Literature Collection

Substance use-related harms including drug overdose deaths and new cases of human immunodeficiency virus (HIV) and hepatitis C (HCV) are increasing in the US. Syringe services programs (SSPs) started in the 1980s as community-based efforts to distribute sterile syringes and provide safe injection information to people who inject drugs (PWID) in response to rising HIV infection rates. SSPs are guided by harm reduction principles, which aim to mitigate the negative consequences of drug use. The term SSP broadly refers to the provision of sterile syringes and other supplies and is inclusive of any setting that provides these supplies for the intended injection of drugs. The present report is an attempt to provide an overall picture of what is known about the benefits and potential harms of SSPs, which has been an active area of research for the past 4 decades. This report was requested by the VA Offices of Mental Health and Suicide Prevention, Research and Development, and Specialty Care Services to inform VA efforts to meet the goals of the Office of National Drug Control Policy and to implement best practices for harm reduction in VHA settings.

Substance use and illicit drug use are a growing problem in the United States. SUDs occur when the recurrent use of alcohol or drugs causes significant impairment, such as health problems. The veteran population has been particularly at risk. Veterans are 1.5 times more likely to die from opioid overdose than the general population, according to VA and Centers for Disease Control and Prevention data. Furthermore, veterans live in rural areas at a higher rate than the general population, which may affect their ability to access SUD services. VA is the largest integrated health care system in the United States, providing care to about 6.2 million veterans. VA provides SUD services through outpatient, inpatient, and residential care settings and offers various treatment options, including individual and group therapy, medication-assisted treatment, and naloxone kits to reverse overdoses. This report describes (1) trends in the number of and expenditures for veterans receiving SUD services, including specialty SUD services; and (2) any differences between veterans' use of SUD services in rural and urban areas, and the issues affecting access to those services in rural areas.; Background. -- Number of veterans receiving, and expenditures for, VHA specialty SUD services have remained unchanged in recent years, community care SUD services have increased. -- Veterans' usage differed between urban and rural areas for some specialty SUD services; VHA is taking steps to address access issues in rural areas. -- Agency comments. -- Appendices.

COVID-19 could cause infection in persons with opioid use disorder, increase opioid overdose rates, reverse system-level gains in expanding access to medication for opioid use disorder, halt critical research, and prevent exacting legal reparations against opioid manufacturers. The authors call for urgent action to counteract these risks.