Expansion of Mail-Delivered Harm Reduction Services in the U.S.

In the US, we have had record high overdose deaths and high risk for future injection-related HIV and hepatitis c (HCV) outbreaks. Innovative approaches are urgently needed to expand access to syringes and naloxone, a drug used for opioid overdose reversal, for the prevention of HIV/HCV outbreaks and opioid overdose fatalities. Expansion and scale-up of mail-based safer drug use services may address access gaps by providing a more convenient and confidential way to obtain services. To inform scale-up these services, we aim to 1) describe policy barriers to national expansion of mail-based syringe services and fentanyl strip distribution, 2) conduct a national, longitudinal cohort study to examine predictors of uptake and long-term engagement in mail-based safer drug use services, and 3) assess the add-on safer drug use and health services preferences of mail delivery clients.

For Aim 1, we will conduct a systematic legal review of relevant laws in each of the 50 states and the District of Columbia to determine whether and how state law may impact the legality of distributing syringes and fentanyl test strips by mail. We will develop a taxonomy of policies that may prevent legal expansion of mail-delivered syringes. To understand the perception of legal risks associated with mailing syringes among potential adopters, we will survey and interview 20 stakeholders (i.e., health departments and SSPs) from states representing different legal environments for mail-delivery. For Aim 2, we will conduct a social media-recruited survey examining uptake and acceptability of mail-delivered safer drug use services at 12 months.

This will allow us to assess predictors of uptake and mail-delivered safer drug use service engagement over the long-term in order to fully understand who uses mail-delivered services and how these services are being used over time. For Aim 3 we will design and implement discrete choice experiment (DCE) surveys to determine mail-based service client preferences for receiving add-on safer drug use and health services. These results will be disseminated to policy stakeholders, potential adopters, and NEXT Distro affiliates to inform expansion and scale-up of mail-based safer drug use services, improve engagement with current NEXT users, and expand the type of services offered through these programs.

Grant Number: 4R01DA057654-02
NIH Institute/Center: NIH
Principal Investigator: Czarina Behrends