The need to save lives and reduce negative health outcomes from drug use is unprecedented. In 2021 alone, the overdose epidemic took the lives of more than 107,000 people in the U.S., according to provisional data from the Centers for Disease Control and Prevention. These deaths were largely driven by fentanyl, sometimes contaminating or taken in conjunction with other drugs. This includes stimulants as well as opioids. There are many other health consequences of addiction, including the transmission of infectious diseases like HIV and hepatitis C.
Enabling people to access treatment for substance use disorders is critical, but first people need to survive long enough to have that choice. Other consequences of drug use, such as infectious disease transmission, must also be mitigated. The United States’ overdose crisis requires bold, evidence-based actions to save more lives, which is why NIH is announcing a $36 million, five-year investment in research to reduce the overdose epidemic and improve care access for people who use drugs through the establishment of a harm reduction research network. The network, funded by the NIH Helping to End Addiction Long-term Initiative (NIH HEAL Initiative) through the National Institute on Drug Abuse, begins this year with nine research grants and one grant to establish a coordinating center.
The projects funded by these grants will test harm reduction interventions so that we can develop evidence-based actions to help prevent overdoses and save lives. Research projects will also assess how well some existing harm reduction programs work, with concrete endpoints like overdose rates. And they will test novel harm reduction approaches meant to gather data on what works, what doesn’t, and acceptability in communities.
Harm reduction is a crucial part of our overall strategy to address the addiction and overdose crises. We know that overdose education and naloxone distribution programs and provision of naloxone to people who take drugs and to first responders saves lives. And, nearly 30 years of evidence shows that access to syringes and other injection equipment helps reduce the spread of diseases like HIV and hepatitis C. People who encounter harm reduction services during active use are often more likely to take steps toward treatment and recovery and stay in better health – saving long-term healthcare dollars and protecting the overall community’s health, too. Other harm reduction techniques such as fentanyl test strips show promise as well, but we need additional data to evaluate their effectiveness and to know more about how to best deploy new tools. The bottom line is that investing in more harm reduction research and tools is key to saving lives.
In addition to overdose prevention, harm reduction programs often have additional benefits, such as linkage to treatment with medications for opioid use disorder (MOUD) as well as other healthcare services provided onsite. Harm reduction programs can be an important way of delivering services to people who otherwise might be afraid of seeking care because of the stigma they encounter in most settings, including traditional treatment settings.
Harm reduction is an important part of reducing the impact of stigma because these services are often staffed by people in recovery or with lived experience of addiction, and thus clients are treated with dignity. This can open doors that lead to treatment, recovery, increased employment, education, and stronger family bonds, as well as reduced drug use.
Several of the studies funded by the new grants will target populations disproportionally affected by drug use and its negative impacts, including Black and Latino/Latina communities, women, and people in rural areas of the country. Multiple projects will examine the efficacy of providing harm reduction services and tools via mobile vans and other on-the-ground outreach.
This is particularly needed in rural areas, where people may need to travel great distances to receive services. Harm reduction techniques must be examined in or adapted to rural settings to see if they can work and are desirable. Overdose deaths involving psychostimulants were higher in rural counties than in urban counties from 2012 through 2020, so some grantees will specifically be investigating harm reduction for people in rural areas who use stimulants.
Projects will also study barriers to accessing harm reduction services more broadly, which can include the physical inaccessibility of services that are located far away from those who need them, and other factors like clinician attitudes that can discourage use.
Some projects are assessing implementation of the evidence-based approach of employing peer counseling and referral, which has been found to increase the ability of programs to reach the hardly reached. All projects will have a community advisory board and/or people with lived experience will have paid positions to support the research. Greater involvement of people with lived experience in all aspects of research is one of the themes of NIDA’s 2022-2026 Strategic Plan.
As is also true of recovery support services, development and implementation of harm reduction over the years has often been driven by peers and people in recovery from substance use disorders—responding nimbly, creatively, and compassionately to the needs of people who are seeking help in their communities. NIDA can help by supporting research that builds on their work, finding out which strategies work, and ways to implement these most effectively for all who need them.
NIH is committed to addressing the overdose crisis with urgency and precision. The number of deaths we are seeing requires us to expand our thinking with evidence-based, scientific action that can meaningfully save more lives. These grants will help us achieve that mission.
For more information about the new harm reduction research network, read the NIH press release. NIH is not providing funds for the purchase of pipes, syringes or needles.