The National Campaign for Harm Reduction Funding

December 22, 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 nation-
wide

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 US1 (72,000 fatal overdoses in 2019
alone) 2 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 ser-
vices, 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.3

Altogether, these events have made clear the need to direct resources towards building an en-
hanced 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 imple-
mented by directing resources towards low threshold health and social services and crisis inter-
ventions for Americans/US residents – 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 re-
form, this solution can no longer be ignored.

1Understanding the Epidemic. Center for Disease Control. 2020, available at https://www.cdc.gov/drugoverdose/epi-
demic/index.html

2 Ahmad 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_da-
ta

3 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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 The National Campaign for Harm Reduction Funding

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 not 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, hepati-
tis 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 ser-
vices such as medical care and drug treatment services. Life-saving harm reduction interven-
tions 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 psychother-
apy and counseling to bridge the gap from public health interventions to a full array of evi-
dence-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.4 This troubling treatment gap can and must be addressed –
but it requires more direct assistance for those not actively seeking treatment today.

These individuals are at tremendous risk of a fatal overdose, are frequently homeless or unsta-
bly 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 fa-
cilitate 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 con-
nection 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, al-
though extremely helpful to those actively seeking mainstream treatment, provide minimal sup-
port 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.

4SAMHSA 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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We appreciate that the annual $18 billion Federal drug budget for addiction treatment and pre-
vention 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 per-
cent increase for harm reduction related services – about $3.7 billion a year – is urgently need-
ed. 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 popula-
tion. 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 in-
volved 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 in-
clude: Naloxone training and provision, new innovative overdose prevention strategies, syringe
service programs, health care services (including for HIV/AIDs, hepatitis C, wound care and in-
vasive 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 en-
actment. If you have questions or suggestions, please contact us through our campaign’s coor-
dinator. There are millions of people in the US who need the help which this initiative can pro-
vide. With so many people dying, and so many more at great risk, we urge you to support this
critical initiative.

Sincerely,

Heather J. Haase, LL.M, Campaign Coordinator

hhaase.NCHRF@gmail.com

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Organizations

AIDS United Center for Popular Democracy

Zachary S. Ford Jennifer Flynn Walker
Senior Program Manager Senior Director of Mobilization and Advocacy

Addiction and Behavioral Health Dallas Harm Reduction Alliance

Alliance LLC Candice Fortier
Bob Lynn, Ed.D Executive Director
CEO and Founder
Drug Reform Coordination Network
Advanced Integrative Medical Science David Borden
Institute Executive Director
Sunil Aggarwai, MD, PhD, FAAPMR
Co-Founder and Co-Director Enso Recovery
Timothy Cheney
American Academy of Cannabinoid Founder and CEO
Medicine
David Ostrow, PhD Evergreen Health Services
Vice President of Research and Outreach Raymond Ganoe
President and CEO
Any Length Retreat
Robert White EXPONENTS
CEO Joe Turner, JD
President and CEO
C4 Recovery
Ricard Ohrstrom Faith in Harm Reduction
Chairman Erica Poellot, MDiv, MSW
Director
CARMAhealth
Carlos F. Tirado, MD, MPH Families for Sensible Drug Policy
Founder and CMO Carol Katz Beyer
President
Center for Collegiate Recovery
Communities Harm Reduction Therapy Center
Thomas Kimball, PhD, LMFT Patt Denning
Director Director of Clinical Services and Training
Jeannie Little
Central Texas Harm Reduction Alliance Executive Director
Richard Bradshaw
Executive Director Homeless Health Care Los Angeles
Mark Casanova
Center for Motivation and Change Executive Director

Jeff Foote, PhD

Co-Founder and Executive Director Housing Works
Carrie Wilkins, PhD Charles King
Co-Founder and Clinical Director CEO
The Center for Optimal Living HRH413
Andrew Tatarsky, PhD Albert Park
Founder and Director Co-Founder
Jess Tilley
Co-Founder

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National Harm Reduction Coalition National Advocates for Pregnant Women
Monique Tula Lynn Paltrow, JD
Executive Director Executive Director

IGNTD Recovery National United Church of Christ

Adi Jaffe, PhD Rev. Michael Schuenemeyer
CEO and Founder Executive for Health and Wholeness
Advocacy
Integrative Sex Therapy Institute
Tammy Nelson, PhD New England Users Union
Director Jess Tilley
Executive Director
International Conference on Addiction and
Associated Disorders New Jersey Harm Reduction Coalition
Sam Quinlan Jenna Mellor
Founder Executive Director

Judson Memorial Church New York State Harm Reduction

Rev. Dr. Donna Schaper Association
Senior Minister Joe Turner, JD
Co-Chair
La Hacienda Treatment Center Alexis Pleus, PE, LEED AP, CWI
James C Boone, MD Co-Chair
Medical Director
O.D. Aid
The Levenson Foundation Lizzie Maldonado
Benjamin A. Levenson Executive Director
Chairman
The Perfectly Flawed Foundation
Los Angeles Medicinal Psychedelics Luke Tomsha
Society Founder and Executive Director
Tara Rodriguez
Co-Chair Pharmacy Addictions Research &
Medicine Program at the University of
Love Cassidy Texas at Austin
Susan Seward Lucas G. Hill, PharmD, BCPS, BCACP
Executive Director Director

MAP Health Management Reach Medical

Jacob Levenson Justine Waldman, MD, FACEP
CEO CEO

MG Consulting Recovery Alliance of Austin

Michael Galipeau Joseph Sanchez
Director Founder and President

Multidisciplinary Association for Recovery Alliance of El Paso

Psychedelic Studies Ben Bass
Sara Gae, MA Executive Director
Harm Reduction Officer
Natalie Ginsberg, MSW Recovery People, Inc
Director of Policy and Advocacy Jason Howell
Executive Director

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Recovery Spectrum Texas Harm Reduction Conference
Brian Lane Lisa Medina, MA, LCDC
Peer Recovery Support Specialist Founder and Chair

Samadhi Recovery Community Texas Overdose Naloxone Initiative

Outreach Center Mark Kinzly
David McNamara Director
Executive Director
Truth Pharm
Santa Maria Hostile & Houston Alexis Pleus, PE, LEED AP, CWI
Sobering Center Founder and Executive Director
Alicia Kawalchuk, MD
Medial Director Unity Recovery
Robert Ashford, PhD, MSW
The Seven Challenges Program Executive Director
Robert Schwebel, PhD
Author Urban Survivor's Union
Jess Tilley
Southern Tier AIDS Program Leadership Team
John Barry
Executive Director Vital Strategies
Daliah Heller, PhD MPH
St. Ann's Corner of Harm Reduction Director
Joyce A. Rivera
Founder and CEO West Texas Harm Reduction Coalition
Mike Prado
Texas Harm Reduction Alliance Director
Gilberto Perez
Executive Director