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:
Overdose reversal, including naloxone distribution, outreach and education programs
Syringe service programs (SSPs), including syringe access and syringe or needle exchange programs
Hepatitis C and HIV screening and treatment
Drunk driving interventions, including sobriety checkpoint programs, ignition interlocks and blood alcohol concentration laws
Housing First (rapid access to permanent housing without pre-condition of addiction treatment)
E-cigarettes for current smokers
Safe injection sites, also known as safer consumption spaces and drug consumption rooms, and heroin-assisted treatment
Drug checking, such as fentanyl testing strip programs
This resource page provides links to three types of credible guidance on what works to address addiction:
Expert consensus statements and guidelines: Recommendations developed by groups of experts convened by a federal agency, medical professional association or other credible organization. In most cases, these expert panels used a rigorous and systematic process to compile and evaluate peer-reviewed research evidence and translate research findings into specific implications for policy and practice.
Evidence registries: Searchable databases or other user-friendly compilations of evidence-based policies and programs. These registries use specific screening criteria to identify effective strategies and/or rate strategies on the strength of their available evidence of effectiveness.
Model policies: Model legislation developed by experts.
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.
U.S. Government Accountability Office, 2021
Drug Misuse: Most States Have Good Samaritan Laws and Research Indicates They May Have Positive Effe
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.
CDC Health Alert Network (HAN), 2018
Health Update: Rising Numbers of Deaths involving Fentanyl and Fentanyl Analogs, Including Carfentan
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.
American Medical Association, 2017
Help Save Lives: Co-prescribe Naloxone to Patients at Risk of Overdose
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.
Trust for America’s Health, 2017
Pain in the Nation: The Drug, Alcohol and Suicide Crisis and the Need for a National Resilience Strategy
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).
Office of the Surgeon General, U.S. Department of Health and Human Services, 2016
Facing Addiction in America Chapter 4: Early Intervention, Treatment and Management of Substance Use Disorders
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.
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.
Centers for Disease Control and Prevention, 2020
Syringe Services Programs: A Technical Package of Effective Strategies and Approaches for Planning,
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).
Centers for Disease Control and Prevention, 2016
HIV and Injection Drug Use: Syringe Services Programs for HIV Prevention
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.
Institute of Medicine (now National Academies of Sciences, Engineering and Medicine), 2010
Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C
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.
County Health Rankings and Roadmaps, University of Wisconsin Population Health Institute and the Rob
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.
American Association for the Study of Liver Diseases and Infectious Diseases Society of America, 2021
HCV guidance: Recommendations for testing, managing and treating Hepatitis C
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.
Center for Disease Control, 2020
What Works: Strategies to Reduce or Prevent Alcohol-Impaired 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.
County Health Rankings and Roadmaps, University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation
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.
American Cancer Society, 2018
American Cancer Society Position Statement on Electronic Cigarettes
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.
National Academies of Sciences, Engineering and Medicine, 2018
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).
RAND Corporation, 2018
Considering Heroin-Assisted Treatment and Supervised Drug Consumption Site in the United States
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.
European Monitoring Centre for Drugs and Drug Addiction, 2017
Drug Consumption Rooms: An Overview of Provision and Evidence
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.
Meta-analyses and systematic reviews
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
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.