The evidence shows that both SSPs and OPCs save lives and connect people to treatment while reducing disease transmission and improving public safety. By driving people into the shadows, increasing their risk of disease and death, and creating massive barriers to healthcare, the punitive approach causes far more damage than a health-centered one. The law was intended to target commercial drug dens where drugs were sold and consumed—not public health interventions, which didn’t exist in the U.S. at the time. While public health data on saving lives is compelling, community fears about safety and disorder remain a powerful political force.

However, 1 study found that an accelerated vaccination schedule (0, 1, and 2 months) offered through SSPs, with the initial vaccination dose given at screening, could improve completion rates . The caveat with HBV vaccination is the extended follow-up necessary for completion of the vaccination schedule (0, 1, and 6 months), which can be a barrier to care in this population . In an ID setting, clinicians can recommend prevaccination serologic testing in high-risk individuals including persons with HIV, MSM, and past or current IDU, per CDC recommendations . Additionally, it is important to offer HCV treatment as usual, Reducing injection harm even if IDU is ongoing, as lack of treatment will not break the cycle of HCV transmission and will decrease the likelihood of global eradication of HCV. The increasing mortality rate despite highly effective treatments is attributed to potential ineligibility due to co-infection with HIV, incomplete treatment, and economic burden, all of which are already particularly concerning in the context of IDU .

Injection Behaviors and Harm Reduction

Some interventions show promise across multiple substances—for example, prevention strategies like skills-based education in schools. For example, if you’re working in a community that doesn’t have a lot of opioids and predominantly uses stimulants, you should meet the needs of the population. They historically had endemic heroin markets and relatively limited access to prescribed pain medications. For example, I used to work in Baltimore City and then in Chicago, and neither of those cities saw high rates of overdose deaths from prescription pain pills. We now have what some are calling the 4th wave, which is polysubstance overdose, with a combination of illicitly manufactured fentanyl and stimulants like cocaine or methamphetamine. Then, for a very short time, we saw an increase in heroin-related overdoses, and for over one decade, we’ve seen continual increases in fentanyl-involved overdoses.

The Evidence on SSPs

Syringes are more accessible in some states, but there are still 13 where syringes are considered drug paraphernalia, and syringe service programs are not available. In terms of the specific services that have been shown to reduce risk of death, we have naloxone distribution and medications for OUD, specifically methadone and buprenorphine. So utilizing harm reduction techniques like motivational interviewing and trauma-informed care can fit into all clinical environments. It’s also one extra step for patients, but if you’re prescribing other meds and you know your patient is going to the pharmacy anyway, it can be a great way to provide access to naloxone. If you can’t offer those in your environment, then make sure you know what’s available in your community.Provide education about using appropriate terminology, using non-stigmatizing terms, and making sure that people feel welcomed. Can you talk about harm reduction in the inpatient care setting?

Evidence of Syringe Service Programs Benefit in Infectious Disease Prevention

One analysis projected that an additional national investment of $10 million in SSPs would avert 194 HIV infections, yielding net savings of $65.8 million in avoided lifetime treatment costs. Rather than harming public safety, SSPs actively improve it by providing safe collection and disposal of used syringes. For many, SSPs are the most accessible pathway to effective treatment. A common misconception is that SSPs discourage people from seeking treatment.

Societal and Policy-Level Barriers

GovFacts is a nonpartisan site focused on making government concepts and policies easier to understand — and government programs easier to access. Please consult a qualified professional for financial, legal, or health advice specific to your circumstances. However, these programs face significant legal, political, and social barriers rooted in competing moral frameworks about drug use and the role of government in addressing it. They represent cost-effective interventions that can be part of a comprehensive approach to addressing the overdose crisis.

From this perspective, preventing a fatal overdose is the ethical priority that outweighs concerns about condoning drug use. The judge reasoned that Safehouse’s purpose was to save lives and provide medical care, not to facilitate illegal drug use. The application of this 1980s law to modern public health facilities was tested in the landmark case of United States v. Safehouse. Proponents also point to evidence that OPCs reduce public nuisance by moving drug consumption from public spaces like parks, restrooms, and sidewalks into a controlled, private setting and by reducing discarded drug paraphernalia.

We had also heard from our syringe service program and street outreach partners that people who inject drugs often have wounds but are too afraid to go to urgent care, the ED, or primary care, so we incorporated other services into our care model. Our goal should be that regardless of where you are seen — at a community harm reduction site, in the ED, in the field after an overdose, or at an addiction treatment program — all of the clinicians know where harm reduction services exist and how to link you to necessary services. By prioritizing the health, safety, and dignity of people who use substances, these strategies acknowledge the realities of substance use and use disorders and offer practical solutions that reduce immediate risks and promote long-term well-being.

What Is Harm Reduction?

• A tourniquet should be used to tie off above the injection site utilizing a slip knot to ensure easy removal 2, 34.
• This approach aims not only to improve the health and safety of people who inject drugs (PWID), but also to protect their families and communities .
• Authors collected data on study design; location; urbanicity; whether the SIF was legally sanctioned; whether possession of injectable drugs is illegal, legal, or decriminalized; study duration; intervention/SIF program details; statistical analysis; sample size; demographic information; outcomes; and conclusions.
• Sometimes that means taking health care out of the clinic, and sometimes it means bringing harm reduction programming or services into healthcare settings.

We know that SUDs are chronic health conditions, and we want to create an environment where people can seek supportive, evidence-based services without fear of punitive responses. I would start with the state public health department and ask whether the state is donating naloxone to community clinics for distribution. We heard from a variety of community partners that patients who were interested in buprenorphine had trouble accessing it for several reasons.

