NEXT Louisiana Advocacy Brief by nextdistro

Saving Lives, Reducing Costs:

A Case for Expanding Harm Reduction in Louisiana

Disclaimer This document is provided by Next Harm Reduction (“NEXT Distro”) for informational purposes only. Next Harm Reduction assumes no responsibility for any errors or omissions in these materials. The content provided herein is based on the best knowledge available at the time of publication. This advocacy brief is licensed under Creative Commons BY-NC-ND 4.0. You may copy and distribute this material in any medium or format in unadaped form only, for noncommercial purposes online, and only so long as attribution is given to Next Harm Reduction. Next Harm Reduction’s names and logos and all related trademarks are the property of Next Harm Reduction and cannot be used without its written permission. Illustrations by Lindsay Morano.

2023 by Next Harm Reduction

Table of Contents Introduction Glossary What is Harm Reduction? Syringe Service Programs (SSPs) in Louisiana Barriers to Harm Reduction Rural Areas Need Harm Reduction Mail-Based Distribution for Harm Reduction NEXT Mail-Based Distribution in Louisiana Opioid Settlement Funds Our Three Recommendations Conclusion Thank Yous Read More NEXT Data

1 2 3 3 6 10 11 14 16 18 20 22 23 26

Introduction This advocacy brief is a collaborative effort by Next Harm Reduction and our state-wide partner, Trystereo: New Orleans Harm Reduction Network.

Together, we delve into the tangible benefits that arise from implementing harm reduction initiatives in local communities across Louisiana. The insights presented here are drawn from the first-hand experiences shared by those accessing Next Harm Reduction’s services, as recorded through online forms since 2022. Our focus zeroes in on the perspectives of NEXT enrollees based in Louisiana. NEXT Distro’s innovative online and mail-based harm reduction service plays a pivotal role in serving individuals across all 64 parishes, especially those in predominantly rural areas. This tailored approach yields positive outcomes, particularly for local communities. Importantly, these harm reduction efforts translate into notable economic advantages for the state. By ensuring access to safer use supplies, testing materials, overdose reversal tools, and

wellness resources, we effectively reduce healthcare costs and bolster workforce productivity. This marks a direct investment in the economic prosperity of Louisiana.

Moreover, addressing harm reduction at the local level significantly contributes to a safer, more secure environment. Through the mitigation of overdose fatalities and the reduction of injection-related disease transmission, we fortify public health, rendering communities more resilient and better prepared to face future challenges. Amid intricate economic and healthcare landscapes, the strategic focus on harm reduction emerges as both practical and prudent. Through a steadfast investment in harm reduction strategies, Louisiana not only stands to gain in terms of economic prosperity but also in the overall wellbeing and resilience of its communities. This advocacy brief serves as an informative guide, offering insights to make informed decisions that positively impact the state’s localities and parishes.

Glossary SSP PWUD PWID MOU NEXT HIV HCV CDC SAMHSA

Syringe Service Program People Who Use Drugs People Who Inject Drugs Memorandum of Understanding Needle Exchange Technology Human Immunodefieciency Virus Hepatitis C Center for Disease Control Substance Abuse and Mental Health Services Administration

What is Harm Reduction? Harm reduction is a set of practices, philosophy, and organizing that acknowledges drug use is an ongoing part of our world, and seeks to minimize its negative effects. Drug use occurs on a spectrum, and harm reduction seeks

to meet people where they are and get them the care they need and deserve. Often, this looks like supplying safer use materials like sterile syringes, Naloxone, fentanyl test strips, wound care; training on overdose reversal; and connection to resources such as healthcare enrollment

or medication-assisted treatment.1 Harm reduction values individual freedom, personal responsibility, and community well-being. It recognizes that individuals who use drugs possess invaluable insights into their own lives and circumstances. Therefore, their input should play a significant role in shaping the programs, policies, and resources designed to support them.

The aim is to foster self-sufficiency and safety, and ultimately enhance individual and community welfare.

