This resource page is part of the HPIO Addiction Evidence Project and covers topics relevant to two components of the comprehensive policy response to addiction framework: Overdose reversal and other forms of harm reduction.
Overdose reversal involves the use of naloxone (Narcan) or other medical interventions to reverse respiratory depression caused by opioids that could otherwise have been harmful or fatal. Overdose reversal is considered a form of harm reduction because it reduces deaths but does not prevent or treat substance use disorder.
Other harm reduction approaches aim to reduce the adverse health, social and economic outcomes of addiction, including death, homelessness and infectious diseases such as HIV/AIDS and hepatitis C. Many harm reduction approaches are aimed at helping opiate users and people who inject drugs (PWID), although harm reduction can also benefit those with addictions to other substances including alcohol and tobacco.
This resource page contains the following sections:
Click here for the resource page on prevention, treatment and recovery. The final components of the framework—children services, law enforcement and criminal justice reform—will be addressed in a future phase of this project.
This resource page provides links to three types of credible guidance on what works to address addiction:
The evidence base for the effectiveness of harm reduction varies widely by approach. There are decades of research from the U.S. and other countries on SSPs and several research-informed recommendations regarding overdose reversal programs and policies. Housing First and e-cigarettes for current smokers also have credible reviews of evidence to determine effectiveness in reducing harm.
The evidence base for safe injection sites and drug checking, by contrast, is emerging because these are newer approaches with limited implementation in the U.S. Therefore, these topics are not yet addressed by U.S.-based expert consensus statements, evidence registries or model policies. Links to the best-available information on these topics are included in this resource page to provide Ohio stakeholders with an introduction to these approaches.
A report on the efforts the Office of National Drug Control Policy has taken collect and disseminate information on Good Samaritan and Naloxone Access laws; the extent
to which states, territories and D.C. have these laws and the characteristics of them; and what research indicates concerning the effects of Good Samaritan laws.
Health alert for emergency health professionals that includes recommendations regarding fentanyl detection and use of naloxone.
Systematic review that determines optimal doses, routes of administration and dosing strategies of naloxone for suspected opioid overdose in out-of-hospital settings, and whether transport to a hospital following successful opioid overdose reversal with naloxone is necessary.
Guidance from the American Medical Association Opioid Task Force encouraging physicians to co-prescribe naloxone with opioid medications when clinically appropriate.
Report to inform the FDA on evidence around prescription opioid abuse, including recommendations related to the use of naloxone to reverse overdose and the reduction of disease transmission, such as syringe exchange, supervised injection facilities, drug checking and behavioral interventions.
Report that includes list of evidence-based and promising policies and programs to reduce overdose death, including naloxone access and Good Samaritan laws (see Section 4, Recommendations for Building a National Resilience Strategy and Appendix A, list of state performance on policy indicators).
Report that summarizes research findings about harm reduction strategies, including outreach and education, needle/syringe exchange programs and naloxone.
Searchable database that rates the strength of evidence of effectiveness (strong, moderate, suggestive) for a wide range of clinical health care innovations.
Searchable database of evidence-based policies and programs. Rates strength of evidence of effectiveness (scientifically supported, some evidence, expert opinion, insufficient evidence, mixed evidence, evidence of ineffectiveness). Includes Good Samaritan drug overdose laws and naloxone education and distribution programs.
Searchable database of systematic reviews on wide range of healthcare topics, including a “Tobacco, drugs and alcohol” category and “Opioids, opiates, heroin” subcategory.
Model policy intended to increase naloxone access in adopting states.
A set of evidence-based strategies based on a systematic literature review on the prevention of opioid overdose. These strategies include naloxone distribution, Medication-Assisted Treatment, Good Samaritan Laws and syringe services programs.
Technical package that provides evidence of the effectiveness of strategies and approaches for supporting successful planning, design, implementation and sustainability of syringe services programs.
Report that includes list of evidence-based and promising policies and programs to reduce overdose death, including syringe exchange programs (see Section 4, Recommendations for Building a National Resilience Strategy and Appendix A, list of state performance on policy indicators).
Fact sheet that summarizes evidence of effectiveness of SSPs, describes the components of SSPs and describes the role of various stakeholders in supporting SSPs to prevent HIV infection.
Guidance for programs funded by CDC that are exploring implementation or expansion of syringe services programs.
Report containing expert consensus statements regarding the underlying principles and programmatic elements that lead to effective syringe exchange programs.
