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]

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 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]

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.^[14] On-site staff may not assist in the injection of drugs, but may provide services like wound care, overdose monitoring, and safe supply.^[14] 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.

Medication-assisted treatment (MAT) for opioid use

Medication-assisted treatment (MAT) combines behavioral therapy and counseling with the use of medication.^[16] MAT is used effectively in the treatment of opioid use disorders (OUD).^[16] The U.S. Food and Drug Administration (FDA) has approved buprenorphine, methadone, and naltrexone for use in MAT.^[16]

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.^[19] This treatment approach is designed for individuals who use illicit heroin but wish to stop.^[19]

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.^[19]

Naloxone distribution

Naloxone, often referred to by the commercially available brand name Narcan, is an antagonist that can reverse an opioid overdose.^[21] Narcan is distributed as a nasal spray, though other forms of naloxone are administered intravenously.^[21] For example, the FDA has approved Evzio as a naloxone auto-injector, which includes verbal instructions for use.^[22] In the U.S., at least 26,500 overdoses were reversed through the administration of naloxone by civilians between 1996 and 2014.^[23]

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.^[24]

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.^[27] REACH acquired funding from the New York City Department of Health and Mental Hygiene for the creation of overdose education and naloxone distribution.^[27] As a result, 4,235 naloxone kits were distributed to 3,906 individuals and REACH conducted both bystander training and clinic staff training.^[27]

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.^[28] Former mayor Bill de Blasio authorized the center 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.^[29]

San Francisco, California

In November 1988, Prevention Point was started as an all-volunteer organization to distribute unused, sterile syringes in two neighborhoods.^[30] Prevention Point operated illegally but was not frequently disrupted by law enforcement in its early years.^[30] 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.^[30] The prospect of sanctioned drug consumption site in San Francisco is in doubt following the announcement related to New York City.^[31]

The San Francisco Health Commission unanimously passed a resolution adopting harm reduction as a policy on September 5, 2000.^[32] This was passed as a means for drug users' health as well as the prevention of sexually transmitted infections and HIV.