"The impact of federal funding should support a reverse in the increase in overdose deaths seen throughout the pandemic through increased naloxone distribution and the availability of additional syringe service programs, as well as providing spaces for individuals using substances to connect to programs and services that can provide additional education, support, and linkage to other services," Ruberto tells Well+Good.
Congress has allocated $30 million to enhancing harm-reduction interventions like syringe services programs within the American Rescue Plan, a COVID-19 economic stimulus package. The pandemic caused a huge rise in the number of overdose deaths. Between November 2019 and November 2020, the number of reported overdose deaths increased by 29 percent, compared to a 3 percent increase over the course of the previous year, according to data from the Centers for Disease Control and Prevention (CDC). The new policy has been met with opposition from those who argue that harm reduction encourages drug use.
What is harm reduction and why is it controversial?
"The Drug Policy Alliance defines harm reduction as a set of ideas and interventions that seek to reduce the harms associated with both drug use and ineffective, racialized drug policies," says Ruberto. "Harm reduction can include specific interventions designed to reduce harm associated with substance use, such as syringe exchange for IV drug users to reduce risks associated with sharing needles [such as] HIV or Hep C and other infections, naloxone distribution to prevent opioid overdose, and techniques designed to reduce use overall or use in safer settings."
Ruberto explains that harm reduction is considered a person-centered care approach. "It broadens the scope of available education, assistance, and support that can be provided to someone using substances who is not ready—and may never be ready—for complete abstinence from all or some substances," he says.
The availability of naloxone, a medicine that rapidly reverses an opioid overdose, in communities has shown to reduce mortality from opioid overdoses between roughly 20 and 40 percent. Syringe services programs are associated with about a 50 percent reduction in HIV and hepatitis C incidences. While proven to be effective, harm reduction is often met with a lot of pushback in favor of abstinence. Just last week, West Virginia's legislature passed a law placing new restrictions on syringe exchange programs which may force these programs to shut down.
"The controversies surrounding harm reduction are rooted in and connected to the stigma associated with any substance use in our society," says Ruberto. "This is tied to the criminalization of substances and substance use, and further entrenched in laws and policies that were designed to target and hence disproportionately impact Black, Indigenous, and people of color communities. In addition, the positive impact and success of abstinence-based models for many, including AA/12-step programs along with inpatient and outpatient treatment, leads many to believe that these approaches are the only ones that can be effective in working with someone who uses substances."
If a person desires, they can use harm reduction and abstinence together. For example, Ruberto says that harm reduction can also include a person abstaining from one substance while continuing to use another substance they deem less harmful.
"Any one individual’s relationship with any substance is a highly complex one," he says. "Here at The LGBT Community Center, in our substance use treatment program we do not view abstinence and harm reduction as polar opposites, but two ends of a spectrum of possibilities for a person to reach a relationship with substances that is healthiest for them and fully informed."
For help finding treatment, please contact the Substance Abuse and Mental Health Services Administration (SAMHSA) at 1-800-662-4357.
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