Opioid Crisis Response and Harm Reduction
Cuyahoga County, OH
Population: 1,000,000 - 1,500,000 | Government type: County | Topic: Harm Reduction
Narcan is a nasal spray that is used to treat opioid overdose. Photo: Getty/Kena Betancur/AFP
The Program
For decades, the United States has attempted to solve the problem of overdose through arrest and criminalization. The War on Drugs has led not only to mass incarceration but also to worse public health outcomes. Criminalization is not an efficient, productive, or cost-effective approach to addressing the tragic magnitude of the opioid crisis. The crisis is a public health problem that demands public health solutions. It is time past time for states and localities to combat the opioid and overdose crisis by investing in public health programs as opposed to criminalization and policing. A public health approach should invest in harm reduction that seeks to reduce the damage caused by drug use and drug policy by meeting people where they are and respecting the inherent dignity of people who use drugs. Because so many people who use drugs do not wish to seek treatment, investing in treatment alone is not enough to prevent overdose.
When it comes to specific examples, harm reduction programs ensure that people who continue to use drugs can do so safely. These include:
Syringe Service Programs: providing clean syringes and decriminalizing syringe possession promotes safe drug use and reduces the transmission of HIV and Hepatitis C.
Naloxone Distribution: this drug helps to quickly reduce overdose and poses no health risks itself. It is inexpensive and FDA-approved. The wide distribution of Naloxone is key to safe drug use.
Drug Checking/Testing: testing equipment allows people to check drugs for dangerous contaminants like fentanyl, ensuring people know exactly what they are consuming.
Safe Consumption Services: this allows for the supervised, safe use of drugs. While these centers have been found to reduce overdose, a federal judge recently ruled them illegal, so their future remains uncertain.
In 2019, Cuyahoga County, Ohio was one of the first counties in the country to reach an agreement with four major drug companies in response to the opioid crisis. While more states and localities will follow, this is useful as an early example to build upon for best practices. Specifically, Cuyahoga and Summit Counties reached a $260 million settlement with three opioid distributors and one drug manufacturer, as well as a $20.4 million settlement with Johnson & Johnson. Cuyahoga County will receive 62 percent of these funds and Summit County will receive 38 percent.
Cuyahoga County’s approach appears to defer to local programs that have already been working on the issue. Examples of local programs that will receive investments in the first wave of funding include the Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Board, which will invest in adding hundreds of beds to its residential treatment programs, invest in peer recovery supports, improve emergency room department capacity to treat overdose, and divert individuals away from jails to drug treatment. MetroHealth will also receive funding to invest in treatment programs for incarcerated individuals with substance use and mental health issues.
Another highlight is that Cuyahoga County has created a separate opioid fund to ensure this money goes to address the overdose. A common alternative is simply adding the money to the County’s general fund, where it could be used for matters unrelated to overdose. This was a common way states and localities used tobacco settlement money after a major settlement in 1998. Much of those funds never addressed tobacco use. Cuyahoga seems to have this issue in mind as they approved the creation of an Opioid Mitigation Fund for money from the settlement to keep it separate from the county’s general fund and ensure that it would only be spent for purposes related to fighting the opioid epidemic.
There is no explicit mention yet of money going to organizations doing harm reduction work in Cuyahoga. While the plan’s investments are beneficial, they do not address overdose among people who use drugs and who plan to continue doing so. In addition to the crucial expansions in treatment described in this plan, investments in naloxone distribution, clean syringe distribution, and drug testing would be beneficial.
Collaborative Governance
Negotiating settlements with drug companies—whether through collective state or local negotiation or through individual families—reflect an admission that drug companies are liable for the damage they have caused millions of families. The settlements are often intended to pay for treatment and prevention programs. And as local governments are exploring how best to utilize the money, it’s critically important to consider those directly impacted by overdose as key stakeholders and advisors. Their role in decision making will empower them to offer insight as to what programs and support will most affect their community.
The Cuyahoga County plan appears encouraging so far and has been notably using this principle of incorporating the voices of those directly impacted by opioid use and overdose. The ADAMHS Board said that they choose to fund organizations “based on the services they already provide and their good reputations.” As the work continues, the perspective and guidance from harm reduction workers on the ground will be critical in assessing the level of success. Localities doing this work should always prioritize a planning council model of funding where the people directly impacted decide where the money goes.
Emphasis on equity
States should invest in harm reduction, and the people most impacted should be directly involved in deciding where the money goes. These individuals are often left out of discussions that directly influence their health and well-being. As a result, the solutions may perpetuate their trauma, hinder their recovery, and make it less safe to use drugs.
The county will use its $116 million in multiple phases. Phase One will spend $23.1 million primarily to add residential treatment beds, hire more recovery coaches through local organizations such as Thrive Peer Support, and create Medication-Assisted Treatment (MAT) programs for jails and prisons. They have yet to announce how they will spend the remaining $14 million in the additional phases.
This effort is an important step towards a harm reduction world without the need for police or prisons. States and localities should use opioid settlement money to invest in public health solutions to overdose, not criminal justice. People who use drugs have been stigmatized, vilified, and incarcerated for too long. These approaches have exacerbated overdose, torn apart families and communities through a racist criminal justice system, and made life more difficult for some of this country’s most vulnerable populations. Substance Use Disorder is an illness, not a weakness, and our public policy should reflect that. Harm reduction and treatment give people who use drugs the dignity they deserve.
Analysis
Preemption: While the state of Ohio preempts localities on a range of issues, the county utilized federal settlement funding to support this effort, thus avoiding state interference. Many Ohio localities are joining the statewide One Ohio plan - the state will negotiate a statewide settlement in ongoing litigation and distribute funds equitably throughout the state.
Local government: The Cuyahoga County funding is restricted to opioid crisis response efforts through a designated fund to ensure that settlement money addresses overdose.
Policy impact: Given the initiative is new, the impact is yet to be determined. On the positive side, the county’s plan prioritizes well established local treatment and recovery programs. Still, it fails to explicitly outline investments in harm reduction measures, and it funds certain aspects of the carceral system, including drug courts.
Last updated: January 25, 2021
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