Preventing Fentanyl Overdose Deaths: Focus on Harm Reduction Versus Use Reduction

Harm reduction may be more effective than use reduction in minimizing fentanyl’s deadly contribution to increasing overdoses, a new report argues. Richard G. Frank, PhD, and Harold A. Pollack, PhD, from Harvard Medical School, address the use of harm reduction as a strategy for health care systems to combat synthetic opioid deaths.

Use reductions work to reduce the volume of illicit drug consumption, whereas harm reduction involves decreasing the harmful consequences associated with use. The authors believe that a harm reduction approach will enable policy tools to increase transparency of illicit markets, strengthen incentives for drug suppliers to avoid formulating products with fentanyl, and increase the likelihood that overdoses can be reversed.

According the authors, health care systems are positioned to intervene in the fentanyl epidemic by offering opportunities for surveillance and developing an early-warning system about fentanyl’s presence in certain drug products. Additionally, naloxone serves as an effective means of preventing death in the event of an overdose, although it requires more rapid administration for fentanyl overdoses compared to heroin or other opioids.

The authors note 3 implications for naloxone use with fentanyl overdoses:

• Naloxone kits will need to meet higher dosage requirements when fentanyl is present.
• User-friendly formulations (intranasal and auto-injector) should be rapidly available at the site of a fentanyl overdose.
• Timely availability of naloxone could also be provided by creating so-called safe bases for taking drugs.

Counseling users on their drug use and proper response to a fentanyl overdose, as well as a provision allowing take-home naloxone, would further ensure rapid administration response and improve the likelihood of survival, according to the report’s authors.

The report also highlights the need for expanded access to evidence-based substance use disorder treatment, such as medication assisted therapy. Health care providers should also be aware of the dangers of overdose risk associated with treatment when users experience reduced tolerance but continue to use at the same level.

The authors conclude that employing a combination of prevention, treatment, and harm reduction strategies can better position health care providers to prevent deaths from fentanyl overdoses.

Reference

Frank RG, Pollack HA. Addressing the fentanyl threat to public health. N Engl J Med. 2017; 376;605-607.