Syringe Service Programs (SSPs) in Louisiana As a national organization, NEXT utilizes a hub and spoke model that allows us to expand our services across the country while uplifting local, in-person Syringe Service Programs (SSPs). In practice, this means that when people fill out our order forms or enroll with NEXT, our Louisiana state affiliate, Trystereo, distributes supplies according to the various parish regulations.

This affiliate model allows us to work in partnership with local public health initiatives and

provide the support they need to meet the needs of PWUD in their area. Trystereo is an all-volunteer harm reduction collective based in New Orleans. They were founded in 2011 to affirm the dignity of people who use drugs and to access limited harm reduction resources in their community. They operate primarily as a mobile and street-based syringe access program that provides fresh syringes and injection supplies, wound care kits, naloxone, education, and linkage to care.

In 2019, Trystereo became NEXT’s statewide affiliate for naloxone distribution across Louisiana. This was a critical partnership because overdose rates in Louisiana have been skyrocketing.2 According to NEXT’s Louisiana data, of

the 821 people who have requested naloxone since July 2019, over 70.6% have witnessed an overdose and 12.6% have personally overdosed. Of people attempting to enroll for full-service programming with NEXT since 2022, 32.1% have personally experienced an overdose, and 77.2% of people have witnessed an overdose. People who use drugs in Louisiana are on the frontlines of the overdose epidemic. Ensuring they have access to overdose reversal tools like naloxone is a key component of harm reduction.

32.1%

& 77.2% personally overdosed

witnessed an overdose

In 2020, Trystereo launched full-service harm reduction services across Louisiana. Through this partnership, we received enrollment requests from 1014 people in the state since 2022 as well as the following supply requests since the beginning of 2023:

Trystereo’s mailing program is just one aspect of their work. Trystereo has played a significant role in advocating for expanded legalization of harm reduction services in Louisiana. Their work has accomplished allowing syringe access programs in Louisiana to be authorized by local government, securing an ordinance legalizing syringe access programs in New Orleans, and a Louisiana Department of Health standing order allowing the distribution and use of naloxone without a doctor’s prescription.3 Even with these improvements, barriers remain in existing legislation for Syringe Service Programs. According to publicly-available information, there are at least 7 operating SSPs or naloxone distribution programs in Louisiana, three of which are based in New Orleans and the others spread

between Baton Rouge, Lake Charles, Alexandria, and Shreveport. Beyond Trystereo, the other 6 publiclyoperating SSPs in Louisiana include Central Louisiana AIDS Support Services (CLASS), Southwest Louisiana Area Health Education Center (SWLA), the Philadelphia Center, Capitol Area Reentry Program (CARP), New Orleans Syringe Access Program (NOSAP), and Women With a Vision(WWAV). There are more SSPs in Louisiana than are named here. In every community where they exist, SSPs are where people put their boots to the ground in harm reduction. Much of the work SSPs do occurs in the face-to-face interactions volunteers and employees have in community with the people they serve. SSPs like Trystereo create a necessary bridge of care, services, and resources for PWUD. For example, SSPs can provide safer-use educational materials, “bad batch” alerts when overdoses are spiking

among a concentrated group of people or area of the state, as well as access to wound care supplies–a need for the many people facing chronic skin and soft tissue infections, especially as xylazine and other contaminants make the drug supply more unstable and potentially harmful. Syringe Service Programs have the potential to connect people to housing, legal aid, and critical medical care. They get people who use drugs the sterile supplies they need to prevent infection, injury, and even death as well as create benefits for public health and society.

While Medicaid has made healthcare coverage more accessible to many low-income people––including many people who use drugs––there is still a substantial coverage gap. According to NEXT’s data, 42.4% of Louisiana enrollees since 2022 are uninsured or unsure about their insurance status.

Barriers to Harm Reduction

Access to Medical Care and Budget Constraints

All people–including those who use drugs–need and deserve access to quality medical care. Insurance status often poses a major barrier to achieving one’s healthcare goals. Tools and resources for providers caring for PWUD are sorely needed: our data shows that of Louisiana enrollees since 2022, 63.3% have ongoing health issues. 35.1% have been diagnosed with Hepatitis C (HCV), and 42.2% live with a mental health disorder.

