Indicator Profile

Number of harm reduction service encounters

Indicator Overview

Description:

Number of harm reduction service encounters including but not limited to: distribution of supplies, education, medical services and behavioral health support (see examples in definition section).

Rationale:

Harm reduction indicators relate to evidence-based approaches that save lives and lessen the harms of drug use, including disease transmission. Harm reduction activities can include distribution of sterile syringes, drug test strips, naloxone and education about safer drug use. Harm reduction programs focus on putting people first and addressing their direct, immediate needs by meeting people where they are without judgement.

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.^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

While organizations may not provide or collect data on all types of harm reduction services, tracking available data can provide insight into trends which can further inform areas of need and overdose prevention efforts. For example, a change in the number of service encounters and/or participants’ needs may indicate either a decreased need of services, an extreme weather-related event, political context or something else that should be investigated to understand the decrease in encounters.

Related Indicators:

Pairing the number of harm reduction supplies distributed with the number of service encounters can provide a greater understanding of the needs and characteristics of people served in an area (e.g. supplies given per encounter or types of supplies per encounter) and may assist in the accounting and ordering/accessing products (e.g., naloxone, syringes) available and inventory control.

In addition, monitoring the number of participants who have experienced an overdose allows organizations to gain insight into the people they serve, better address their needs and identify trends in overdose over time.

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 service encounter is an interaction with service providers where a need expressed by a participant is addressed and where harm reduction services are provided including, but not limited to the following:

• Provision of supplies – this includes distributing naloxone (Narcan), drug test strips, wound care kits, safer drug use supplies such as safer smoking kits, safer sex kits, medication lock boxes and food
• Education/information – refers to providing education and training on topics such as overdose prevention, how to recognize an overdose, proper naloxone use, safe drug use and safe disposal; HIV and hepatitis prevention and testing and information about local resources
• On site or referral to medical services – includes offering Hepatitis C and HIV services, primary medical, wound care or OB/GYN care
• On site or referrals to behavioral health support – includes connecting individuals to counseling and providing referrals to treatment for substance use disorders
• Other services – includes any other harm reduction service not mentioned above, such as providing on-site drug checking services.
• Naloxone – overdose reversal drug otherwise known by name brands, such as Narcan.

Ways to Examine the Data:

1. Type of harm reduction service provided (e.g., provision of supplies, education, referrals, etc.)
2. Type of setting in which the service was provided (e.g., school, syringe service program (SSP), harm reduction mobile unit, harm reduction outreach unit, health clinic, correctional facility, housing unit)
3. Zip code where service was provided (this may be particularly important for mobile units/operations)

Data Sources:

• Encounter-level data (logs and records) from organizations providing harm reduction services
• Program case notes

Data Collection Methods:

• Service encounters are typically tracked by the programs providing the harm reduction service. Approaches to collecting and analyzing this data include a review of programmatic data, case notes, records and logs tracked by organizations providing the harm reduction services.

Note: Some programs may track an encounter as each time a person comes “through the door” to access services anonymously. Others may have a way to track individual participants (e.g., with a unique number) with identity protection and can track new encounters or types of encounters by participant. However your organization operates, there are ways to collect this indicator.

Application and Considerations

Suggested Use:

Program Implementer

• To use as a proxy for the number of clients served
• To compare number of encounters by setting (if tracked across multiple settings or sites). This may help programs select the optimum time and place for services
• To assess the change in needs of clients among different populations
• To ensure fiscal responsibility (i.e., check that input of supplies is in line with outgoing services)
• To understand which types of services are being used most frequently

Community Convener

• To use as a proxy for the number of clients served
• To evaluate accessibility of programs for all populations
• To identify gaps in availability of and access to harm reduction services
• To identify which communities have the greatest access to harm reduction services
• To assist service providers in finding the correct setting and time for operation
• To understand which types of services are being used most frequently
• To assess the change in needs of clients among different populations

Funder

• To inform funders whether a program is providing the types of services for which they are being funded
• To provide insight into trends which can further inform areas of need in overdose prevention programming. Additional information, if tracked, can help funders understand a) where services are being provided, b) what types of services are provided and c) potential gaps/opportunities for program improvements and expansion

Health Access Considerations:

You may want to consider:

• Is there equitable access to all harm reduction services provided?
• Are the harm reduction needs of all people who use drugs (PWUD) being met, regardless of what/how they use?
• Are gender-based services offered equitably?
• Are encounters being conducted in settings relatively free of stigma?

Evaluation Considerations:

Limitations:

• Does not track the number of people receiving services
• Does not track how/if supplies are used
• Does not track service outcomes

Additional Resources

Examples:

• Rodriguez, M., McKenzie, M., McKee, H., Ledingham, E., John, K., Koziol, J., Hallowell, B., (2024, March/April). Differences in Substance Use and Harm Reduction Practices by Race and Ethnicity: Rhode Island Harm Reduction Surveillance System, 2021-2022. Journal of Public Health Management and Practice. 30(2),E84-E93. https://pubmed.ncbi.nlm.nih.gov/38153310/. DOI: 10.1097/PHH.0000000000001863
• Smith, K. R., Shah, N. K., Adamczyk, A. L., Weinstein, L. C., & Kelly, E. L. (2023). Harm reduction in undergraduate and graduate medical education: a systematic scoping review. BMC Medical Education, 23(1), 986.

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). An Assessment of Opioid-Related Deaths in Massachusetts (2013–2014). Boston, MA: Department of Public Health.
   https://www.mass.gov/doc/legislative-report-chapter-55-opioid-overdose-study-september-2016/download.
5. Baggett, T. P., Hwang, S. W., O'Connell, J. J., Porneala, B. C., Stringfellow, E. J., Orav, 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 internal medicine, 173(3), 189–195.
   https://doi.org/10.1001/jamainternmed.2013.1604