Two months after California Gov. Gavin Newsom declared a state of emergency over a monkeypox outbreak, the state has surpassed 5,000 confirmed cases of the highly contagious infection. To make matters worse, California has a shortage of JYNNEOS, the FDA-approved monkeypox vaccine. As public health officials urge action to mitigate the spread of monkeypox, the state government must make a concerted effort to reach the one group of people most at risk of contracting the virus: people who use drugs.
They are particularly vulnerable to monkeypox due to associated risks such as housing insecurity, limited access to health services and needle sharing. Mitigating the spread of monkeypox in this group requires creative solutions, one of which may be investing in a service that already shows promise: harm reduction.
Harm reduction services are designed to create supportive spaces for substance users without judgment or stigma. Controlled consumption sites, a key aspect of harm reduction, help to avert overdose and unwanted complications; have been shown to reduce the risk of opioid-related morbidity and mortality without increasing crime rates in surrounding communities. The same services could reduce monkeypox infections by minimizing risk behaviors involved in its spread, such as needle sharing.
The most effective harm reduction tool is also its simplest: directly linking at-risk populations to medical services. In 2019, California implemented the California Harm Reduction Initiative (CHRI), a $15.2 million pilot program that represented the state’s largest investment in harm reduction services to date. The initiative has enabled 37 community-based organizations across California to hire staff, create positions dedicated to treatment navigation and, in many cases, make telehealth services available. Analyzes by the National Harm Reduction Coalition (NHRC), a harm reduction advocacy organization, showed that harm reduction sites that received funding from the initiative had higher rates of overdose prevention and patient entry into treatment, according to Jenny Haywood, associate director. NHRC.
However, the California Legislature chose not to restore CHRI funding in its state budget proposal without officially justifying the end of the program. Following that decision, Governor Newsom vetoed a bill that would have allowed California cities to open controlled drug injection sites. Newsom’s office justified the decision by pointing to a lack of infrastructure and support for the site; suggested that unrestricted development of new sites would have “unintended consequences”. Together, these decisions could spell the end of harm reduction funding in California.
State legislatures should reverse course before it’s too late. It should reconsider the opportunity to renew CHRI and make it a budget priority next year. In fact, the state should expand the initiative by increasing the number of needle exchange programs to ensure their availability in areas with increasing incidence of monkeypox. Public health officials could even use these programs to connect otherwise naïve populations to health care, to promote monkeypox education campaigns and referrals for treatment. Harm reduction sites could serve as hubs for other support services, such as case management for vulnerable population groups or registration for benefit programs.
Using harm reduction services to address infectious diseases is not a new concept. Sterile syringe programs have helped reduce the burden of blood-borne infections such as HIV/AIDS and hepatitis C. In addition, decades of studies show that syringe programs are a cost-effective and effective way to increase treatment rates and reduce death rates. among people who use drugs.
Now is the time when we need more harm reduction services, not less. By providing clean needles and safe-sex supplies (such as condoms), harm reduction programs have the unique potential to minimize the possibility of substance overdose and reduce the transmission of monkeypox among people who share these substances.
Some critics of harm reduction programs see it as encouraging or supporting drug use, but evidence has shown that it does not increase rates of substance use. By accepting the fact that people who use drugs will continue to use them regardless of whether their drugs are available or legal, harm reduction programs promote responsible interventions that minimize the risks associated with drug use.
We cannot sit back and allow monkeypox, fueled further by the opioid epidemic, to become another American policy and public health failure.
Aditya Narayan (@adityalearns) is an MD candidate and drug policy researcher at Stanford University School of Medicine.
Tasnim Ahmed (@TasnimMAhmed) is an MD candidate at Stanford University School of Medicine.
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