Harm Reduction: Come As You Are

The Public Health response to the growing opioid crisis within North Dakota

The Harm Reduction Center based in Fargo, North Dakota, is a crucial evidence-based strategy for interacting with drug users and providing them with knowledge and resources that might help them make beneficial changes to their lives that could possibly even save their lives. The Overdose Prevention Strategy of the U.S. Department of Health and Human Services is based on harm reduction.  

Opioid and substance abuse is a national epidemic and catastrophe–anyone can be affected by opioid abuse and addiction.  Sixty percent of all drug overdose deaths in North Dakota in 2021—74 opioid overdose deaths—were caused by opioids. Sevent-five percent of all drug overdose deaths in the United States in 2021 were a result of opioid overdoses.  

In North Dakota, the age-adjusted overdose fatality rate rose from 4.5 per 100,000 to 10.2 per 100,000. From 2011 to 2021, the age-adjusted death rate in the United States increased from 6.4 per 100,000 to 24.7 per 100,000.  According to the report, the number of drug overdose deaths in North Dakota increased by 9% in 2022 compared to 2021. North Dakota was rated at number fifteen among states with an increase in drug overdose deaths in 2022 with 142 reported overdose deaths.

The goal of harm reduction is to give drug users and their families the choice to live healthy, independent, and fulfilling lives by integrating community-driven public health strategies such as prevention, risk reduction, and health promotion. Drug users’ lived experiences, particularly those in marginalized communities, are at the center of harm reduction, which uses these techniques and the practices that follow them.  

Based on the substance abuse mortality and morbidity statistics data from the Centers for Disease Control and Prevention due to historical trauma and socioeconomic hardships that interfered with traditional cultural resilience characteristics and raised the risk of behavioral addictions, Indigenous people are more vulnerable and at risk of higher opioid abuse within the state of North Dakota.  

The rise in substance usage and deaths disproportionately affects people of color. White people continue to account for the vast majority of drug overdose deaths each year. 

In order to avoid overdoses and the spread of infectious diseases; to promote physical, mental, and social welfare; and to provide low-barrier options for accessing health care services, including substance use and mental health issue treatment, the Harm Reduction Center places a strong emphasis on connecting directly with drug users.

As part of President Biden’s comprehensive effort to prevent overdoses and save lives, the U.S. Department of Health and Human Services (HHS), through the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Health Resources and Services Administration (HRSA), is today awarding more than $1.6 billion in investments for communities across the nation dealing with the addiction and overdose crises.

Funding provided by SAMHSA’s State Opioid Response(SOR) and Tribal Opioid Response(TOR) grant programs as well as HRSA’s rural communities opioid response programs will assist communities in utilizing all available resources, including prevention, harm reduction, treatment, and recovery supports for those who need them. President Biden made addressing the opioid crisis and overdose epidemic a top priority of his administration in his first State of the Union address, and earlier last year in 2022, he released his National Drug Control Strategy in an effort to increase access to treatment for addiction and overdose as well as to stop drug trafficking.  

The initiatives are in line with President Biden’s strategic priorities and HHS’s dedication to combating stimulant and opioid usage across the country, particularly in Tribal communities. More than 107,000 Americans died from drug overdoses in 2021, up more than 15% from 2020, according to data from the Centers for Disease Control and Prevention. 

Harm reduction is an important component of the Biden-Harris Administration’s holistic strategy to address substance use disorders through prevention, treatment, and rehabilitation–as well as empowering individuals to achieve their own goals through incremental change.

The center uses a variety of interventions to meet people where they are on their own terms, and it may serve as a gateway to other health and social services, such as prevention, treatment, and recovery.  Its primary goal is to address greater health and social challenges through better policies, programs, and practices.

The recent global pandemic has made the drug use and overdose epidemic in the United States and certain states like North Dakota worse. It is also being fueled by the widespread use of stimulants, fake prescription pills, and highly potent synthetic opioids that contain fentanyl or fentanyl analogs, as well as animal tranquilizers like xylazine. 

The Fargo Harm Reduction Center provides an opportunity for everyone, regardless of gender, class, or socioeconomic background, to access free healthcare services, receive Naloxone to reverse an overdose, and be connected to other essential resources. Treatment services, such as behavioral health intervention and pharmaceuticals for opioid use disorder, can, for example, be co-located with harm reduction services and offered as an option.

Reaching out for assistance and treatment is critical.  Only around one out of ten people with a substance use disorder have received treatment.  Almost all substance use disorder sufferers who did not receive treatment at a specialized facility did not believe they required treatment. In order to make a difference, the center fills the gap by providing services that people believe they require.

Students from the Public Health Association at North Dakota State University are under the supervision of Dr. Mark Strand, a doctor of philosophy in pharmaceutical sciences.

He encourages students to abstain from alcohol and other substances.  “It is important to me to get students out into the community to observe real public health problems and then to see the ways organizations and people are working to solve them,” said Dr. Strand.

When dealing with substance abuse issues, one should not be ashamed to seek treatment because no human is perfect.  The program saves lives by being available and accessible in a way that emphasizes the importance of humility and compassion for all drug users. The Harm Reduction Center located in downtown Fargo, North Dakota, focuses on reducing drug-related mortality and boosting access to healthcare, social services, and treatment. These services reduce overdose deaths, acute life-threatening illnesses caused by unsterile drug injection, and chronic diseases such as human immunodeficiency virus (HIV), viral hepatitis, and bacterial and fungal infections.

The students support the program and encourage the North Dakota legislature to continue advocating for the vulnerable, by eliminating health inequities and improving health and social services legislation affecting the state’s population.  The program focuses on allowing people to take responsibility for making better health decisions without discrimination, making Harm Reduction a form of justice in health and human rights that promotes dignity and acceptance.  

“Every effort to discourage opioid and substance use is a step toward saving lives and promoting well-being. Together, we can make a difference,” explained Samuel F. Saidu, an NDSU Student in Epidemiology with the sub-specialty of Maternal and Child Health.

As part of a comprehensive, integrated approach, the partnership will reduce overdose deaths, enhance links to care, and facilitate co-location of services. Reduce the stigma attached to substance abuse and co-occurring diseases. Encourage a philosophy of hope and healing by putting people with lived experience in positions of leadership and in the design, delivery, and assessment of services. 

People with lived experience can also show their peers what genuine change in their lives can look like, which will help develop a community and boost protective factors for drug users and their families.  When people feel heard, they feel cared for as individuals, and this puts them in a psychological position to make a decision.

By using harm reduction concepts, healthcare workers and practitioners can help lessen the negative consequences of high-risk behaviors while also promoting community health by attaining and addressing the needs of the population and well-being.

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