Harm Reduction Unit

What is Harm Reduction?

• "Meeting people where they are".
• Recognizes that many people aren’t willing or able to stop using substances.
• Focuses on decreasing the negative consequences associated with drug use.

• Syringe service programs.
• Providing medications for addiction treatment (MAT).
• Peer programs.
• Safe consumption sites and more.

Frequently Asked Questions (FAQ)

• How do you know if harm reduction is really working?
  The overarching goal of harm reduction is to decrease the negative consequences from substance use on the individual and the community. 30 years of harm reduction practices in the United States have shown that it is effective in reducing overdose deaths and blood-borne infections and is safe and cost-efficient. For example, the lifetime cost of medical care for each new HIV infection is over $400,000; the equivalent amount of money spent on harm reduction programs prevents at least 30 new HIV infections.
• Why is harm reduction important in LA County?
  Los Angeles County is in its worst overdose crisis in history. Just last year, about 2,700 people in Los Angeles County died from an overdose and over half of those involved fentanyl or methamphetamine. Harm reduction saves lives by distributing medications and supplies to reverse overdoses and decrease rates of blood-borne infections. Harm reduction also includes building relationships with people using drugs to help them reduce or stop drug use, secure stable housing, finish their education, or find a job. Creating relationships built on trust helps us provide these life-saving services.
• Have the harm reduction efforts in LA County made a difference so far
  Yes. In 2022, Los Angeles County provided over 50,000 doses of naloxone into the community which yielded over 3,000 overdose reversals. Any human being who is alive still has a chance for recovery, but that chance is lost in a fatal overdose.
• What is a Safer Consumption Site?
  A Safer Consumption Site (also known as Overdose Prevention Programs) is a safer place for people to use drugs off the streets and away from public spaces. These sites decrease accidental overdose deaths, infectious disease transmission, untreated wounds, and risks of other harmful health outcomes. Safer Consumption Sites do not provide any substances for people to use. Rather, a drug user brings their substance into the Safer Consumption Site and can use the drug under the supervision of trained staff. These sites provide basic first aid and hygiene supplies, sterile use equipment and other safer consumption supplies for single use, which lowers the risk of supplies being shared between people and decreases the spread of blood-borne infections such as HIV and Hepatitis. Furthermore, Safer Consumption Sites collect used syringes and other equipment used to consume drugs so that the syringes and equipment are disposed of properly and safely.
  
  Safer Consumption Sites are staffed by people who are familiar with the possible health effects of illicit drugs up to and including possible death. As such, they keep naloxone on hand to reverse a potential opioid overdose. Staff may be trained in first aid, such as CPR and rescue breathing, and will call 911 if someone is overdosing or experiences a medical emergency. Safer Consumption Sites are generally supplied with emergency medical equipment such as an automatic external defibrillator (AED) and supplemental oxygen, which could be used even before emergency medical services arrive on scene. Safer Consumption Sites may also offer people who use drugs other wrap-around services such as any of the following: information resources and referrals to substance use treatment and recovery services; infectious diseases testing and treatment services or referrals; wound care services; links to other supportive services such as mental and behavioral health care, links to housing services, and/or to other resources that promote health and wellbeing.
  
  Los Angeles County does not fund or operate any Safer Consumption Sites. There are currently no Safer Consumption Sites in Los Angeles County.
• What other harm reduction services does LA County provide?
  The Los Angeles County Department of Public Health currently works with many partner organizations to promote the health and safety of all LA County residents, including but not limited to people who use drugs and other groups of people who are at risk for harmful health outcomes but who may have barriers to accessing health care. Throughout LA County, community members can access fourteen (14) Public Health Centers, fifty (50) Wellbeing Centers, and six (6) CORE Centers to get services like substance use prevention, overdose prevention, and links to services. Public Health maintains the RecoverLA app, which offers information and resources related to substance use. Public Health also works with extensive networks of contracted providers who offer services related to substance use prevention, substance use treatment and recovery, and contracted engagement and overdose prevention (EOP) Hubs.
  
  With our partner networks, The Los Angeles County Department of Public Health provides a spectrum of public health services designed to prevent substance use, prevent drug overdoses, offer treatment and recovery services, and support the health of all county residents including people who use drugs, wherever they may be in their journey of use and recovery. Public Health closely collaborates with other LA County departments, such as the Department of Health Services, Department of Mental Health, Department of Children and Family Services, EMS Agency, LA Homeless Services Authority, other County departments, and State and Federal partners to promote the health and wellbeing of our residents.
• Is there any research that shows that harm reduction works?
  Articles:
  
  Wilson DP, Donald B, Shattock AJ, Wilson D, Fraser-Hurt N. The cost-effectiveness of harm reduction. Int J Drug Policy. 2015 Feb;26 Suppl 1:S5-11
  
  Singh, S., Banta-Green, C., & Kingston, S. (2006). Distribution of Safer Drug Smoking Supplies as a Public Health Strategy. Seattle, WA: Addictions, Drug & Alcohol Institute, University of Washington, January 2022.
  
  Arendt D. Expanding the accessibility of harm reduction services in the United States: Measuring the impact of an automated harm reduction dispensing machine. J Am Pharm Assoc (2003). 2023 Jan-Feb;63(1):309-316. doi: 10.1016/j.japh.2022.10.027. Epub 2022 Nov 12.
  
