Overdose Measures Matter

Indicator Profile

Number of harm reduction supplies distributed

Category: Harm Reduction

Audience: ConvenerFunderProgram Implementer

Data Type: Quantitative

Indicator Overview

Description:

Number of harm reduction supplies distributed free of charge to individuals within a given timeframe. Organizations can determine the defined timeframe in which data are collected based on their reporting needs, resources and capacity.

Rationale:

Harm reduction encompasses a set of practical strategies and interventions aimed at reducing negative consequences associated with drug use. Harm reduction programs focus on putting people first and addressing their direct, immediate needs by meeting people where they are.

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, tracking harm reduction supplies can be helpful for inventory tracking and provide justification for greater funding for certain supplies that are in high demand.

Related Indicators:

If you are a funder, consider asking grantees or recipients to provide the number of naloxone doses distributed or to track specific supplies you are funding. To support the tracking of naloxone doses, make sure to work with recipients to develop a consistent way to measure “doses.” For example, if there are 2 doses in 1 kit, count 2 doses. It is important to consider the amount of naloxone in each dose. Actual amounts of naloxone may vary by application method as well as brand.

If you are a program implementer, consider asking your clientele what supplies they need to help you tailor this indicator. Needs change due to changes in substances, availability of drugs and routes of administration, among other things. Asking participants directly helps keep your program relevant and abreast of these changes.

Indicator Details

Definitions:

A harm reduction supply is a tool or resource that is critical to potentially saving the lives of people who use drugs by preventing overdose and other harmful or negative consequences associated with drug use.

Examples include, but are not limited to, naloxone medication for overdose reversals, drug testing strips, safer smoking or inhalation kits and wound care kits. Drug testing strips are low-cost harm reduction tools that can be used to prevent overdoses by detecting the presence of harmful substances such as fentanyl, xylazine and other drugs.

Naloxone, also known as Narcan, is an important harm reduction tool used to rapidly reverse opioid overdose and reduce population level opioid-related mortality. Tracking the number of naloxone doses distributed can help measure saturation in communities and access by underserved populations, particularly those experiencing social, language or income-driven challenges. Identifying access gaps help communities overcome barriers to improve program effectiveness.

Drug testing strips are low-cost harm reduction tools that can be used to prevent overdoses by detecting the presence of harmful drugs/substances such as fentanyl, xylazine and other drugs. Test strips can inform people who use drugs about the presence of substances so they can take steps to reduce their risk of overdose.

Safer smoking or inhalation kits contain sterile smoking materials to help prevent the spread of infectious disease. These kits may include glass stems and pipes, plastic mouth pieces, and items to hold the substance in place, such as screens, wires and wooden sticks. Some kits may also include alcohol wipes and lip balm to help further reduce the risk of HIV and Hepatis C.6

Wound care kits contain supplies to clean and treat wounds. These kits may include hand sanitizer, gloves, wipes (e.g., alcohol, saline), sterile gauze pads, bandages, dressings, topical antibiotic ointment and anti-septic wipes or a solution for cleaning the wound.7

Ways to Examine the Data:

  1. Type of supply (e.g., naloxone doses, drug test strips, safe smoking kits, syringes, wound care kits, etc.)
  2. Type of organization distributing supplies (e.g., harm reduction organization, public safety organization, health department, etc.)
  3. Zip code (or other geographical region or area such as neighborhood) where supplies were distributed

Data Sources:

  • Program data from organizations involved in harm reduction supply distribution efforts
  • Logs and records (e.g., vending machines, mail-in programs, leave-behind programs, mobile routes, dispensing, refills)
  • Invoices or receipts (e.g., purchasing logs, acknowledgment of receipt from partner organizations)
  • Program case notes
  • Inventory logs

Data Collection Methods:

  • Harm reduction supply distribution is typically tracked by the programs distributing these supplies. Approaches to collecting and analyzing this data include reviewing program data, distribution logs, records, inventory and case notes.
  • Depending on your relationship with the organization leading distribution efforts, these records may be maintained internally, shared by a partner organization or may be accessed through a shared database.

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

Application and Considerations

Suggested Use:

Program Implementer

  • To determine if supplies are being distributed in higher burden regions. By comparing distribution points, either by zip code or neighborhood, to regions with the highest overdose burden, distribution efforts may be targeted to areas of greatest need.
  • To ensure inventory and distribution accountability
  • To understand the community’s preferred location of distribution. Where are harm reduction supplies typically dispensed?
  • Are supply locations accessible to the entire community?

Community Convener

  • To determine if supplies are being distributed in higher burden regions. By comparing distribution points, either by zip code or neighborhood, to regions with the highest overdose burden, distribution efforts may be targeted to areas of greatest need.
  • To understand community partnership gaps for dispensing harm reduction supplies. What groups have legitimacy in the community and are they being utilized?
  • To determine access and saturation for disproportionately affected populations. Are the needs of all people being met?

Funder

  • To inform funders whether a program is providing the types of services for which they are being funded
  • To provide insight into trends in supply distribution to further inform areas of need in overdose prevention programming
  • To provide justification for greater funding for certain supplies that are in high demand

Health Access Considerations:

You may want to consider:

  • Are harm reduction supplies being distributed equitably to impacted communities? In other words, is there equitable access to all harm reduction supplies that are being distributed?
  • Are harm reduction supplies being distributed in settings relatively free of stigma?
  • Are supplies meeting the needs of the populations being served? Do different communities need different harm reduction supplies?
  • How far do people need to travel to access harm reduction supplies?
  • Are people able to easily access harm reduction supplies? What barriers exist to accessing these supplies and is the process considered “low-barrier” by participants/clients?
  • What types of organizations are leading these efforts in your community? What is the range of services they provide? (e.g., Do they distribute naloxone only? Do they provide comprehensive harm reduction services?)

Evaluation Considerations:

Limitations:

  • Does not track where supplies are used (e.g., where naloxone is administered)
  • Does not track use outcomes (i.e., naloxone use outcomes, results from drug test strips)
  • Does not track the number of people receiving supplies
  • Does not track challenges or barriers related to distribution of supplies

Policy Considerations and Resources:

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.
    https://pubmed.ncbi.nlm.nih.gov/19147339/
  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.https://pmc.ncbi.nlm.nih.gov/articles/PMC5005759/
  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.
    https://pubmed.ncbi.nlm.nih.gov/11027894/
  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
  6. Singh S, Banta-Green C, Kingston S. (2022). Distribution of Safer Drug Smoking Supplies as a Public Health Strategy. Seattle, WA: Addictions, Drug & Alcohol Institute, University of Washington.
  7. Public Health Seattle & King County. Self-care kits for large or chronic wounds.
    https://cdn.kingcounty.gov/-/media/king-county/depts/dph/documents/health-safety/health-programs-services/healthcare-for-the-homeless/wound-care-kits-for-organizations-en.pdf
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