HARM REDUCTION AND RECOVERY.

HARM REDUCTION AND RECOVERY.

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[Brooke Heimann] Harm reduction to me is being able to go to a place and get clean stuff to use and not have to rely on like going to a street and buying it, or like hoping you're getting something clean, or whatever it is.

[Dr. Tookes] Last night that we started 12 people on Suboxone and those are people who otherwise would not have had access to this lifesaving medication. And now they're on their road to recovery. Harm reduction is the first step in recovery. Syringe services is the first step. But now we have the ability to start people on lifesaving medications for opioid use disorder. We're helping people in their recovery, but wherever they are on that spectrum.

[Dr. Suarez] Harm reduction is holding someone by the hand and saying, "You're going to come with me because I have the time to commit to you because you're worth it. And so what do you need, do you need to go to detox? I'm going to go with you." Did you get them to the door? Did you follow up two days later to make sure they're still in treatment, or did they fall out? It should be, "Hey, I'm in this journey with you. You've now met me. You seem to want to do something to better your life, and I'm going to support you. Let's run that mission."

Abundant research shows the value of interventions and services aimed at reducing harms associated with drug use. Overdose deaths are significantly reduced in communities that distribute naloxone to people who use drugs and to their families or other potential bystanders, and syringe-services programs (SSPs) reduce the spread of HIV and other infectious diseases like HCV, and they help link people to addiction and infectious disease screening and treatment.

NIDA supports extensive research on SSPs, including on the expanded provision of sterile syringes, HIV/HCV testing and linkage to care, and integrated pre-exposure prophylaxis (PrEP) delivery and highly active antiretroviral therapy (HAART) to reduce HIV/HCV transmission as well as to prevent overdose. Through the HEALing Communities Study, researchers are using novel community-based approaches to deliver opioid treatment and overdose education, combined with naloxone distribution to prevent opioid overdose. Other studies are exploring models to initiate buprenorphine maintenance treatment in SSPs, implement SSPs in rural communities vulnerable to opioid injection-related HIV outbreaks, and examine whether integrated health services delivered through mobile clinics improve outcomes for both HIV and SUDs. Still other studies are examining the effects of harm reduction policies on public health. NIDA will continue to support research to examine how best to implement effective harm reduction strategies and to explore the effectiveness of novel approaches such as overdose prevention centers and drug-checking technologies.

NIDA supports research on pharmacological and non-pharmacological approaches for treating SUDs and overdose, including the development of medications, immunotherapies, digital therapeutics, neuromodulation, and behavioral treatments. This work has led to several effective interventions, including the nasal formulation of naloxone to reverse opioid overdose; buprenorphine and naltrexone, which along with methadone, are FDA-approved medications for treating OUD; lofexidine to treat the symptoms of opioid withdrawal; and nicotine replacement therapy, bupropion, and varenicline for treating tobacco use disorder.

"},"children":"Harm reduction is a set of policies and practices intended to reduce the negative effects of drug and alcohol use.\n"}Harm reduction programs exist for several types of drugs, including opioids, alcohol, stimulants, Ecstasy, and marijuana. They range from needle exchange sites to managed alcohol programs to drug-testing kits at music festivals. Studies have found many of these methods to be effective. But critics see the programs as encouraging drug use and keeping people addicted to drugs.

Harm reduction is a broad term that applies to policies, programs, and practices that aim to minimize the health, social, and economic consequences of substance abuse.1 The idea behind harm reduction is not to necessarily eliminate substance abuse but to diminish its harmful effects.

Harm reduction acknowledges that many people will continue to abuse drugs and engage in other dangerous behaviors despite prevention efforts. It also accepts that many people are unwilling or unable to seek treatment. But while some people who use substances may not necessarily require treatment, it is helpful for them to be aware of resources that can help minimize harm from their drug use.1

Harm reduction for heroin and other opioids is designed to reduce the risk of overdose and decrease the transmission of blood borne viruses associated with needle drug use. It also includes referring heroin and opioid users for addiction treatment and medical care.2

