Kate Deskey
Dec 14, 2022
Over $160 million has been invested in Massachusetts harm reduction programs. Yet, these measures have not yet diminished the opioid, and overdose, crises.
With overdose deaths rising in Massachusetts, state and federal government funds are allocated towards harm reduction programs that claim to reduce risk of overdose and substance abuse. However, with the available data and research, there is no evidence that harm reduction services are effective in actually reducing the number of overdose deaths.
The U.S. Department of Health & Human Services granted Massachusetts an opioid response grant of $57,647,564 in September 2022. The Massachusetts Department of Public Health has invested an additional $120 million since 2016 into services such as STI testing, needle exchange, overdose prevention education, and risk reduction counseling and supplies. Despite allocating significant funding toward overdose prevention, the overdose death rate increased by 8.8% in 2021.
“By the end of 2022, over 130,000 people will have lost their lives to accidental drug overdose,” said Brittney Ballantyne, representative of the National Harm Reduction Coalition. “It doesn’t have to be this way. We believe that, together, we can create a world healing from harm, free from judgment, and built on equity.”
A key component of harm reduction efforts is the non-committal approach. These programs do not require individuals to be sober to access their services and do not have any measures to check in with individuals after leaving the facility.
“They’re helping keep people alive long enough so that you can get them into full treatment and hopefully be able to move them to a healthier space,” said Allison Bauer, former Director of the Bureau of Substance Addiction Services (BSAS) of the Massachusetts Department of Public Health.
Harm reduction facilities which provide needle exchange or risk reduction supplies serve as an entry point, or gateway, into a broader system of care and education, Bauer said. Researchers disagree about whether this gateway approach is effective in combating the overdose crisis, despite the clear connection between supervised drug use and treatment.
A study by Norah Palmateer concluded that needle and syringe exchange programs are ineffective in reducing the transmission of viruses amongst drug users. Experts at the Brookings Institute found that because experimental trials are unethical in opioid use, there is not yet adequate evidence to prove that these needle and syringe exchange programs are effective in combating virus spread or reducing overdose deaths. The study’s authors declined to comment on this story. Studies in public health literature claim the opposite: these measures are effective in making drug use safer.
“People who are otherwise opposed to these programs, when they see what happens in their community, they often reverse course and recognize the other advantage with the clean needle programs,” said Bauer. “You have the opportunity to give people some counseling at the time that you’re giving [needles] to them.”
Bauer traveled to Australia to meet with colleagues who also worked on reducing the spread of HIV through similar programs. She learned about how they used safe injection sites to build relationships with people in the community. Creating these relationships can increase the likelihood of getting individuals into care support and treatment.
The Medically Supervised Injection Centre (MSIC) in Sydney has supervised over a million injections and managed over 8,500 overdoses with zero fatalities. Since they opened in 2001, they have made approximately 14,500 referrals to additional support and treatment. Of clients who regularly sought injection supervision, 80% accepted referrals for further treatment of their condition.
“It’s a pretty powerful tool from a harm reduction standpoint,” said Bauer. “By preventing injury, preventing death, giving them medical assistance and hopefully connecting them to referrals…people work to minimize the harm on [drug users].”
The National Harm Reduction Coalition has implemented measures in the past year to address the rise in Hepatitis C amongst opioid users by providing screenings, harm reduction and community education in five states. They also aim to strengthen the healthcare infrastructure surrounding overdose prevention.
“These vital strategies helped reduce HCV transmission and supported the health of people who use drugs in underserved communities,” said Dr. Orisha Bowers, Executive Director of the NHRC, in a written statement.
In addition to providing clean needles and supervising injections, harm reduction facilities also provide individuals with doses of naloxone. Naloxone displaces opioids from receptor sites in the brain and reverses respiratory depression, which is typically the cause of overdose deaths, according to a report by SAMHSA.
Massachusetts’ BSAS couples needle exchange programs with Naloxone distribution in Opioid Overdose Education & Naloxone Distribution (OEND) programs in order to give users the chance to reverse an overdose themselves.
“If you don’t die, you have a chance of getting into treatment. These OEND programs are the types of programs that couple all of the different elements of harm reduction,” said Bauer.
A 2018 study by the IZA Institute of Labor Economics found that naloxone may unintentionally increase opioid abuse. Their research shows that reducing the risk of death from opioid use can make riskier opioid use more appealing. The study concludes that saving the lives of active drug users won’t deter them from further abusing opioids. Unless there is a guarantee of full rehabilitation, drug users who seek these harm reduction services don’t improve their chances of avoiding death by overdose. There are unintentional trade-offs to providing harm reduction services and policymakers need to be careful when choosing how to combat the overdose crisis, the study warns.
However, a study on Massachusetts OEND programs found observational evidence that overdose death rates were reduced when potential bystanders were trained to prevent, recognize, and respond to opioid overdoses. This discrepancy in the effectiveness of harm reduction programs seems to be consistent throughout the research available on the topic.
“It’s explosive for politicians and still very controversial ethically among people in the medical community. Some critics say harm reduction enables or encourages drug use. One problem with these cutting-edge programs is that they’re still so new that there’s not a lot of great research showing whether the benefits outweigh the risks,” said NPR correspondent Brian Mann in an interview.
Bauer believes that harm reduction is the best approach to connecting with opioid users in an environment free from judgment.
“You couldn’t just have dry shelters because you would be cutting people off from the potential of being healthy. You need to be able to have a space where they can get healthy,” said Bauer. “It’s a compassionate care model and it’s a model that doesn’t bring judgment.”
The City of Boston’s Access to Harm Reduction, Overdose Prevention and Education (AHOPE) program is based in a facility on Massachusetts Avenue near the Boston Medical Center. They provide harm reduction services to active drug injection users. There are no public records about the amount of people whom they’ve served or information on how they determine that their services reduce overdose deaths in Boston. The Boston Public Health Commission failed to provide these records before the publication of this article, claiming they needed additional time to produce this information.