Incorporating Health Equity Into Overdose Prevention

Overdose Data to Action (OD2A) Case Study: New York State’s Power of Voice Program

July 30, 2024 | Alyssa Merski

In 2022, the New York State Department of Health (NYSDOH) established the Power of Voice, a leadership capacity building institute. Grounded in the Denver Principles of “nothing about us without us”, Power of Voice mobilizes and trains people who use drugs (PWUDs) to engage in the policy and programmatic decision-making activities that impact the lives of PWUDs. Recognizing that overdose prevention should be grounded in both equity and justice, NYSDOH designed this program to meaningfully incorporate people who actively use or have lived experience using drugs.

The Power of Voice program trains PWUD to share their stories in a way that is trauma informed and meaningfully engages them in the planning, implementation, and evaluation of harm reduction programs and policies. The training consists of two in-person, two-day training courses and three virtual webinars. PWUDs train to develop skills in community engagement, educate through their stories and expertise, and influence the development and provision of social justice and equity-focused programming and policy. NYSDOH incorporates participant input on harm reduction and prevention programs and policies to meet the needs of PWUDs in participant communities, removes barriers to access including stigma, and addresses structural inequities.

NYSDOH recognized that achieving health equity and racial justice outcomes requires centering the experiences of PWUD that are most affected by structural inequities and harm associated with drug use including formerly incarcerated people, LGBTQ+ people, and BIPOC communities. Program staff worked with their financial administrative staff to ensure compensation for participant time and all travel expenses including meals. Fair compensation was critical to equitable participation from people who may be unhoused, have not traveled before, or do not have credit cards.

NYSDOH evaluated the program by conducting focus group interviews with participants to ensure that lessons learned are effectively addressed in future iterations of the program. For example, focus groups highlighted that some participants were newer than others to harm reduction, which led to including a harm reduction 101 training and a community engagement training based on harm reduction principles.

Results and Successes

Program graduates continue to participate in various activities and programming around New York State and receive payment for their expertise and time. Examples include:

• Serving as community consultants and members of the Office of Drug User Health’s working group of PWUDs.
• Participating in a statewide overdose awareness day.
• Leading workshops by sharing their stories at a syringe service summit.
• Providing feedback on NYSDOH’s programming and messaging.
• Presenting at NYSDOH’s Ending the Epidemic Summit.
• Reviewing messaging released by NYSDOH and partners.
• Conducting naloxone trainings, including at the New York State Fair.
• Doing peer-delivered syringe exchange.

Program participants provide feedback and recommendations on issues critical to the equity of overdose prevention efforts, including best practices for working with people who are unstably housed and ways to help them access buprenorphine. NYSDOH attributes some of the program's success to a strong grounding in harm reduction and community engagement and a diversity in the perspectives the trainees brought to the program.

Lessons Learned

To combat stigma and ensure attendee safety and comfort, program staff worked diligently to ensure all who interacted with the trainees were respectful and that no one was treated negatively because they are a person who uses drugs. This included hotel staff where the training took place and NYSDOH fiscal staff responsible for budgets and payment to participants. Power of Voice program staff trained everyone involved at all levels in harm reduction approaches to interact with program trainees. NYSDOH program staff also worked with syringe services programs/ Drug User Health Hubs and participants directly to ensure any travel needs were identified before the program such as ensuring participants on any medications, including medications for opioid use disorder, had enough to bring to the in-person training. Additionally, overall support for participants' needs were provided during the in-person training session. This included but was not limited to provision of program staff numbers in case of an emergency, safe use support such as: naloxone, fentanyl and xylazine test strips, and access to a social worker, if needed. Partnerships were also integral to the development and implementation of the program. Key partners included the New York City Capacity Building Assistance Program and harm reduction partners, including the NYSDOH AIDS Institute Drug User Health Hubs and syringe service programs. Harm reduction partners were critical in getting the word out about the program, recruiting participants, and ensuring that participants’ needs were met.

Advice to Other Jurisdictions

While many programs and organizations engage with people with lived experience with drug use in their work, the voices of people who actively use drugs are often lost due to various barriers, including stigma and access to safe use support. NYSDOH found support for PWUD must include explicit recognition of their unique value and perspective by both public health agencies and local governments. Payment that recognizes the critical expertise of PWUD is an important part of that support. Power of Voice participants were paid $25 per hour for their work by check and not gift cards. Support must also include capacity-building and financial backing for innovative projects and programs that embody the principles of meaningful involvement. Organizational policies and practices may need to be reconceptualized to meaningfully involve PWUD. It is important to remember that PWUD created harm reduction, i.e., syringe exchange, naloxone distribution, and drug checking. Reaching PWUDs requires jurisdictions to think through each step of a program using a harm reduction lens.

Next Steps for the Power of Voice

NYSDOH plans to continue to expand the Power of Voice program in the years to come. Past participants are heavily involved in the program's continuous improvement and mentor current participants. Future iterations of the program will include more sessions on self-care and boundaries for the trainees to increase their own safety around sharing their story. NYSDOH will continue to seek funding sources for the program and will build on the successes of all the participants who engaged with the program to make their communities safer.

Please reach out to OD2A@astho.org with any questions.