In addition to programs and services, harm reduction includes influencing policy changes that reduce the stigma of addiction and increase available resources.
More and more organizations and policymakers in the U.S. and around the world are advocating for:
- Harm reduction by working to decriminalize drug use to provide both drug-related and non-drug-related medical treatment like prenatal care,
- And to make those who help drug users with medication-assisted treatments or overdose reversal exempt from liability.
Here, you’ll find some of the current laws, federal policies, and official recommendations for harm reduction principles such as syringe access, prenatal care, and naloxone usage.
As the drug epidemic continues and more lawmakers realize the necessity of harm reduction, these laws will continue to expand to offer more understanding, opportunities, and resources for those with substance use disorders.
Laws embracing harm reduction
The opioid crisis in America has reached such epidemic proportions that lawmakers and policymakers are no longer able to ignore the issue. The U.S. Surgeon General issued a report on drug addiction in 2016, for the first time ever. In this report, he outlines support for the use of harm reduction techniques, including “outreach and education programs, needle/syringe exchange programs, overdose prevention education, and access to naloxone to reverse potentially lethal opioid overdose.”
In 2016, Congress passed the Comprehensive Addiction and Recovery Act (CARA). According to the law, “CARA establishes a comprehensive, coordinated, balanced strategy through enhanced grant programs that would expand prevention and education efforts while also promoting treatment and recovery.”1
Along with expanding drug prevention and education, CARA supports:
- Expanding the use of naloxone to reverse overdoses
- Diversion programs that send low-level drug law violators to evidence-based treatment programs rather than into the criminal justice system
- Launching evidence-based opioid treatment and intervention programs
- Creating a medication-assisted treatment and intervention demonstration program
- Allowing nurse practitioners and physician assistants to prescribe buprenorphine
- Establishing best practices for drug treatment, disposal, and monitoring
While Congress must pass additional funding to fully support the legislative changes established in CARA, this is an important step for harm reduction and substance use disorder protocols in America.
California’s Substance Abuse and Crime Prevention Act (SACPA) of 2000 is another notable policy development. This state law requires anyone convicted of a non-violent drug possession offense to have the opportunity to receive drug treatment in place of incarceration.
In the 16 years since SACPA was implemented, more than 36,000 people have entered treatment through the program each year.2 The program has been particularly effective for treatment of methamphetamine addiction, with 19,000 annual participants, making it the largest methamphetamine treatment program in the country.3
Studies have also indicated that SACPA has saved California $2,317 per offender over a 30-month follow-up, mostly from reduced levels of incarceration.4 More law enforcement programs around the country are voluntarily adopting the principles of this act and seeing similar success.5
In 2016, Congress passed a spending package that, for all intents and purposes, lifted the ban on using federal funds for syringe access programs. Funds can’t be used for the purchase of actual syringes, but they may be used for program maintenance costs, like paying employees, rent, vehicles and gas, community outreach, counseling and referral, and other expenses.6 The Centers for Disease Control identifies the at-risk communities that are eligible to receive these designated funds.7
Syringe access was supported by Former U.S. Surgeon General Dr. David Satcher,8 and Vice President Mike Pence also advocated for syringe access while governor of Indiana. After declaring a public health emergency in the state in 2015, he reversed his previous opposition to the approach, calling for the opening and funding of temporary syringe access programs.9
States are responsible for creating their own laws regarding syringe access, and currently, syringes can be purchased over the counter without a prescription in most states.10 All states have laws that prohibit the sale and distribution of drug paraphernalia, but some are making the move to exempt syringes.11 As of 2016, only 18 states have state laws that explicitly authorize syringe exchange.12
Prenatal care for drug-addicted women
There is no federal policy about prenatal care for women with substance use disorders, and states are responsible for establishing their own laws concerning the care of pregnant women who use drugs. Currently, 19 states run or fund drug treatment programs for pregnant women, and 16 states give pregnant women priority status for entering state-funded treatment programs.13 Of the states that do not provide priority access, nine have made it illegal for publicly funded drug treatment programs to discriminate against pregnant women.14
However, many states also have laws that criminalize drug use during pregnancy:
- 23 states and the District of Columbia qualify substance use during pregnancy as child abuse, and this distinction may result in the termination of parental rights.15
- 23 states that require medical professionals to report a pregnant woman’s suspected drug use,
- 7 states require a drug test to be given to a pregnant woman if drug use is suspected.16
You can find specific information about how each state handles drug use during pregnancy at Pro Publica.
