Harm reduction in the United States

Last updated

Harm reduction consists of a series of strategies aimed at reducing the negative impacts of drug use on users. [1] It has been described as an alternative to the U.S.'s moral model and disease model of drug use and addiction. [2] While the moral model treats drug use as a morally wrong action and the disease model treats it as a biological or genetic disease needing medical intervention, harm reduction takes a public health approach with a basis in pragmatism. [2] Harm reduction provides an alternative to complete abstinence as a method for preventing and mitigating the negative consequences of drug use and addiction. [3]

Contents

Types of harm reduction in the U.S.

Drug checking

Drug checking describes the processes by which a user may test a substance for the presence of a variety of drugs to determine what drugs the substance contains before consumption. [4] One common form of drug checking is fentanyl test strips (FTS). FTS are an affordable product available as small paper strips that can detect the presence of fentanyl. [5] The Centers for Disease Control and Prevention (CDC) determined synthetic opioids, like fentanyl, to be the main culprit in increased U.S. opioid-related deaths. [6] In 2017, 38.9% of drug overdose deaths in the U.S. involved fentanyl. [7] According to the CDC, the "12-month count of synthetic opioid deaths increased 38.4% from the 12-months ending in June 2019 compared with the 12-months ending in May 2020." [6]

Legality

In April 2021, the CDC and the Substance Abuse and Mental Health Services Administration (SAMHSA) announced that federal funding can be used in the purchase of rapid FTS.

Syringe service program

Syringe exchange programs (SEPs), syringe services programs (SSPs), or needle exchange programs (NEPs), involve the implementation of safe used syringe disposal as well as access to clean syringes. [8]

Intravenous drug use places the user at an increased risk of contracting human immunodeficiency virus (HIV) as well as hepatitis C virus (HCV). [9] According to the CDC, HIV can survive on a syringe for up to 42 days, which means that an HIV-negative individual who uses a syringe can potentially contact the virus weeks after it was used by an HIV-positive individual. [10] Sharing syringes is the second biggest risk factor for contracting HIV after receptive anal sex. [10] Of the 3,216 reported cases of acute HCV in the U.S. in 2017, 1,059 individuals reported participating in injection drug use. [11]

As of February 2023, according to the North American Syringe Exchange Network (NASEN), 45 states in the U.S. had some form of syringe exchange in at least one location, with the exceptions being Kansas, Mississippi, Nebraska, South Dakota, and Wyoming. [12]

In some places, such as Seattle Washington, foil and drug pipes purchased at tax payer expenses for distribution to drug users. [13]

Legality

The Federal Consolidated Appropriations Act of 2016 allows for state and local health departments may allocate federal funding from the Department of Health and Human Services (DHHS) to SEPs. [14] However, federal funds are not permitted to be used in the purchase of syringes or needles. [14] Health departments interested in DHHS funding for SEPs are required to consult with and present evidence to the CDC that the community they serve is either currently in or at risk for an outbreak of HIV of hepatitis infections as a direct result of syringe drug use. [14] The use of Federal grant for the purchase of smoking supplies, such as drug pipes is prohibited. [15] Federal law also prohibits the sale, importation and mailing of drug paraphernalia. [16] [17]

Safe consumption sites

A safe consumption facility, or a safe injection site, is a supervised environment in which an injection drug user can inject externally acquired substances in the presence of a licensed health care professional. [18] On-site staff may not assist in the injection of drugs, but may provide services like wound care, overdose monitoring, and safe supply. [18] The CDC urges drug users to never use drugs alone to lower the risk of a fatal overdose. [5] Safe injection facilities create a space in which users do not have to inject drugs alone and are in the presence of personnel who can administer naloxone or provide emergency medical care if needed.

