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. Harm reduction incorporates a spectrum of strategies from safer use, to managed use to abstinence to meet drug users “where they’re at,” addressing conditions of use along with the use itself. Because harm reduction demands that interventions and policies designed to serve drug users reflect specific individual and community needs, there is no universal definition of or formula for implementing harm reduction.
The IRA shifts resources and power to people who use drugs. We reduce both the individual and structural harms caused by racialized drug policy through direct action and advocacy to ensure belonging.
We educate participants and community members on the racialized nature of the war on drugs at every opportunity, event, and educational session. We aim to increase collaboration with groups engaging in racial justice work locally, and to hire professionals to engage IRA staff/volunteers in anti-racism and/or diversity training to better understand the intersection of our harm reduction work with marginalized groups.
Accepts, for better and or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them.
Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe abuse to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others.
Establishes quality of individual and community life and well-being–not necessarily cessation of all drug use–as the criteria for successful interventions and policies.
Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm.
Ensures that drug users and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them.
Affirms drugs users themselves as the primary agents of reducing the harms of their drug use, and seeks to empower users to share information and support each other in strategies which meet their actual conditions of use.
Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm.
Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.
harm reduction incorporates certain ideas about drug user health and dignity, focuses on participant-centered services, encourages participant involvement, values participant autonomy, recognizes the importance of sociocultural factors and practices that are pragmatic and realistic.
Harm reduction does not mean "anything goes."
Harm reduction does not enable drug use or high risk behaviors.
Harm reduction does not condone, endorse, or encourage drug use.
Harm reduction does not exclude or dismiss abstinence-based treatment models as viable options.
1. Federal Research on Syringe Exchange Programs Proves Effectiveness
Between 1991 and 1997, the US Government funded seven reports on clean needle programs for persons who inject drugs. The reports are unanimous in their conclusions that clean needle programs reduce HIV transmission, and none found that clean needle programs caused rates of drug use to increase (1).
2. Policy Implementation in Indiana
In March of 2015, Governor Mike Pence acknowledged an increasing outbreak of HIV in southeastern Indiana. As a response to the rising cases, Pence endorsed the operation of Needle Exchange Programs like our own to dispose of used and obtain sterile syringes. These efforts protect users from unnecessary disease transmission, and the general public from contaminated needles (2).
3. Indiana-Relevant Statistics
As of 2014, Scott County, Indiana has experienced an influx in HIV cases. Given an increase in syringe use for opioid analgesics in rural areas – particularly in or near the Appalachian region – SSPs would have proven benefits (3). The expansion into rural areas could be vital to reducing the effects of syringe-sharing in harder-to-reach locations.
4. Syringe Service Programs and Treatment
In efforts to expand SSPs to Indianapolis, it has been noted that those who engage with SSPs are “five times more likely to enter drug treatment than people who do not participate in the program" (4).
5. Syringe Need and Availability
The IRA prides itself in being a least-restrictive SSP program, where participants can receive syringes as needed, rather than as a one-for-one return system. This is crucial to keep up with the needs of the community. “Respondents reported injecting a median of 60 times per month, visiting the syringe exchange program a median of 4 times per month, and obtaining a median of 10 syringes per transaction; more than one in four reported reusing syringes. Fifty-four percent of participants reported receiving fewer syringes than their number of injections per month. Receiving an inadequate number of syringes was more frequently reported by younger and homeless injectors, and by those who reported public injecting in the past month" (5).
1. Syringe Exchange – Impacts Beyond HIV Reduction
In addition to reducing the rates of HIV transmission, Syringe Service Programs have expanded to become multiservice locations, providing education and referrals on drug addiction treatment, housing, careers, and other services (6).
2. CDC Information on Other Services
Harm reduction services often include hygiene and safe sex resources in addition to clean syringes. As of 2008, all SSPs provided alcohol pads, and 98% provided male condoms (7). At the IRA, we offer alcohol pads and wound care, cookers, cottons, condoms, lube, period and female hygiene supplies, naloxone, and more.
