Harm Reduction
interventions aimed at reducing the negative effects of health behaviors without necessarily extinguishing the problematic health behaviors completely
any positive change
Principle 1
accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore them or condemn them
Principle 2
understands drug use as a complex, multi faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence and acknowledges that some ways of using drugs are clearly safer than others
Principle 3
establishes quality of individual and community life and well-being as the criteria for successful interventions and policies
Principle 4
calls for the non-judgemental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing harm
Principle 5
ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them
Principle 6
affirms people who use drugs themselves as the primary agents of reducing the harms of their drug use and seeks to empower them to share information and support each other in strategies
Principle 7
recongizes that the realities of povery, class, racism, social isolation, past trauma, sex based discrimination, and other inequalities affect people’s vulnerability to and capacity for effectively dealing with drug harm
Principle 8
does not minimize or ignore the real and tragic harm and danger that can be associated with drug use
Medications for Opioid Use Disorder
Methadone: agonist
- requires active withdrawal with no opioid 8-10 hours before
Buprenorphine: partial agonist
- requires active withdrawal with no opioid 6-12 hours before
Naltrexone: antagonist
How do OUD Medications reduce harm
- safer and regulated products that increase patient survival and decrease infections
- decrease illicit opioid use and criminal activity
- increase ability to gain employment
- decrease drug use triggers
What is the evidence based for OUD medications
- all medications show higher retentions in care
- agonist medications show decreased overdose mortality
- better maternal and infant outcomes
MAT Act
waiver elimination for the prescribing of medications like buprenorpphine
Naloxone
What is it? opioid antagonist that binds to the opioid receptor and kicks off other opioids
- available as nasal spray, IM, subQ, IV
How does Naloxone reduce harm
- reverses life threatening respiratory depression
- precipitates opioid withdrawal
- will not cause harm if administered to someone not overdosing
What is the evidence based for Naloxone
- saved 27,000 lives
- after naloxone laws in place, decreased 14% of overdose deaths
- only 1 naloxone Rx is dispensed for every 70 opioid medications
What two naloxone products are OTC?
Narcan & Rivive
Syringe Service Programs
- free and safe places to dispose used needles in exchange for sterile ones
How do SSP reduce harm
- decrease needle sharing to reduce HIV, HBV, HCV, and other infections
- increase connections to primary care and SUD treatment
- decrease community presence of needles and needlesticks
What is the evidence based for SSP
- 50% reduction in HIV and HCV
- 3x likelier to reduce or stop injection drug use
- 5x likelier to enter SUD treatment
- no evidence of increase illicit drug use or crime
- healthcare cost savings
How many SSP in Indiana?
12
Sterile Syringes in Pharmacies
pharmacists can dispense sterile syringes without a prescription but must maintain a record book:
- name
- address
- name and quantity of syringes
- date
- initials of RPh
YOU DO NOT NEED TO DOCUMENT REASON
Supervised Consumption Sites
- sites where people can bring in and use drugs under supervision of trained personnel who can provide lifesaving measures
How do SCS reduce harm
- prevent fatalities from opioid overdoses
- decrease needle sharing to reduce HIV, HBV, HCV, and other infections
- increase connections to primary care and SUD treatment
- decrease public drug consumption
