December 22, 2020

Presidential Transition Office

1401 Constitution Ave NW

Washington, DC 20230

Dear President-Elect Biden and Vice-President-Elect Kamala Harris:

RE: Request for new Federal funding for Harm Reduction programs & services nationwide

Until 2020 the public health crisis receiving the most attention in the US has been the response to opioid overdose. With almost 450,000 lives lost in the US (72,000 fatal overdoses in 2019 alone) the crisis was already reaching unprecedented proportions. The COVID-19 pandemic has, understandably, shifted attention at the federal and state levels from overdose response to slowing the spread of COVID-19. However, this shift, along with complicating pandemic-related factors such as social isolation and difficulties in obtaining medication, treatment and social services, has exacerbated an already dire situation – affecting those in urban, suburban and rural areas.

Contemporaneously, the nationwide call for racial justice and accountability following the deaths of George Floyd, Breonna Taylor and others at the hands of law enforcement has dramatically highlighted the need for criminal justice reform. Black and brown communities are among the hardest hit by both the pandemic and the opioid crisis: in 2018, the highest increase in rates of overdose deaths were among Black men, and by the end of 2018, nearly half of all people who injected drugs and were living with HIV were Black. 

Altogether, these events have made clear the need to direct resources towards building an enhanced public health response to drug use, to finally start to alleviate the harm done to our communities as the result of punitive and ineffective policies. This critical shift can be implemented by directing resources towards low threshold health and social services and crisis interventions for Americans/US residents – most urgently Black and Brown people – impacted by drug use and mental health problems. With these services at an all-time low utilization rate due to the COVID-19 pandemic, coupled with the immediate and dire need for criminal justice reform, this solution can no longer be ignored.

We are therefore writing today to urge your support for $15 billion in new Federal support over four years to fund lifesaving ‘Harm Reduction’ services (see Box A). This 20 percent increase over current funding levels is necessary to reach those not now getting help.

“Box A: What is Harm Reduction?”

“Harm reduction” is an umbrella term for a set of principles and a wide range of interventions that:

(1) reduce the immediate risk of death (e.g., opiate-related overdose);

(2) help make it less likely that people who use drugs will contract serious medical diseases (e.g., HIV, hepatitis C, endocarditis, etc.);

(3) serve to provide direct services and form relationships that help those with drug and alcohol problems, and

(4) facilitate entrée into higher threshold social services such as medical care and drug treatment services. 

Life-saving harm reduction interventions include:

1) wide distribution of the opiate blocker, Naloxone, to reverse potentially lethal overdose;

2) sterile syringe availability to prevent infection and

3) harm reduction psychotherapy and counseling to bridge the gap from public health interventions to a full array of evidence-based addiction treatment interventions.

We feel that the implementation of these tools is not only the moral, but also most cost effective, way to help people who struggle with drug problems to thrive in our society.

Although we strongly support current efforts to fund treatment, including programs to expand evidence-based medication assisted treatment (MAT) for those with opioid or other substance use disorders, surveys show that over 80 percent of those with substance use disorders do not seek and do not receive treatment. This troubling treatment gap can and must be addressed – but it requires more direct assistance for those not actively seeking treatment today.

These individuals are at tremendous risk of a fatal overdose, are frequently homeless or unstably housed, and impose significant criminal justice, health, and emergency response costs in communities where they live. The COVID-19 pandemic has only intensified these problems: the number of fatal overdoses has risen sharply as people are more likely to use drugs in isolation and are largely cut off from life saving support systems. In addition, those at highest risk for overdose (or are in close proximity to those at risk) are oftentimes afraid to access medical care or to visit hospitals in an emergency, due to the pandemic. We know how to help people who use drugs, to reduce healthcare costs, to increase their health and safety, and to effectively facilitate treatment entry. This is what harm reduction organizations do every day. It is difficult work, requiring outreach workers to meet people who use drugs where they are, to build a connection and a relationship of trust with them, and to support small steps to improve their health. We know these efforts both prevent loss of life and provide a path to better health for all, and for some a drug-free life. Unfortunately, current large Federal substance use disorder grants, although extremely helpful to those actively seeking mainstream treatment, provide minimal support for this lifesaving work. It is time to launch a new national program which directly supports harm reduction that focuses on this huge unmet need.

We appreciate that the annual $18 billion Federal drug budget for addiction treatment and prevention is a large, complex enterprise. However, considering that this funding is not reaching the majority of people who use drugs, in particular Black and Brown people, we believe a 20 percent increase for harm reduction related services – about $3.7 billion a year – is urgently needed. Although much of this funding could be added to existing large grant programs, we believe it is essential to create at least one new program dedicated to helping this under-served population. To do this quickly and effectively we recommend funding at $250 million a year geographic-based cooperative grants to non-governmental organizations and public health agencies involved in addressing the needs of people who use substances who are not actively engaged in formal treatment, with a specific focus on providing services to Black and Brown people and communities. This approach will enable the rapid development of a comprehensive, sustainable, collaborative approach across areas of the United States with the greatest need.

The services which will be funded by this effort will follow all Federal and State laws. There is so much more that can be done to help people under current laws. Services to be funded will include: Naloxone training and provision, new innovative overdose prevention strategies, syringe service programs, health care services (including for HIV/AIDs, hepatitis C, wound care and invasive infections, and mental health), offers of low threshold addiction services, including harm reduction psychotherapy, and mobile access to medications approved by the FDA for opioid, stimulant, and alcohol use disorders.

