Thursday, April 22, 2021

GHJP Open Letter Urges CT to Invest in Harm Reduction

On April 14, 2021, the Connecticut Harm Reduction Working Group, an informal network of harm reduction practitioners, advocates, and scholars and coordinated by the Global Health Justice Partnership (GHJP), released an open letter to Connecticut Governor Ned Lamont, the Connecticut Department of Mental Health and Addiction Services, and the Connecticut Department of Public Health. The open letter urges the Governor’s office and state agencies to use American Rescue Plan (ARP) funding to invest in vital harm reduction programs in Connecticut. 

In 2020, Connecticut experienced a 14 percent increase in overdose deaths to more than 1,350, with 87 percent involving fentanyl. This recent increase is due, in part, to the unprecedented levels of isolation caused by the COVID-19 pandemic exacerbating already insufficient access to effective substance use disorder treatment and harm reduction services.

“Due to greater isolation and less ability to access services, almost every aspect of harm reduction was affected,” said Jason Crowell, Director of Outreach of the Sex Workers and Allies Network of New Haven.

Despite an irrefutable need to build, support, and invest in harm reduction-based solutions to address the COVID-19 pandemic, harm reduction service providers have faced barriers in accessing basic personal protective equipment and necessary resources. “Harm reduction programs across the state remain severely underfunded,” said Ryan McNeil, Director of Harm Reduction Research at the Yale Program in Addiction Medicine of the Yale School of Medicine. “These programs are in urgent need of funding to scale up their services to meet demand and address the overdose crisis.”

The COVID-19 pandemic comes at a time where the state is still struggling to respond to the overdose crisis. Despite these overlapping crises, the state has yet to form an adequate response to the mounting need.

“The opioid use disorder treatment gap is the result of lack of standardized training among health professionals,” said Jeanette Tetrault, Associate Director for Education and Training at the Yale Program in Addiction Medicine. “The state must commit to supporting standardized, interprofessional education to arm frontline healthcare workers with the skills needed to care for patients with opioid use disorder and decrease the treatment gap.”

Incoming funding provides Connecticut with a chance to address these gaps and invest in innovative, evidence-based approaches to drug treatment and overdose prevention. The American Rescue Plan (ARP) specifically allocates $30 million dollars for harm reduction services, including community-based overdose prevention programs and syringe services programs, and $50 million dollars to address community-based behavioral health needs worsened by the COVID-19 pandemic. Connecticut will receive a further $18.2 million in state block grants for substance use disorder programs.

Building on calls from legislators for transparency in the state’s use of federal funds, the letter recommends the governor and relevant state agencies to develop a transparent, publicly visible, and accountable mechanism for ensuring ARP funds for community behavioral health and harm reduction services are equitably and effectively distributed across the state. 

The letter provides several recommendations for the allocation of these funds to sustain and expand support for harm reduction services; invest in a harm reduction-centered workforce to address the overdose crisis and educate health professionals to identify, prevent, and treat opioid use disorder; and invest in innovative, evidence-based treatment approaches to provide care and support for people who use drugs. 

Melissa Weimer, Medical Director of the Yale Addiction Medicine Consult Service at Yale New Haven Hospital and the Yale Program in Addiction Medicine, noted that these recommendations were informed by the signatories’ “collective experience in the field of addiction treatment, harm reduction services, and public health from direct patient care to research.” Signatory organizations include the Sex Workers and Allies Network of New Haven, the Alliance for Living and the Ledge Light Health District of New London; the Greater Hartford Harm Reduction Coalition; and the Community Health Care Van, the Yale Program in Addiction Medicine, and the Yale Global Health Justice Partnership at Yale University.

The letter also calls for a deliberate campaign to reduce stigma through public health messaging to the public and targeted education of health professionals. “Harm reduction best practices are still seen as enabling, rather than as the public health response that they are,” said Mark Jenkins, founder and Executive Director of the Greater Hartford Harm Reduction Coalition.

Dr. Robert Heimer, Professor of Epidemiology at the Yale School of Public Health, added that “ongoing stigmas against drug users and the medications effective in treating them” constitute the main barriers to effective harm reduction and successful treatment for substance use disorders in Connecticut.

With more states, including Connecticut, moving to legalize cannabis, and Oregon recently decriminalizing possession of all drugs, communities across the United States are rethinking the collective response to substance use and starting to reckon with the consequences of the War on Drugs, which has driven the stigmatization and incarceration of people who use drugs and disproportionately targeted people of color, according to the letter. The letter calls for political leaders to disengage Connecticut’s drug response from a reliance on punitive approaches, in line with CDC recommendations to direct resources on wrap-around care for people who use drugs instead of criminal prosecution and incarceration. “If the opposite of addiction is connection, we are failing miserably,” said Jenkins.