Table of Contents
What is Harm Reduction?
Harm reduction programs are essential to providing equitable and life-saving access to drug treatments. However, West Virginia’s new restrictions may place these services, and their users, at risk.
At its core, harm minimization is about centering the experience of the drug user. It’s about meeting people where they are and giving them the tools and support to achieve their drug reduction goals. Harm reduction accepts that complete cessation of drug use is not always possible and instead focuses on reducing negative consequences, both personal and through policy.
Principles of Harm Reduction
Four main principles underlie harm minimization programs and initiatives.
The first principle of harm reduction centers around respecting and protecting the rights of people who use drugs, also called PWUD. Health policy is most impactful when it speaks to specific populations, listens to their unique needs, and takes action in alignment with community collaboration.
For this reason, the second principle centers on collaboration with PWUD to ensure potential interventions meet their needs and don’t generate negative consequences.
The third principle of harm reduction programs is commitment. As defined by the drug policy alliance, this is a commitment to advocate for:
- Overdose death prevention interventions
- Fact-based drug education
- Effectual and evidence-based medications and treatments for problematic use
- Drug-related injury prevention or illness
- Untangling and healing the harms of racialized drug policies focused on punishment and incarceration rather than public health
The fourth primary principle of harm reduction programs is to address and reduce the stigma associated with drug use, which can contribute to difficulty seeking help.
What Are Harm Minimization Strategies?
Harm reduction programs incorporate a spectrum of strategies to meet PWUD where they are and speak to their needs. These programs typically target safer use, managed use, abstinence, and address the conditions that led to use in the first place.
Beyond meeting the different drug use and lifestyle goals of their community, people enacting harm minimization strategies must tailor their efforts to gain the trust of affected communities and collaborate with them to ensure long-term success.
Issues Faced in Harm Reduction
There are many directions that harm reduction programs can be expanded to increase equitable access to life-saving options for those struggling with addiction.
A core focus of the harm reduction movement is addressing bias and discrimination in both drug policy and related stigma. For example, while drug use is often normalized for white Americans, the same cannot be said for other ethnicities who use drugs at proportional rates but face higher rates of incarceration.
Harm reduction also seeks to reduce the social stigma associated with drug use, regardless of its illicit or licit nature, and encourage care providers and communities to lead with a non-judgmental and compassionate approach.
Harm reduction policies often work to expand the Good Samaritan protective policy, as it helps reduce drug-induced deaths. When a group of people is using drugs and someone overdoses, many often worry they’ll face consequences if they call emergency services like 911. For this reason, spreading awareness and expanding Good Samaritan laws is a key focus of harm reduction.
Harm reduction programs aim to implement strategies that decrease drug overdoses and increase access to life-saving treatment at state and federal levels. For people under fifty, the leading cause of death is drug overdose.1 Harm minimization seeks to center sensible policy at the heart of drug treatment programs.
Naloxone is a federally approved, inexpensive drug that reverses opioid overdoses without risk of abuse or addiction. Its low cost and life-saving nature make naloxone a promising intervention in drug treatment policies. Yet few people have access to naloxone should they experience an opioid overdose. Therefore, harm minimization often involves increasing access to naloxone in case of overdose emergencies.
Improving access to clean syringes is a crucial focus of harm reduction policies, as it’s relatively easy to implement and has a significant impact on reducing disease transmission. Communities that have decreased funding or shut down syringe exchanges in recent years, like West Virginia’s Charleston county, are now experiencing spikes in HIV transmissions. Harm minimization seeks to maintain and increase access to clean syringes and decrease the burden of disease outbreaks both on the individual and the community.
Contrary to what many might assume, supervised consumption services (SCS) – also known as supervised injection facilities (SIF) – do not lead to increases in drug use, addiction, or overdose.
Instead, SCS programs offer safe environments that: prevent overdose, reduce infections from unhygienic needles, decrease public injections, increase the safe disposal of syringes, reduce the transmission of Hep C and HIV, and offer more access to social and medical services.2 There are currently no supervised injection facilities in the U.S.
Harm reduction strategies also seek to expand drug checking facilities, where individuals can verify what they’re taking to ensure it’s not laced or cut with other drugs. This aspect can help prevent dangerous drug interactions from unknown contaminants like fentanyl.
Uncertainty with West Virginia’s Harm Reduction Plans
Many healthcare providers in West Virginia offering harm reduction programs currently find themselves on shaky ground as legislation enacted this year places ambiguous yet extreme limitations on syringe exchanges.
West Virginia has been ground zero for ongoing and evolving restrictions surrounding syringe exchange programs. In 2018, the Kanawha-Charleston County Health Department eliminated its syringe exchange program. In February of 2021, Senate Bill 334 was introduced to mitigate the circumstances under which clean needles can be distributed throughout West Virginia.3
At the same time, Charleston county enacted regulations in response to concern from West Side community members about grassroots groups distributing needles in their neighborhood without their consent, according to Mayor Amy Goodwin.4
In June of 2021, the American Civil Liberties Union (ACLU) filed a federal lawsuit challenging the new policy. They argue the policy’s unclear nature and the threat of hefty fines makes the restrictions unenforceable, and are further prompting many harm reduction providers to discontinue vital health services. The ACLU followed up with a temporary restraining order to prevent the ordinance until the regulations had been ruled on federally.
One month later, the federal judge ruled the measure to be enforceable and passed Senate Bill 334. These new regulations involve denying clean needles to those who don’t return their used needles, only providing services to people with state IDs, and other rules that CDC officials have labeled unnecessary and obstructive to delivering health services.5
Response to Restrictions
In response to these new restrictions, many healthcare providers are worried about increasing rates of HIV and Hep C, as well as the impact on people who struggle with substance abuse and currently rely on these services. With some of the highest opioid addiction and overdose death rates in the country, West Virginian healthcare providers understand the essential nature of programs like syringe exchanges.6
West Virginia is currently facing its second in a slowly growing progression of HIV outbreaks in recent years. Huntington experienced an outbreak in 2019, and now Charleston is in the throes of its own HIV outbreak, with a record 39 HIV cases in the first half of 2020, as opposed to its annual average of five. This outbreak is attributed by many as resulting from Charleston’s elimination of needle exchange programs in 2018. In surveying the situation, the CDC members sent in to support Charleston healthcare provider’s primary recommendation was increasing access to syringe exchanges and furth harm reduction programs.
As Senate Bill 334 has passed, it’s now up to the creativity and commitment of healthcare providers to continue offering vital healthcare and harm reduction services in compliance with newly evolving and unclear legislation.