  Puzhko S, Eisenberg MJ, Filion KB, Windle SB, Hébert-Losier A, Gore G, Paraskevopoulos E, Martel MO, Kudrina I. Effectiveness of Interventions for Prevention of Common Infections Among Opioid Users: A Systematic Review of Systematic Reviews. Front Public Health. 2022 Feb 22
  
  Gibson DR, Flynn NM, Perales D. Effectiveness of syringe exchange programs in reducing HIV risk behavior and HIV seroconversion among injecting drug users. AIDS. 2001 Jul 27;15(11):1329-41
  
  Levengood TW, Yoon GH, Davoust MJ, Ogden SN, Marshall BDL, Cahill SR, Bazzi AR. Supervised Injection Facilities as Harm Reduction: A Systematic Review. Am J Prev Med. 2021 Nov;61(5):738-749. doi: 10.1016/j.amepre.2021.04.017. Epub 2021 Jul 1
  
  Jakubowski, A., Fowler, S. & Fox, A.D. Three decades of research in substance use disorder treatment for syringe services program participants: a scoping review of the literature. Addict Sci Clin Pract 18, 40 (2023)
• Why spend money on harm reduction and syringe exchange instead of treatment programs?
  No money is diverted from treatment services to provide harm reduction services. Sometimes people aren’t ready to participate in substance use treatment programs. For those people, harm reduction reduces the risk of overdose and infection. Los Angeles County is expanding financial support for harm reduction programs and substance use treatment services that include abstinence-focused substance-use treatment services. LA County is committed to offering substance use treatment to every eligible Los Angeles County resident, including those who access harm reduction services. We also have a 24/7/365 hotline (SASH Helpline: 1-844-704-7500) that will connect any eligible person to substance use treatment in Los Angeles County.
• Why does LA County distribute sterile syringes to people who use drugs?
  Providing sterile (unused) syringes (needles) decreases the spread of blood-borne infections such as HIV and viral hepatitis because drug users do not have to share or reuse syringes. Harm reduction programs distribute sterile syringes and collect used syringes in the community.
• Does LA County limit the number of syringes someone can take at any one time?
  No. Los Angeles County practices a “needs-based” distribution of syringes. This means providing the number of syringes/needles a person needs with no restrictions, including no requirement to return used syringes. This approach has been shown to prevent new HIV and viral hepatitis infections. Infectious diseases can be transmitted through the use of previously used syringes, which occurs more frequently when people don’t have access to a sterile syringe supply. To prevent infections related to injecting drugs, we encourage people to use one sterile needle and syringe for each injection.
• Do syringe exchange programs cause syringe littering?
  No. Studies show that Sterile Syringe Programs protect the public and first responders by providing safe needle disposal and reducing the presence of needles in the community. Harm reduction programs are associated with a decrease in syringe litter in the community, in part because they allow people to safely dispose of used syringes. This may in turn decrease the risk of accidental needlestick injuries. In a national study in 2012, researchers found 86% fewer used syringes in parks and sidewalks in a community that had harm reduction programs than in a similar community without an equivalent program.
• Does LA County give syringes to people who do not bring in used syringes?
  Yes. LA County certified harm reduction programs use best practices for harm reduction work. This includes following needs-based exchange methods which provide people who inject drugs access to the number of syringes they need to ensure that a new, sterile syringe is used for each injection. A needs-based approach provides sterile syringes with no restrictions, including no requirement to return used syringes. Organizations that use a needs-based approach reduce their clients’ risk of transmitting hepatitis C, HIV, and other infectious diseases.
• Why does LA County distribute naloxone to people who use drugs?
  Naloxone is the life-saving emergency medication that quickly reverses the effects of opioids such as heroin, fentanyl, morphine, hydrocodone, oxycodone, codeine, and other opioids including both prescription and illicit opioids such as heroin. During an opioid overdose, someone stops breathing and can die within minutes. If naloxone is administered quickly enough, it can return normal breathing in the person who is overdosing. Widespread naloxone distribution helps lower risk of death from accidental opioid overdoses in our community. By making sure this medication is available in the community, we can save lives.
  
  Naloxone is the generic name of this life-saving medication, which comes in both an injectable form and as a prepackaged nasal spray. Naloxone is known by multiple brand names, including: Kloxxado®, Narcan®, Zimhi™, and Evzio®. Nasal naloxone has been Food and Drug Administration (FDA) approved to be sold over the counter and its manufacturer has announced that over-the-counter naloxone will be available in 2023
• Will touching a small amount of fentanyl cause overdose? Can I overdose if I inhale air in a room where someone is smoking fentanyl?
  No. Fentanyl needs to be ingested by a person—through their mouth, nose, eyes, or injected into their skin or veins—for it to have an effect. Casually touching a pill or powder that may contain fentanyl will not result in an overdose. Similarly, if you walk into a room where a person is smoking fentanyl, you cannot overdose by inhaling the air in the room. It would take more than 3 hours of exposure to air with fentanyl in it to cause any opioid effects, and far longer to cause a fentanyl overdose.

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