Fentanyl Test Strips, Clean Needles a Focus of Federal Substance Use Grant Program

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WASHINGTON — Harm reduction strategies, including syringe service programs and use of fentanyl test strips, will be eligible for federal grants under a $30 million, 3-year program announced Wednesday by the Biden administration.

“A hundred thousand overdoses in a 12-month period — it’s simply heartbreaking,” Rahul Gupta, MD, director of the White House Office of National Drug Control Policy, said on a phone call with reporters. “We’re losing one American every 5 minutes to this epidemic, driven largely by illicitly manufactured fentanyl. This is an unacceptable situation and requires an unprecedented and urgent response. We must use every tool available to us; this includes our production strategies, which have long been underemphasized at the federal level.”

“I want to define what harm reduction means to the federal government,” he continued. “It means placing life at the center. It means creating conditions where it becomes easier to save a life than to let one perish. It means focusing on policies based on science, evidence, and data. That’s why the Biden-Harris administration’s new harm reduction strategy includes expanding access to naloxone, drug test strips, and syringe service programs.”

In addition to the harm reduction grants — which will be given at a rate of $10 million per year for 3 years — the administration also released model legislation for states that want to start up or refine their syringe service programs, formerly known as needle exchange programs. “High-quality syringe service programs can prevent the spread of disease, save lives, and connect people to other health services, including treatment for substance use disorder,” Gupta said. “They have a proven track record of improving public safety and saving costs. However, their availability is limited in many areas.”

The model law “provides states with a framework to make sure syringe service programs are available wherever needed,” he added. “It does things like give guidance to authorize the establishment of comprehensive syringe service programs within states … It helps give guidance about how to reduce needlestick injuries to law enforcement and other first responders; [suggests] data collection and reporting requirements; provides recommendations on immunity from criminal arrest, charge, and prosecution; and provides training materials as well as funding strategies for syringe service programs.”

Health and Human Services Secretary Xavier Becerra said that the grants and model law are part of the administration’s four-pronged strategy on substance use, which includes primary prevention, harm reduction, evidence-based treatment, and recovery support as its four priorities. The announcement “builds on the work SAMHSA [the Substance Abuse and Mental Health Services Administration] is already doing on harm reduction, including allowing federal grant dollars to be used to purchase fentanyl test strips, and considering how to make naloxone widely available, including over the counter,” he said.

“Overcoming addiction is not easy, and it rarely happens overnight,” Becerra added. “And where we can’t prevent someone from using these substances, we should at least be trying to make sure we prevent severe consequences like death. That means we need to be helping people reduce harm while they fight their addiction, not silencing them, stigmatizing them, or pushing them into the shadows.”

The harm reduction grants will be available to both traditional and non-traditional substance use disorder treatment providers, including primary care practices, SAMHSA’s Miriam Delphin-Rittmon, PhD, told MedPage Today during a question-and-answer session at the briefing. “This grant award is open to state and local providers, to primary care providers, nonprofit community based organizations, and behavioral health providers,” she said. “We know that people who may be struggling with substances connect to a range of different organizations, and we want to create multiple entryways into services and multiple entryways into accessing harm reduction support.”

The Biden administration sees addiction recovery as occurring along a continuum, said Delphin-Rittmon, who is the assistant secretary for mental health and substance use at SAMHSA. “Returning to drug use is often a part of the recovery process, and therefore, harm reduction does not see abstinence as the only positive outcome. “

Asked by MedPage Today to elaborate on this further, she continued, “We know that everyone’s journey to recovery is different, and for some people abstinence has absolutely worked for them. For others, abstinence doesn’t work for them, and that’s where harm reduction absolutely comes in; it helps some individuals who may be continuing to use. It gives them tools and resources to test substances so that they can remain alive and ultimately be engaged in services and support.”

One issue officials did not address directly during the call was the use of safe injection sites — places where people suffering from addiction can go to use street drugs under medical supervision; the sites also offer connections to substance use treatment services. New York City opened two such sites last week, but a potential safe injection site in Philadelphia has been blocked from opening by a legal challenge.

Asked about the sites, Becerra said he couldn’t comment directly because of “ongoing litigation,” likely referring to the fact that the federal government is among those included in the Philadelphia case. He added, however, that “the administration is also looking at ways to support research on the clinical effectiveness of emerging harm reduction practices; we want to be able to see that in real- world settings … I hope to be able to give more detail in the future.”

Racial equity is also a focus of these grants, Gupta said. “If you look at the numbers, there is a disproportionate impact in the environment of the pandemic that we’re seeing on communities of color” when it comes to substance use. “So it’s also important as we are going forward, we’re also focusing on making sure that we’re not widening, but narrowing, the gap when it comes to racial equity.”

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    Joyce Frieden oversees MedPage Today’s Washington coverage, including stories about Congress, the White House, the Supreme Court, healthcare trade associations, and federal agencies. She has 35 years of experience covering health policy. Follow

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