In 2016, Louisiana was one of few southern states to accept and implement the Medicaid expansion, making 292,000 uninsured, low-income people eligible for coverage. In 2020, the federal government further expanded Medicaid in response to the COVID-19 public health emergency by requiring continuous enrollment of participants.

In response, the uninsured rate of adults in Louisiana dropped from 22.7% to 8.9% and rates of access to care and medication likewise increased.4

Lifetime Cost of HIV Treatment

$420,285

Cost of a Single Syringe

$0.10

Now that the federally-mandated COVID-19 public health emergency has ended, what is being called the ‘great unwinding,’ referring to mass eligibility redetermination for Medicaid, is taking place.5 Nationally, almost 14 million people face the possibility of losing access to Medicaid. In just three months of 2023, over 125,000 people have been disenrolled in Louisiana. This number is expected to rise to 222,400 or more.6 In recent news, the Louisiana

Department of Health is facing a $100 million budget cut, which turns into a $400-$700 million loss factoring in federal matching dollars. $22 million of

this cut has to come from funding for Louisiana’s Medicaid.7

This cut will specifically impact hospitals receiving additional funding to treat people covered by Medicaid, leading to the revocation of services for low-income patients. Health Secretary Stephen Russo presented a list of ßoptional Medicaid services as potential options for cuts, including funds for public-private partner hospitals, nursing homes, elderly care, health clinics, mental health, substance use, and ambulatory surgical centers. The LA Department of Health is also eyeing community behavioral health services–which may include harm reduction programs like SSPs–as potential targets for budget cuts.8 This has the potential to cause a lot of harm. Through our work, we see that harm reduction programs are a pragmatic and effective public health tool and strategy to address the needs of Louisianans who use drugs. Compared to the cost of treatment for bloodborne infections as well as policing and criminalizing people who use drugs,

needle and syringe exchanges are significantly cheaper and are proven to reduce HIV & HCV by nearly half.

A reduction in funding or services, however, is linked to a spike in infections. On the contrary, the cost containment potential of SSPs is huge: the cost of one sterile syringe is mere cents whereas the lifetime cost of HIV treatment is estimated to be $420,285.9 The biggest measure of success for harm reduction programs is individual health engagement and improvement, which is shared among the community. The best measure of success is not how many people enter treatment and abstain entirely from drug use, but entire communities exercising safer use practices and agency over their own wellness and healthcare goals.

highlighted in the increased risk of overdose upon release.11 Programs for opioid treatment in jails and after release can provide some assistance, but the availability of these programs is still limited. Of the folks enrolled with NEXT in Louisiana since 2022, 25.6% have been arrested or incarcerated in the past year alone.

Criminalization of PWUD The overdose crisis alone has led to national overdose death rates increasing by 44% among Black people and 39% among Indigenous people between 2019 and 2020.10 Disparities in overdose death rates are greatest in counties with larger income inequality. Other factors that contribute to this are lack of healthcare access, the perception of the overdose crisis as mostly affecting white individuals, and the criminalization of drug use. The impact of incarceration on substance use and overdose risk is

SSPs can offer bridges to services such as legal aid for record expungement; drugrelated charges on one’s record make it extremely difficult to access necessities like housing, work, and legal aid.

Our data shows that 44.5% of all individuals signing up with NEXT in Louisiana since 2022 were or are homeless or unstably housed. That’s on par with NEXT’s national data for the same time period, which shows 45.4% of enrollees across the US were or are homeless or unstably housed.

paraphernalia that includes syringes and other safer injection equipment.

Part of the solution to this is supporting housing, work, and legal aid programs centering individuals with drug-related charges. SSPs offer a continuum of care that can help get people connected to said programs and is part of why they are such successful public health measures. People who use drugs and their communities have, by and large, also experienced mass disenfranchisement from society, including the healthcare system. This is especially true for Black, Brown, and Indigenous people, especially in the context of the overdose crisis.