The 2017 study of Myer and colleagues46 examined crime in Vancouver, Canada using a quasi-experimental design (interrupted time series with comparison) following the opening of an SIF. Review authors determined one study (Myer and colleagues46) to be of greatest suitability and good quality, and another study (Salmon et al.47) to be of moderate suitability and fair quality. Patients were more likely to require ambulance transport for overdose when the SIF was closed for the day. Salmon and colleagues48 described a greater decline in opioid-related overdoses seen by ambulances in the vicinity of an SIF in Sydney, Australia after it opened compared with the rest of the state where it was located. Marshall et al.41 found 26% net reduction in overdose deaths in the area immediately surrounding an SIF in Vancouver, Canada after its establishment as compared with the rest of the city. The study with the greatest suitability of study design that examined crime as an outcome observed a sustained decrease in crime following the opening of a SIF; the reduction was only observed in the vicinity of the SIF and was not observed in the rest of the city.

Harm Reduction Services to Prevent and Treat Infectious Diseases in People Who Use Drugs

In the US, approximately three-fourths of people who have SUD don’t engage in treatment. If people were not able to comply with that goal or weren’t interested, they didn’t fit in and were discharged from care. A lot of our treatment system has used strict and often punitive approaches toward people who use substances, with the idea that abstinence was the only acceptable outcome. We should support them in their health the way we support all of our patients, including those who have a chronic condition that may have some behavioral associations.

Although several respondents felt that they did not have the expertise or experience to provide addiction care, many suggested that the ID community should take the lead in coordinating these efforts. ID physicians largely reported positive attitudes toward harm reduction strategies. However, there are many practical barriers, including education for me as a prescriber and health system support/protocols/guidelines.” Very few ID physicians reported prescribing naloxone to PWID (78 of 374 21%), for reversal of opioid overdose, despite the lack of regulatory barriers to offering this life-saving medication (Figure 1). One respondent commented that it is “difficult, if not impossible in the absence of addiction services to get very far,” while another responded, “we need better resources for treatment of the primary problem.” This was a common theme repeated in many of the comments. Only 223 of 373 respondents (60%) reported having access to outpatient addiction medicine services, including access to MOUD, with an even smaller number having access to inpatient addiction medicine consultation (200 of 373 54%).

• We have a peer support specialist, a nurse care coordinator, medical assistant, and physician assistant on our team, and we meet regularly to talk about service delivery.
• Of the 14 studies with fair quality of execution, 6 studies29,35,43,44,47,52 received 2 limitations and 8 studies28,31,33,34,36,42,45,53 received 3 limitations.
• National polling reveals a stark difference in public opinion based on terminology.
• However, this review includes more sites than the previous review of Potier and colleagues,22 suggesting that research may be expanding to include additional locations.

WHAT IS HARM REDUCTION?

Beyond harm reduction is treatment with pharmacotherapy of an underlying SUD if one exists. Secondary to loss of vein access, PWID reported purposeful soft tissue injection (as opposed to “missed hits,” which is when one misses a vein during injection), which can independently contribute to abscess formation . Heroin and heroin-cocaine combination injections are independent risk factors for SSTIs, with methamphetamine injection having lower rates .

Crushed pills should be avoided for injection if possible, as they can be difficult to dissolve, which increases the risk of thrombus formation after IV injection, or abscesses if injected subcutaneously 2, 34. Additionally, loss of peripheral vein function or venous sclerosis may occur, which increases the risk of other serious complications, noted below, due to use of alternative, potentially dangerous central injection sites 2, 34, 38. To address this unmet need, ID clinicians should consider offering sterile syringes or safe injection kits, prescribing syringes for pickup at a local pharmacy, or assisting PWID in finding the nearest SSP.

Overdose Prevention Centers: The Next Step

Rates of syphilis, particularly, have been increasing in many regions of the United States, with an epidemiologic link to those who use drugs . Interestingly, however, engagement with PrEP may create opportunities to offer other forms of preventive care , effectively linking PWID into a primary care system that was previously not accessible. While not yet widely implemented, strategies using hospital admission for complications of IDU as an opportunity to provide preventive/primary care may be crucial for reaching this population.

Reduce cost

However, institutionally and locally support services are minimal and personally it is not where I am going to invest my time, although I would definitely support development and availability of these services.” “I would love to see more joint ID fellowship/addiction medicine fellowships and I would like to see treatment of SUD become a core competency for all ID fellows.” There seems to be strong interest in the use of long-acting lipoglycopeptides as treatment in this population, which is stymied by a lack of evidence and guidance.

In Scott County, Indiana, implementing an SSP during a major public health crisis led to a 96% reduction in new HIV infections, yet the center was closed in 2021. This disconnect stems from a fundamental clash between public health and criminal justice frameworks for addressing drug use. These community-based programs have been studied for nearly 30 years and are endorsed by major public health bodies, including the CDC. This model shows harm reduction is one essential component of a broader, integrated community drug strategy. The Harm Reduction Coalition frames it as “a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”

Rates of adverse childhood experiences and adult trauma are extremely high among people with SUDs. Medicaid often covers naloxone with limited, if any, copay, but Medicare and private payers can be different. Most people coming to see us are also getting a prescription for buprenorphine, so we co-prescribe naloxone. Some of the challenges in patients with substance use disorder face include undertreated pain, undertreated withdrawal symptoms, movement and visitor restrictions, and feeling stigmatized by hospital staff.