Legality

The Third Circuit of the U.S. Court of Appeals ruled in January 2021 that opening of site for consumption of illegal drugs is a federal crime. [19] This decision was rooted in the Controlled Substances Act, which bans an entity from providing a space intended for illicit drug use. [19]

Medication-assisted treatment (MAT) for opioid use

Medication-assisted treatment (MAT) combines behavioral therapy and counseling with the use of medication. [20] MAT is used effectively in the treatment of opioid use disorders (OUD). [20] The U.S. Food and Drug Administration (FDA) has approved buprenorphine, methadone, and naltrexone for use in MAT. [20]

Legality

Title 42 of the Code of Federal Regulations (CFR) Part 8 details the certification and accreditation process for opioid treatment programs. [21] This process is overseen by SAMHSA. [22]

Heroin-assisted treatment

Heroin-assisted treatment (HAT), also called heroin maintenance, consists of, diacetylmorphine, or pharmaceutical-grade heroin, being administered in clinics under medical supervision. [23] This treatment approach is designed for individuals who use illicit heroin but wish to stop. [23]

The North American Opiate Medication Initiative (NAOMI) disclosed plans in 1999 for three U.S.-based sites to administer HAT as part of a randomized controlled trial of HAT, but were unable to proceed due to regulatory barriers. [23]

Legality

Since heroin is categorized as a Schedule I drug by the U.S. Drug Enforcement Administration (DEA), it cannot be prescribed legally at this time. [24] Schedule I drugs are considered by the DEA to lack a current medical use as well as possess a high risk of abuse. [24]

Naloxone distribution

Naloxone, often referred to by the commercially available brand name Narcan, is an antagonist that can reverse an opioid overdose. [25] Narcan is distributed as a nasal spray, though other forms of naloxone are administered intravenously. [25] For example, the FDA has approved Evzio as a naloxone auto-injector, which includes verbal instructions for use. [26] In the U.S., at least 26,500 overdoses were reversed through the administration of naloxone by civilians between 1996 and 2014. [27]

Since its inception in 2017 through 2019, NEXT Harm Reduction distributed naloxone kits by mail to 3,609 individuals and received 335 reports of overdose reversals by naloxone provided by NEXT and its affiliates. [28]

Legality

According to the CDC, naloxone is available in all 50 states. [29] State laws vary in terms of immunity for legal liability in the prescription, distribution, and administration. [30]

20 states have codified the prescription of naloxone accompanying the prescription of an opioid, known as co-prescription. [30]

Example projects

New York City, New York

Mount Sinai Hospital's Respectful and Equitable Access to Healthcare Program (REACH) received Opioid Overdose Prevention Status (OOPP) in 2017. [31] REACH acquired funding from the New York City Department of Health and Mental Hygiene for the creation of overdose education and naloxone distribution. [31] As a result, 4,235 naloxone kits were distributed to 3,906 individuals and REACH conducted both bystander training and clinic staff training. [31]

On November 29, 2021, New York City officials authorized the nation's first two supervised injection facilities in Manhattan, one in East Harlem and one in Washington Heights. These sites are operated by OnPoint NYC. [32] Former mayor Bill de Blasio authorized the center shortly before his departure and the succeeding mayor Eric Adams shows support, however Federal prosecutor for Manhattan said the site is illegal. It remains uncertain if or what actions will be taken. [33]

San Francisco, California

In November 1988, Prevention Point was started as an all-volunteer organization to distribute unused, sterile syringes in two neighborhoods. [34] Prevention Point operated illegally but was not frequently disrupted by law enforcement in its early years. [34] The client pool grew quickly, with 7,821 syringes exchanged in the spring of 1989 compared to 343,833 syringes exchanged in the spring of 1992. [34] The prospect of sanctioned drug consumption site in San Francisco is in doubt following the announcement related to New York City. [35]

The San Francisco Health Commission unanimously passed a resolution adopting harm reduction as a policy on September 5, 2000. [36] This was passed as a means for drug users' health as well as the prevention of sexually transmitted infections and HIV.