Paraphernalia Laws The primary pieces of legislation currently affecting SSPs and harm reduction organizations are LA Stat. Ann. 40:1021 and LA Stat. Ann. 40: 1024 (2023).12 Under these laws, employees and volunteers of SSPs cannot be held criminally liable for distributing or possessing drug

For an SSP to operate, local government approval is required. This legislation creates hurdles to starting and running harm reduction programs like Trystereo and Syringe Service Programs in general. It also makes it difficult to distribute harm reduction supplies according to need across the state, whether through in-person or mail-based systems. Furthermore, harm reduction supplies like safe smoking kits are not included in an exception for syringes. According to frontline harm reductionists, a higher proportion of Black and Brown PWUD smoke or snort drugs rather than inject them.13 Ensuring safe smoking kits are legal makes harm reduction responsive and accessible to more Black and Brown people who use drugs in Louisiana, which is especially critical in the midst of the overdose crisis that disproportionately impacts Black and Brown communities. Analyzing the data available on the Louisiana Opioid Data and Surveillance System reveals that the state-wide overdose death rate for people of all races increased by 199.6% between

2018 and 2021. The overdose

death rate for Black people of all genders increased by 327.3% and for Black women 353.3%.

Meanwhile, the statewide opioid overdose death rate increased for white people by 174.93%. Caddo Parish, which is 50.3% Black or African American,14 has the highest opioid prescription rate in the state–210.6% higher than the national average.15 Shreveport, a major city in Louisiana, is situated between Caddo and Bossier Parishes, which have different laws regulating drug paraphernalia and SSPs. This means that in a majority-Black area with extremely high rates of opioid prescription and overdose, harm reductionists with the Philadelphia Center are unable to equally distribute all of the necessary supplies people who use drugs need to do so safely.

Rural Areas Need Harm Reduction

In-person SSPs are not an option for every person who uses drugs. Only 20% of SSPs in the US are in rural areas, which also tend to have a lack of healthcare services overall. 16 In a 2016 study, the CDC found that 220 counties were vulnerable to the

rapid spread of HIV and high rates of HCV among people who inject drugs. The common denominator among those 220 counties was rurality.17 Of the 64 parishes in Louisiana, 39 are designated as rural by the Federal Office of Management and Budget–that’s 60.9%.18

Only 20%

of SSPs The farther people

inject drugs are rural who live from an SSP, the

more likely they will be forced to share injection equipment. A lack of access to sterile equipment and limited healthcare access often results in syringe sharing and syringe reuse.

Sharing equipment is directly linked to the transmission of bloodborne diseases like HIV and HCV. This leads to an increase in healthcare costs, mortality rates, and co-morbid chronic health issues for individuals in these already underserved areas.

Rural areas are disproportionately impacted by the HCV epidemic, often seeing infection rates twice as high as those in urban areas. Surveillance of four mostly rural states–Kentucky, Tennessee, Virginia, and West Virginia–indicate a 364% increase in the number of acute HCV infections from 2006 to 2012.19

According to the CDC, the presence of SSPs is associated with an estimated 50% reduction in HIV and HCV incidence. More than half of new HCV infections are linked to injection drug use. Proximity and access to SSPs and the use of sterile supplies result in lower health risks for people who inject drugs.20 In rural areas, the establishment and sustainability of Syringe Service Programs (SSPs) often encounter formidable challenges. Limited funding, stringent local and state regulations, and prevailing attitudes toward drug use pose significant hurdles, particularly in less densely populated regions. Moreover, financial resources present a critical barrier. Securing funding for these programs in rural areas can be particularly challenging due to limited budgets and a focus on competing priorities. Even in cases where an SSP is in place, individuals who use drugs encounter additional barriers. Limited availability of private transportation and, in some cases, a lack of public transit options can severely hinder access. Finding a discreet location for accessing services can be exceedingly challenging. Moreover,

those in rural areas contend with the same stigma as their urban counterparts, within a smaller, closely-knit community with personal, professional, and familial connections to consider. The unique difficulties in setting up and operating SSPs in rural areas, combined with the additional obstacles faced by those seeking harm reduction resources, result in a significant gap in healthcare access for individuals who use drugs in these communities. This issue requires thoughtful consideration and innovative solutions to ensure that everyone, regardless of location, can access the vital resources they need.

