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Harm reduction is a set of public health strategies that aim to lessen the effects and consequences that are associated with drug use in hopes of reducing drug use all together. Many people believe harm reduction programs encourage or increase drug use. Evidence suggests these assumptions are inaccurate and they actually decrease drug use.  This padlet aims to highlight several aspects of harm reduction theory to specifically decrease drug abuse.

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Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.

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Harm Reduction Principles | National Harm Reduction Coalition

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Harm reduction is a set of practical strategies aimed at reducing negative consequences associated with drug use. Understand the principles of harm reduction.

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Since the war on drugs was declared by former president Nixon in 1971, there has been a negative association with the use of drugs. The war on drugs was enacted to reduce the use of drugs primarily through punishment and coercion. However, the war on drugs was unsuccessful and instead has created a negative connotation associated with the usage of drugs and its effects. As of 2017, more than 1.5 million drug arrests occur in the United States each year, which is more arrests than all violent crimes combined in a year. People caught for drug possession can also lose their right to federal financial aid, lose their right to vote, and can be denied public assistance. In order to promote harm reduction, this stigma on the use of drugs needs to change.

The purpose of harm reduction is to help people who are misusing drugs and provide a safe alternative. One of the ways to promote harm reduction is to decriminalize drug use. Drug decriminalization is the elimination of criminal penalties for drug use and possession. Some ways society can push to make this change is to drastically reduce the number of people arrested for drug possession or use. This allows the reduction of harm on families and the consequences that follow with a criminal record. Another way to decriminalize drug use is to improve drug treatment facilities and allow easier access to them. In addition, there should be more education about the usage of drugs and its effects for police officers, teachers, and people in the workforce. More information and knowledge on drugs allows for a better understanding of them and reduces the stigma and negative connotation associated with them.

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One aspect of the harm reduction theory is increased access to drugs such as Naloxone, which is an opioid antagonist. Naloxone hydrochloride is a FDA approved antidote for opioid overdose. Naloxone is able to block opioids at the mu receptors in the central nervous system.  This can stop an overdose in the midst and potentially save one's life.
Harmful effects of an overdose such as hypotension and respiratory failure are reversed almost immediately at the first dose of Naloxone.  However, depending on the amount of opiates that were taken, sometimes a second dose of Naloxone is needed to fully prevent the effects of the overdose. After the first dose of Naloxone is given, it is important that emergency personnel is called right away.
There have been many changes in the legal system to increase the availability of Naloxone in order to decrease the number of overdoses. Even though access to the public has increased, it is still not utilized as much officials and healthcare providers were hoping. While first responders such as EMTs and paramedics carry Naloxone, many overdoses occur while they are not present. Because of this, lay people, or individuals who are not first responders are beginning to have access to Naloxone because opioid overdoses are so common. By increasing access to Naloxone and the implementation of Good Samaritan laws for reporting overdoses, opioid overdoses can be reduced drastically and treatment options and other resources can be given to those who need it the most.

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According to the Centers for Disease Control and Prevention, more than 50,000 people died from drug overdoses in the U.S. in 2015. ¹ More than 60 percent involved an opioid. ²

We know that Americans from all walks of life are finding that prescription drug abuse is hitting closer and closer to home; nearly one in three Americans report that they have been personally affected, according to a recent survey conducted by CVS Health.

While abuse-prevention education and outreach programs are vital for curbing drug misuse and abuse, one strategy that can help communities address overdoses in the moment is ensuring access to the life-saving drug naloxone.

What is Naloxone?

Naloxone, also known by the brand name Narcan, is a lifesaving drug that blocks opioid receptor sites to reverse the effects of an overdose. ³ Over the past two years CVS Health has worked to expand access to naloxone without individual prescriptions in 43 states, most recently to CVS Pharmacy patients in Arizona.

Increasing Access to Naloxone Saves Lives

Many states have recently passed Naloxone Access Laws (NALs) that widen access to naloxone by providing specific statutory protections for nonmedical professionals to possess and administer naloxone without a prescription. This enables any person without a prescription to have naloxone and to give it to a person showing signs of an opioid overdose without having to fear legal repercussions. ⁴

According to the National Bureau of Economic Research (NBER), ⁵ states that have adopted NALs have seen a nine to 11 percent reduction in opioid-related deaths. This research underscores the importance of increasing access to naloxone as part of a larger strategy to address the impact of prescription drug abuse.