1. Modification and Partial Lifting of the Federal Ban on Funding of Syringe Exchange Programs, 2016
While the ban on using federal funding for SSPs has been lifted, as well as a bill being implemented to allow SSPs startups without state approval, “no funds appropriated in this Act shall be used to purchase sterile needles or syringes for the hypodermic injection of any illegal drug… such limitation does not apply to the use of funds for elements of a program other than making such purchases if the relevant State or local health department, in consultation with the Centers for Disease Control and Prevention, determines that the State or local jurisdiction, as applicable, is experiencing, or is at risk for, a significant increase in hepatitis infections or an HIV outbreak due to injection drug use, and such program is operating in accordance with State and local law (8).
2. Legality of Syringe Possession
According to a study in 1996, “Drug paraphernalia laws in 47 states make it illegal for injection drug users (IDUs) to possess syringes.” The study concludes, “decriminalizing syringes and needles would likely result in reductions in the behaviors that expose IDUs to blood bone viruses" (9).
3. OTC Syringe Availability
According to an interview-based study conducted in Eastern Kentucky in 2022, researchers concluded that “restrictive OTC pharmacy policies are rooted in stigmatizing views of PWID [people who inject drugs]. Anti-stigma education about substance use disorder (SUD), human immunodeficiency virus (HIV), and Hepatitis C (HCV) is likely needed to truly shift restrictive pharmacy policy.” Many pharmacies operate such that one must provide proof of medical need to receive syringes. The “fastest-moving HIV outbreak ever identified in the USA was detected among PWID in rural Indiana in 2015,” with trends persisting most in areas that are “overwhelmingly rural.” SSPs allow people who inject drugs to do so safely, without the fear of pharmaceutical stigma and restrictions (10).
4. Syringe Access, Limits, and Infection Risk
Our facility is a needs-based SEP, rather than a one-for-one needle exchange – this is intentional. A 2004 study conducted by Ricky N. Bluthenthal et. al. found that “greater legal access to syringes, if accompanied by limitless on the number of syringes that can be exchanged, purchased, and possessed, may not have the intended impacts on injection-related infectious disease risk” for intravenous drug-users. SEPs without limitations on syringes were found to have lower syringe reuse rates (11).
5. Homelessness, SEP Access, & Policing
Insofar as the intersections of homelessness and syringe use, a 2009 study conducted in New York City found that “characteristics of social marginalization and vulnerability – homelessness and public injecting – were associated with inadequate syringe acquisition.” Additionally, SEP participants reported “‘not needing’ more syringes, but many also identified program limits and fear of police contact as main reasons for not obtaining adequate syringes at their most recent visit to the SEP” (12). The IRA takes active steps to address these barriers, including adherence to Indiana state laws. We will never collect or provide information about service-users to law enforcement. Additionally, “law enforcement officers do not wait outside of syringe service programs to arrest people and work in partnership with participants and prosecutors to prevent unnecessary charges related to participation in these programs” (13).
(1) National Commission on AIDS, The Twin Epidemics of Substance Abuse and
HIV (Washington DC: National Commission on AIDS, 1991).
General Accounting Office, Needle Exchange Programs: Research Suggests
Promise as an AIDS Prevention Strategy (Washington DC: US Government Printing Office, 1993).
Lurie, P. & Reingold, A.L., et al., The Public Health Impact of Needle Exchange
Programs in the United States and Abroad (San Francisco, CA: University of California, 1993).
Satcher, David, MD, (Note to Jo Ivey Bouffard), The Clinton Administration’s
Internal Reviews of Research on Needle Exchange Programs (Atlanta, GA: Centers for Disease Control, December 10, 1993).
National Research Council and Institute of Medicine, Normand, J., Vlahov, D. &
Moses, L. (eds.), Preventing HIV Transmission: The Role of Sterile Needles and Bleach (Washington DC: National Academy Press, 1995).
Office of Technology Assessment of the U.S. Congress, The Effectiveness of
AIDS Prevention Efforts (Springfield, VA: National Technology Information Service, 1995).