Comprehensive guide for starting and managing a syringe access program. The guide offers practice suggestions and guidance in several areas including planning and design, operational issues, organizational issues, external issues and population-specific considerations.
Consensus statement that summarizes best practice recommendations to reduce Hepatitis B and C infections, including prevention efforts and research and policy priorities. Recommendations include increasing access to sterile needle syringes.
Searchable database of evidence-based policies and programs. Rates strength of evidence of effectiveness (scientifically supported, some evidence, expert opinion, insufficient evidence, mixed evidence, evidence of ineffectiveness). Includes syringe services programs.
Guidance on the screening and treatment of Hepatitis C, from testing and linkage to care to the optimal treatment regimen in particular patient situations.
Guidance from the Centers for Medicare and Medicaid Services related to Medicaid beneficiary access to hepatitis C treatment, including direct-acting antiviral (DAA) drugs.
A recommendation by the U.S. Preventive Services Task Force to screen for hepatitis C virus (HCV) infection in persons at high risk for infection, including injection drug users.
A recommendation by the U.S. Preventive Services Task Force to screen for HIV infection in adolescents and adults aged 15 to 65 years. Younger adolescents and older adults who are at increased risk should also be screened, including injection drug users.
Guide that presents strategies that are demonstrated to be effective in reducing alcohol-impaired driving. Includes topics such as sobriety checkpoints and ignition interlocks.
Policy statement on the consequences of driving while under the influence of alcohol, including a set of policy, educational, clinical and community interventions to reduce drunk driving.
Searchable database of evidence-based policies and programs that rates strength of evidence of effectiveness. Includes publicized sobriety checkpoint programs, ignition interlocks and blood alcohol concentration laws.
Searchable database of evidence-based policies and programs. Rates strength of evidence of effectiveness (scientifically supported, some evidence, expert opinion, insufficient evidence, mixed evidence, evidence of ineffectiveness). Includes Housing First.
Provides background for E-cigarette use and differences from cigarettes. Explains that there is emerging evidence of effectiveness in using E-cigarettes for smoking cessation but that more research is needed.
Provides information on E-cigarettes and explains that E-cigarettes should not be used for smoking cessation. Provides helpful guidance for adults and adolescents and includes support of policies that regulate E-cigarettes.
Consensus study report that summarizes the current state of evidence regarding what is known about health effects, initiation and cessation of combustible tobacco cigarette use and harm reduction. The Conclusions by Outcome document includes specific harm reduction conclusions (see Conclusions 18.1-18.5). Note that while there is evidence that completely switching from combustible tobacco to e-cigarettes reduces harm, there is also evidence that e-cigarette use increases risk of ever using combustible tobacco among youth and young adults (see Conclusions 16-1-17-4).
Mixed-methods report that assesses evidence on and arguments made about heroin-assisted treatment and supervised consumption sites and examines issues associated with implementing them in the U.S. Includes a review of existing research literature, as well as results of key informant interviews and focus groups with stakeholders in two Ohio counties.
Review of the evidence from various countries on drug consumption rooms, including the impact of these spaces on the incidence of HIV and hepatitis C, as well as certain drug use behaviors, such as needle sharing and injecting drugs in public.
The following journal articles report the findings of meta-analyses and systematic reviews on the effectiveness safe injection sites. A subscription or fee is required to obtain the full text of these articles.
McNeil, Ryan, and Will Small. “‘Safer environment interventions’: A qualitative synthesis of the experiences and perceptions of people who inject drugs.” Social Science & Medicine 106 (2014): 151-158. doi: 10.1016/j.socscimed.2014.01.051
Potier, Chloé, Vincent Laprévote, Francoise Dubois-Arber, Olivier Cottencin, and Benjamin Rolland. “Supervised injection services: what has been demonstrated? A systematic literature review.” Drug and alcohol dependence 145 (2014): 48-68. doi: 10.1016/j.drugalcdep.2014.10.012
Brief summary and findings of an evaluation study of a fentanyl test strip pilot project conducted in 2017-2018 in San Francisco, CA.
A research article that reviews and highlights the weak research evidence informing the use of fentanyl self-testing strips.
Report summarizing the results of a study conducted in 2017 to determine the accuracy of three technologies for checking drugs for the presence of fentanyl and to gather stakeholder feedback on the feasibility and usefulness of drug checking services.
Last updated: 8/24/2021. Resources on this page will not be updated after 2021.
