Preliminary data from the National Center for Health Statistics shows the crossing of a tragic milestone: 100,000 overdose deaths occurred in the U.S. between May 2020 and April 2021, a nearly 29% increase over the previous year.
Harm reduction services offer health care treatment and social services to people suffering from drug-related challenges. This evidence-based, compassionate approach to drug users results in fewer life-threatening infections related to unsterile drug injection, lower rates of chronic diseases such as AIDS and hepatitis C, and reduced overdose fatalities.
Harm reduction services illustrate that communities can come together to support, rather than shun, chronic drug users.
“When I say I work with chronic heroin users or chronic meth users, lots of people think, ‘Oh, those people have lost human agency, and there’s really nothing we can do to help them,’” says Dr. Ricky N. Bluthenthal, associate dean for social justice at the University of Southern California and professor in the Department of Population and Public Health Sciences and the Institute for Health Promotion and Disease Prevention Research at the Keck School of Medicine.
“That’s the farthest thing from the truth. There are lots of ways to work with people to help enable their success.”
What Are Harm Reduction Services?
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines harm reduction as “a proactive and evidence-based approach to reduce the negative personal and public health impacts of behavior associated with alcohol and other substance use.”
Harm reduction services include interventions to:
- Combat stigma around people who use drugs and people with co-occurring disorders
- Promote referrals to care, counseling and treatment services
- Educate individuals about overdose risks and how to respond
- Provide lifesaving overdose reversal medications, including naloxone
- Supply syringe services programs (SSPs) that prevent HIV and hepatitis
- Connect individuals who express interest in treatment to recovery support systems
Health care organizations, government agencies and nonprofits can administer harm reduction services to both individuals at risk of overdose (e.g., by distributing naloxone and other overdose reversal medications) and to communities (e.g., by creating SSPs).
By treating drug users as capable of agency and change — and as people deserving of treatment and support — harm reduction services promote hope and healing.
Facing the Opioid Epidemic
Harm reduction services can prevent drug-related deaths by expanding access to treatment. This is more important than ever, since the coronavirus (COVID-19) pandemic and a mass upwelling of highly potent synthetic opioids have combined to create what SAMHSA refers to as “the most significant substance use and overdose epidemic it has ever faced.”
Dr. Bluthenthal explains: “We basically have a situation where fentanyl, which is a synthetic opiate, is replacing heroin in most of the illicit markets. Fentanyl is much more potent and lasts a shorter period of time, so it creates a lot of public health problems.”
Fentanyl is a painkiller that is 80 to 100 times stronger than morphine, developed originally to help cancer patients manage their worst ailments. It’s extremely easy to overdose, and the drug has been sold illegally and cut with other street drugs throughout the pandemic.
USA Today reports that the emotional and material toll of the pandemic — the loss of income, jobs, housing and social connection — has caused the spike in overdose deaths.
“At the same time,” Dr. Bluthenthal continues, “we’re also seeing for the first time just a ton of co-use of opiates and methamphetamines. So the sort of drug combinations and their effects on people’s behavior are not well understood.”
Facing the opioid epidemic means confronting the facts about why people start using drugs and what evidence-based treatments exist to help people once they become addicted.
Health Inequities and Social Determinants of Health
Public health experts recognize the importance of contextualizing public health data, explaining how social factors such as a person’s socioeconomic status, race, education and living environment affect health, well-being and access to care.
“We have a sort of social determinants of health crisis,” says Dr. Bluthenthal, “driven by the economic inequality in the country.”
Dr. Bluthenthal has researched and published extensively on the multiple health emergencies related to drug use affecting the U.S. today, including rises in overdose deaths, infective endocarditis, HIV and HCV among people who use drugs. In a 2021 article for Drug and Alcohol Dependence, he called for further interventions that address how structural racism and structural violence contribute to chronic drug use and a diminished ability to protect one’s own health.
For example, one facet of structural racism regards housing inequality. Histories of residential segregation and redlining, in addition to income inequality, have contributed to whether a person has safe, stable housing. The Census Bureau found that only 41% of Black households own their homes, compared with over 73% of non-Hispanic white households.
During the pandemic, safe housing became a premium. Dr. Bluthenthal wants people to think about why we, as a nation, tolerate the suffering of disadvantaged groups “even when there are alternatives.”
“If I needed to ever quarantine, I live in a large house, so I can quarantine easily for my wife or my children. That’s not the circumstances of most of the people in the country. And we [as a nation] tolerate that.”
Dr. Bluthenthal believes scholars and researchers must speak up in support of vulnerable groups. “I feel like it’s incumbent upon those of us who are in the knowledge creation business to [speak up]. If we know something, and we know other people aren’t going to act on it, then we should.”
Why Harm Reduction Services Work
The Centers for Disease Control and Prevention (CDC) cites Dr. Bluthenthal’s pioneering research on the efficacy and sustainability of syringe services programs (SSPs). Repeated studies show that people who access harm reduction services such as SSPs are more likely to seek treatment and stop using compared with people who do not.
Dr. Bluthenthal sees this as a sign of progress and a source of optimism for improving the lives of vulnerable people in our communities.
“Syringe services programs went from being illegal in the late ‘80s and early ‘90s to now being widely accepted everywhere — in Republican states and Democratic states, in rural areas and urban areas,” he says. “So there’s progress. It’s uneven, but there’s been real progress.”
Change Lives With Equitable, Sustainable Harm Reduction Services
Harm reduction services expand health equity, help drug users seek treatment and ultimately save lives. Such services start from the radical premise that every person deserves lifesaving medical treatment and social services, regardless of whether they use drugs. In this way, harm reduction services offer a compassionate, humane approach to public health delivery.
Discover how you can promote equitable, effective public health by enrolling in USC’s online Master of Public Health (MPH) program, where you’ll work with faculty members such as Dr. Ricky N. Bluthenthal. The USC online program is the only MPH delivered by a top-ranked medical school with a world-renowned faculty. Learn more about how earning an MPH from USC can springboard your career in public health today.
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American Progress, “Systemic Inequality: Displacement, Exclusion, and Segregation”
Centers for Disease Control and Prevention, Provisional Drug Overdose Death Surveillance
Harm Reduction International, What Is Harm Reduction?
National Center for Health Statistics, 2022 Provisional Drug Overdose Death Counts
Substance Abuse and Mental Health Services Administration (SAMSHA), Harm Reduction
USA Today, “Drug Overdoses Surged Amid COVID Lockdowns; More Deaths in One Year Than Ever Before”
U.S. Census Bureau, “Quarterly Residential Vacancies and Homeownership, Fourth Quarter 2021”
U.S. Department of Health and Human Services, Harm Reduction