Mail-Based Distribution for Rural Harm Reduction Mail-based distribution stands as an effective solution to meet the needs of individuals residing in rural areas seeking harm reduction resources. Presently, NEXT Distro has successfully delivered harm reduction supplies through mail services to 80% of U.S. counties. In Louisiana, NEXT is actively serving communities in every single Department of Health Region, ensuring widespread access to vital harm reduction materials.

to those in need. It’s worth noting that our efforts in the state are, however, constrained by the regulations of individual parishes concerning drug paraphernalia. Mail-based distribution opens up new pathways to connect with individuals who may not have previously engaged with or had access to traditional syringe service programs. This is particularly pivotal for rural, remote, and underserved communities of individuals who use drugs. In certain instances, individual pharmacists may opt not to sell sterile syringes, potentially creating a barrier to accessing safer use supplies through traditional pharmacy channels. Mail-based services offer a discreet and convenient alternative. This empowers individuals to request necessary supplies at their own convenience, without the constraints of limited in-person SSP hours. In areas where local policies or prevailing attitudes may impede harm reduction efforts, mail-based distribution steps in to provide essential supplies

NEXT data reveals that our client base increases rapidly after new communities of people who use drugs become aware of our services. However, of 173 SSPs surveyed in April 2020, only 6% had mailing supplies. This tells us that potential demand for mail-based services likely far exceeds current capacity.21

NEXT Data reveals another benefit of mail-based distribution programs: a high number of women access harm reduction supplies through our mailbased distribution program.

In Louisiana alone, 56.7% of NEXT enrollees since 2022 are women. This is not an outlier: NEXT’s national data reveals that women make up 52.6% of enrollees since 2022. On the other hand, in-person SSPs tend to interface with a significantly higher number of men than women. These statistics show that mail-based distribution has a unique ability to

specifically reach out and support women who use drugs or who are in community with people who do. In Louisiana, where HCV rates are rising rapidly and disproportionately affecting Black people, mail-based distribution has the chance to reach Black women, who are bearing the impacts of the HCV epidemic.22 To clarify, mail-based distribution is not an alternative or superior to in-person harm reduction services. Mail-based distribution gives us a chance to reach people who are not traditionally reached by SSPs and in-person SSPs offer necessary services, care, and resources to people who use drugs that are impossible to provide through the mail.

Gender Breakdown of NEXT’s Louisiana Enrollees Since 2022

NEXT Mail-Based Distribution in Louisiana Discussing what harm reduction, SSPs, and mail-based distribution look like in the context of Louisiana is critical;

60.9% of Louisiana’s parishes are rural. 23

In Region 8, 36 people have submitted enrollment requests to NEXT Distro since the beginning of 2022. Again, over 1014 people in Louisiana have attempted to enroll with NEXT since the beginning of 2022. Of these people, 96% have reported reusing their syringes, while 67.9% have reported sharing their syringes.

In terms of Louisiana Department of Health Regions, Region 8 is one of the most fully rural regions of the state. It encompasses Union, Lincoln, Jackson, Ouachita, Caldwell, Franklin, Tensas, Madison, Richland, Morehouse, West Carroll, and East Carroll Parishes.

Easy access to sterile syringes gives PWUD an immediate alternative to reusing or sharing syringes: mail-based distribution makes this accessible for people living in rural or remote areas. In every LA Department of Health region, there are people who have submitted requests for supplies or enrollment, indicating a quantitative reused syringes in demand for the past month harm reduction services. shared syringes in the past month

100%

& 63.6%

27.3%

& 36.4% personally overdosed

witnessed an overdose

Getting harm reduction supplies to people who use drugs and their communities in Louisiana is critical now more than ever. Overdose death rates continue to rise and the overdose crisis continues.

Overdose death rates in Louisiana increased by 199.6% between 2018 and 2021, according to the Louisiana Opioid Data and Surveillance System.

