woman getting therapy for harm reduction
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Summary: Yes, there are harm reduction services for addiction in California. The California Harm Reduction Initiative (CHRI), a program designed to mitigate the damaging effects of substance use and substance use disorder (SUD), with a focus on opioid use disorder (OUD) and opioid overdose.

Key Points:

  • The drug overdose crisis in the United States has claimed the lives of more than one million people over the past 25 years.
  • Over 3/4ths of those overdose fatalities involved opioids.
  • The misuse and/or disordered use of prescription opioids such as oxycontin and illicit opioids such as heroin can have a devastating effect on individuals, families, and communities.
  • Harm reduction services for addiction in California support patients and families mitigate the negative consequences of substance use, misuse, and disordered use.

Harm Reduction Services for Addiction in California: Effective Programs, Decreasing Overdose Rates

The reason we discuss harm reduction services for addiction in California is the fact that the overdose crisis, also known as the opioid crisis, is ongoing. Eclipsed in the news media first by the pandemic and more recently by politics, the overdose crisis still needs our attention, focus, and the same all-hands-on-deck mentality we had before COVID.

Here’s what the trends in overdose fatalities looked like in the years immediately before we committed to harm reduction, as published by the Centers for Disease Control (CDC):

Overdose Fatalities: 2019-2022

  • 2019:
    • 50,178 opioid-related overdose deaths
    • 67,697 overdose deaths
  • 2020:
    • 70,029 opioid-related overdose deaths
    • 93,655 overdose deaths
  • 2021:
    • 80,816 opioid-related overdose deaths
    • 107,622 overdose deaths
  • 2022:
    • 82,807 opioid-related overdose deaths
    • 109,360 overdose deaths

The steady increase in overdose deaths reflected in these numbers convinced lawmakers to allocate millions of dollars in funding to harm reduction programs. California was one of the first states in the country to commit to harm reduction almost ten years ago

The National Institute on Drug Abuse (NIDA) in the U.S. indicates that harm reduction services can:

  • Help people access addiction treatment
  • Increase access to naloxone
  • Supply naloxone to first responders
  • Decrease transmission of disease
  • Decrease overdose fatalities
  • Increase access to addiction assessment/treatment in primary care settings
  • Increase access to addiction assessment/treatment in emergency room settings
  • Decrease stigma around addiction and addiction treatment
  • Improve treatment outcomes by including people in recovery to help create and initiate harm reduction programs
  • Increase access to social services to improve the lives of people with SUD and/or OUD

This information from NIDA and other organizations such as the American Medical Association (AMA) reinforces the fact that this is an effective, data-driven approach to helping people with substance use disorder (SUD). In fact, harm reduction programs present the best possible way to reverse steady upward trend in drug overdose deaths in the U.S.

When we committed to a harm reduction approach to the opioid crisis in 2022, here’s what happened:

Opioid Overdose Fatalities After Harm Reduction Initiated Nationwide

  • 2022: 47,454
    • Harm reduction legislation passed end of 2022
  • 2023: 55,529
    • Harm reduction programs initiated
  • 2024: 36,684
    • Opioid overdoes fatalities drop 34%

Those figures show that the largest decrease in opioid overdose fatalities since 1999 happened only after we included harm reduction services for addiction in California and nationwide as part of our comprehensive strategy

To learn more about harm reduction, please read the following article on our blog;

What Should I Know About Harm Reduction in Opioid Addiction Treatment?

Now let’s answer a question you may have. We talk about the benefits of harm reduction above, but what is harm reduction?

Harm Reduction: A Basic Definition

For a full review of the principles and practices of harm reduction in the U.S., please read the article we link to above. We’ll quickly review the essentials here, in order to set the stage for discussing harm reduction initiatives in California.

Here’s how The National Harm Reduction Coalition (NHRC) and the World Health Organization (WHO) define harm reduction:

“Harm reduction is a set of practical strategies and ideas aimed at reducing negative physical and social consequences associated with drug use.” 

In addition, the principles of harm reduction include a basic acknowledgment of the direct relationship between harm reduction and foundational human rights:

“Harm reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.”

In the United States, one component of this approach is an attempt to correct the mistakes and unintended negative consequences of our previous national strategy to reduce drug use and related problems in the 1980s and 1990s, which we called the war on drugs. This is not news to many of us, but it’s plain to see: the war on drugs didn’t work.

The war-like posture towards drug use included focusing on the criminal component of drug use. Policies focused on increasing arrests for use, possession, and distribution of drugs and establishing policies like mandatory minimum sentences and three-strikes laws. In retrospect, we can see that this approach – while it may have put some violent criminals behind bars – ended up stigmatizing drug use, and by extension. stigmatized treatment for drug use.

Data over the past thirty years show that the best approach to reducing drug use and addiction is harm reduction. Here’s the statement released by SAMHSA about in the 2023 publication Harm Reduction Framework:

“SAMHSA defines harm reduction as a practical and transformative approach that incorporates community driven public health strategies — including prevention, risk reduction, and health promotion — to empower PWUD and their families with the choice to live healthy, self-directed, and purpose-filled lives. Harm reduction centers the lived and living experience of PWUD, especially those in underserved communities, in these strategies and the practices that flow from them.”

While the term harm reduction is currently under review at the federal level, the primacy policies that form the foundation of harm reduction in the U.S. – as medication-assisted treatment (MAT), expanded access for MAT and medications of opioid use disorder (MOUD), expanded access to naloxone (Narcan), and access to fentanyl test strips – remain as core components of our current national drug control policy.

