Harm reduction is a public health approach that aims to reduce harms related to substance use by treating people with dignity and compassion. It includes a variety of approaches with the goal of connecting people who use drugs to resources and helping them to thrive in a supportive environment. Harm reduction strategies, which are gaining support at the federal level, include: safer use, managed use, abstinence, and meeting people who use drugs “where they are” with consideration given to key principles central to harm reduction practice.
In New Jersey, Harm Reduction Centers (HRCs) have served to bridge gaps in health services for people who use drugs. These community-based programs offer a safe and non-judgmental space for people who use drugs to access sterile injection equipment, naloxone (medication designed to rapidly reverse opioid overdose), pre-exposure prophylaxis (medication that people at risk for HIV take to prevent getting HIV from sex or injection drug use) as well as education about preventing overdoses and safer drug use. HRCs are also places where people can safely discard used equipment to prevent the spread of blood-borne diseases like HIV and hepatitis C (HCV). Notably, these programs — in seven locations across New Jersey — also connect people to critical health services, such as health screenings, pregnancy testing and prenatal care, nutrition counseling, reproductive counseling, vaccinations, wound care, and mental health and addiction treatment.
Learn more about New Jersey HRCs, in this video from the New Jersey Department of Health.
To learn more about HRCs, their value, and the services they provide to people who use drugs, the Center for Health Care Strategies spoke with Christopher Menschner, MSW, MA, Assistant Commissioner for the Division of HIV, STD, and TB Services at the New Jersey Department of Health, which oversees the state’s HRCs. The interview is a product of CHCS’ work with New Jersey to inform activities to improve health outcomes for Medicaid beneficiaries, made possible through support from the Robert Wood Johnson Foundation.
What is the value of harm reduction?
A: At a high level, approaching service delivery through a harm reduction lens makes people feel safe and respected, and therefore more likely to engage in services. Johann Hari, an author and journalist who has covered drug-related issues, says, “The opposite of addiction is not sobriety. It is human connection.” I hear this all the time from people with lived experience. When the health care system, family, friends, and society at large have rejected someone because of their drug use, harm reduction practitioners and centers have accepted them. And it’s not just that they accept them, but they welcome them with open arms for who they are and where they are in their journey. Harm reduction also reduces the risk for overdose and acquiring communicable diseases, such as HIV and HCV.
Can you describe HRCs in New Jersey? Why are they so important?
Whether it’s a comprehensive site, a fixed mobile unit, or something in between, all HRCs offer a broad suite of services and take a welcoming, non-judgmental, trauma-informed approach to care.
A: New Jersey adopted HRCs in 2006, in part because of the need to prevent HIV infection among people who inject drugs. Since 2006, new HIV transmissions by injection drug use in New Jersey have decreased from 11.5 percent to less than five percent of all new HIV transmissions in the state.
There are HRCs in seven New Jersey cities: Asbury Park, Atlantic City, Camden, Jersey City, Newark, Paterson, and Trenton. They are all run by community-based organizations and come in a variety of shapes and sizes. For instance, the Newark site, run by the North Jersey Community Research Initiative, is a multi-faceted health care and social services agency. They have a drop-in center where people can come in and get off the street, get out of the heat or cold, take a shower, use a washing machine. The Paterson site is a fixed mobile unit outfitted for public health outreach and run by the Hyacinth AIDS Foundation.
Whether it’s a comprehensive site, a fixed mobile unit, or something in between, all HRCs offer a broad suite of services and take a welcoming, non-judgmental, trauma-informed approach to care. Individuals are not required to provide a lot of information to qualify for or justify services. You show up, say what you need, and receive services. HRCs are staffed by harm reduction counselors, who are specially trained social services professionals. They are all also staffed with Access to Reproductive Care and HIV Services (ARCH) nurses, who provide an array of services, including testing for HIV, HCV, sexually transmitted diseases (STD) and pregnancy, STD treatment, wound care, medical case management, and referrals to more comprehensive care and treatment.
