The National Campaign for Harm Reduction Funding

December __, 2020

Presidential Transition Office

1401 Constitution Ave NW
Washington, DC 20230

Dear President-Elect Biden and Vice-President-Elect Kamala Harris:

RE: Request for new Federal funding for Harm Reduction programs & services nationwide

Until 2020 the public health crisis receiving the most attention in the US has been the response
to opioid overdose. With almost 450,000 lives lost in the US (71,000 fatal overdoses in 2019
alone)1 the crisis was already reaching unprecedented proportions. The COVID-19 pandemic
has, understandably, shifted attention at the federal and state levels from overdose response to
slowing the spread of COVID-19. However, this shift, along with complicating pandemic-related
factors such as social isolation and difficulties in obtaining medication, treatment and social
services, has exacerbated an already dire situation – affecting those in urban, suburban and
rural areas.

Contemporaneously, the nationwide call for racial justice and accountability following the deaths
of George Floyd, Breonna Taylor and others at the hands of law enforcement has dramatically
highlighted the need for criminal justice reform. Black and brown communities are among the
hardest hit by both the pandemic and the opioid crisis: in 2018, the highest increase in rates of
overdose deaths were among Black men, and by the end of 2018, nearly half of all people who
injected drugs and were living with HIV were Black.2

Altogether, these events have made clear the need to direct resources towards building an
enhanced public health response to drug use, to finally start to alleviate the harm done to our
communities as the result of punitive and ineffective policies. This critical shift can be
implemented by directing resources towards low threshold health and social services and crisis
interventions for Americans – most urgently Black and Brown people – impacted by drug use
and mental health problems. With these services at an all-time low utilization rate due to the
COVID-19 pandemic, coupled with the immediate and dire need for criminal justice reform, this
solution can no longer be ignored.

1Ahmad FB, Rossen LM, Sutton P., Provisional drug overdose death counts. National Center for Health Statistics.
2020, available at https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm?source=email#nature_sources_of_data
2 See KFF (Kaiser Family Foundation), Opioid Overdose Deaths by Race/Ethnicity, available at Opioid Overdose
Deaths by Race/Ethnicity | KFF; see also Centers for Disease Control and Prevention: Diagnoses of HIV Infection in
the United States and Dependent Areas, 2018: Persons Who Inject Drugs, available at Persons Who Inject Drugs |
Volume 31 | HIV Surveillance | Reports | Resource Library | HIV/AIDS | CDC.

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We are therefore writing today to urge your support for $15 billion in new Federal support
over four years to fund lifesaving ‘Harm Reduction’ services (see Box A). This 20 percent
increase over current funding levels is necessary to reach those now getting help.

“Box A: What is Harm Reduction?

“Harm reduction” is an umbrella term for a set of principles and a wide range of interventions
that: (1) reduce the immediate risk of death (e.g., opiate-related overdose); (2) help make it
less likely that people who use drugs will contract serious medical diseases (e.g., HIV,
hepatitis C, endocarditis, etc.); (3) serve to provide direct services and form relationships that
help those with drug and alcohol problems, and (4) facilitate entrée into higher threshold
social services such as medical care and drug treatment services. Life-saving harm reduction
interventions include: 1) wide distribution of the opiate blocker, Naloxone, to reverse
potentially lethal overdose; 2) sterile syringe availability to prevent infection and 3) harm
reduction psychotherapy and counseling to bridge the gap from public health interventions to
a full array of evidence-based addiction treatment interventions. We feel that the
implementation of these tools is not only the moral, but also most cost effective, way to help
people who struggle with drug problems to thrive in our society.

Although we strongly support current efforts to fund treatment, including programs to expand
evidence-based medication assisted treatment (MAT) for those with opioid or other substance
use disorders, surveys show that over 80 percent of those with substance use disorders do not
seek and do not receive treatment.3 This troubling treatment gap can and must be addressed –
but it requires more direct assistance for those not actively seeking treatment today.

These Americans are at tremendous risk of a fatal overdose, are frequently homeless or
unstably housed, and impose significant criminal justice, health, and emergency response costs
in communities where they live. The COVID-19 pandemic has only intensified these problems:
the number of fatal overdoses has risen sharply as people are more likely to use drugs in
isolation and are largely cut off from lifesaving support systems. In addition, those at highest risk
for overdose (or are in close proximity to those at risk) are oftentimes afraid to access medical
care or to visit hospitals in an emergency, due to the pandemic. We know how to help people
who use drugs, to reduce healthcare costs, to increase their health and safety, and to effectively
facilitate treatment entry. This is what harm reduction organizations do every day. It is difficult
work, requiring outreach workers to meet people who use drugs where they are, to build a
connection and a relationship of trust with them, and to support small steps to improve their
health. We know these efforts both prevent loss of life and provide a path to better health for all,
and for some a drug-free life. Unfortunately, current large Federal substance use disorder
grants, although extremely helpful to those actively seeking mainstream treatment, provide

3SAMHSA Substance Abuse and Mental Health Services Administration, 2019 National Survey of Drug Use and
Health (NSDUH) Releases, available at https://www.samhsa.gov/data/release/2019-national-survey-drug-use-and-
health-nsduh-releases. See Table 5.18B.

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minimal support for this lifesaving work. It is time to launch a new national program which
directly supports harm reduction that focuses on this huge unmet need.

We appreciate that the annual $18 billion Federal drug budget for addiction treatment and
prevention is a large, complex enterprise. However, considering that this funding is not reaching
the majority of people who use drugs, in particular Black and Brown people, we believe a 20
percent increase for harm reduction related services – about $3.7 billion a year – is urgently
needed. Although much of this funding could be added to existing large grant programs, we
believe it is essential to create at least one new program dedicated to helping this under-
served population. To do this quickly and effectively we recommend funding at $250 million a
year geographic-based cooperative grants to non-governmental organizations and public health
agencies involved in addressing the needs of people who use substances who are not actively
engaged in formal treatment, with a specific focus on providing services to Black and Brown
people and communities. This approach will enable the rapid development of a comprehensive,
sustainable, collaborative approach across areas of the United States with the greatest need.

The services which will be funded by this effort will follow all Federal and State laws. There is so
much more that can be done to help people under current laws. Services to be funded will
include: Naloxone training and provision, new innovative overdose prevention strategies,
syringe service programs, health care services (including for HIV/AIDs, hepatitis C, wound care
and invasive infections, and mental health), offers of low threshold addiction services, including
harm reduction psychotherapy, and mobile access to medications approved by the FDA for
opioid, stimulant, and alcohol use disorders.

We look forward to working with you on developing this proposal and moving it forward to
enactment. If you have questions or suggestions, please contact us through our campaign’s
coordinator. There are millions of Americans who need the help which this initiative can provide.
With so many Americans dying, and so many more at great risk, we urge you to support this
critical initiative.

Sincerely,

Heather J. Haase, LL.M, Campaign Coordinator

SIGNED- organizations