We look forward to working with you on developing this proposal and moving it forward to enactment. If you have questions or suggestions, please contact us through our campaign’s coordinator. There are millions of people in the US who need the help which this initiative can provide. With so many people dying, and so many more at great risk, we urge you to support this critical  initiative.

Sincerely,

Heather J. Haase, LL.M, Campaign Coordinator

hhaase.NCHRF@gmail.com

Organizations

AIDS United

Zachary S. Ford

Senior Program Manager

Addiction and Behavioral Health Alliance LLC

Bob Lynn, Ed.D  

CEO and Founder

Advanced Integrative Medical Science Institute

Sunil Aggarwai, MD, PhD, FAAPMR

Co-Founder and Co-Director

American Academy of Cannabinoid Medicine

David Ostrow, PhD

Vice President of Research and Outreach

Any Length Retreat

Robert White

CEO

C4 Recovery

Ricard Ohrstrom

Chairman

CARMAhealth

Carlos F. Tirado, MD, MPH           

Founder and CMO

Center for Collegiate Recovery Communities

Thomas Kimball, PhD, LMFT

Director

Central Texas Harm Reduction Alliance 

Richard Bradshaw 

Executive Director   

Center for Motivation and Change  

Jeff Foote, PhD

Co-Founder and Executive Director

Carrie Wilkins, PhD 

Co-Founder and Clinical Director

The Center for Optimal Living 

Andrew Tatarsky, PhD

Founder and Director

Center for Popular Democracy

Jennifer Flynn Walker

Senior Director of Mobilization and Advocacy

Dallas Harm Reduction Alliance

Candice Fortier

Executive Director

Drug Reform Coordination Network

David Borden

Executive Director

Enso Recovery

Timothy Cheney

Founder and CEO

Evergreen Health Services

Raymond Ganoe

President and CEO

EXPONENTS

Joe Turner, JD

President and CEO

Faith in Harm Reduction

Erica Poellot, MDiv, MSW

Director

Families for Sensible Drug Policy 

Carol Katz Beyer

President

Harm Reduction Therapy Center  

Patt Denning

Director of Clinical Services and Training 

Jeannie Little

Executive Director

Homeless Health Care Los Angeles

Mark Casanova

Executive Director

Housing Works

Charles King

CEO

HRH413

Albert Park 

Co-Founder

Jess Tilley

Co-Founder

National Harm Reduction Coalition

Monique Tula

Executive Director

IGNTD Recovery

Adi Jaffe, PhD 

CEO and Founder

Integrative Sex Therapy Institute  

Tammy Nelson, PhD

Director

International Conference on Addiction and Associated Disorders    

Sam Quinlan     

Founder

Judson Memorial Church

Rev. Dr. Donna Schaper

Senior Minister

La Hacienda Treatment Center

James C Boone, MD    

Medical Director

The Levenson Foundation

Benjamin A. Levenson

Chairman

Los Angeles Medicinal Psychedelics Society    

Tara Rodriguez

Co-Chair

Love Cassidy

Susan Seward

Executive Director

MAP Health Management

Jacob Levenson

CEO

MG Consulting 

Michael Galipeau

Director

Multidisciplinary Association for Psychedelic Studies

Sara Gae, MA

Harm Reduction Officer

Natalie Ginsberg, MSW

Director of Policy and Advocacy

National Advocates for Pregnant Women  

Lynn Paltrow, JD

Executive Director

National United Church of Christ

Rev. Michael Schuenemeyer

Executive for Health and Wholeness 

Advocacy

New England Users Union

Jess Tilley

Executive Director

New Jersey Harm Reduction Coalition

Jenna Mellor

Executive Director

New York State Harm Reduction Association 

Joe Turner, JD

Co-Chair

Alexis Pleus, PE, LEED AP, CWI

Co-Chair

O.D. Aid

Lizzie Maldonado

Executive Director

The Perfectly Flawed Foundation   

Luke Tomsha

Founder and Executive Director

Pharmacy Addictions Research & Medicine Program at the University of Texas at Austin

Lucas G. Hill, PharmD, BCPS, BCACP  

Director

Reach Medical

Justine Waldman, MD, FACEP

CEO

Recovery Alliance of Austin

Joseph Sanchez

Founder and President

Recovery Alliance of El Paso

Ben Bass  

Executive Director

Recovery People, Inc

Jason Howell

Executive Director

Recovery Spectrum

Brian Lane

Peer Recovery Support Specialist

Samadhi Recovery Community Outreach Center

David McNamara

Executive Director

Santa Maria Hostile & Houston Sobering Center

Alicia Kawalchuk, MD

Medial Director

The Seven Challenges Program

Robert Schwebel, PhD

Author

Southern Tier AIDS Program

John Barry

Executive Director

St. Ann's Corner of Harm Reduction

Joyce A. Rivera

Founder and CEO

Texas Harm Reduction Alliance

Gilberto Perez

Executive Director

Texas Harm Reduction Conference

Lisa Medina, MA, LCDC 

Founder and Chair

Texas Overdose Naloxone Initiative

Mark Kinzly

Director

Truth Pharm

Alexis Pleus, PE, LEED AP, CWI

Founder and Executive Director

Unity Recovery

Robert Ashford, PhD, MSW      

Executive Director

Urban Survivor's Union                      

Jess Tilley

Leadership Team

Vital Strategies

Daliah Heller, PhD MPH

Director

West Texas Harm Reduction Coalition

Mike Prado

Director