Defining Harm Reduction
This summer, the SHAWN team had the pleasure of discussing research with Dr. Robert Heimer, a professor at the Yale School of Public Health who is affiliated with the Yale Center for Interdisciplinary Research on AIDS at the Yale School of Public Health. Dr. Heimer’s diverse program of research focuses on the mortality and morbidity rates associated with injection drug use (IDU). This research also prioritizes evaluating the effectiveness of intervention programs, like the syringe exchange program, that seek to reduce the negative consequences of IDU. Our conversation focused on harm reduction, how it can save the lives of people who use drugs, and how Dr. Heimer’s work relates to SHAWN.
The National Harm Reduction Coalition defines harm reduction as “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use, as well as a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.” Dr. Heimer explained it best when he said, “Put simply, harm reduction is any positive change.” Syringe exchange began in the 1980s as an underground, illegal, harm reduction movement. In November 1990, the CT Department of Public Health established a syringe exchange program to be implemented in New Haven Connecticut, which led to a 40% reduction in transmission of HIV among people who inject drugs. Today the program continues to operate and, according to Dr. Heimer, there has been a 97.5% reduction in the transmission of HIV across Connecticut due to syringe exchange programs.
During this meeting we also discussed the opioid overdose crisis. During 2020, medical professionals prescribed opioids at record highs. When restrictions were later placed on the number of opioids a person could get from their doctor, people began to buy street opioids in order to manage their addiction and pain. This led to more harm, especially for minority groups, as users had little certainty about what drugs they were consuming. There were 1,524 drug overdose deaths in Connecticut during 2021, an 11% increase from 2020 (CT DPH, 2022). Most (93%) drug overdose deaths in 2021 involved opioids and occurred at a residence (60.1%); People are most likely to overdose when they are using alone. The increase on overdose deaths is a predictable result of the conditions created by the restrictions on opioid prescriptions amidst the Covid-19 pandemic.
While the Covid Era was undoubtedly tragic and continues to negatively impact the lives of many people today, there have also been some unintended positive outcomes. One of which is the opportunity to discover what can happen when society chooses not to send people to prison. Guided by a harm reduction model, the SHAWN research team has begun to collect data. Already we are finding a theme of poverty, child loss, and housing instability amongst the interviewees. We know by the data collected so far that time in prison has not led to reform for the women in this study. This knowledge and the impact of the conversation with Dr. Heimer has led me to ask another, perhaps deeper, question. If we could meet the basic needs of everyone in our society, would prisons continue to exist; Would there still be a “need” for prisons in a society that provides for its people? As I continue my work, as a research assistant and social worker, I hope to find clarity and inspiration in the additional data SHAWN has yet to collect.