Drug Use Harm Reduction Programs: Assessing Quality and Accessibility for Individuals Who Identify as Female

Abstract

Over the past 30 years, the United States has recorded unprecedented increases in drug overdose mortality, particularly from a class of drugs called opioids. Since 1999, over 770,000 people have died of a drug overdose in the United States; opioids were involved in 60% of deaths (Centers for Disease Control and Prevention, 2018). Rates of opioid overdose in the U.S. have risen steadily by about 10% each year. The crisis now claims 192 American lives each day. In addition to significant mortality, the rising toll of opioid overdose has caused wide ranging social and economic consequences. The White House Council of Economic Advisers estimates that opioid overdose deaths cost the U.S. $696 billion each year, $2.5 trillion between 2015 and 2018 alone (Council for Economic Advisers, 2019). U.S. life expectancy has decreased for three consecutive years, for reasons largely attributed to increases in drug overdose, as well as suicide and other “deaths of despair” (Redfield, 2018). The unprecedented rise of opioid overdose in the U.S. has come to be known as the opioid overdose crisis, or the opioid epidemic. Problematic drug use has become one of the burning societal crises of the twenty-first century. Drug use is a complex social behavior, affected by a multitude of factors. Decisions about which drugs to consume, how to consume them, and how to manage their risks, are highly dependent on individuals’ identities, environments, and experiences. Gender and gender identity are significant factors in this decision-making process. There is evidence for a gender effect on drug use behaviors, risk reduction, and care-seeking (Cotto et al, 2010). However, there is little known about how this gender effect is reflected in overdose prevention resources. What, then are the best practices for engaging non-male populations with available resources? The objective of this thesis is examining the intersection of gender and opioid harm reduction and overdose prevention resources. First, we set the stage with the history and evolution of the U.S. overdose crisis, contextualizing the epidemic as it exists in 2020. Then, we discuss the philosophy of harm reduction and harm reduction interventions for opioid use. After discussing the effect of gender on drug use behaviors, we introduce the idea of “gendersensitive” harm reduction – organizations or programs that incorporate gender explicitly into their outreach and are, presumably, more effective at engaging non-male individuals. Through qualitative interviews with harm reduction providers across the U.S., specific elements of their gender-sensitive programming will be better understood. From these interviews, major, cross-cutting themes will be identified as best practices for any harm reduction organization conducting gender-sensitive outreach.