National Campaign for Harm Reduction Funding Position Statement
Until 2020, the public health crisis receiving the most attention in the US has been the response to opioid overdose, which has led to almost 450,000 lives lost in the US, with 72,000 fatal overdoses in 2019 alone. The overdose crisis is reaching unprecedented proportions. In light of the Covid-19 pandemic, which has exacerbated the overdose crisis, and the death of George Floyd, which has dramatically highlighted the urgency for criminal justice reform, the need to direct resources towards building an enhanced public health response to drug use has never been more clear. 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.
As a coalition, we endorse the messages below:
We urge the Biden administration to support $15 billion in new Federal support over four years to fund lifesaving ‘Harm Reduction’ services. 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 strongly support current efforts to fund evidence-based treatments, including medication assisted treatment (MAT) programs for those with opioid or other substance use disorders. However, surveys show that over 80 percent of those with substance use disorders do not seek and do not receive treatment. This troubling treatment gap indicates that current efforts are not enough to adequately address the actual needs of this population. We urge the administration to expand live-saving Harm Reduction services and direct assistance for those not actively seeking treatment.
We support the creation of a new national grant program that directly supports harm reduction, providing 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.
We support the repeal of the ban on federal funding of syringe programs. We also support enacting legislation to provide a “safe haven” for Safe Consumption Sites (or “Overdose Prevention Centers”) to preclude criminal enforcement of operators of these sites under the federal “crack house” statute. These services save lives, and also have community support. We request that the Biden/Harris administration prioritize the reversal, amendment or non-enforcement of these restrictions within the first 100 days of the new administration.
We support the expansion of medication-assisted treatment (MAT) for the dependence of opioids and other substances as recommended by the International Standards for the Treatment of Drug Use Disorders. We request that the administration investigate ways to make MAT programs more widely available and less regulated, including continuing some of the measures enacted in response to the COVID-19 pandemic, such as the elimination of the X-waiver requirement (discussed in Item 9 below) and the relaxations of Methadone distribution restrictions.
We support the retraining/re-educating of the traditional treatment system to understand and incorporate a Harm Reduction approach, in lieu of outdated, unscientific abstinence-only treatments. Some state health authorities, such as New York’s Office of Addiction Services and Supports (OASAS), are already seeking to expand health education in the treatment system by mandating the adoption of person-centered treatment practices. These programs require additional federal funding to better implement these practices.
We recommend that as part of the call for 100,000 public health jobs in the American Rescue Plan, ample support be provided for Harm Reduction peer outreach workers, as these workers are critical to ensuring public health. Employing people with lived experience in these roles provides a solid foundation from which to stabilize their lives. In return, these people provide indispensable knowledge and skills both to direct service employers and to the overall public health response.
We support the incorporation of the voices of the mothers, fathers, and loved ones of people who have been lost to the overdose epidemic into the policymaking process. In addition, it is vital that people with lived experience be included in all levels of government where decisions are made on their behalf.
We support that doctors be given the latitude and support to use Harm Reduction interventions to deliver patient-centered care to provide interventions without judgment or criminalization.
We support eliminating the X-Waiver requirement for Buprenorphine access. Buprenorphine is a life-saving, evidence-based treatment for substance use disorder, but in order to prescribe it, physicians must complete a burdensome additional training. This training is a burden that prevents many from getting the care they need. In January, the outgoing HHS issued guidance dropping this requirement for physicians. While this guidance did not expand access as much as we hoped, it was nonetheless a crucial step to delivering treatment to those in need. We are disappointed to learn that the Biden administration is rolling back these new regulations. We hope this is merely a pause before permanently dropping the training requirement on more sound legal grounds. However, we need action, and we need it now. We urge President Biden to take executive action to enable medical providers to prescribe buprenorphine treatment whenever it is appropriate.
We support alternatives to criminal sanctions for certain categories of drug offenses in support of a public health approach to drug use. To that end, we encourage the administration to look beyond the traditional drug court model. While efforts to divert offenders to treatment by judges are often well-intentioned, drug courts have many limitations. These limitations include placing health and patient decisions in the hands of judges and prosecutors, instead of in the hands of substance use professionals. These judges and prosecutors often rely on outdated abstinence-only treatment models and reject evidence-based, clinically indicated treatment. In addition, they often “punish” recurrence of use, which is a normal part of the process of improving one’s relationship with substances, with criminal sanctions. We encourage the administration to explore innovative programs, such as pre-arrest diversion programs and other research-tested approaches, in order to lessen the impact of the criminal justice system on people who use substances.
We support access to treatment and interventions that support family units and keep children with their parents. We support ending child separation under ambiguous circumstances such as the results of a urinalysis or hair toxicology, We believe these measures are not indicative of a parent’s ability to raise their child. These kinds of CPS practices have led to the traumatic experiences of children across the United States and have structurally deepened inequalities for our poor Black and Brown communities.
We support the following legislation:
CARE Act (Warren/Cummings, now Maloney)
Modeled after the Ryan White Care Act, this legislation would invest $100 Billion over 10 years to combat the overdose crisis. Sets up local planning councils so those directly impacted can decide where the money goes.
Mainstream Addiction Treatment Act (Tonko)
Eliminates the redundant, outdated requirement that practitioners apply for a separate DEA waiver to prescribe buprenorphine for substance use disorder treatment. Requires the Secretary of HHS to conduct a national campaign to educate practitioners about the change in law and encouraging providers to integrate substance use treatment into their practices
Medicaid Reentry Act (H.R. 1329, Tonko (D-N.Y.), Turner (R-OH), Sensenbrenner (R-WI))
Reinstates Medicaid eligibility for incarcerated individuals up to 30 days prior to their release. Helps reduce recidivism, curb overdose deaths, and promote the health care needs of individuals transitioning back into communities.
Emergency Support for Substance Use Disorders Act (Smith/Murkowski)
Invests $50 Million in harm reduction during COVID.