Overdose rescue and naloxone
Naloxone accessibility is determined individually by each state, and 33 states and the District of Columbia currently allow naloxone to be sold by pharmacies without a prescription. In many states, prescribers of naloxone are exempt from criminal and civil liability, and some states also extend that exemption to any layperson who administers naloxone to reverse an overdose.17
There are also 37 states, plus the District of Columbia, that have some kind of “Good Samaritan” law or “911 drug immunity” policy.18 These laws are intended to encourage bystanders or witnesses to treat an overdose, call 911, or help an overdose victim get aftercare by providing immunity from prosecution for drug possession or other low-level drug charges.
You can find specific information about state naloxone and overdose prevention laws at the Policy Surveillance Program.
Success stories of effective harm reduction programs
Across America, more and more communities are implementing harm reduction programs, and they’re seeing promising results. As of 2016, there are at least 194 syringe access programs operating across the United States.19 There are at least 644 naloxone programs nationwide, and over 26,500 overdoses have been reversed.20 Harm reduction programs may be sponsored by the city or state, and some neighborhoods also work with private organizations to fund resources for those with substance use disorders.
Here are just a few recent examples of harm reduction success stories.
- The Chicago Recovery Alliance is a community outreach program that has been operating since 1992 to provide syringes, naloxone, drug testing, and education in the Chicago area. According to its most recent annual report, the alliance distributed nearly 38,000 naloxone kits with training—and received reports of 5,767 opioid overdose reversals through 2014. It also vaccinated nearly 1,200 people, tested 817 people for diseases, and exchanged 12,471 contaminated syringes for sterile syringes in 2014 alone.21
- Founded in 2016, the Police Assisted Addiction and Recovery Initiative (PAARI) began as a Gloucester Police Department initiative to provide treatment instead of arrest for any opioid addicted people asking for help. PAARI has already created 160 police-based programs for pre-arrest treatment in its first year and has provided resources and training for 143 departments and state agencies in 27 states. The program has also distributed more than 5,000 doses of naloxone and reports that participating communities have saved as much as 25% on crimes associated with addiction simply by providing substance use treatment.22
- A similar program in the Seattle area has also had tremendous success. LEAD—Law Enforcement Assisted Diversion—also diverts low level drug crimes from the criminal justice system to community-based treatment services. The 2016 outcomes report shows that at the time of the LEAD follow-up, participants in the program were 89% more likely to have found permanent housing, 46% more likely to be employed or in vocational training, and 33% more likely to have income and benefits.23
- In Canada, several programs that provide prenatal care to women who use drugs have reported making substantial positive impacts. One such program, Edmonton’s H.E.R. (Healthy, Empowered, and Resilient) Pregnancy program works with women who live on the streets to provide prenatal care. In 18 months, 130 pregnant women received treatment, visiting the doctor an average of 29 times from preconception through birth. The program also reported that 40% stopped drug use and 26% reduced drug use during their pregnancies.24
- The Sheway program in Vancouver also works with pregnant women and women with infants who have drug and alcohol issues, providing health and social services to 150 women per month. The program reports that almost all pregnant women in Vancouver’s Downtown Eastside now get some type of prenatal care, and 70% of children go home with their mothers instead of into the foster system.25
- Proactive in the battle against HIV, the state of Rhode Island was an early supporter of harm reduction. The state authorized a syringe exchange program in Providence in 1994, reduced syringe possession from a felony to a misdemeanor in 1998, and allowed pharmacists to sell syringes without a prescription in 2000. A research study showed that over time, there was an 80% decrease in HIV diagnoses related to intravenous drug use in Rhode Island – a much more significant reduction than national averages.26
These are just some of the success stories reported by organizations and jurisdictions involved with harm reduction programs, and there are countless more that go unreported. As more communities, states, and countries adopt harm reduction policies, the resources, treatment, and compassion for those with substance use disorders will continue to grow while the stigma will continue to decline. And that’s a success story we can all celebrate.