We have programs in place around the country. Let’s take a look at the current harm reduction services for addiction in California.

California Adopts Harm Reduction Programs

There’s a common adage that appears across a wide range of endeavors we undertake:

If you can’t measure it, you can’t improve it.

To that end – improving the lives of people in California by taking proactive steps to address the opioid crisis, the California Department of Public Health created a public overdose surveillance dashboard to report the latest information on the drug overdose crisis in California. Up-to-date, reliable data is essential for policymakers, treatment providers, and community advocates. It helps them to target underserved communities and allocate resources to where they’re needed most.

Anyone can check the dashboard for the latest information on:

  • Overdose deaths
  • Hospital visits for opioid overdose
  • Opioid prescription rates
  • Links to all pubic addiction support programs in California
  • Links to harm reduction programs

This public overdose surveillance system exemplifies the potential benefits of getting citizens and leaders on the same page: real change that impacts real people in real ways. California led the way in their response to the opioid crisis in the U.S. In 2014, government officials formed the Statewide Opioid Safety Workgroup (SOS) that elicited the participation of all stakeholders – public, private, individual – to brainstorm a way to mitigate the significant harm caused by the opioid crisis.

Among other things, the SOS workgroup identified areas where the state could implement harm-reduction programs, such as:

  1. Expanding access to medication-assisted-treatment (MAT)
  2. Expanding access to naloxone, an overdose reversal medication
  3. Increase support for underserved populations high-settings
  4. Expand access to all SUD treatment, including warm handoff programs in emergency rooms
  5. Increase treatment support in prisons and jails under a program called the Integrated Substance Use Disorder Treatment (ISUDT)

We’ll elaborate on the ISUDT below. Now, we’ll review another outcome of the SOS workgroup: the California Harm Reduction Initiative (CHRI), a program established by the state in 2019.

About The CHRI

Officials in California allocated 15.2 million dollars to form a partnership with the National Harm Reduction Coalition to create harm reduction programs that address needs unique to the citizens of California. The diversity of California makes implementing any statewide program a challenge, but that challenge also creates an opportunity for the rest of us: programs that succeed in a state as diverse as California can serve as templates for other areas of the country that are just as diverse, and face similar problems with implementation, scale, and access.

If a program succeeds in California, a state which include urban, suburban, exurban, semi-rural, and rural areas, then it’s likely it can succeed anywhere. Since 2019, the CHRI has implemented programs that:

  • Increase programs that prioritize reducing harm
  • Expand access to treatment for SUD, especially OUD
  • Mitigate the damaging effects of drug use for individuals, families, and communities.

One of the most successful programs launched by the California Harm Reduction Initiative is the California Bridge Program, called CA Bridge. The goal of the bridge program is to allow any person in California to initiate SUD treatment in hospitals in California, wherever the hospital is and whenever anyone needs treatment.

That’s a goal we can relate to.

The CA Bridge program is important because it leverages a specific time – when a person with SUD or OUD visits a hospital for a drug-related reason, including overdose – that evidence shows people who use drugs are most willing to accept and initiate treatment. When a person ends up in the hospital emergency room for drug-related reasons, they often spend the hours re-evaluating their circumstances – and many decide it’s time to make a change.

California Bridge: The Impact

As we mention above, if you can’t measure it, you can’t improve it.

With that in mind, let’s look at the measurable impact of the California Bridge Program on the people of California, as reported on their comprehensive website.

  • As of 2023, 83% of California hospitals participate in CA Bridge
    • 25% in 2020
    • 49% in 2021
    • 73% in 2022
  • 109,000 patients screened for substance use disorder
  • 31,000 patients administered or prescribed buprenorphine, one of the medications for opioid use disorder (MOUD) used in medication-assisted treatment (MAT) programs.
  • 37,300 patients made a follow-up appointment for SUD counseling/treatment
  • 36,078 patients initiated MAT as the result of CA Bridge
    • 8,544 were in a criminal justice setting
    • 33% were people of color
    • 33% reported housing insecurity
    • 77% were uninsured
    • 70% had co-occurring mental health disorders
  • 85% of patients offered MAT accepted MAT
  • 40% of patients who initiated treatment in the hospital participate in ongoing care

The heroes of the CA Bridge program are Substance Use Navigators, who help connect people in the hospital with MAT services while in the hospital, then connect them to ongoing support after discharge from the hospital. Substance Use Navigators introduce the concept of harm reduction, treat patients with dignity, focus on empathy and understanding, and show patients without support how they can access support and treatment that can change their lives for the better.

Harm Reduction Services for Addiction in California Help Everyone in Need

The success of these programs in mitigating the harm caused by the opioid crisis is significant. In just over five years, CA Bridge has had a positive impact on the lives of people in California. In that way, California is indeed leading the way in comprehensive harm reduction programs in the U.S.

Another area where California is ahead of the rest of the country is in the implementation of SUD treatment with MAT in prisons and jails.

The California Department of Corrections and Rehabilitation (CDCR) and the California Correctional Health Care Services (CCHCS) created a program called Integrated Substance Use Disorder Treatment (ISUDT)  to offer substance use disorder treatment – including MAT – to incarcerated individuals in California. The goals of ISUDT are in the CDCR are to “reduce SUD-related morbidity and mortality, and recidivism.”

We’ll report news about the ISUDT as it appears, as well as any other news on the robust harm reduction services for addiction available in the State of California.