RIZE in Health Affairs Blog on Harm Reduction and Strategic Grant Making

January 4, 2019

By Health Affairs

The nation is gripped by an opioid overdose epidemic. Opioid use disorder is a chronic but treatable illness. However, untreated, this disease can cause numerous harms—including death. Effective treatment strategies must incorporate harm reduction interventions, yet lack of funding and ideological barriers have blocked broad implementation of these necessary interventions.

To effectively address the devastation of the opioid overdose epidemic, the health care–related philanthropy community should consider a strategic approach to grant making that builds up and supports harm reduction services and makes them an equal part of the treatment process for opioid use disorder.

The Harm Caused By Opioid Use Disorder

There are many factors causing harm and death for people with opioid use disorder. Unsterile syringes can result in infections and exposure to diseases like HIV/AIDS and hepatitis B and C. The unpredictability of the illicit drug market has resulted in exposure to potent fentanyl analogues for people who use drugs, dramatically increasing the risk of fatal overdose.

Current Harm Reduction Measures

Harm reduction measures used today include syringe service (exchange) programs, overdose education, naloxone distribution, and testing for HIV and hepatitis. Newer approaches to harm reduction are gaining momentum such as making fentanyl test strips available. There are also harm reduction methods, such as safe consumption sites, under way in other countries. These methods are being reviewed and debated in the US.

No single intervention is sufficient to address the opioid overdose epidemic. Harm reduction is a set of tools focused on keeping people who use drugs alive and as safe as possible, whether or not their ultimate goal is recovery. Integrating harm reduction services with low-threshold (easier) access to effective treatment can create a better, more humane approach to care.

RIZE Massachusetts’ Strategic Approach

The RIZE Massachusetts Foundation is a statewide foundation committed to achieving zero stigma and zero deaths related to opioid use disorder by investing in the best solutions and brightest minds that will save lives, reduce harm, and end the opioid epidemic in Massachusetts.

RIZE is unique in that it is similar to an operating foundation but is technically a public charity. According to the Philanthropic Initiative, which did a scan looking for similar organizations, there are no other organizations like RIZE anywhere in the US. The funding for RIZE comes mainly from private-sector entities, although it has received a small amount of funds from the general public. The work RIZE is doing, and its unique organizational structure—are necessary since traditional philanthropy has not caught up with the scope of the opioid crisis.

RIZE’s belief is that we can prevent death and improve care for people suffering from opioid use disorder if we increase harm reduction services and integrate them with access to clinical addiction treatment programs. To that end, we made a strategic decision to create a special grant program focused on singling out and supporting the best harm reduction efforts under way in the state.

RIZE’s start-up funding in 2017 was through multiyear commitments, so it is still accessing the contributions from the GE Foundation, Blue Cross Blue Shield of Massachusetts, and Partners HealthCare. These grants for harm reduction come from that initial source of funding.

The criteria in our request for proposals (RFP) were:

  • That harm reduction services be coupled with immediate access to effective, low-threshold opioid use disorder treatment
  • There be a clear path to increasing harm reduction services to their target populations
  • Applicants have, or will forge, partnerships with clinical partners that will provide easy access to treatment for physical and mental health care, as well as addiction treatment
  • They embed tracking and assessment tools into projects so they can measure effectiveness of the services in improving health and advancing patients into clinical treatment.

Grantees’ Harm Reduction Activities

We chose six finalists based on these criteria and on how they will collectively improve and increase the presence of harm reduction services throughout Massachusetts. As we do with the treatment programs we fund, we will assess these programs, learn from them, and then scale the most promising ones to serve more people across the state.

Highlights from the proposed work of our awardees underscore the benefits of investing in harm reduction services:

Expanding access to integrated harm reduction and treatment

  • The AIDS Support Group of Cape Cod (ASGCC)will geographically expand its harm reduction services into new areas of Cape Cod. These locations were not being serviced for harm reduction before by the ASGCC because of lack of funding. It will partner with clinical organizations to launch a pilot program that will easily connect harm reduction clients with same-day entry into clinical treatment. The addition of a peer recovery treatment navigator will ensure that clients are guided through the clinical treatment process and stay engaged in their recovery.
  • The Life Connection Centerin Lowell, Massachusetts, will use its funding to extend the hours of its harm reduction program, which is situated in a soup kitchen, so that the center can serve more people.
  • Meeting clients where they are
  • The Kraft Center Mobile Health Initiativewill strengthen its Boston-based mobile health care team to reach more people who use drugs and are experiencing homelessness. It will continue to partner with AHOPE, Boston’s frontline syringe service and overdose prevention program, to bring both clinical health and treatment services to the “hot zones” in the city, where the most overdoses and deaths are occurring.
  • Fenway Community Health Center will create a mobile unit to reach more neighborhoods in the Boston metro area and increase enrollment in harm reduction programs including syringe services, provision of fentanyl test strips, and testing for HIV and hepatitis C.

Harm reduction as a survival plan

  • There are people who avoid medical treatment in clinical settings because of being homeless, working in the sex trade, or being involved with the criminal justice system. The organization HRH413, which focuses on peer-led harm reduction for these high-risk communities and serves Western Massachusetts, will use the grant to expand its work. This will include going into the streets to save the lives of people who may be averse to receiving services in a typical clinical setting. By increasing its harm reduction services, HRH413 will be able to improve the survival rate and health of some of the most vulnerable citizens in that area.
  • The Greater Lawrence (Massachusetts) Family Health Center will supplement its current syringe services program by hiring a licensed social worker and a community health worker to incorporate behavioral health into harm reduction services for people experiencing homelessness.

With Our Collective Help, There Is Hope

The scope of the opioid overdose epidemic and the deaths associated with it makes it an overwhelming challenge. However, it’s a challenge we must, and can, solve. The health-related philanthropic community can contribute to saving and improving lives through strategic grant making that helps shape the right balance of prevention, treatment, harm reduction, and recovery services. With our collective help, there is hope.