"Some participants noted that in their country there was a move towards greater recognition of the need for public health-oriented approaches to tackle drug problems accompanied by a shift in the goals of drug policies towards reducing drug-related harms. However, the relatively limited set of indicators that has historically been used to evaluate drug policy may have limited utility for informing on outcomes relevant to this perspective.
"Long-term retention on OAT in trials and observational studies is suboptimal, which limits the effect of OAT with regard to reducing drug-related deaths.131 There was consistent evidence that retention was slightly better on methadone than buprenorphine across RCTs and observational studies at timepoints beyond 1 month, although few RCTs examined long-term retention.
"This study also demonstrates that available technologies fail to fully meet the needs of drug checking programs. As legal avenues for drug checking services expand, additional resources at the local, state, and federal levels should be directed towards the improvement of portable spectrometry devices and other technologies that might be useful for drug checking.
"Perhaps our most significant finding is that all of this SSP’s success in implementing drug checking was achieved in spite of, rather than thanks to, the legal and policy environment in which it operates. The COVID-19 pandemic made drug checking practically impossible, but only after systematic police violence against participants and threats against staff had already curtailed provision of this harm reduction service. Indeed, it is likely that drug checking could have persisted during the pandemic absent the very real risk of police interference.
"RAD involves a four-step process. First, wearing gloves, SSP staff members wipe or swab used drug paraphernalia received from registered SSP participants. Each individual wipe or swab is then placed into a small paper envelope that is collected in a larger mailing envelope (2). Program staff members administered a deidentified questionnaire simultaneously with paraphernalia sample collection and linked the questionnaire and sample with a unique barcode number.§§ Second, samples are mailed to NIST in accordance with U.S. Postal Service regulations.
"Once OPCs were operating in NYC, local Community Board members and other local leaders were invited to tour the sites and see the services firsthand. This has been a powerful tool to demystify OPCs and educate observers about harm reduction. It was helpful, in terms of building community support, that OnPoint already had strong community relationships developed over more than 20 years of operating an SSP.
"As with any service provided to the public, NYC Health Department viewed community engagement and education as critical to the success of OPCs, particularly given the stigma that substance use providers and participants often face. Prior to implementation, the NYC Health Department conducted general educational briefings with local community groups and leaders in neighborhoods across the city, including those where the OPCs would be located.
"NYC engaged in a series of discussions with local, state, and federal stakeholders to gauge the viability of opening OPCs in the absence of clear authorization. Strong political engagement of local stakeholders—including the New York City Police Department (NYPD), district attorneys, and local elected officials—was critical to not only mitigate risks of local enforcement against OPC operations but also to ensure successful service provision. Education and engagement of city agencies and elected officials have been ongoing since the release of the feasibility report in 2018.
"In 2021, NY State and the USA elected executive branch leaders who publicly supported harm reduction as a public health approach to reducing overdose deaths. In April 2021, the Biden administration explicitly listed “enhancing evidence-based harm reduction efforts” as a drug policy priority for its first year in office, which NYC interpreted as potentially aligned with the concept of OPCs.