\nHeroin and opioid harm reduction is accomplished through a number of practices and programs, such as:\n\nInjection sites, which are facilities focused on preventing overdose and the contraction of infectious diseases through medical supervision of people who use heroin and other injectable drugs. Other services include education on safer injection, medical care and counseling, and referrals to treatment. Staff do not provide drugs, and employees do not inject users.3 Sites are located in Europe, Australia, and Canada. Time magazine reports that Philadelphia may be the first U.S. city to have an injection site, while Seattle, San Francisco, Ithaca, and Denver are also considering them.4 \nNeedle exchange programs (NEP), also referred to as syringe services programs (SSP) or needle-syringe programs (NSP), which are community-based programs that offer free sterile needles and syringes. They also help dispose of used needles and syringes. By using a clean and sterile needle and syringe, IV users can significantly reduce the risk of HIV, hepatitis, and other blood borne infections.5 \nOpioid treatment programs (OTP). These are programs that dispense prescription medications and provide comprehensive treatment, including counseling and other rehabilitative methods, to help people overcome opioid addiction. This type of treatment is often referred to as MAT, or medication-assisted treatment. MAT can reduce the risk of contracting HIV and hepatitis C, lower opioid use, increase survival rates, improve treatment retention rates, improve odds of finding and maintaining employment, and reduce criminal activity.6 \n\n\n"}{"props":{"scalar":""},"children":"\nThe medications used in MAT are:7\n\nMethadone: This is one of the most widely used medications for treating opioid addiction. It is available in several different forms, but many patients take it orally as a liquid. It is a long-acting drug that alleviates cravings and withdrawal symptoms. Methadone is only available at certified OTPs. It is an effective tool in managing heroin and other types of opioid dependence, but can cause some unpleasant side effects (e.g., nausea, constipation, sedation)\nBuprenorphine: This is a medication taken daily as an orally disintegrating tablet or film or an implant that slowly releases the medication over 6 months. Physicians who have completed a training and certification process can dispense buprenorphine, so you can receive it at a doctor\u2019s office or at an OTP. As a partial opioid agonist, the risk of overdose is lower than with methadone, and withdrawal symptoms may be somewhat less severe. Buprenorphine is sometimes combined with naloxone (trade name: Suboxone), a drug that helps discourage misuse of this treatment medication should it dissolved and injected\nNaltrexone: This medication blocks the effects of opioids to minimize the high if you use. By reducing the rewarding effects of opioids, it may be easier for you to stop using. Naltrexone does not help with withdrawal symptoms, and you cannot begin taking it until 7-10 days after your last opioid use because it can cause the onset of or worsen withdrawal. It is also available in an extended-release injectable formulation that lasts for 30 days\nNaloxone: This FDA-approved opioid antagonist medication is used to quickly reverse an overdose. Naloxone blocks opioid receptor sites and helps to restore breathing. It is available as an injectable (which requires professional training), a nasal spray, and an auto-injectable. Naloxone is a prescription drug in many states, but it can be obtained in a pharmacy without a prescription in some parts of the country. People (and their families) who use heroin or other opioids might want to consider keeping naloxone in their homes in case of overdose.8 \n\n\n"}AlcoholHarm reduction for alcohol aims to minimize harm due to alcohol use and abuse which, in addition to potentially developing an alcohol use disorder, includes increased risk for cancer, heart disease, liver cirrhosis, stomach problems, mental health issues, and injuries and accidents.9

\nSome of the harm reduction programs and practices for alcohol use include:\n\nHAMS, a free peer support group that stands for Harm reduction, Abstinence, and Moderation Support. The aim of this group is to meet people \u201cwhere they are at,\u201d minimize the harmful effects of alcohol, and help people change their drinking habits. People choose their own goals, whether that means quitting alcohol or reducing consumption. HAMS uses 17 elements to help people develop and choose goals\u2014they can complete the elements in any order and stop whenever they want.10 \nManaged alcohol programs (MAPs), which are designed to minimize harm due to chronic alcohol abuse among the homeless. MAPs provide small and regular doses of alcohol, and housing, in a treatment facility setting. The amount of alcohol provided is not enough to get drunk but helps prevent withdrawal.11 MAPs can increase stability by reducing interactions with emergency services and police as well as hospital admissions, detox episodes, and police contacts leading to custody. 12 \nNaltrexone, a medication that may help people control their drinking because it reduces some of the pleasurable effects associated with alcohol use and may reduce alcohol cravings. Studies among the chronically homeless have shown that extended-release naltrexone and harm reduction counseling promote reductions in alcohol use and alcohol-related harm and support patient-driven goal setting.13 \nDesignated driver programs, which are services provided by for-profit companies (which means you need to pay) and non-profit organizations (which often offer free services) to help both you and your car get home safely if you are intoxicated. There are two approaches to this type of program. One is known as \u201cTeam Lift,\u201d where two people come to you and your vehicle\u2014one drives you home in your car while the other follows in their car. The \u201cScooter\u201d approach involves a person coming to you with a special folding scooter; the person drives you home and leaves on the scooter.14 \n\n\n"}Tips for safer drinking include:10 2b1af7f3a8