Controversy

A working paper published in August 2021 suggests that expanded access to naloxone increased the distribution of fentanyl. [37] This paper also found a positive correlation between naloxone access and the number of uses and/or potency of each use of opioids. [37]

Dr. Laura G. Kehoe, medical director of the Massachusetts General Hospital Substance Use Disorder Bridge Clinic, shared in a U.S. News article that she believed stigma surrounding drug use to be a driving factor in the push against harm reduction initiatives. [38]

See also

Related Research Articles

<span class="mw-page-title-main">Harm reduction</span> Public health policies which lessen negative aspects of problematic activities

Harm reduction, or harm minimization, refers to a range of intentional practices and public health policies designed to lessen the negative social and/or physical consequences associated with various human behaviors, both legal and illegal. Harm reduction is used to decrease negative consequences of recreational drug use and sexual activity without requiring abstinence, recognizing that those unable or unwilling to stop can still make positive change to protect themselves and others.

<span class="mw-page-title-main">Fentanyl</span> Opioid medication

Fentanyl is a highly potent synthetic piperidine opioid primarily used as an analgesic. It is 30 to 50 times more potent than heroin and 100 times more potent than morphine; its primary clinical utility is in pain management for cancer patients and those recovering from painful surgeries. Fentanyl is also used as a sedative. Depending on the method of delivery, fentanyl can be very fast acting and ingesting a relatively small quantity can cause overdose. Fentanyl works by activating μ-opioid receptors. Fentanyl is sold under the brand names Actiq, Duragesic, and Sublimaze, among others.

<span class="mw-page-title-main">Naloxone</span> Opioid receptor antagonist

Naloxone is an opioid antagonist: a medication used to reverse or reduce the effects of opioids. For example, it is used to restore breathing after an opioid overdose. It is also known as Narcan. Effects begin within two minutes when given intravenously, five minutes when injected into a muscle, and ten minutes as a nasal spray. Naloxone blocks the effects of opioids for 30 to 90 minutes.

<span class="mw-page-title-main">Drug overdose</span> Use of an excessive amount of a drug

A drug overdose is the ingestion or application of a drug or other substance in quantities much greater than are recommended. Typically it is used for cases when a risk to health will potentially result. An overdose may result in a toxic state or death.

<span class="mw-page-title-main">Needle and syringe programmes</span> Method of providing drug users with uninfected equipment

A needle and syringe programme (NSP), also known as needle exchange program (NEP), is a social service that allows injection drug users (IDUs) to obtain clean and unused hypodermic needles and associated paraphernalia at little or no cost. It is based on the philosophy of harm reduction that attempts to reduce the risk factors for blood-borne diseases such as HIV/AIDS and hepatitis.

Needle sharing is the practice of intravenous drug-users by which a needle or syringe is shared by multiple individuals to administer intravenous drugs such as heroin, steroids, and hormones. This is a primary vector for blood-borne diseases which can be transmitted through blood. People who inject drugs (PWID) are at an increased risk for Hepatitis C (HCV) and HIV due to needle sharing practices. From 1933 to 1943, malaria was spread between users in the New York City area by this method. Afterwards, the use of quinine as a cutting agent in drug mixes became more common. Harm reduction efforts including safe disposal of needles, supervised injection sites, and public education may help bring awareness on safer needle sharing practices.

<span class="mw-page-title-main">Opioid use disorder</span> Medical condition

Opioid use disorder (OUD) is a substance use disorder characterized by cravings for opioids, continued use despite physical and/or psychological deterioration, increased tolerance with use, and withdrawal symptoms after discontinuing opioids. Opioid withdrawal symptoms include nausea, muscle aches, diarrhea, trouble sleeping, agitation, and a low mood. Addiction and dependence are important components of opioid use disorder.

<span class="mw-page-title-main">Drug injection</span> Method of introducing a drug

Drug injection is a method of introducing a drug into the bloodstream via a hollow hypodermic needle, which is pierced through the skin into the body. Intravenous therapy, a form of drug injection, is universally practiced in modernized medical care. As of 2004, there were 13.2 million people worldwide who self-administered injection drugs outside of medical supervision, of which 22% are from developed countries.

