Clean Needles

If a drug addict goes to a hospital for treatment, they might not be able to obtain clean needles to help them avoid contracting HIV or hepatitis C.

If they go to a harm reduction clinic, they’ll get the clean needles, but they might not be able to get treatment for their tuberculosis or other ailments.

Those split services might convince a drug user to stay away from one or even both of the facilities and therefore not receive the treatment they most certainly need.

Their relationship with the mainstream healthcare system is very fraught and fragmented and they have not had many good experiences with healthcare in part due to stigma.
Daniel Raymond, Harm Reduction Coalition

“Many drug users are often on the outskirts of society and have experienced incarceration, homelessness, poverty, adverse childhood experiences, and trauma,” said Daniel Raymond, policy director of the Harm Reduction Coalition, which advocates for policy and public health reform for drug users. “Their relationship with the mainstream healthcare system is very fraught and fragmented and they have not had many good experiences with healthcare in part due to stigma.”

So, some harm reduction centers are now adopting a new strategy.

Instead of offering addicts and other clients a limited array of services such as needles or free condoms, they are coordinating with hospitals and other medical facilities to provide a full range of health treatments.

So there is a single place for all medical needs.

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All Services Under One Roof

That’s what Boom!Health in New York City is doing.

In addition to harm reduction services, the organization has a federally qualified health center onsite that provides primary care as well as a pharmacy.

The clinic offers drug users mental health services, drug addiction treatment, food and nutrition counseling, and legal aid services.

A case study on Boom!Health found that it can help facilities deliver individually focused care to vulnerable patient populations and ultimately reduce readmissions.

“We looked at what type of relationships are developing between harm reduction providers and healthcare providers and we found this happening in a lot of different degrees. But the most complete way we found was at Boom!Health,” Peter Schafer, senior policy associate, health policy, at The New York Academy of Medicine, told Healthline.

Healthcare providers on a whole don’t like having drug users as patients.
Peter Schafer, The New York Academy of Medicine

The organization conducted the case study. It focuses on advancing solutions that promote the health and well-being of people in cities worldwide.

Besides the convenience of offering several services in the same facility, Schafer says having well-trained providers is another reason Boom!Health is effective.

“Healthcare providers on a whole don’t like having drug users as patients,” said Schafer. “They feel like they manipulate them to get pain pills, which they go on to abuse.”

Schafer adds that hospital personnel may not be well-trained to treat such clientele.

“The first thing they may say to a drug addict is ‘You need to stop using drugs,’ and if that’s not really what a drug user is there for, it’s off-putting to have the provider ignore your needs,” he said. “This leads to the issue of drug users not using primary care often enough. Having services colocated really forces a common philosophy and understanding and if the center invites harm reduction and healthcare and pharmacy under the same roof, it gives them the upper hand in determining what philosophy that will be.”

At Boom!Health, the providers don’t demand that people stop using drugs before they’re treated for other conditions, notes Schafer.

Instead, the providers take a harm reduction approach by reducing the harm associated with drug use and understanding people’s priorities so they can create an environment where they can seek treatment.

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Healthcare Reform Helps Make It Happen

Medicaid expansion in New York is making it easier for clinics like Boom!Health to survive.

Over the next few years, it will move to a value-based payment system. This means that healthcare providers will get paid on the value of care they’re providing in improving health outcomes rather than the volume-related fee for services.

 “We’re seeing a lot of different models that are creating a system for savings so that if the healthcare providers manage to provide quality care with better outcomes at a lower cost, they can participate in some of the savings and that becomes a resource of revenue,” Raymond told Healthline.

Harm Reduction Centers

He explains that harm reduction is a place for providers to reap savings and ultimately increased revenue since there is a lot of room for improvement when it comes to quality of care and controlling the cost of care if drug users are involved in the healthcare system.

“A lot of the people that harm reduction centers are serving are high utilizers of emergency room departments and are at risk of rehospitalization, so there’s opportunity for healthcare providers to understand the role of harm reduction programs and to partner with them in an effort to engage and retain this population, which is exactly the challenge that the healthcare system is facing,” Raymond said.

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Integration Takes Many Forms

Many hospitals and healthcare providers are attempting to help populations like drug users and the homeless by providing services that incorporate aspects of harm reduction.

One strategy is to have teaching hospitals establish clinic hours at harm reduction centers.

Another is to have healthcare organizations coordinating and colocating clinical and harm reduction services.

And another is to have hospitals place clinical and pharmacy services at harm reduction centers as well as send medical vans to poor communities to provide free primary care services.

“There are other models that we’re interested in where harm reduction programs are working on the front lines and helping people enroll in healthcare, training clinicians about how to work effectively with this population, and providing patient navigation and care coordination services,” Raymond added.

The Washington Heights CORNER Project in New York is an example.

Raymond sits on the board of directors for the organization and says it’s been building a collaboration with New York-Presbyterian Hospital.

The set up is part of a project that’s under the New York system’s redesign of Medicaid called Delivery System Reform Incentive Payment Program.

“The state is giving New York-Presbyterian some funds to reduce unnecessary hospital use and in turn they’re subcontracting with the Washington Heights CORNER Project to help provide care coordination for some of the patients that are being seen by both facilities,” Raymond explained.

Setting the Tone for Change

As the New York Medicaid system pioneers a change toward integration of harm reduction and healthcare, Raymond says he hopes other parts of the country will follow.

“For a long time, there was the thought that you either support harm reduction or drug treatment, but over the last few years I’ve seen some change of attitude,” he said. “I think it’s the accumulation of experience and evidence and great exposure to what harm reduction actually looks like.”

Raymond said the prevalence of drug use is also a factor.

“We’re also in the midst of an overdose epidemic and harm reduction centers have been at the front lines of saving lives, so that’s really helped people see and understand their value,” he said.