More and more states recognize the valuable role that harm reduction services can play in a comprehensive approach to preventing death, overdose, and infectious disease (e.g., HIV, hepatitis C) among people with substance use disorder (SUD). In addition to saving lives, evidence shows that harm reduction services, such as needle-exchange, support reductions in drug use and increase entry into substance use treatment programs.

Harm reduction services are a critical component of a comprehensive, evidence-based state strategy to address the urgent health needs of groups that have been marginalized. A  recent study on overdose mortality data shows that — while overdose deaths increased for nearly all subgroups examined — American Indian or Alaska Native men (aged 15 to 34 years) and Black and American Indian or Alaska Native men (aged 35 to 64 years) had the highest overdose death rates; for women, the highest rates were among American Indian or Alaska Native individuals. Targeted harm reduction interventions offer an opportunity to address health inequities by reaching these and other populations disproportionately affected by SUD, such as people who identify as lesbian, gay, or bisexual.

Drawing from State Principles for Financing Substance Use Care, Treatment, and Support Services, this checklist identifies four areas for states to explore as they consider expanding harm reduction services:

  1. Assess the status of publicly financed harm reduction services;
  2. Assess the policy landscape for expanding harm reduction services;
  3. Ramp up emerging and innovative, evidence-informed harm reduction programs; and
  4. Use public health data to address disparities through harm reduction.

The checklist is part of a series detailing practical steps to guide state policy development aimed at strengthening substance use disorder (SUD) treatment systems, with a focus on sustainability and equity. It draws from the report State Principles for Financing Substance Use Care, Treatment, and Support Services. The report and series were developed by the Center for Health Care Strategies through a partnership with The Pew Charitable Trusts and support from Bloomberg Philanthropies.