<span class="mw-page-title-main">Substance abuse prevention</span> Measures to prevent the consumption of licit and illicit drugs

Substance abuse prevention, also known as drug abuse prevention, is a process that attempts to prevent the onset of substance use or limit the development of problems associated with using psychoactive substances. Prevention efforts may focus on the individual or their surroundings. A concept that is known as "environmental prevention" focuses on changing community conditions or policies so that the availability of substances is reduced as well as the demand. Individual Substance Abuse Prevention, also known as drug abuse prevention involves numerous different sessions depending on the individual to help cease or reduce the use of substances. The time period to help a specific individual can vary based upon many aspects of an individual. The type of Prevention efforts should be based upon the individual's necessities which can also vary. Substance use prevention efforts typically focus on minors and young adults — especially between 12–35 years of age. Substances typically targeted by preventive efforts include alcohol, tobacco, marijuana, inhalants, coke, methamphetamine, steroids, club drugs, and opioids. Community advocacy against substance use is imperative due to the significant increase in opioid overdoses in the United States alone. It has been estimated that about one hundred and thirty individuals continue to lose their lives daily due to opioid overdoses alone.

<span class="mw-page-title-main">Opioid overdose</span> Toxicity due to excessive consumption of opioids

An opioid overdose is toxicity due to excessive consumption of opioids, such as morphine, codeine, heroin, fentanyl, tramadol, and methadone. This preventable pathology can be fatal if it leads to respiratory depression, a lethal condition that can cause hypoxia from slow and shallow breathing. Other symptoms include small pupils and unconsciousness; however, its onset can depend on the method of ingestion, the dosage and individual risk factors. Although there were over 110,000 deaths in 2017 due to opioids, individuals who survived also faced adverse complications, including permanent brain damage.

<span class="mw-page-title-main">Boston Public Health Commission</span>

The Boston Public Health Commission, the oldest health department in the United States, is an independent public agency providing a wide range of health services and programs. It is governed by a seven-member board of health appointed by the Mayor of Boston. Its mission is to "protect, preserve, and promote the health and well-being of all Boston residents, particularly those who are most vulnerable." The commission is headquartered at 1010 Massachusetts Avenue in Boston.

Low-threshold treatment programs are harm reduction-based health care centers targeted towards people who use substances. "Low-threshold" programs are programs that make minimal demands on the patient, offering services without attempting to control their intake of drugs, and providing counselling only if requested. Low-threshold programs may be contrasted with "high-threshold" programs, which require the user to accept a certain level of control and which demand that the patient accept counselling and cease all drug use as a precondition of support.

<span class="mw-page-title-main">Acetylfentanyl</span> Opioid analgesic

Acetylfentanyl is an opioid analgesic drug that is an analog of fentanyl. Studies have estimated acetylfentanyl to be 15 times more potent than morphine, which would mean that despite being somewhat weaker than fentanyl, it is nevertheless still several times stronger than pure heroin. It has never been licensed for medical use and instead has only been sold on the illicit drug market. Acetylfentanyl was discovered at the same time as fentanyl itself and had only rarely been encountered on the illicit market in the late 1980s. However, in 2013, Canadian police seized 3 kilograms of acetylfentanyl. As a μ-opioid receptor agonist, acetylfentanyl may serve as a direct substitute for oxycodone, heroin or other opioids. Common side effects of fentanyl analogs are similar to those of fentanyl itself, which include itching, nausea and potentially fatal respiratory depression. Fentanyl analogs have killed hundreds of people throughout Europe and the former Soviet republics since the most recent resurgence in use began in Estonia in the early 2000s, and novel derivatives continue to appear.

<span class="mw-page-title-main">Opioid epidemic in the United States</span> Ongoing overuse of opioid medication in the US

There is an ongoing opioid epidemic in the United States, originating out of both medical prescriptions and illegal sources. It has been called "one of the most devastating public health catastrophes of our time". The opioid epidemic unfolded in three waves. The first wave of the epidemic in the United States began in the late 1990s, according to the Centers for Disease Control and Prevention (CDC), when opioids were increasingly prescribed for pain management, resulting in a rise in overall opioid use throughout subsequent years. The second wave was from an expansion in the heroin market to supply already addicted people. The third wave starting in 2013 was marked by a steep 1,040% increase in the synthetic opioid-involved death rate as synthetic opioids flooded the US market.

