Harm Reduction is rooted in acknowledging that a person who is an active drug user deserves to be treated with dignity and respect, including being offered safe access to clean syringes and naloxone. This work can be done while building trust and opening the door to recovery options. Harm reduction services that promote safer drug use are essential and can facilitate access to needed medical and behavioral health support for drug users who cannot or will not access outpatient programs. Indeed, many people who use drugs have felt unwelcome in healthcare settings and some have even been banned by mental health and substance abuse treatment programs, healthcare clinics, and service providers.
Local and national attention is focused on multifaceted approaches to public safety, overdose prevention, and access to treatment for opioid and heroin users. Between 2010 and 2015, New York City saw a 66 percent increase in opioid-related deaths. In 2015, there were 937 unintentional drug overdose deaths, compared to 800 in the previous year (https://www1.nyc.gov/assets/doh/downloads/pdf/epi/databrief74.pdf). Roughly every seven hours in New York City a person is dying from an overdose.
Harm reduction offers a life-affirming, and even life-saving, entry point into a network of care and support. Yet the vital integration of behavioral health treatment, primary health care and recovery support services with harm reduction methods has been lacking. Now, as population health models continue to expand, reaching at-risk groups is a priority and new opportunities exist for peer outreach, including outreach by individuals who may still be using drugs themselves.
The Washington Heights CORNER Project (WHCP) and the New York Harm Reduction Educators (NYHRE) are two non-profit organizations devoted to promoting the health, safety and well-being of marginalized, low-income persons who use drugs, their loved ones, and their communities. The two organizations share leadership and resources to reach the highest risk and highest cost individuals who are the least likely to be engaged by the traditional service system throughout Northern Manhattan and the South Bronx. In the past year, the two organizations reached nearly 7,000 individuals experiencing a broad range of co-occurring conditions. WHCP’s weekly Uptown Friday Trans Social and its sex worker outreach program, called “Rest Here,” demonstrate success in further growing the organization’s reach.
The organizations provide street outreach and drop-in center programming. Services are provided by peer and professional staff who are grounded in radical openness and acceptance and trained to create safe and welcoming environments for individuals who are otherwise stigmatized and unlikely to engage in primary care and/or other community-based programs. Together, the organizations conducted a community mapping initiative to better target street outreach based on epidemiological data, and both agencies are credited with preventing deaths by administering and distributing Naloxone. Often their contacts within drug-using peer networks and on social media are able to spread the word when overdose risk is high due to known contamination within the local drug supply. For instance, when a “bad batch” leads to law enforcement “flooding the zone,” users who frequent the area will scatter, making the public health response more difficult. Outreach staff are able to bridge the gaps between enforcement, protection, and public safety by strategically seeking known contacts to spread the word to individuals who have fled to alternate locations and may not have heard about the health threat.
Low-barrier engagement is not just about outreach and needle exchange. People often ask for help to stop using drugs and to find safe and stable housing. Staff support people to initially access services. For example, if an individual wanted to begin seeing a mental health treatment provider, staff will walk through the options based on the specific benefits and programs that are available, help make an appointment, and then support the individual to physically get to the appointment. As well, engagement at NYHRE and WHCP often expands outward from each participant to their network. For example, an individual may come in with a friend who is just interested in getting a cup of coffee, but then perhaps a staff member approaches just to say hello. In this organic way, additional individuals are engaged via existing participant networks.
The capacity to demonstrate success reaching high numbers of people who are active intravenous drug users well-positions harm reduction organizations to deepen partnerships with payers, such as managed care organizations and entities engaged in value-based payment models. Indeed, both NYHRE and WHCP are connected to Performing Provider Systems, implementing Medicaid financed HCBS services, and partnering to offer an array of on-site services. The organizations are part of the iHealth network of care management providers serving those with HIV/AIDS and they are exploring additional service delivery opportunities via new partnerships. For instance, the Licensed Behavioral Health Practitioner Benefit (https://www.omh.ny.gov/omhweb/bho/docs/guidance-on-licensed-behavioral-health-practitioner-benefit.pdf) is a Waiver option that allows treatment providers to conduct offsite services for individuals whose managed care provider approves the need for community-based engagement. Approaches like Motivational Interviewing, Seeking Safety and Non-Violent Crisis Intervention work well with people who are active drug users dealing with both trauma and addiction.
In addition to service expansion and new linkages, both organizations offer opportunities for practitioners to build their counselling skills in order to better engage active drug users who lack support and are struggling in isolation. New York Harm Reduction Educators (NYHRE) operates national training and capacity building services to promote non-judgmental, evidence-based, approaches to enhance individual, organizational and community effectiveness. These tailored, capacity-building services for community-based organizations, Health Departments, and community coalitions are collaborative and interactive to promote:
- Drug User Health: Syringe access and other harm reduction services including prevention of HIV, hepatitis C and overdose, etc.
- Drug User Dignity: Anti-stigma, leadership development, and increasing cultural competency
- Community Impact: Program development & sustainability, organizational development, monitoring and evaluation, and community mobilization
The health and behavioral health community seeks opportunities to reach people – and their families – to help them connect and navigate the system of care. Harm reduction programs offer places where people are encouraged to support one another, find hope, and better cope with their drug use until recovery is possible.