Community Perceptions of Harm Reduction and Its Implications for Syringe Exchange Policy

• Author: Joshua T. Barnett,Amanda Sharp,Enya B. Vroom
• DOI: 10.1177/0022042620932289
• Published date: 01 October 2020
• Date: 01 October 2020
• Subject Matter: Articles

https://doi.org/10.1177/0022042620932289

Journal of Drug Issues

2020, Vol. 50(4) 507 –523

© The Author(s) 2020

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DOI: 10.1177/0022042620932289

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Article

Community Perceptions of Harm

Reduction and Its Implications

for Syringe Exchange Policy

Amanda Sharp1, Joshua T. Barnett1,2 ,

and Enya B. Vroom1

Abstract

In the United States, the rising prevalence of opioid addiction has led to an increase in opioid-

related overdose deaths and transmission of infectious disease. This resulted in the declaration

of a national public health emergency and the need for harm reduction strategies such as syringe

exchange. Florida has seen increases in blood-borne diseases and fatal/nonfatal opioid overdoses,

yet harm reduction policy integration has been historically limited. To inform policy change, this

study explores the perspectives of community members in Manatee County, Florida, on harm

reduction services. Six focus groups were conducted with findings centralized around three

emergent themes related to the implementation of a syringe exchange program: (a) awareness

and acceptability; (b) facilitating factors; and (c) perceived barriers. The results of this qualitative

research helped to inform the successful adoption of a local syringe exchange ordinance.

Recommendations for community education and engagement regarding harm reduction policy

are discussed.

Keywords

harm reduction, opioid use disorder, syringe exchange, needle exchange, community engagement,

policy

Introduction

Opioid use in the United States is a major public health problem, where rates of prescription

opioids and heroin use has doubled over the last 10 years (Romo et al., 2018). In 2017, opioid-

related overdoses were 6 times higher than in 1999 (Scholl et al., 2019), and in this same year,

one in 10 HIV diagnoses were attributed to injecting drug use (Centers for Disease Control and

Prevention [CDC], 2017b). Florida has led the country as the state with the highest number of

drug overdose deaths (CDC, 2018a), reported the highest rate of AIDS-related deaths in 2016

(CDC, 2018b), and in 2018, led the nation in the number of new HIV cases (CDC, 2019).

1University of South Florida, Tampa, USA

2Manatee County Government, Bradenton, FL, USA

Corresponding Author:

Amanda Sharp, Department of Mental Health Law and Policy, College of Behavioral and Community Sciences,

University of South Florida, 13301 Bruce B. Downs Blvd, MHC2731, Tampa, FL 33612, USA.

Email: amandasharp@usf.edu

932289JODXXX10.1177/0022042620932289Journal of Drug IssuesSharp et al.

research-article2020

508 Journal of Drug Issues 50(4)

Despite the multiple efforts to combat the adverse health effects caused by the opioid crisis in

the United States, additional strategies are needed. Attention has been given to harm reduction-

based approaches to combat the transmission of infectious diseases, promote access to personal

safety measures, and enhance treatment acceptance. As it relates to an addiction treatment frame-

work, harm reduction is an approach that prioritizes safety measures for people who use drugs

with the intention of reducing the personal and population health risks associated with drug use

(Single, 1995). While harm reduction services have largely been advocated for by grassroots

organizations, anti-stigma campaigns, and human rights activists for decades, it was not until

recently that harm reduction approaches have garnered the attention of public health profession-

als and policymakers.

In Florida, harm reduction options have historically been restricted and few options for inno-

vative harm reduction strategies have been embraced in comparison to other states. As these

strategies continue to be considered, public perception is one way to influence the development

and adoption of harm reduction policies. This study highlights one way that community member

perspectives can be leveraged to influence policy around a specific harm reduction measure, the

implementation of syringe exchange programs (SEPs).

Background

As opioid use has increased, consequences such as opioid-related overdose and the spread of

infectious diseases caused by injecting drug use have promulgated the urgency to address the

opioid crisis (Hedegaard et al., 2017; Zibbell et al., 2018). Opioids include illicit substances such

as heroin and fentanyl analogs in addition to prescription pain relievers such as hydrocodone

(e.g., Vicodin), fentanyl, oxycodone (e.g., OxyContin, Percocet), and morphine (e.g., Kadian,

Avinza). A significant number of heroin users initially become addicted to prescribed and/or

nonprescribed opioid medications, but later divert to illicit opioids as the less expensive, more

powerful, and often more available option (Mars et al., 2014).

In the United States, the number of heroin users rose by 50% from 404,000 in 2002 to 828,000

in 2015 (CDC, 2017a; Muhuri et al., 2013). Of the 70,237 drug overdose deaths that occurred in

2017 in the United States, 47,600 of those deaths were caused by opioid-related overdoses which

is the highest number of opioid-related deaths to date (Ahmad et al., 2020). In 2016, opioids

killed more people than either car accidents, gun violence, or breast cancer (Hedegaard et al.,

2017).

In addition to being at increased risk for overdose, people who inject drugs (PWID) are also

at increased risk for blood-borne illnesses such as HIV and viral hepatitis (Des Jarlais et al.,

2001). Latest reports from the CDC estimate that in 2016, over 1.1 million people over the age of

13 are living with HIV in the United States (CDC, 2019). In addition, an adjusted estimate of

44,700 cases of acute hepatitis C occurred from 40 states in 2015, of a total of 2.4 million people

living with the viral infection (CDC, 2017c). According to the CDC, injecting drug use is the

most common means of transmission for hepatitis C in the United States (CDC, 2016). With such

a rapid increase in the prevalence of fatal opioid overdoses and diseases related to injection drug

use, harm reduction strategies offer solutions to reduce these negative trends.

Harm Reduction and Syringe Exchange

Harm reduction represents a series of solutions and interventions aimed at reducing the harm

associated with risky drug use behaviors (Single, 1995). One such method of harm reduction

includes SEPs. SEPs, also known as needle exchange programs (NEPs) or syringe services pro-

grams (SSPs), are social service programs designed to promote public health by providing PWID

the opportunity to obtain sanitary hypodermic needles (and other safe drug use resources) at little