The centers provide sterile syringes, fentanyl strips, HIV and STD testing, condoms, medical care, social services, housing support services, overdose prevention, and education. They train individuals on overdose prevention and safe use, currently mainly for injection drug use because of the opioid epidemic. HRCs also offer safe use supplies, including syringes, cookers, cotton balls, sterile water to clean supplies, and clean smoking and snorting materials, as well as survival resources, such as clothing, food, water, and sleeping bags. They also manage safe disposal of used syringes.
As part of their work, HRC staff conduct community sweeps, in partnership with local departments of public works and police in some cities, to gather discarded syringes from the streets to promote community safety.
What are misconceptions about HRCs that you feel should be debunked?
A: A big misconception is that a HRC or any kind of syringe access program will bring increased crime and drug use into the community. That is simply not true, and we have empirical and anecdotal evidence to support that. Another misconception is that giving people access to clean syringes and other materials will increase someone’s drug use. This is also not the case. People are just using more safely, staying alive, and staying free of serious communicable diseases. Moreover, research shows that new users of harm reduction services are five times more likely to enter drug treatment and about three times more likely to stop using drugs than those who don’t use the services.
Another misconception is that it is best to provide a one-to-one syringe exchange to protect people’s health, as opposed to allowing clients to choose the number of needles they receive. The opposite is true and in fact, CDC supports a needs-based syringe distribution approach as best practice.
What are your plans for 2021 related to HRCs, particularly given the impact of the pandemic?
A: We will continue to do whatever we can to support New Jersey’s HRCs. A tremendous amount of work took place last year during the beginning of the pandemic to help keep the HRCs running, including ensuring flexibilities in their state grant agreements to purchase personal protective equipment and to ensure they were able to provide services to people effectively and safely.
In 2020, NJ’s HRCs served around 3,000 clients, approximately the same number of clients served in 2019 (3,323) and made over 1,000 referrals to care, including for substance use disorder treatment, HIV, HCV, STDs, PrEP, housing services, vaccines, naloxone, and ARCH services. HRCs also continued to provide direct access to low threshold buprenorphine induction treatment at two of the seven HRCs, in Asbury Park and Atlantic City, and continued the provision of these critical services during the pandemic, and successfully linked 67 clients to drug treatment.
In addition to the continued prioritization of safe operations due to COVID-19, the other priority in 2021 is to keep up our HRC expansion efforts. This includes working closely with municipalities with high rates of overdose deaths and/or high incidence of HIV and HCV transmission to expand and develop new HRCs. This entails having a lot of in-depth conversations with municipal officials, mayors, and other key decision-makers to bring awareness and education of the benefits of HRCs and dispelling myths. We’re also always working closely with existing HRCs to make sure their services are responsive to the needs of the clients they serve. As of late, this includes COVID vaccine outreach and distribution.
Can you share any patient stories that highlight the importance of HRCs and harm reduction in general?
HRCs have not only welcomed them with open arms but gave them everything they needed. They allowed them to use safely, kept them alive, and allowed for the possibility to work toward wellness, in whatever way they define wellness for themselves.
A: I’ve had the privilege of meeting so many people with lived experience since I’ve been in this role. I’d reiterate that one central theme is human connection and acceptance. I’ve heard individuals’ stories underscoring that HRC staff welcomed them with open arms during a time when they were experiencing rejection and stigma from other health care providers, and from their communities, families, and friends. HRCs have not only welcomed them with open arms but gave them everything they needed. They allowed them to use safely, kept them alive, and allowed for the possibility to work toward wellness, in whatever way they define wellness for themselves.
If someone is interested in accessing an HRC in New Jersey, how would they go about that?
A: For individuals interested in learning more about or accessing NJ’s HRCs, I would point them to the following resources:
- NJ Department of Health’s HIV, STD, and TB Services web page
- The NJ HIV/STD Hotline: 1-800-624-2377
- NJ Harm Reduction Coalition website
I’d also like to give a shout out to the people doing harm reduction work on the ground. The staff at our seven HRCs and the New Jersey Harm Reduction Coalition are just so impressive. They are so committed and passionate, and it is truly inspiring to work with them.