Discrimination against people with substance use disorders is a form of discrimination against people with this disease. In the United States, people with substance use disorders are often blamed for their disease, which is often seen as a moral failing, due to a lack of public understanding about substance use disorders being diseases of the brain with 40-60% heritability. People with substance use disorders are likely to be stigmatized, whether in society or healthcare.

A take-home naloxone program is a governmental program that provides naloxone drug kits to those that are at risk of an opioid overdose. Naloxone is a medication that was created to reverse opioid overdoses. As an opioid antagonist, it binds to the μ-opioid receptors blocking the opioid's effects. Naloxone quickly restores normal respiration. The ongoing opioid epidemic has caused many public health authorities to expand access to naloxone.

<span class="mw-page-title-main">Opioid epidemic</span> Deaths due to abuse of opioid drugs

The opioid epidemic, also referred to as the opioid crisis, is the rapid increase in the overuse, misuse/abuse, and overdose deaths attributed either in part or in whole to the class of drugs called opiates/opioids since the 1990s. It includes the significant medical, social, psychological, demographic and economic consequences of the medical, non-medical, and recreational abuse of these medications.

<span class="mw-page-title-main">Response to the Opioid Crisis in New Jersey</span> Policy

New Jersey's most recent revised policy was issued September 7, 2022 pursuant to P.L.2021, c.152 which authorized opioid antidotes to be dispensed without a prescription or fee. Its goal is to make opioid antidotes widely available, reducing mortality from overdose while decreasing morbidity in conjunction with sterile needle access, fentanyl test strips, and substance use treatment programs. A $67 million grant provided by the Department of Health and Human Services provides funding for naloxone as well as recovery services. This policy enables any person to distribute an opioid antidote to someone they deem at risk of an opioid overdose, alongside information regarding: opioid overdose prevention and recognition, the administration of naloxone, circumstances that warrant calling 911 for assistance with an opioid overdose, and contraindications of naloxone. Instructions on how to perform resuscitation and the appropriate care of an overdose victim after the administration of an opioid antidote should also be included. Community first aid squads, professional organizations, police departments, and emergency departments are required to "leave-behind" naloxone and information with every person who overdosed or is at risk of overdosing.

In response to the surging opioid prescription rates by health care providers that contributed to the opioid epidemic in the United States, US states began passing legislation to stifle high-risk prescribing practices. These new laws fell primarily into one of the following four categories:

  1. Prescription Drug Monitoring Program (PDMP) enrollment laws: prescribers must enroll in their state's PDMP, an electronic database containing a record of all patients' controlled substance prescriptions
  2. PDMP query laws: prescribers must check the PDMP before prescribing an opioid
  3. Opioid prescribing cap laws: opioid prescriptions cannot exceed designated doses or durations
  4. Pill mill laws: pain clinics are closely regulated and monitored to minimize the prescription of opioids non-medically

Beth E. Meyerson is an American professor at the University of Arizona with interest in public health. She is best known for her research on public health policy with focus on harm reduction and sexual health. She is a Professor of Family and Community Medicine at the University of Arizona College of Medicine – Tucson.

