Harm reduction is an important movement that started thirty years ago in the early days of the HIV epidemic, when people who inject drugs and their sex partners were dying of AIDS at alarming rates. Harm reduction is a framework for meeting people where they are at and reducing the negative consequences of drug use. The movement emphasizes having respect for all people and ensuring high quality care for them. The Harm Reduction Coalition defines the core principles of harm reduction as the following:
- Accepts that licit and illicit drug use is part of our world and works to minimizes the harmful effects rather than punish or ignore them;
- Understands the complexity and multifaceted nature of drug use and acknowledges that some ways of using drugs are safer than others;
- Prioritizes quality of life rather than absence of drug use as a criteria for all successful interventions and policies;
- Calls for the provision of non-judgmental and non-coercive services and resources to people who use drugs in the community they live;
- Ensures that current or former drug users have a real voice in the creation of the programs that serve them;
- Seeks to empower drug users to reduce the harm of their drug use by sharing information and support for each other;
- Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm; and
- Does not minimize the real harm and danger associated with licit and illicit drug use.1
With an opioid epidemic raging across the United States, harm reduction is an increasingly important framework for local health departments to employ in their response to rising overdose deaths and increasing incidence of hepatitis C virus (HCV) in their communities. Since harm reduction will be a vital component in curbing the harms of the opioid epidemic, NACCHO staff attended the 2016 Harm Reduction Conference in San Diego this November.
The Harm Reduction Conference is a biennial event attended by a diverse community – drug users, governmental public health, clinicians, frontline service providers, researchers, law enforcement, and policymakers – who participate in panel discussions, workshops, and town halls on key issues. As Alex Shirreffs, Viral Hepatitis Prevention Coordinator for the Philadelphia Department of Public Health describes, “Coming to the Harm Reduction Conference feels like a family reunion. It’s amazing to be surrounded by public health rock stars who believe in treating some of the most marginalized people in our society – people who use drugs, sex workers, people of color, immigrants, LGBTQ folks – with dignity and making sure they have access to tools to live a healthy life.”
This year’s conference highlighted recent successes of harm reduction including increased acceptance of naloxone and expanded access throughout the United States; the recent changes in the federal funding ban that allow additional resources for syringe services programs; bipartisan support for state syringe services program (SSP) legislation; and greater access to substance use treatment, particularly medication-assisted therapy such as buprenorphine. Some cities are even establishing safe injection sites. The conference also highlighted innovative solutions to the diminishing resources, soaring need, and changing demographics that are driving programs from urban centers to rural and suburban communities.
Many city and county health departments shared the work they are doing to support harm reduction. New York City Department of Health and Mental Hygiene has developed a syringe exchange-based model of peer navigation for people living with hepatitis C, Louisville Metro Department of Public Health and Wellness has recently established a syringe exchange to meet the growing demand in Appalachia through innovative efforts to gain political buy-in, and San Francisco Department of Public Health has developed a public health detailing program to increase education and awareness of naloxone, an opioid overdose reversal medication, among healthcare providers. San Francisco is also the first city to establish a plan to eliminate hepatitis C, the End Hep C SF initiative, and the health department shared its role in the program. The CDC also showed their commitment to the issue and held a listening session titled “What Should the CDC Response to the Opioid Epidemic Crisis Look Like?”
NACCHO is committed to supporting its members as they respond to the Opioid Epidemic. NACCHO’s Winter issue of NACCHO Exchange will highlight what local health departments, including San Francisco Department of Public Health, are doing across the country to reduce and prevent overdoses, ensure access to substance use treatment, and prevent the spread of bloodborne pathogens such as HIV and HCV through injection drug use. This issue of NACCHO Exchange will be available in the NACCHO Bookstore in late February 2017. Stay tuned!
1. Principles of Harm Reduction. Retrieved November 28, 2016 from: http://harmreduction.org/about-us/principles-of-harm-reduction/.