Efforts to defund harm reduction in Idaho will have dire consequences
An essay recently published by the Idaho Freedom Foundation makes the case for ending what it calls “taxpayer-subsidized drug abuse” in Idaho. The argument posits that “harm reduction projects and needle exchanges” in the Gem State encourage continued drug use and “support the deterioration of the institution of the family.” The passage of House Bill 350 to redirect $19 million in federal funds to first responders, it argues, is a better way to address the opioid epidemic.
Regrettably, this is an immense miscalculation.
The evidence used to justify this rests upon a single working paper by the National Bureau of Economic Research (NBER). As stated in the document, “NBER working papers are circulated for discussion and comment purposes. They have not been peer-reviewed or been subject to the review by the NBER Board of Directors that accompanies official NBER publications.” If funding harm reduction services results in negative health outcomes, as is articulated by the foundation, then it would be helpful to provide the actual studies that informed this effort.
The working paper did result in a study published by the same author in the Journal of Public Economics, which triggered a response from R Street scholars. Our analysis of the evidence found there to be “too many substantial limitations to have conclusive implications” for evidence-based health policy decision-making. By referencing a single study, the conservative establishment in Idaho has fallen prey to haphazard policy making: cherry-picking data to make the case for change. As such, we thought it prudent to analyze this most recent essay to shed light on common misperceptions surrounding harm reduction and clarify the large degree of misinformation it contains.
The essay calls attention to cost savings estimates compiled by the Idaho Department of Health and Welfare (IDHW) for curbing bloodborne infections via needle exchanges, more commonly known as syringe service programs (SSPs). However, it then conflates the national costs of the opioid epidemic with the cost effectiveness of SSPs. In New York, one of the states referred to in the essay, the cost-savings of SSPs was found to be an estimated $3,000 per client, and research from both low and high-income settings around the world has found SSPs to be highly cost-effective. In fact, SSPs are one of the most cost-effective public health interventions ever created. A more accurate portrayal of the hospital costs of opioid overdoses are estimated at $11 billion annually.
There is a common adage that harm reduction, in particular SSPs, encourages drug use and abuse. This is patently false. Even the U.S. Centers for Disease Control and Prevention (CDC) has publicly stated that “[n]early thirty years of research shows that comprehensive SSPs are safe, effective, and cost-saving, do not increase illegal drug use or crime, and play an important role in reducing the transmission of viral hepatitis, HIV and other infections.”
It is important to note the introduction of SSPs in the 1980s predates the current opioid epidemic and the prevalence of fentanyl in the U.S. drug supply. Given the novelty of these co-occurring epidemics, more research is needed to understand the complete effects of SSPs on overdose numbers. Emerging data indicates that SSPs have adapted to these epidemics, from overdose identification and response training to increasing access to the overdose reversal medication, naloxone.
Should states follow Idaho’s lead, we can expect the costs associated with drug use to rise dramatically as HIV and other infectious disease outbreak clusters emerge, which is what happened when West Virginia attempted to prohibit SSP operations. What’s more, evidence shows us that harm reduction is at its most effective—and its most cost effective—when local, on-the-ground experts are given the autonomy to tailor programs to their communities. Removing state funding increases organizations’ dependence on federal dollars, thus putting federal voices and priorities ahead of local ones.
The essay’s arguments are equally centered on “the deterioration of the institution of the family” by alleging that linkage to services for infectious disease prevention and sexual health promotes promiscuity. This puritanical approach to human behavior is the byproduct of an abstinence-only approach to sexual health that has been an abject failure across all metric definitions for success. The CDC, again, notes that condom availability programs do not result in an increase in sexual activity as this essay suggests and as evidence shows.
Ultimately, the most dangerous synthesis of these arguments can be boiled down to one sentence in the essay that represents a reductive solution to drug use in the Gem State: “The $19 million will no longer keep the problem going.” Defunding harm reduction programs, it argues, will resolve the issue.
We beg to differ. Simply ignoring individuals who use drugs or have sex does not make them stop using drugs or stop having sex, but it does increase the risks associated with these behaviors. There are promising programs that increase the ability of first responders to address addiction but you’ll note one important fact: First responders also need harm reduction providers.