National Institutes of Health Consensus Panel, Interventions to Prevent HIV Risk
Behaviors (Kensington, MD: National Institutes of Health Consensus Program Information Center, February 1997).
(2) AMA J Ethics. 2016;18(3):252-257. Doi: 10.1001/journalofethics.2016.18.3.hlaw1-1603.
(3) Persad, Prasanthi, et al. “Comparison between Needs Based and One-for-One
Models for Syringe Exchange Programs .” Department of Public Health and Wellness, 2017. https://louisvilleky.gov/health-wellness/document/seprptneedsbasedvsoneforone2017pdf
(4) “Safe Syringe Access and Support Program.” MCPHD,
marionhealth.org/safesyringe/#:~:text=The%20Safe%20Syringe%20Access%20and,not%20participate%20in%20the%20program.
(5) Daliah I Heller, et al. “The syringe gap: an assessment of sterile syringe need
and acquisition among syringe exchange program participants in New York City,” Harm Reduction Journal (London, United Kingdom: January 2009), p. 1. http://www.harmreductionjournal.com/content/pdf/1477-7517-6-1.pdf
(6) Don C. Des Jarlais PhD, Ann Nugent, Alisa Solberg MPA, Jonathan
Feelemyer MS, Jonathan Mermin MD, and Deborah Holtzman PhD. “Syringe Service Programs for Persons Who Inject Drugs in Urban, Suburban, and Rural Areas – United States, 2013,” Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR) 2015;64:1337-1341. http://www.cdc.gov/mmwr/pdf/wk/mm6448.pdf
(7) Jonathan Mermin MD, and Deborah Holtzman PhD. “Syringe Service Programs for Persons Who Inject Drugs in Urban, Suburban, and Rural Areas – United States, 2013,” Centers for Disease Control and Prevention Morbidity and Mortality Weekly Report (MMWR) 2015;64:1337-1341.
https://www.cdc.gov/mmwr/preview/mmwrhtml/mm5945a4.htm/Syringe-Exchange-Programs-United-States-2008#:~:text=In%20addition%20to%20exchanging%20syringes,98%25)%20provided%20male%20condoms.
(8) HR2029, “Consolidated Appropriations Act, 2016,” Passed by 114th Congress
and Signed Into Law on December 18, 2015.
https://www.congress.gov/bill/114th-congress/house-bill/2029/text
https://www.congress.gov/114/bills/hr2029/BILLS-114hr2029enr.pdf
(9) Bluthenthal, Ricky N., et al. “Drug paraphernalia laws and injection-related
infectious disease risk among drug injectors”, Journal of Drug Issues, 1999;29(1):1-16. Abstract available on the web at http://www.nasen.org/NASEN_II/research1.htm.
(10) Fadanelli M, Cooper HLF, Freeman PR, Ballard AM, Ibragimov U, Young
AM. A qualitative study on pharmacy policies toward over-the-counter syringe sales in a rural epicenter of US drug-related epidemics. Harm Reduct J. 2022 Jan 8;19(1):1. doi: 10.1186/s12954-021-00569-2. PMID: 34996466; PMCID: PMC8742380.
(11) Bluthenthal, Ricky N., et al. “Sterile Syringe Access Conditions and
Variations in HIV Risk Among Drug Injectors in Three Cities,” Diffusion of Benefit through Syringe Exchange Study Team. Addiction Journal, Vol. 99, Issue 9, p. 1136, Sept. 2004, abstract online at https://onlinelibrary.wiley.com/doi/10.1111/j.1360-0443.2004.00694.x/abst last accessed June 8, 2013.
(12) Daliah I Heller, et al. “The syringe gap: an assessment of sterile
syringe need and acquisition among syringe exchange program participants in New York City,” Harm Reduction Journal (London, United Kingdom: January 2009), p. 4.
http://www.harmreductionjournal.com/content/pdf/1477-7517-6-1.pdf
(13) “Syringe Service & Harm Reduction Programs: Frequently Asked Questions.” Indiana Department of Health. 2022.
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