Compared to other southern states, Louisiana has a high proportion of people enrolled with and/ or requesting harm reduction supplies from NEXT Distro. Out of the entire country, Louisiana is in the top 7 for the highest demand for fentanyl testing strips, safer sex supplies, and safer smoking kits. To put that into perspective, let’s compare Louisiana data to requests coming in from other southern states:

It’s essential to ensure that policies and initiatives directly addressing drug use are both effective and practical. This can be achieved by seeking input and insights from individuals who have lived experience with drug use. Their perspectives offer valuable real-world knowledge about the challenges faced and the impact of policies on their lives and communities. In addressing the overdose crisis and its repercussions, it’s crucial to consider the input of those with direct experience.

Opioid Settlement Funds The effective utilization of Louisiana’s $325 million opioid settlement funds is a matter of great significance, one that warrants careful consideration. These funds, allocated to address the impact of the opioid crisis, carry a weighty responsibility.

In 2020 and 2021, Louisiana tragically witnessed the loss of 4,359 lives due to drug overdoses, underscoring the urgency of our response.24 Currently, these funds are distributed with 20% allocated to sheriffs across the 64 parishes, while the remaining 80% passes through the Opioid Abatement Taskforce to reach local governments. This allocation strategy was outlined in an MOU led by GovernorElect Jeff Landry during his tenure as Attorney General.25

The Opioid Abatement Task Force, primarily composed of law enforcement and government officials, plays a pivotal role in shaping the distribution and application of these funds. Furthermore, the task force has transitioned into a private, nonprofit entity known as the Opioid Abatement Administration Corporation. The approved uses for parish funds must align with three key categories: providing treatment for individuals affected by substance use disorders, extending support for those in addiction recovery under SAMHSA-licensed care, and targeting treatment for addiction services not covered by Medicaid or private insurance. Transparency and accountability measures surrounding the 20% allocated to law enforcement remain a subject of concern. While parishes are required to report their expenditure, it is unclear whether these reports will be made public or if mechanisms are in place to address potential fund mismanagement.

Louisiana is the only state to allocate such a substantial portion of settlement funds to law enforcement.26 This has raised concerns among harm reductionists and legal experts, particularly regarding transparency and any potential unintended consequences of this allocation. It’s crucial to recognize that law enforcement is increasingly being tasked with addressing public health challenges, a role they were not traditionally designed for. They should not be expected to bear the burden of all societal issues. The opioid crisis, in particular, is a complex problem that requires a multi-faceted approach involving healthcare, social services, and community engagement. Christine Minhee, attorney and founder of the Opioid Settlement Tracker, aptly

noted that transparency around opioid settlement fund use is critical. As she emphasized, “We are in an era where transparency matters a lot. The fact that hundreds of thousands of people had to die for states and localities to receive their millions makes it such that the least that states can do is to speak their expenditures loudly and clearly into the mic for the people in the back of the room to hear.” In conclusion, every Louisianan deserves dignity, support, and security. This necessitates their involvement in decisions that impact them directly, ensuring access to essential resources for survival and prosperity, and the autonomy to make responsible choices. The principles of harm reduction offer a path forward, answering this call for a more informed and inclusive approach.

“We are in an era where transparency matters a lot. The fact that hundreds of thousands of people had to die for states and localities to receive their millions makes it such that the least that states can do is to speak their expenditures loudly and clearly into the mic for the people in the back of the room to hear.” -Christine Minhee, attorney and founder of the Opioid Settlement Tracker.27

Our Three Recommendations: 1. Opioid settlement fund decisions should be informed by and include people who use drugs. It’s crucial to recognize that individuals impacted by drug use should play a pivotal role in decisions about settlement funds. Upholding values of self-reliance and individual responsibility, their input is vital in shaping the use of these resources. The intention behind these funds is to mend the wounds caused by the overdose crisis, and it’s imperative that they directly benefit those most affected. This encompasses committed volunteers and employees of SSPs, individuals often equipped with firsthand experience. They stand at the forefront of addressing the challenges posed by the surge in fentanyl, which has heightened the risks associated with drug use. By ensuring that settlement funds directly aid those on the frontlines, we not only address immediate needs but also foster a stronger, more resilient community.

