October is National Substance Abuse Prevention Month, an opportunity to acknowledge the impact of substance use in the U.S. and honor the people on the frontlines of the substance use epidemic—from local health departments, to community-based service providers, to people who use drugs (PWUD) and their loved ones. The epidemic of substance use is closely interconnected with HIV, STIs, and viral hepatitis. Consequently, a coordinated approach is needed to effectively combat this syndemic. That’s why this October, NACCHO is highlighting the role of harm reduction in the prevention of substance use, infectious diseases, and related health outcomes.
After decreasing between 2017 and 2018, preliminary data indicate that fatal overdoses increased in 2019, and the COVID-19 pandemic appears to be driving another increase in overdoses. The corresponding rise in injection drug use has catalyzed the spread of HIV and viral hepatitis: HIV diagnoses among people who inject drugs (PWID) increased 11% between 2016 and 2018, and hepatitis C (HCV) incidence rose 71% between 2014 and 2018. Substance use is also closely associated with STIs and the behaviors that contribute to their spread, further demonstrating the need for a coordinated approach to substance use, HIV, STIs, and viral hepatitis. Not only are these epidemics closely interconnected, but they share social and structural risk factors, including poverty; inequitable access to housing, healthcare, and employment; stigma; and mass incarceration.
Harm reduction refers to a set of strategies that reduce the harms associated with substance use, including syringe services; education and counseling; the provision of the overdose reversal medication naloxone, fentanyl test strips, and condoms; and the provision of or referral to HIV, STI, hepatitis, or substance use disorder services. By meeting people where they are, harm reduction providers equip PWUD with tools to protect themselves from infectious diseases and overdose and build trust with a population that is often disconnected from public health and healthcare services.
Harm reduction is a powerful tool for the primary prevention of HIV, hepatitis B and C, and overdose. Syringe services programs reduce HIV and HCV incidence by 50%. By distributing naloxone and fentanyl test strips or by providing safe consumption counseling and education, harm reduction providers are also able to prevent fatal overdoses.
Harm reduction providers also play important roles in the secondary and tertiary prevention of substance use, infectious diseases, and related health outcomes. Harm reduction providers often offer testing and treatment or linkage to care for HIV, STIs, and viral hepatitis, ensuring early detection, improving health outcomes, and reducing further transmission. Local health departments and healthcare providers can play a similar role by screening for substance use among patients seeking HIV, STI, or hepatitis services and connecting them to harm reduction services or substance use treatment.
While harm reduction services are designed to meet the needs of PWUD, regardless of where they are in their journey of substance use or recovery, the trust they build with clients often leads to reductions in substance use and increased access to treatment. PWID are five times more likely to enter substance use treatment and three times as likely to reduce or stop injection drug use if they regularly visit a syringe services program.
Harm reduction service providers play a critical role in the primary prevention of HIV, viral hepatitis, and overdoses and the secondary and tertiary prevention of substance use and related health outcomes. To learn more about the safety and effectiveness of harm reduction services or opportunities for local health departments to provide or strengthen harm reduction services, check out NACCHO’s Syringe Services Programs & Other Harm Reduction Strategies policy statement.