Community Leaders Amplify Naloxone's Value

During an event hosted by CVS Health, Arizona State Attorney General Mark Brnovich and State Representative Heather Carter joined CVS Health in announcing that naloxone would be available at all Arizona CVS Pharmacy locations without a prescription. Their remarks echoed the importance of naloxone in addressing prescription drug abuse and opioid abuse more broadly.

"The opioid epidemic is an urgent public health crisis facing Arizona and the entire country," said Attorney General Brnovich. "We want to ensure that Arizona families who have loved ones struggling with addiction have access to naloxone because it saves lives."

Representative Carter, a sponsor of the naloxone access legislation signed into law last year, added, "The main purpose behind the legislation I sponsored was to get this medication in the hands of a person who may have an opportunity to save a life."

Our Ongoing Work

Opioid abuse is an epidemic that does not discriminate, and it continues to be an area of great concern and focus for CVS Health. There is no single cause to the problem, and the solution will require a multipronged effort including pharmacy, physicians, the pharmaceutical industry and government.

In addition to expanding access to naloxone, CVS Health is working to help communities address prescription drug abuse through education, outreach and safe medication disposal:

CVS Health's Medication Disposal for Safer Communities Program has donated more than 800 collection units to law enforcement partners across the country, allowing for the safe disposal of more than 100 metric tons of unwanted medication. This program offers an online search tool through which anyone can find a drop box location near them.

Pharmacists volunteering through the company's Pharmacists Teach program have helped educate more than 250,000 students about the dangers of prescription drug abuse.

For more information about our efforts in the fight against opioid abuse, visit our Prescription Drug Abuse information center. And to stay informed about the most talked-about topics in health care, register for content alerts and our bi-weekly health care newsletter.
This article was originally published on June 8, 2017, and was updated to reflect current data on September 21, 2017.
1 Centers for Disease Control.
2 Centers for Disease Control.
3 The Substance Abuse and Mental Health Services Administration.
4 National Conference of State Legislatures.
5 National Bureau of Economic Research.

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Expanding Access to Naloxone Saves Lives | CVS Health

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According to the Centers for Disease Control and Prevention, more than 50,000 people died from drug overdoses in the U.S. in 2015. 1 More than 60 percent involved an opioid.

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Many witnesses of drug overdoses consciously make the decision to forego summoning life-saving medical services for fear of being arrested or punished for their involvement with drugs. One aspect of harm reduction that confronts this particular fear is the presence of Good Samaritan Laws in place for witnesses of drug overdoses. These are called Good Samaritan Overdose Immunity Laws and they are currently present in 40 out of 50 states, as well as the District of Columbia. Generally, they offer immunity from "arrest, charge or prosecution for certain controlled substance possession and paraphernalia offenses when a person who is either experiencing an opiate-related overdose or observing one calls 911".

This contributes to harm reduction significantly because it decreases the amount of people who refuse to call 911 for fear of being arrested, therefore giving life-saving medical treatment to so many more people experiencing an overdose. I personally know someone who ignored someone having an overdose for this very reason, but because there are no Good Samaritan Overdose immunity laws present in SC, they were not protected from the law and failed to call for help. The person overdosing tragically passed away because this aspect of harm reduction had not been put in place in our state yet. The presence of these laws could be the difference between life and death for so many people.

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One way to reduce the harmful effects of drug use is to provide drug users access to clean syringes. These syringe exchange programs are community-based programs that allow drug addicts, who use drugs intravenously, access to clean needles which decreases the risk of contracting a disease. This decreases the spread of blood-borne diseases, such as HIV and AIDS. Drug users no longer have to use needles repeatedly or share needles with others if clean needles are accessible to them.  Additionally, these programs also offer other services such as overdose prevention, contraception, education on safer injection practices, wound care, and access to substance abuse clinics.

The Consolidated Appropriations Act of 2016 gives states limited funds to help support syringe exchange programs. Each of these communities who utilize these funds must provide proof the community has had a rise in HIV/AIDS and are experiencing high levels of drug use. People are hesitant about syringe exchange program because they fear they only increase and encourage people to use more drugs. Evidence supports that this assumption is not true and it actually decreases the use of drugs because of the connections that are formed between drug users and non-drugs when they go to pick up clean needles.

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Syringe Services Programs | Injection Drug Use | HIV Risk and Prevention | HIV/AIDS | CDC

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Some jurisdictions can now use federal funds to support some components of syringe services programs. This page provides guidance on how to consult with CDC about using federal funds for SSPs.