References

  1. ↑ Brocato, Jo; Wagner, Eric F. (May 2003). "Harm reduction: a social work practice model and social justice agenda". Health and Social Work. 28 (2). Oxford University Press: 117–125. doi:10.1093/hsw/28.2.117. PMID   12774533.
  2. 1 2 Marlatt, G. Alan (1 November 1996). "Harm Reduction: Come as You Are". Addictive Behaviors. 21 (6): 779–788. doi:10.1016/0306-4603(96)00042-1. PMID   8904943.
  3. ↑ Taylor, Jessica L.; Johnson, Samantha; Cruz, Ricardo; Gray, Jessica R.; Schiff, Davida; Bagley, Sarah M. (2021-12-01). "Integrating Harm Reduction into Outpatient Opioid Use Disorder Treatment Settings". Journal of General Internal Medicine. 36 (12): 3810–3819. doi:10.1007/s11606-021-06904-4. ISSN   1525-1497. PMC   8218967 . PMID   34159545.
  4. ↑ Fregonese, Martina; Albino, Andrea; Covino, Claudia; Gili, Alessio; Bacci, Mauro; Nicoletti, Alessia; Gambelunghe, Cristiana (22 February 2021). "Drug Checking as Strategy for Harm Reduction in Recreational Contests: Evaluation of Two Different Drug Analysis Methodologies". Front Psychiatry. 12: 596895. doi: 10.3389/fpsyt.2021.596895 . PMC   7938318 . PMID   33692707.
  5. 1 2 "Fentanyl Test Strips: A Harm Reduction Strategy". Centers for Disease Control and Prevention. 16 February 2023.
  6. 1 2 CDC Health Alert Network (17 December 2020). "Increase in Fatal Drug Overdoses Across the United States Driven by Synthetic Opioids Before and During the COVID-19 Pandemic". Centers for Disease Control and Prevention.
  7. ↑ Hedegaard, Holly; Bastian, Brigham A.; Trinidad, James P.; Spencer, Merianne Rose; Warner, Margaret (25 October 2019). "Regional Differences in the Drugs Most Frequently Involved in Drug Overdose Deaths: United States, 2017" (PDF). National Vital Statistics Reports. 68 (12) – via Centers for Disease Control and Prevention.
  8. ↑ "Syringe Services Programs (SSPs) FAQs". Centers for Disease Control and Prevention. 7 December 2020.
  9. ↑ Hagemeier, Nicholas E.; Dowling-McClay, KariLynn; Baladezaei, Mahnaz; Curtis, Sabrina J.; Spence, Matthew (April 2021). "Pharmacists' nonprescription syringe dispensing perceptions and behaviors: A three-state descriptive analysis". Drug and Alcohol Dependence. 221: 108597. doi:10.1016/j.drugalcdep.2021.108597. PMID   33631542. S2CID   232057697.
  10. 1 2 "HIV and Injection Drug Use". Centers for Disease Control and Prevention. 30 March 2022.
  11. ↑ "Hepatitis C Tables and Figures". Centers for Disease Control and Prevention. 10 February 2021.
  12. ↑ "Harm Reduction Locations". NASEN.
  13. ↑ Rantz, Jason (2024-09-23). "Public Health Seattle distributes drug kits with pipes, instructions". MyNorthwest.com. Retrieved 2024-11-04.
  14. 1 2 3 "Determination of Need for Syringe Services Programs". Centers for Disease Control and Prevention. 2 March 2022.
  15. ↑ Russoniello, Kellen; Vakharia, Sheila P.; Netherland, Jules; Naidoo, Theshia; Wheelock, Haven; Hurst, Tera; Rouhani, Saba (January 2023). "Decriminalization of drug possession in Oregon: Analysis and early lessons". Drug Science, Policy and Law. 9. doi:10.1177/20503245231167407. ISSN   2050-3245.
  16. ↑ Sullivan, Kevin (2015), "Code of Federal Regulations Title 31 Section 103.18", Anti–Money Laundering in a Nutshell, Berkeley, CA: Apress, pp. 171–173, ISBN   978-1-4302-6160-5 , retrieved 2024-11-04
  17. ↑ "Drug Paraphernalia Fast Facts". www.justice.gov. Retrieved 2024-11-04.
  18. 1 2 Beletsky, Leo; Davis, Corey S.; Anderson, Evan; Burris, Scott (February 2008). "The Law (and Politics) of Safe Injection Facilities in the United States". Am J Public Health. 98 (2): 231–237. doi:10.2105/AJPH.2006.103747. PMC   2376869 . PMID   18172151.
