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Upstream Opportunities for Reducing the Harm of Alcohol and Drug Use

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Upstream Opportunities for Reducing the Harm of Alcohol and Drug Use Upstream Opportunities for Reducing the Harm of Alcohol and Drug Use Brandeis University Schneider Institutes for Health Policy 781-736-3834 Institute for Behavioral Health 781-736-3986 FAX The Heller School for Social Policy and Management [email protected] 415 South Street, MS 035, Waltham, MA 02454-9110 http://sihp.brandeis.edu Upstream Opportunities Acknowledgments This White Paper was drafted by Mary Jo Larson and Laura Lorenz of the Institute for Behavioral Health, Schneider Institutes for Health Policy, Heller School for Social Policy and Management, Brandeis University. Other significant contributors at the Heller School include Kathleen Dennehy, Mary Brolin, Margot Trotter Davis, Tom Clark, Constance Horgan, and Deborah Garnick and at the Open Society Foundations, Kimá Joy Taylor, Ruzana Hedges, and Andy Ko of the Campaign for a New Drug Policy. The paper benefited from the critical review and document editing of other reviewers outside of Brandeis and Open Society who volunteered their time: Alex S. Bennett, Jeannie Little, Kris Nyrop, and Mishka Terplan. We are grateful to the many individuals who shared both their valuable time and expertise by participating in the informal fact-gathering interviews that we conducted: Alex S. Bennett, Margot Trotter Davis, Michelle Demore-Taber, Daliah Heller, Hendree Jones, John E. Lewis, Jeannie Little, Kris Nyrop, Thomas P. O’Toole, Daniel Raymond, Jeremy Saunders, Mishka Terplan, and Tricia Wright. Prepared with a grant from the Campaign for a New Drug Policy, Open Society Foundations. Brandeis University Heller School for Social Policy and Management Page ii Upstream Opportunities Table of Contents Overview .......................................................................................................................................................... vi Synopsis .......................................................................................................................................................... vii 1. THE CASE FOR HARM REDUCTION ........................................................................................................... 1 1.1 Purpose of This White Paper ................................................................................................................. 2 1.2 The Current Situation: Why We Care ..................................................................................................... 3 Further Reading on the Current Situation ................................................................................................... 5 2. DEFINITION OF HARM REDUCTION .......................................................................................................... 6 2.1 Harm Reduction Principles ..................................................................................................................... 6 Further Reading on Definition and Principles of Harm Reduction .............................................................. 7 3. GOALS AND OUTCOMES OF HARM REDUCTION ..................................................................................... 8 3.1 Improved Personal and Family Health .................................................................................................. 8 3.2 Improved Community Well-being ......................................................................................................... 8 3.3 Policy Change ........................................................................................................................................ 9 Further Reading on Goals and Outcomes of Harm Reduction .................................................................... 9 4. A PUBLIC HEALTH FRAMEWORK OF HARM REDUCTION ....................................................................... 10 4.1 Investing “Upstream” .......................................................................................................................... 10 4.2 Gradualism Concept of Addiction Treatment ..................................................................................... 11 Further Reading on Harm Reduction Models and Concepts ..................................................................... 12 5. HARM REDUCTION STRATEGIES ............................................................................................................ 13 5.1 Upstream Strategies in Personal Health Care ..................................................................................... 13 1. Build new expectations and infrastructure for preventative initiatives. ........................................... 14 2. Create a Medical Home for Drug Users with Chronic Health Problems. .......................................... 14 3. Address patients’ chronic pain. ......................................................................................................... 15 5.2 Upstream Strategies for Addiction Systems of Care ............................................................................ 16 1. Recognize the potential of patient-centered, psychosocial treatment approaches that foster harm reduction. ............................................................................................................................................... 16 2. Use incentives to engage drug users into services. .......................................................................... 17 3. Adopt low-threshold approaches for drug users not in treatment. ................................................. 17 4. Create an integrated service network with seamless access to support services for positive change. ............................................................................................................................................................... 18 5.3 Upstream Strategies for Harm Reduction Organizations Working with Other Systems and Community Coalitions ................................................................................................................................ 19 1. Change media representations of harm reduction and chronic drug users. .................................... 20 2. Make health reform work for harm reduction. ................................................................................ 21 3. Invest in the community’s capacity to operate the full spectrum of prevention activities related to reducing harm from drug use. ............................................................................................................... 22 4. Distribute naloxone and train good Samaritans to prevent opioid overdose. ................................. 22 5. Adopt and expand needle and syringe exchange programs. ............................................................ 23 Brandeis University Heller School for Social Policy and Management Page iii Upstream Opportunities 6. Develop and collaborate on harm reduction training for law enforcement personnel. .................. 24 7. Create a data-driven criminal justice approach for low-risk, non-violent drug users who are being prosecuted. ............................................................................................................................................ 24 8. Build pre-booking diversion programs through collaboration of harm reduction organizations and law enforcement. ................................................................................................................................... 25 9. Use community policing, “smart policing”, that reduces crime not simply increases arrests.......... 26 10. Integrate use of data from the state prescription drug monitoring program (PDMP) into community prevention efforts. .............................................................................................................. 27 11. Enable access to legal services in communities disproportionately affected by drug offenses. .... 27 12. Work collaboratively to reform sentencing practices. .................................................................... 27 13. Create opportunity for economic empowerment of drug users. ................................................... 28 5.4 Conclusion ........................................................................................................................................... 28 Further Reading on Harm Reduction Strategies ........................................................................................ 31 6. THE IMPORTANCE OF ACCOUNTABILITY AND EVALUATION ................................................................. 32 Further Reading on Evaluation and System Change .................................................................................. 33 7. FINANCING APPROACHES FOR HARM REDUCTION SERVICES ............................................................... 35 7.1 The Affordable Care Act (ACA) ............................................................................................................ 35 More individuals who use drugs and their families will have health insurance coverage. ................... 35 Health delivery systems are being reformed. ........................................................................................ 36 The Essential Health Benefit Package for Health Exchanges and Medicaid .......................................... 36 Medicaid Health Home .......................................................................................................................... 37 Center for Medicare and Medicaid Innovation (“The Innovation Center”). .........................................
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