Harm Reduction

Xylazine is a non-opioid that is approved for animals, and not FDA-approved for humans. New York State's Department of Health provides information on what it is, sources and trends, effects, why people use it, why clinicians should be concerned, and other information on Xylazine. Information about Xylazine is important to understand now that it has been showing up in illicit drug supply.

This study's objective was to develop and validate a survey tool to assess emergency department physician attitudes, clinical practice, and willingness to perform opiate harm reduction interventions. After surveying physicians, most showed they were willing to provide necessary interventions, while few do perform them. Although there was an increased willingness to perform the interventions, a disparity remains. 

The U.S. Department of Health and Human Services (HHS) announced the progress made since the release of the Overdose Prevention Strategy (Strategy) last fall. The new data shows treatment capacity, lives saved from overdose, and commitments to long-term recovery supports, as well as a hopeful trend of a decrease in overdose deaths.

In their new 2022 Clinical Practice Guideline, the Centers for Disease Control and Prevention (CDC) provides updated evidence and research on the risks and benefits of prescription opioids for acute, subacute, and chronic pain.  These include dosing strategies, tapering and discontinuation, comparisons with nonopioid pain treatments, and risk mitigation strategies. 

The webinar held by NASTAD on October 26, 2022, 4:00-5:30pm featured a dynamic discussion on integrating harm reduction principles and practices, including naloxone distribution, safe disposal, and harm reduction supply access, within the community health care setting. Health centers across the country that offer these services as part of comprehensive care shared their experiences and the ways that service expansion can contribute to engagement and care access.

Overdose deaths have increased in urban and rural counties; however, rural communities continue to be disproportionately impacted. Approximately half of rural counties do not have a provider waivered to prescribe buprenorphine and there is extremely limited access to harm reduction services in rural communities.

Nitazenes are a novel group of powerful illicit synthetic opioids derived from 2-benzylbenzimidazole that have been linked to overdose deaths in several states. Nitazenes were created as a potential pain reliever medication nearly 60 years ago but have never been approved for use in the United States. Laboratory test results indicate that the potency of certain nitazene analogs (e.g., isotonitazene, protonitazene, and etonitazene) greatly exceeds that of fentanyl, whereas the potency of the analog metonitazene is similar to fentanyl.

Researchers interviewed community partners, health care providers, and people who inject drugs in Maine to see how the pandemic affected programs, including syringe services, safe drug supply, low barrier treatment, and peer support. Some barriers to access were unavoidable, but they found specific policy decisions that mitigated barriers, while other policies exacerbated them. 

This observational study of 719 612 pharmacy claims data shows that OOP costs of naloxone grew substantially beginning in 2016. However, OOP costs did not increase for all patients and all brands of naloxone but primarily for uninsured patients and for the Evzio brand. The findings suggest that the OOP cost of naloxone has been an increasingly substantial barrier to naloxone access for uninsured patients, a population that constitutes nearly one-fifth of adults with opioid use disorder.

This essay is adapted by the author Beth Macy, who's book "“Raising Lazarus: Hope, Justice, and the Future of America’s Overdose Crisis" is forthcoming.