How Harm Reduction Can Help Win the Fight Against Opioids

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Last year, nearly 70,000 people in the United States died of opioid-related overdoses, up from 49,860 in 2019—a rise driven by synthetic opioids.

Despite three years of aggressive enforcement-based attempts to target the trafficking of these drugs, opioids increasingly dominate illicit markets across the country. The current approach is failing both to reduce supply and to prevent deaths.

Furthermore, it has health and criminal justice consequences of its own, especially in communities of color.

It’s time for a different response.

portrait of woman

Diane Goldstein

Harm reduction can be that solution, helping people mitigate the risks associated with certain behaviors. Most Americans already engage in some version of it, such as wearing seatbelts, and it is among the most effective ways to reduce the potential negative consequences of substance use.

When it comes to opioids, harm reduction primarily aims to decrease infectious disease transmission and reduce overdose risk through a variety of strategies: providing sterile needles and syringes; making fentanyl test strips or naloxone, an overdose reversal drug, widely available; and promoting medication-assisted treatment, widely accepted as the “gold standard” therapy for opioid-use disorder, in place of abstinence-only recovery.

Unfortunately, although both red and blue states have been hammered by the opioid crisis, lawmakers from West Virginia to Indiana continue to resist this life-saving approach. These legislators are missing the far-reaching benefits of harm reduction policies. Beyond helping individuals who misuse substances, it keeps communities and first responders safer; saves taxpayers money; and connects people with treatment and other supportive services.

An Argument for Medication Assisted Treatment

Although opponents worry that harm reduction enables drug use and increases crime, numerous studies show that it does neither. In fact, medication-assisted treatment (MAT)—in which substances such as buprenorphine help mitigate cravings and withdrawal symptoms—is better at reducing long-term use than abstinence-based alternatives.

Furthermore, just engaging with syringe services programs increases people’s likelihood of entering detox.

However, treatment resources are limited: of the two million people in the U.S. with an opioid use disorder, a majority want help, yet only 26 percent are able to access treatment in a given year. Thus, it’s key that harm reduction leads people to engage in fewer criminal and disruptive activities, even if they continue to use.

[see: Dydyk AM, Jain NK, Gupta M. Opioid Use Disorder. [Updated 2021 Jul 12]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2021 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK553166/]

portrait of woman

Stacey McKenna

For example, syringe exchange programs and strategically placed sharps containers encourage proper syringe and needle disposal, keeping dangerous equipment out of parks and playgrounds. When syringe possession is legal, people are more willing to admit they possess paraphernalia, reducing first responders’ and police officers’ risk of occupational needlestick injuries and improving community-law enforcement relations.

Being on MAT cuts patients’ likelihood of overdosing or engaging in criminal activity, and when the treatment is available in jails and prisons, drug-related recidivism rates consistently fall below 50 percent, compared to 77 percent in the absence of such programs.

These health and social benefits have financial payoffs that should make their implementation feasible and appealing. Opioid use disorder and fatal overdoses cost the United States an estimated $1.02 trillion in 2017. Harm reduction services and policies can drastically reduce that economic burden.

Syringe Services are Cost Effective

Syringe services programs—which are legal in more than 30 states—have been called one of the most cost-effective public health interventions ever funded since their inception in the 1980s. Every dollar spent on syringe services programs saves taxpayers about $27 in healthcare expenses alone.

Meanwhile, MAT promises a four to ten-fold return on investment, and several studies suggest heroin-assisted treatment is even more cost-effective, likely because of increased declines in patients’ criminal activity. While savings from individual interventions varies, more comprehensive programs are generally deemed the most cost-effective.

Criminal justice professionals in the U.S. increasingly recognize the impact of substance use disorders and harmful overcriminalization. To combat this, stakeholders—including lawmakers on both sides of the aisle, police and other criminal justice professionals—must help design and support policy that promotes community health while mitigating the disparate harms that substance misuse and enforcement-first strategies enact on their constituencies.

 Harm reduction is an evidence-based solution that proves we can save lives without endangering or impoverishing our communities. The approach reduces suffering, frees up resources and helps build a safer society for all.

Lieutenant Diane M. Goldstein (Ret.) is a 21-year veteran of law enforcement who served as the first female lieutenant for the Redondo Beach Police Department in California. She is the executive director for the Law Enforcement Action Partnership, a group of criminal justice professionals that work to advance justice and public safety solutions. She is a guest columnist for many media organizations, and is recognized as a subject matter expert on criminal justice and drug policy.

 Stacey McKenna, Ph.D., is a medical anthropologist and senior fellow in Integrated Harm Reduction at the R Street Institute. She researches and writes about practical ways people and policy can mitigate the risks associated with a range of behaviors, including sex and both licit and illicit drug use.

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