Harm Reduction: Tipping the Balance Toward Treatment and Recovery

Abstract

AbstractOpioid use has risen dramatically over the past 40 years. In response, federal programs and policies aimed at decreasing supply of prescription opioids have stabilized excessive prescribing. Unintended consequences of limiting the quantity of prescription opioids in the population has resulted in increased use of illicit drugs and opened a pathway of transition from misuse of pills to injection of heroin and use of potent formulations of cheap, synthetic opioids such as fentanyl. Harm reduction interventions function at the community level to provide health benefits and avoidance of harm to persons engaging in illicit and injection drug use. The Consolidated Appropriations Act of 2016 gives states, local, tribal, and territorial health departments the opportunity to use federal money to support a comprehensive set of harm reduction services. Critics of harm reduction strategies argue that formalizing and legalizing certain activities creates the perception that communities and local authorities are sanctioning or encouraging illicit/illegal drug use. Syringe services programs that provide clean needles and syringes so people who inject drugs are not forced to share or reuse injection equipment, are often at the heart of such controversy. This story addresses tensions that exist in communities grappling with harm reduction approaches to opioid and injection drug use.