Overdose Measures Matter

Indicator Profile

Number of harm reduction programs

Category: Harm Reduction

Audience: Convener

Data Type: Quantitative

Indicator Overview

Description:

Number of operating harm reduction programs in a designated community, region or jurisdiction

Indicator counting harm reduction programs within geographically defined parameters, tailored by how the organization defines harm reduction

Rationale:

Harm reduction indicators relate to evidence-based approaches that save lives and lessen the harms of drug use, including disease transmission.

Harm reduction programs focus on putting people first and focusing on their direct, immediate needs by meeting people where they are. We have chosen to embrace a broad definition to be inclusive of all programs working with this goal.

Harm reduction strategies have been shown to reduce overdose, increase treatment entry, reduce drug use frequency and improve the health of people who use drugs outside treatment or prescription guidelines.1,2,3 These strategies are particularly important for populations disproportionately affected by overdose, such as individuals recently released from incarceration and individuals experiencing homelessness, as they are several times more likely to experience an overdose event.4,5

Tracking data on the number of harm reduction programs shows the extent to which communities have access to strategies and interventions that reduce the negative effects of drug use. Tracking the locations of these programs can reveal which populations are receiving support and can also highlight gaps in health access for underserved groups.

Although some organizations may not provide or collect data on all harm reduction services or supplies, tracking available data for these programs can help identify trends and inform areas of need in overdose prevention efforts.

Related Indicators:

In addition to finding the number of harm reduction programs that exist in a given area, it might be helpful to know the number of harm reduction service encounters per site. Pairing these indicators together provides insights into which sites may have high or low utilization and can help guide efforts to tailor resources more effectively.

Furthermore, knowing the number of harm reduction supplies distributed can provide a greater understanding of the needs and characteristics of people served in an area (e.g. types of supplies used by participants, drug or method of choice) and may reveal discrepancies in the amount of a product (e.g., naloxone, syringes) available, such as an imbalance between supply and demand or issues related to inventory control.

A community convener could calculate the average number of service encounters or supplies distributed to assess trends over time (e.g., substance use, route of administration, policy changes). With this data, programs can pivot to best serve their participants.

Indicator Details

Definitions:

A harm reduction program is a set of related activities focused on practical strategies and interventions to reduce negative consequences associated with drug use.

Harm reduction programs provide a variety of services dependent upon community needs, financial considerations and legal guidelines and vary by state and community. Harm reduction may include activities such as: naloxone distribution, education, drug test strip distribution, syringe service programs, needle exchange programs, clean paraphernalia distribution, drug checking, wound care, HIV and hepatitis testing and safe injection sites.

Ways to Examine the Data:

  1. Zip code where program operates (can include multiple if program is a mobile unit) Note: Some programs may not wish to report this to protect participants
  2. Types of services provided (e.g., naloxone distribution, syringe/needle exchange, chronic disease testing, etc.)
  3. Type of program (e.g., mobile unit, clinic, school, harm reduction program, etc.)

Data Sources:

  • Information from programs providing harm reduction services via surveys, focus groups or interviews.
  • Publicly available information about harm reduction programs in the region/community/jurisdiction

Data Collection Methods:

  • Environmental or landscape scan of publicly available information
  • Review of reports shared by programs providing harm reduction services
  • Collection of qualitative data via interviews, focus groups or surveys with harm reduction service providers

Note: Collection of data may require additional funding and staff support

Application and Considerations

Suggested Use:

  • To determine if harm reduction programs are in higher burden communities, zip codes, regions. For example, by comparing zip codes of harm reduction programs to zip codes with the highest overdose burden, you may be able to identify if areas with the highest need have the greatest access to harm reduction services or if more targeted efforts are needed.
  • To create partnerships and alliances to support existing programs
  • To support the creation of new programs
  • To calculate the ratio of programs to at-risk population which allows users to identify gaps in availability of and access to harm reduction services

Health Access Considerations:

You may want to consider:

  • What types of harm reduction services are currently provided by existing harm reduction programs? What harm reduction services are not available in your community?
  • Is there equitable access to harm reduction programs in your community?
  • Are the rates of overdose and overdose fatality disproportionate in your community?
  • Are services located along public transportation routes? How far might people have to travel to access services at these programs?
  • How many days per week are these programs in operation? What are their operating hours? How do operating hours impact how accessible programs are for people in the community?
  • Are people who use drugs or people with living and lived experience included in the daily operations of or harm reduction services being provided by existing harm reduction programs?

Evaluation Considerations:

Limitations:

  • Does not track the number of people receiving services nor individual demographic data, so it may be difficult to look at equitable access
  • Outcomes of services provided by harm reduction programs not tracked

Policy Considerations and Resources:

Note: Public health laws do change; please review the above resources for current laws.

Additional Resources

Examples:

References:

  1. Rhodes, T. (2009). Risk environments and drug harms: a social science for harm reduction approach. International Journal of Drug Policy, 20(3), 193-201.
  2. Giglio, R. E., Li, G., & DiMaggio, C. J. (2015). Effectiveness of bystander naloxone administration and overdose education programs: a meta-analysis. Injury Epidemiology, 2, 1-9.
  3. Hagan, H. McGough, J.P., Thiede, H., Hopkins, S., Duchin, J., & Alexander, E.R. (2000). Reduced injection frequency and increased entry and retention in drug treatment associated with needle-exchange participation in Seattle drug injectors. Journal of Substance Abuse Treatment, 19(3), 247-252.
  4. Massachusetts Department of Public Health. (2016, September 16). An assessment of opioid-related deaths in Massachusetts (2013-2014). Boston, MA: Department of Public Health.
    http://www.mass.gov/eohhs/docs/dph/stop-addiction/dph-legislative-report-chapter-55-opioid-overdose-study-9-15-2016.pdf
  5. Baggett, T.P., Hwang, S.W., O’Connell, J.J., Porneala, B.C., Stringfellow, E.J., Oray, E.J., Singer, D.E. & Rigotti, N.A. (2013). Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. Jama International Medicine. 173(3), 189-195.
    https://doi.org/10.1001/jamainternmed.2013.1604
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