A collective of more than 133 organizations working on the frontline of the overdose crisis–including NEXT Distro–have compiled a list of recommendations surrounding the use

of opioid settlement funds. Click here to view this roadmap.28

2. Expand harm reduction services statewide. Invest in, support, and expand established harm reduction programs including syringe service programs. This sort of programming uplifts and helps people who use drugs survive, while also offering cost containment to jurisdictions. Existing SSPs are already grounded in their local communities of people who use drugs; they are often operated by and involve people who use drugs. They need resources to sustainably operate, grow, and thrive. When NEXT partners with SSPs for statewide distribution of harm reduction supplies, we find that the biggest challenge to developing partnerships is limited funding and restrictive local legislation. Even as the overdose epidemic is worsening and despite harm reduction offering a clear investment return, SSPs are often at risk in the face of budgetary constraints.29 Expanding harm reduction is not only about supporting SSPs: it also includes Medication Assisted Treatment (MAT), increasing doctor access to medication like buprenorphine, keeping telehealth available as well as benefits of it like same-day medicine access, and

supporting or establishing programs that center PWUD. Furthermore, it means expanding protections of harm reduction under law; for example, ensuring paraphernalia laws do not at all include harm reduction materials like sterile syringes or safe smoking kits.

departments are one source of financial and infrastructural support. We see the need for expanded mail-based distribution because every time a new community of people who use drugs finds out about NEXT Distro, we see a rapid increase in client base.30

Expanding access to safe smoking supplies statewide is a critical step in providing Louisianians with the healthcare materials needed to reduce negative outcomes of drug use. Smoking is often a less harmful route of administration than injection, which allows people who use drugs to lower their chance of overdose.

3. Support mail-based harm reduction programming.

As long as safe smoking supplies are restricted due to drug paraphernalia laws, people who use methamphetamine–especially in rural, predominantly white areas–and people who use crack cocaine––especially in Black communities or urban areas–lack access to the harm reduction materials they need and deserve. More people using smoking kits reduces the chance of injection-related injury, infection, or illness. Offering safe smoking kits invites more individuals to engage with, learn about, and enter into spaces that center harm reduction and can connect them with other needed resources. Collaborations between harm reduction organizations and health

Mail-based distribution has a unique ability to reach people living in rural areas, especially women. Facing the overdose crisis in a state that is primarily rural means implementing and supporting harm reduction strategies that can reach people living in remote areas. Funding and supporting mailbased distribution increases access to stigma-free harm reduction resources for people in rural areas, resulting in more positive public and individual health outcomes. Another aspect of supporting mailbased harm reduction services is funding to directly pay the people handling distribution at SSPs. Many of the people doing on-the-ground harm reduction work are doing so without compensation. In order to sustainably implement mail-based distribution, especially at a larger scale than it currently exists, there must be personnel with harm reduction experience paid to handle statewide distribution.

Conclusi In Louisiana, harm reduction is both pragmatic and principled. Local initiatives, fueled by grassroots organizations deeply embedded in communities, are leading the charge. These programs extend vital public health resources, ensuring they reach communities across the state, particularly those in rural areas where traditional in-person services face logistical challenges.

In rural and remote regions, where access to in-person harm reduction services is limited, mail-based distribution emerges as a crucial lifeline. It not only effectively reaches people who use drugs but also shows

promise in reaching women disproportionately.

Our data underscores the tangible demand for harm reduction services in Louisiana, where overdose and blood-borne illnesses are on the rise. However, as opioid settlement fund decisions unfold, transparency becomes paramount. Allocating these funds demands the involvement and insight of the communities most affected. A significant portion of these resources should be directed towards expanding harm reduction services and supporting locally-driven mailbased harm reduction programs.

ion

In conclusion, embracing harm reduction strategies aligns with Louisiana’s values by prioritizing individual agency, dignity, and community safety. It offers a prudent and practical path forward, investing in the resilience and well-being of our communities while mitigating the impact of the ongoing overdose crisis. By following these recommendations, Louisiana can lead with integrity, ensuring that the opioid settlement funds serve the betterment and safety of all Louisianans through locally-informed decisions and community-driven initiatives.

