to Install ‘Vending Machines’ with Anti-Overdose Drugs,” announcing a citywide plan to stock the machines with sterile syringes, anti-overdose medications, toiletries, and safer-sex kits in neighborhoods that have been affected by drug overdoses. Similar efforts are being tried in other cities and in rural America, prompted by evidence that they help people stay healthy. Research shows that harm reduction policies like syringe services programs are cost-effective and reduce infection rates among people who use drugs. They also increase the likelihood of connecting people to treatment.

But we need to do more to keep people safe. Through implementation research that figures out how to apply research findings in the real world, we can tease apart which harm reduction strategies are most effective, guiding policy to fund programs in many more communities across the nation. To be most effective, our approaches need to be realistic and pragmatic. HEAL is supporting research on harm reduction through a funding opportunity (due date March 10, 2022) that aims to increase awareness and use of harm reduction approaches across the country.

This research aims to build a Harm Reduction Network consisting of nine groups of researchers testing harm reduction approaches in diverse environments across the country.

Many research questions can be asked to inform this topic:

• What community groups, organizations, and businesses can offer harm reduction services in the places people live and work?
• Can some of these strategies be accomplished through telehealth?
• What barriers prevent use of harm reduction strategies?
• Are stronger doses of overdose-reversal medications needed, given fentanyl and other synthetic opioids?
• Can fentanyl test strips be used effectively to test the current supply of street drugs, including stimulants like methamphetamine and cocaine?
• What are the best ways to provide lifesaving tools to people who are afraid to seek help?

These new studies, which we expect to begin in fall 2022, will inform currently funded HEAL research that is addressing several topics relevant to harm reduction. Among others, examples include:

• Linking justice-involved individuals living with opioid use disorders to syringe services programs and other resources
• Increasing access to naloxone in community pharmacies
• Establishing and testing opioid courts to speed access to treatment in justice systems
• Delivering buprenorphine in the emergency department (with the help of recovery coaches)
• Community-developed anti-stigma communication campaigns
• Optimizing recovery support services, including integrating these services with other health services
• Confronting stigma to facilitate people getting the help they need

Finally, the HEAL community collaborates with our federal partners and the communities they serve, including the Substance Abuse and Mental Health Services Administration and the Centers for Disease Control and Prevention. Both agencies have recently announced a new focus on creating harm reduction policies and practices that create a seamless continuum of care with a focus on community and connection.

As always, share information about HEAL with your networks and remember that we want to hear from you. It just takes a quick email to [email protected].