Harm Reduction is an evidence-based approach critical to engaging with people who use drugs, equipping them with life-saving tools and information to create positive change and potentially save their lives. It is an imperative tool that Ohio has utilized to fight the opioid crisis. This crisis has hit and continues to hit Ohio hard. Addiction, overdoses, and related fatalities continue to plague the state. In 2023, the most recent data available, 4,452 lives were claimed by unintentional drug overdoses. While this is a slight reduction from 2022, there is more that can be done to reduce these deaths through harm reduction. Harm reduction is supported in the as-introduced budget in two ways: policy changes and financial support.
Policy changes to support harm reduction in the Governor’s Budget
The Governor’s as-introduced budget includes financial support for numerous initiatives as well as policy changes. Policy changes are changes to the legislation that take place in the budget bill and do not always inherently have funding associated with it. The policy change that is included in the Governor’s budget is related to a key aspect of harm reduction in Ohio, which is that it is legal to possess and use fentanyl testing strips without fear of being in violation of Ohio’s drug paraphernalia statute.
Ohio’s definition of drug paraphernalia does include testing strips, but fentanyl testing strips are specifically excluded from the definition to encourage its use. The as-introduced budget expands, beyond fentanyl testing strips, items that may be lawfully possessed and used to test for the presence of drugs and to prevent drug poisoning, without being in violation of Ohio’s drug paraphernalia laws. Additionally, the as-introduced budget requires the State Board of Pharmacy to adopt rules for approving the additional types of testing strips that may be possessed and used because they demonstrate efficacy in reducing drug poisoning by determining the presence of specific compounds.
Combatting the chocolate chip cookie effect
There are also known issues with how fentanyl test strips work. Fentanyl test strips are dipped into water containing a small amount of well-mixed drug residue and if fentanyl is in that drug residue, then it shows positive. While these test strips are very sensitive, only requiring a small amount to trigger a positive test, the phenomenon called the “chocolate chip cookie effect” is of concern. The idea is that fentanyl can be clumped together in a small pocket, like chocolate chips inside a cookie, meaning that one section of the drug tested could contain fentanyl while the rest does not, which can cause a false negative.
Xylazine test strips could be used to help detect fentanyl as 9 out of 10 drugs that contain Xylazine also contain fentanyl.
By allowing for additional items beyond fentanyl testing strips to be legalized, the chances of detecting fentanyl, or other harmful compounds, can increase. For example, Xylazine test strips could be used to help detect fentanyl as 9 out of 10 drugs that contain Xylazine also contain fentanyl. Under current law, Xylazine test strips are illegal. By permitting individuals to acquire the tools they need to make an informed decision, we can enable proper risk management and allow them to take whatever steps are necessary to reduce the possible harm they face.
Financial support for harm reduction in the Governor’s Budget
The only dedicated General Revenue Fund (GRF) financial support for harm reduction resides in the Ohio Department of Health’s budget. The Governor recommends that $250,000 be used in each fiscal year of the biennium, in consultation with his RecoveryOhio Initiative, to support local health providers’ harm reduction efforts to reduce overdose rates and deaths. While this is the only dedicated funding for harm reduction, the budget proposal for the Department of Mental Health and Addiction Services’ (OhioMHAS), which is proposed to be renamed the Department of Behavioral Health in the as-introduced budget, includes the creation of state block grants, funded through GRF line items, to be allocated to Alcohol, Drug Addiction and Mental Health Services (ADAMHS) boards.
While a large portion of the funds supporting these block grants are already allocated to ADAMHS Boards, it will provide additional flexibility in how the funding is spent. In addition to the proposed grants, the boards receive funding from voter approved property tax levies. These block grants can be spent on harm reduction services, but do not have to be spent this way. While not state GRF funding, is it imperative to mention the funding present in the Governor’s budget from the federal State Opioid Response (SOR) Grant. SOR Grants are used to support Ohio’s fight against the opioid crisis and will fund $170.0 million worth of activities in each fiscal year. Again, this funding is not exclusively used for harm reduction but will fund harm reduction activities in the state.
SOR Grants are used to support Ohio’s fight against the opioid crisis and will fund $170.0 million worth of activities in each fiscal year.
Harm reduction is an important tool for the state of Ohio to continue utilizing while fighting the opioid crisis. The Center for Community Solutions supports the as-introduced budget’s support for harm reduction activities and encourages the state to continue to encourage this lifesaving tool. Community Solutions will provide updates on legislative changes and financial support relating to harm reduction as the budget process continues.
Image source: https://www.cdc.gov/stop-overdose/safety/index.html
Behavioral health resources
- Free Naloxone/Fentanyl Test Strips: NaloxoneOhio or Project DAWN (Deaths Avoided With Naloxone)
- SAMHSA’s National Helpline: 1-800-622-4357. Confidential, free, 24 hours day, 365 days a year, information service, in English and Spanish, for individuals and family members facing mental and/or substance use disorders. This service provides referrals to local treatment facilities, support groups, and community-based organizations.
- Ohio’s Take Charge Helpline: 1-877-275-6364. Confidential, free, 8:00am – 6:00pm, Monday – Friday. To get information about addiction and to get a referral to treatment.
- Ohio’s Crisis Text Line: Text 4hope to 741741 and a trained crisis counselor will text you within five minutes to confidentially assist you.
- Never Use Alone: 877-696-1996. Toll-free national overdose prevention, detection, life-saving crisis response and medical intervention services for people who use drugs while alone. Available 24 hours a day, 7 days a week, 365 days a year.
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