Our Three Recommendations: - Opioid settlement fund decisions should be informed by and include impacted communities. - Expand harm reduction services statewide. - Support mail-based harm reduction programming.

Thank You to... The team at UW for their invaluable work with NEXT’s data. Without you, this brief would not have been possible. Lindsey Morano whose skillful and talented illustrations prop up everything NEXT creates, especially this brief. All people working or volunteering at SSPs. The hard work you are doing means survival for so many. Everybody using harm reduction supplies to keep themselves and their communities safe and alive. We stand with you.

Read more: To learn more about in-person Syringe Service Programs in Louisiana: Trystereo: https://trystereo.org/ CLASS: https://class-cenla.org/ SWLA: https://www.swlahec.org/ Philadelphia Center: https://philadelphiacenter.org/ WWAV: https://wwav-no.org/ NOSAP: https://www.crescentcare.org/service/harm-reduction-services/ CARP: https://www.carpbr.com/be-safe To access the Louisiana Opioid Data and Surveillance System: https://lodss.ldh.la.gov/

Footnotes:

1 National Harm Reduction Coalition. (2022, December 20). Principles of Harm Reduction. National Harm Reduction Coalition. https://harmreduction.org/about-us/principles-of-harm-reduction/ 2 Williams, T. (2021). Opioid Deaths in Louisiana. Louisiana Opioid Surveillance Program. https://ldh.la.gov/assets/opioid/2021_Annual_Drug_Death_Report.pdf 3 Trystereo: New Orleans Harm Reduction Network. (n.d.). Louisiana Laws for Overdose Prevention - Trystereo: New Orleans Harm Reduction Network. Trystereo. https://trystereo.org/od-state-local-laws 4 Shao, Y., & Stoecker, C. (2021). The effect of Louisiana Medicaid expansion on affordability of Health Care. Public Health Reports, 137(5), 912–920. https://doi. org/10.1177/00333549211041410 5 Seitz, A. (2023, March 10). Millions who rely on Medicaid may be booted from pro-

gram. AP News. https://apnews.com/ article/access-to-health-care-48d1f565c800139bb397bb886436968f 6 O’Donoghue, J. (2023, April 17). Louisiana Health Department has new estimate for Medicaid enrollment drop. Louisiana Illuminator. https://lailluminator.com/2023/04/17/ louisiana-health-department-revises-estimate-for-medicaid-enrollee-purge/ 7 Skinner, V. (2023, June 22). Louisiana lawmakers examine $100m reduction for State Department of Health. L’Observateur. https:// www.lobservateur.com/2023/06/22/louisiana-lawmakers-examine-100m-reduction-for-state-department-of-health/ 8 Louisiana Budget Project. (2023, June 12). Cut to health department angers, confuses lawmakers. Louisiana Budget Project. https://www. labudget.org/2023/06/cut-to-health-department-angers-confuses-lawmakers/ 9 Bingham, A., Shrestha, R. K., Khurana, N., Jacob-

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24Centers for Disease Control and Prevention. (2022b, March 1). Drug Overdose Mortality by State. Centers for Disease Control and Prevention. https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/ drug_poisoning.htm 25 Attorney General, &amp; Landry, J., Louisiana-State Local Government Opioid Litigation Memorandum of Understanding. https:// nationalopioidsettlement.com/wp-content/ uploads/2021/10/2021.10.21-MOU-Opioid-Litigation.pdf 26 Christina Minhee and Vital Strategies. (n.d.). Guide for Community Advocates on the Opioid Settlement: Louisiana. Opioid Settlement Tracker. https://www.opioidsettlementtracker. com/settlementspending/#guides 27 Hawkins, D. (2023, July 18). Louisiana will get $325m from a major opioid settlement. Advocates want to know how it will be spent. WWNO. https://www.wwno.org/ public-health/2023-07-18/louisiana-will-get325m-from-a-major-opioid-settlement-advocates-want-to-know-how-it-will-be-spent 28 VOCAL-NY. (2023, August 14). A Roadmap for

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