Advocates for drug policy reform are doing some admirable work at the state level to improve the health and dignity of people who use drugs. But things are rolling at the federal level too. I recently spoke with Whitney Englander and Daniel Raymond, policy advocates with the Harm Reduction Coalition, about the issues they are working on.
1. Lift Federal Funding Ban on Syringe Exchange
In 1988 Congress imposed a ban on federal funding for syringe exchange. Syringe exchange programs provide people who inject drugs with sterile equipment, a proven method to lower the transmission of blood-borne diseases and to link people to drug treatment programs. The ban was lifted briefly in 2009 under the Obama administration, only to be reinstated by Congress in 2011. Though the restriction only applies to federal funds, it effectively restricts state funding as well because state allocations often reflect federal policy. As a result, viral infections such as hepatitis C and HIV continue to spread through people who share syringes, and in the end, taxpayers foot the bill by paying for costly medical treatment for state Medicaid recipients.
There are currently no congressional champions willing to introduce a bill, but Whitney Englander hopes to show political leaders that funding for syringe exchange is about allowing local communities to have every tool available to combat hepatitis C and to curb rising costs that can cripple health care systems (new hepatitis C treatment costs $1000 a pill, taken daily for 12-48 weeks).
2. Increase Access to Medication-Assisted Treatment
Medication-assisted treatment (MAT) is treatment for addiction that includes medication to control cravings and withdrawal symptoms. Although proven effective at treating addiction and lowering the risk of relapse, disease and death, there are numerous restrictions to MAT, including an arbitrary 100 patient limit for providers who prescribe buprenorphine (an opioid that reduces cravings for illicit drugs). Advocates are working to enforce state parity laws to increase insurance coverage of MAT, enable nurses and physicians assistants to prescribe buprenorphine, and to move a bill (S 2645- TREAT Act) in the Senate to amend the 100 patient cap on buprenorphine prescribing.
3. Standardize Best Practice Policy for Pregnant Women who use Opioids
With the prescription drug epidemic in full swing, hospitals are admitting increasing numbers of pregnant women who use opioids and who may give birth to babies with neonatal abstinence syndrome (NAS), a range of symptoms that may occur in newborns exposed to opiate drugs while in the mother's womb. Although there are standard protocols in place to safely wean newborns off opiates, there does not exist a standard of care for how to treat the mother. In many hospitals, health care workers are instructed to call Child Protective Services (CPS) if they encounter a woman who uses opioids, even those on medication-assisted treatment. The fear of hospital staff calling CPS could cause many women to seek home births, which is unsafe for babies born with NAS. Additionally, some states, such as Tennessee, have passed moral authority legislation that makes it a crime punishable by jail if a mother uses drugs while pregnant and the baby is born with NAS. Critics, including many prominent physicians and medical associations, point out that such laws may only discourage women who use drugs from seeking prenatal care and addiction treatment.
"We want to see policies that incentivize prenatal care and ensure that pregnant women get priority on drug treatment lists," says Whitney Englander. "Science shows that medication-assisted treatment is effective in treating pregnant women and safer than a quick detox, which can cause miscarriages."
4. Access to Hepatitis C Treatment
Lately there have been some exciting advances in hepatitis C treatment, including medications that show 90 percent success rates and fewer side effects than previous treatment options. But the high cost of the treatment, as well as numerous coverage restrictions by public and private insurance companies, is limiting access for current or former drug users. Harm reduction advocates are launching a campaign to ensure that people who use drugs get access to treatment for hepatitis C. This is also a state issue, as many people use drugs are state Medicaid recipients.
5. Overdose Prevention
Overdose prevention is gaining traction on the local and state levels, but currently the federal government has not passed comprehensive overdose prevention legislation. Advocates are working to pass a national immunity law to protect bystanders who administer naloxone and providers who prescribe it from liability (S 2092- Overdose Reduction Act). They are also asking for dedicated federal funding for naloxone distribution and overdose prevention (S 2755 Overdose Prevention Act), as well as looking at opportunities to encourage medical providers to co-prescribe naloxone to patients who take opioids as a standard of care. S 2839, the Comprehensive Recovery Act, addresses criminal justice and addiction treatment reforms, overdose prevention, education and public awareness efforts, and recovery supports.
Ultimately, the national harm reduction agenda is about more than just a set of interventions. It's about integrating harm reduction into a spectrum of health care delivery services.
"With all the media and political attention over the prescription drug epidemic, we have new opportunities to show how harm reduction work saves peoples' lives, dignity and health," says Whitney Englander. "We want to use that opportunity to not just increase naloxone access, and get federal funding for syringe exchange, etc, but to reduce stigma against people who use drugs and make sure that they are represented and included in the public policy debate."