The Critical Role of Harm Reduction in Preventing Overdoses and Saving-Lives | $name

Image of hands being held and a prescription bottle.

The Critical Role of Harm Reduction in Preventing Overdoses and Saving-Lives

Thu, Nov 30, 2023  -  Comments (0)  -   Posted by The Center for Health Affairs


The U.S. is currently in the midst of a substance use and overdose crisis, driven by synthetic opioids, many of which contain fentanyl. Every state has implemented prescription drug monitoring programs that track patient prescription history and potentially dangerous prescription combinations to assist physicians in identifying patients who may be at risk of an opioid overdose. Unfortunately, this is not enough on its own and research indicates the effectiveness of these programs is in question.


Ohio is one of the states hit hardest by the overdose epidemic. Of the state’s 88 counties, 27 – nearly a third – have higher opioid usage than the national average. This staggering statistic on its own would be shocking, but unfortunately, that is not where it ends. In 2020, opioids accounted for 84% of all drug poisonings in the state and an average of 13 Ohioans died every day.


Is there anything that can be done to help? Harm reduction is an evidence-based approach that many believe is a step in the right direction. Cleveland Clinic’s Dr. David Streem discussed the benefits of harm reduction in the recent healthessentials newsletter by saying, “For people who receive best-practice treatment for opioid use disorder, only about 50% of them are successful in abstaining from even occasional use of opiates. So the other 50% of people who are not able to achieve that, need and do benefit from approaches that are classified as harm reduction.”



Harm reduction is one piece of a multi-faceted approach for combatting opioid overdoses that also includes vital treatment and recovery services provided by our area healthcare providers, including Cleveland Clinic, MetroHealth, St. Vincent Charity Community Health Center and University Hospitals, in addition to area federally qualified health centers (FQHCs), peer recovery organizations, and others.



Naloxone Access

Earlier this year, the U.S. Food and Drug Administration approved the selling of naloxone without a prescription as the first overdose-reversing drug to be sold over the counter. Allowing easier access to naloxone means wider access to a life-saving drug that can reverse overdoses of opioids — usually within minutes.


Since 2021, MetroHealth and Cuyahoga Metropolitan Housing Authority installed NaloxBoxes in residential buildings, gas station bathrooms, music venues and other locations where overdoses have been more likely to occur. Purchased by the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County, these boxes hold naloxone and treatment information and are displayed in the same way as an automated external defibrillator box.


Fentanyl test strips

A low-cost method of reducing harm and preventing overdoses, fentanyl test strips can detect the presence of fentanyl in all different kinds of drugs and drug forms. With fentanyl being 50 to 100 times more potent than morphine and the United States’ illicit drug supply being overcome with fentanyl-related compounds, of all the overdose deaths in the country, 64% involved synthetic opioids — primarily fentanyl.


Supervised Injection Site (SIS)

Allowing individuals to bring their own drugs, supervised injection facilities create a safer environment    for drug use. Facility staff do not assist in injecting or handling of drugs, but are there to monitor, provide clean equipment, answer questions and administer first aid if necessary. 


The U.S.’s first SIS opened in New York City in 2021, but it was Canada that featured North America’s first SIS in 2003. While these sites are sometimes viewed as controversial, a study on the Canada location that compared the mortality before and after it was open showed a decrease of 35% in overdose deaths. Earlier this year, the federal government awarded a $5 million grant to study sites in New York City and Providence, RI to evaluate their effectiveness at preventing overdoses.


Proponents of the sites point to additional benefits that include:

  • Reduced infections.
  • Decreased public injecting and increased public safety.
  • Access to vaccinations.
  • Treatment for sexually transmitted diseases.


Syringe Service Programs (SSP)

Also known as “needle exchanges,” these programs supply clean needles, syringes and other supplies intended for the injection of drugs. Typically, an individual can receive free or low-cost services such as naloxone rescue kits, disease screening and health education. While some people may avoid healthcare facilities, SSPs offer an alternative solution for the testing of infectious diseases. As mobile SSP units become more common, the area in which individuals have access to care increases.


Even though SSPs have faced challenges in regard to funding, many will argue that these facilities have reduced high-risk behaviors such as injection equipment sharing and reuse.


Distributing Safer Smoking Kits

Through President Biden’s administration, $30 million of grant money was distributed to communities across the country in 2022 for the funding of safer smoking kits. These kits include alcohol swabs, lip balm, and materials to promote hygiene and reduce the transmission of diseases such as HIV and hepatitis.



MetroHealth’s Project DAWN Expanded Mobile Unit

Providing free education on recognizing the signs and symptoms of an opioid overdose and how to respond and use naloxone, the Project DAWN mobile unit encountered more than 9,000 patients and exchanged more than 375,000 syringes in 2022.


The 30-foot-long vehicle is parked across from the MetroHealth main campus hospital in Cleveland, OH. Not requiring an appointment, most visits typically take less than 15 minutes and their services are free. In addition to syringe exchanges and naloxone distribution, their services include safe injection kits, HIV/HCV rapid antigen testing, Medicaid enrollment assistance and fentanyl test strips.


Thrive for Change

Providing communities hit hardest by the opioid crisis with life-saving tools, Thrive for Change offers community outreach and hosts events to help get naloxone into the hands of those who need it. The organization also offers education and training on how to be a distributor of naloxone in their community and sends naloxone across the state with its mail program. A Project Dawn site, Thrive for Change recently received funding to begin creating and distributing safer smoking kits and they distribute other harm reduction products such as condoms and fentanyl test strips as well.


Project White Butterfly

With a mission to reduce harm, promote recovery and encourage healing from substance use disorder by sharing messages of hope, cultivating a supportive community and providing connections to resources, Project White Butterfly reminds individuals with addiction of the resources available in the community to help them find their individualized road to recovery. Project White Butterfly is consistently working in the community to distribute harm reduction materials, encourage people through cards and conversations, and provide food bags and holiday meals at local treatment centers.


Northern Ohio Recovery Association

Created with a mission to empower individuals, families and communities to support lifestyles of recovery, the Northern Ohio Recovery Association has a vision to establish innovative care to support continued recovery of the communities it serves. In addition to serving as a Project DAWN site, its services include medication-assisted treatment, adolescent services, outpatient treatment, recovery housing, peer recovery support and more.


Harm reduction is all around us. Identifying the ways in which other facets of our society engage in harm reduction may allow us to remove the stigma surrounding harm reduction for people with substance use disorders (SUD). In everyday life, individuals wear seat belts, helmets and partake in countless other safety measures to reduce harm to themselves and their loved ones. Viewing harm reduction in relation to drug use in the same manner can help healthcare professionals and members of the community to build relationships with people who are using drugs and their loved ones, to meet people where they are and provide a better understanding of the many complications related to substance use disorders. The bottom line to remember is that SUD is a disease of the brain and harm reduction methods allow people more time to heal and live.

About the Author

The Center for Health Affairs

See other articles by this author and view full bio »

Leave a Comment

Your email address will not be published..... *Required fields.  

Tag Cloud