  19. 1 2 U.S. Department of Justice (13 January 2021). "Appellate Court Agrees with Government that Supervised Injection Sites are Illegal under Federal Law; Reverses District Court Ruling". U.S. Department of Justice.
  20. 1 2 3 "Information about Medication-Assisted Treatment (MAT)". U.S. Food and Drug Administration. 14 February 2019.
  21. ↑ "Title 42 Chapter I Subchapter A Part 8". Code of Federal Regulations.
  22. ↑ "Medications for Substance Use Disorders: Statutes, Regulations, and Guidelines". Substance Abuse and Mental Health Services Administration. 15 June 2015.
  23. 1 2 3 Nadelmann, Ethan; LaSalle, Lindsay (12 June 2017). "Two steps forward, one step back: current harm reduction policy and politics in the United States". Harm Reduction Journal. 14 (37): 37. doi: 10.1186/s12954-017-0157-y . PMC   5469032 . PMID   28606093. S2CID   7279103.
  24. 1 2 "Drug Scheduling". United States Drug Enforcement Administration.
  25. 1 2 Berardi, Luca; Bucerius, Sandra; Haggerty, Kevin D.; Krahn, Harvey (February 2021). "Narcan and Narcan't: Implementation factors influencing police officer use of Narcan". Social Science & Medicine. 270: 113669. doi:10.1016/j.socscimed.2021.113669. S2CID   231610927.
  26. ↑ "Naloxone for Opioid Overdose: Life-Saving Science". National Institute on Drug Abuse. March 2017.
  27. ↑ Wheeler, Eliza; Jones, T. Stephen; Gilbert, Michael K.; Davidson, Peter J. (19 June 2015). "Morbidity and Mortality Weekly Report (MMWR): Opioid Overdose Prevention Programs Providing Naloxone to Laypersons – United States, 2014". www.cdc.gov. Retrieved 2023-03-03.
  28. ↑ Yang, Carol; Favaro, Jamie; Meacham, Meredith (April 2021). "NEXT Harm Reduction: An Online, Mail-Based Naloxone Distribution and Harm-Reduction Program". American Journal of Public Health. 111 (4): 667–671. doi:10.2105/AJPH.2020.306124. PMC   7958031 . PMID   33600254. S2CID   231963654.
  29. ↑ "Lifesaving Naloxone". Centers for Disease Control and Prevention. 25 January 2023.
  30. 1 2 "Naloxone Access: Summary of State Laws" (PDF). Legislative Analysis and Public Policy Association. January 2023.
  31. 1 2 3 Riazi, Farah; Toribio, Wilma; Irani, Emaun; Hughes, Terence M.; Huxley-Reicher, Zina; McBratney, Elisa; Vu, Trang; Sigel, Keith; Weiss, Jeffrey J. (2021). "Community Case Study of Naloxone Distribution by Hospital-Based Harm Reduction Program for People Who Use Drugs in New York City". Frontiers in Sociology. 6: 619683. doi: 10.3389/fsoc.2021.619683 . ISSN   2297-7775. PMC   8292929 . PMID   34307540.
  32. ↑ Mays, Jeffery C.; Newman, Andy (30 November 2021). "Nation's First Supervised Drug-Injection Sites Open in New York". The New York Times. ISSN   0362-4331 . Retrieved 6 March 2023.
  33. ↑ "Federal Officials May Shut Down Overdose Prevention Centers in Manhattan". 2023-08-08. Retrieved 2023-08-11.
  34. 1 2 3 Watters, John K.; Estilo, Michelle J.; Clark, George L.; Lorvick, Jennifer (1994). "An Evaluation of Needle and Syringe Exchange in San Francisco". National Research Council (US) and Institute of Medicine (US) Panel on Needle Exchange and Bleach Distribution Programs.
  35. ↑ "Drug Crisis: Future of SF Safe Consumption Sites in Doubt". The San Francisco Standard. 2023-08-10. Retrieved 2023-08-11.
  36. ↑ "Harm Reduction Policy". San Francisco Department of Public Health.
  37. 1 2 Doleac, Jennifer L.; Mukherjee, Anita (6 March 2018). "The Effects of Naloxone Access Laws on Opioid Abuse, Mortality, and Crime". doi:10.2139/ssrn.3135264. S2CID   4661876. SSRN   3135264.{{cite journal}}: Cite journal requires |journal= (help)
  38. ↑ Williams, Joseph P. (24 January 2019). "A Fight to Do No Harm: Strategies embraced elsewhere to curb the impact of drug addiction still face obstacles in the U.S." U.S. News & World Report.
This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.