Responding to a surge in overdose deaths: perspectives from US syringe services programs

Abstract

Background US overdose deaths have reached a record high. Syringe services programs (SSPs) play a critical role in addressing this crisis by providing multiple services to people who use drugs (PWUD) that help prevent overdose death. This study examined the perspectives of leadership and staff from a geographically diverse sample of US SSPs on factors contributing to the overdose surge, their organization’s response, and ongoing barriers to preventing overdose death. Methods From 2/11/2021 to 4/23/2021, we conducted semi-structured interviews with leadership and staff from 27 SSPs sampled from the North American Syringe Exchange Network directory. Interviews were transcribed and qualitatively analyzed using a Rapid Assessment Process. Results Respondents reported that increased intentional and unintentional fentanyl use (both alone and combined with other substances) was a major driver of the overdose surge. They also described how the COVID-19 pandemic increased solitary drug use and led to abrupt increases in use due to life disruptions and worsened mental health among PWUD. In response to this surge, SSPs have increased naloxone distribution, including providing more doses per person and expanding distribution to people using non-opioid drugs. They are also adapting overdose prevention education to increase awareness of fentanyl risks, including for people using non-opioid drugs. Some are distributing fentanyl test strips, though a few respondents expressed doubts about strips’ effectiveness in reducing overdose harms. Some SSPs are expanding education and naloxone training/distribution in the broader community, beyond PWUD and their friends/family. Respondents described several ongoing barriers to preventing overdose death, including not reaching certain groups at risk of overdose (PWUD who do not inject, PWUD experiencing homelessness, and PWUD of color), an inconsistent naloxone supply and lack of access to intranasal naloxone in particular, inadequate funding, underestimates of overdoses, legal/policy barriers, and community stigma. Conclusions SSPs remain essential in preventing overdose deaths amid record numbers likely driven by increased fentanyl use and COVID-19-related impacts. These findings can inform efforts to support SSPs in this work. In the face of ongoing barriers, support for SSPs—including increased resources, political support, and community partnership—is urgently needed to address the worsening overdose crisis.

Differential risks of syringe service program participants in Central Ohio: a latent class analysis

“…Harm reduction is key to addressing and responding to the worsening overdose crisis [ 5 , 6 ]. A pragmatic philosophy, harm reduction (a) recognizes drug use is inevitable in any society, (b) acknowledges the dignity of people who use drugs (PWUD), and (c) aims to reduce the negative social and health consequences associated with drug use [ 5 , 7 , 8 ].…”

“…Previous studies have largely been limited to the emergency room [ 20 ] or community corrections programs [ 19 ], and those using community samples have noted varying levels of (dis)engagement in harm reduction programs across PWUD [ 23 – 26 ]. SSPs typically serve client populations that are at high risk of overdose [ 6 ], exacerbated by the introduction of fentanyl and xylazine [ 27 ], but are unlikely to access healthcare services due to stigma [ 6 , 28 ]. Despite similarities in structural barriers, client populations are largely heterogeneous [ 29 – 31 ], posing a challenge to harm reduction organizations in tailoring programs and developing targeted interventions to best serve clients and meet their unique needs [ 16 , 31 ].…”

Dissemination and Evaluation of an Opioid Hazard Awareness Training for Stone, Sand, and Gravel Miners

“…T he opioid epidemic continues to claim tens of thousands of lives per year in the United States and has worsened recently, reaching new highs during the COVID-19 pandemic. 1,2 The rise in overdose deaths has been driven by illicitly manufactured synthetic fentanyl, often in combination with other substances. 3 However, many of those who die because of illicit fentanyl overdose first experienced addiction through prescription opioids.…”